Tx de trastorno bipolar

Türk Psikiyatri Dergisi 2010; Turkish Journal of Psychiatry

Psychotherapeutic and Psychosocial Approaches in Bipolar Disorder: A Systematic Literature Review
Sibel ÇAKIR1, Ayşegül ÖZERDEM2

Abstract
Objective: Aim of this systematic review was critical presentation of psychosocial approaches in bipolar disorders with regard to their fundamentals and impact on the clinical course andoutcome of the illness. Method: PubMed, Medline, PsycINFO and Turkish databases between 1980 and 2009 were searched by using keywords “bipolar disorder” and “psychotherapy”, “psychosocial approaches”, “psychological intervention”. Randomized controlled trials, reviews and meta analysis were included. Results: Fifty studies met the inclusion criteria where four types of interventions -psychoeducation,family focused, cognitive behavioral and interpersonal psychosocial rhythm therapy- were studied. Twenty two of 24 original research papers were randomized controlled trials, 23 were reviews and 3 were meta analysis. In almost all studies psychotherapeutic approach was applied as adjunctive to pharmacotherapy. Group psychoeducation was more effective in preventing manic relapses, whereas cognitivebehavioral and family focused therapies showed efficacy in preventing depressive episodes. Additional benefits on such secondary outcomes as medication compliance, number and duration of hospitalizations, time to recurrence were reported. Effects on functionality and quality of life were assessed rarely, but reported to be beneficial. Cultural adaptation studies are scarce and needs exploration.Conclusion: Psychosocial interventions adjunctive to pharmacotherapy in bipolar disorder seem to be effective in relapse prevention. Stage of illness where the therapy is initiated and the targeted episode for prevention varies between interventions. Future studies are needed to strengthen the place of psychosocial interventions in treatment guidelines and would contribute to narrow the gap betweeneffectiveness of pharmacotherapy and functional improvement. Key Words: Bipolar disorders, psychotherapy, psychoeducation, psychosocial approaches

INTRODUCTION
Recurrence rates in bipolar disorder remain high despite progress in its medical treatment and the fact that genetic and neurobiological fundamentals are better known. The long term remission rate is only 24% (Angst et al., 2005) andeven with a good level of adherence to drug treatment, the 5-year relapse rate is 73% (Gitlin et al., 1995). Patients with bipolar disorder experience subsyndromal symptoms during half of their life that cause significant social, academic and occupational dysfunction (Judd et al., 2002). Noncompliance with medical treatReceived: 23.09.2009 - Accepted: 02.12.2009
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ment is a major problem inbipolar disorder and occurs in 42% of patients (Perlick et al., 2004). Symptoms reduce significantly with good compliance; however, similar improvement cannot be achieved in quality of life and functionality (Goldberg et al., 1995; Revicki et al., 2005). Recent medical treatments have been effective on symptom relief, but not sufficient enough in preventing relapses, reducing disease burden, orregaining functionality. Various psychotherapeutic interventions as adjunctive to pharmacotherapy seem to be beneficial in fulfilling some of the unmet needs in long term treatment mentioned above.

MD, İstanbul U, İstanbul Medical School Psychiatry Department, Mood Disorders Unit, Çapa İstanbul, Turkey, 2Prof. Dokuz Eylül U, Faculty of Medicine, Psychiatry Department, İzmir, Turkey Sibel Çakır MD.,e-mail: drsibelcakir@yahoo.com

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Stressful life events, conflicts within the family, social relationships, disruptions in the sleep-awake cycle, and drug noncompliance play an important role in relapses by precipitating the underlying biological factors (Hays et al., 1998). The stress-diathesis model constitutes an integrated biopsychosocial approach which focuses on the interaction of...