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Impacto de las intervenciones psicoeducativas cognitivas en los pacientes bipolares y sus familiares
Published online by Cambridge University Press: 12 May 2020
Resumen
Antecedentes.
En ãnos recientes, varios estudios controlados pudieron demostrar que las intervenciones psicoeducativas han sido eficaces para prevenir la recaída en los trastornos bipolares. Así, establecimos una intervención de grupo psicoeducativo cognitivo con 14 sesiones que suministraban información sobre la enfermedad, las señales tempranas de aviso, las estrategias cognitivas y conductuales para el tratamiento del estrés y el ritmo social. Además, ofrecimos una intervención de grupo para los familiares de los pacientes. El objetivo de este estudio era describir el desenlace clínico asociado con nuestra intervención psicoeducativa en los pacientes bipolares y sus familiares.
Métodos.
Sesenta y dos pacientes bipolares asistieron a 14 sesiones (de unos 90 minutos) de terapia de grupo psicoeducativa cognitiva. Se evaluó el conocimiento de los pacientes del trastorno bipolar y su satisfacción con el tratamiento utilizando cuestionarios desarrollados por nosotros antes y después de la intervención de grupo. Además, 49 familiares de pacientes bipolares recibieron dos talleres psicoeducativos de 4 horas cada uno. Evaluamos las variables demográficas, la carga, la emoción expresada elevada y los síntomas depresivos de los familiares antes y después de los dos talleres y en el seguimiento al año.
Resultados.
Los pacientes mejoraron significativamente su conocimiento del trastorno bipolar. Se beneficiaron también de los debates y del intercambio de estrategias de afrontamiento útiles. La carga y la emoción expresada elevada no mostraron reducciones significativas en la evaluación posterior; sin embargo, se redujeron significativamente en el seguimiento al año. Los familiares se sintieron también significativamente mejor informados sobre la enfermedad.
Conclusiones.
Estos hallazgos muestran que las intervenciones psicoeducativas en los pacientes bipolares y sus familiares mejoran su conocimiento de la enfermedad y la carga del trastorno, y además las emociones expresadas elevadas se reducen en los familiares en el seguimiento al año.
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- Copyright © European Psychiatric Association 2006
References
Bibliografía
Auracher, C. Belastungen, Attributionen und Reaktionen bei Angehörigen von Depressionspatienten-Entwicklung und Ergebnisse eines Angehörigenfragebogens. München: Ludwig-Maximilians-Universität Unveröffentlichte Diplomarbeit; 2001Google Scholar
Bauer, MS, McBride, L, Chase, C, Sachs, G, Shea, N. Manual-based group psychotherapy for bipolar disorder: a feasibility study. J Clin Psychiatry 1998;59(9):449–55CrossRefGoogle ScholarPubMed
Bauer, MS, McBride, L, Shea, N, Gavin, C, Holden, F, Kendall, S. Impact of an easy-access VA clinic-based program for patients with bipolar disorder. Psychiatr Serv 1997;48(4):491–6Google ScholarPubMed
Beck, AT, Steer, RA, Garbin, MG. Psychometric properties of the Beck Depression Inventory: 25 years of evaluation. Clin Psychol Rev 1988; 8:77–100CrossRefGoogle Scholar
Benazon, NR, Coyne, JC. Living with a depressed spouse. Journal of Family Psychology 2000;14:71–79CrossRefGoogle ScholarPubMed
Butzlaff, RL, Hooley, JM. Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 1998;55(6):547–52CrossRefGoogle ScholarPubMed
Clarkin, JF, Carpenter, D, Hall, J, Wilner, P, Glick, I. Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses. Psychiatr Serv 1998;49(4):531–3CrossRefGoogle ScholarPubMed
Clarkin, JF, Glick, ID, Haas, GL, Spencer, JH, Lewis, AB, Peyser, J, et al. A randomized clinical trial of inpatient family intervention. V. Results for affective disorders. J Affect Disord 1990; 18(1): 17–28CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E. Non-adherence in psychiatric disorders: misbehaviour or clinical feature? Acta Psychiatr Scand 2002;105(3):161–3Google ScholarPubMed
Colom, F, Vieta, E, Martinez-Aran, A, Reinares, M, Benabarre, A, Gasto, C. Clinical factors associated with treatment non-compliance in euthymic bipolar patients. J Clin Psychiatry 2000;61(8):549–55CrossRefGoogle Scholar
Colom, F, Vieta, E, Martinez-Aran, A , Reinares, M, Goikolea, JM, Benabarre, A, et al. A randomized trial on the etficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003;60(4):402–7CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E, Sanchez-Moreno, J, Martinez-Aran, A, Torrent, C, Reinares, M, et al. Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004;6(4):294–8CrossRefGoogle ScholarPubMed
Coyne, JC, Kessler, RC, Tal, M, Tumbull, J, Wortman, CB, Greden, JF. Living with a depressed person. J Consult Clin Psychol 1987;55(3): 347–52CrossRefGoogle ScholarPubMed
Feinstein, E. Fragebogenverfahren zur ErLebung des Expressed-Emotion-Maβes: Kurzverfahren zur Rückfallprognose bei psychiatrischen Patienten. In: Buchkromer, G, Rath, N, editors. Therapeatische Arbeit mit Angehórigen schizophrener Patienten. Messinstrumente, Methoden, Konzepte. Bern:: Hans Haber; 1989. p. 39 45.Google Scholar
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, L. Structured clinical interview for DSM-IV Axis II Personality Disorder (SCID-II). Washington: American Psychiatric Press; 1997Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV Axis I Disorder-Clinician Version (SCID-CV). Washington: Amencan Psychiatric Press; 1997Google Scholar
Frank, E, Hlastala, S, Ritenour, A, Houck, P, Tu, XM, Monk, TH, et al. Inducing lifestyle regularity in recovering bipolar disorder patients: results from the maintenance therapies in bipolar disorder protocol. Biol Psychiatry 1997;41(12): 1165–73CrossRefGoogle ScholarPubMed
Frank, E, Swartz, HA, Kupfer, DJ. Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biol Psychiatry 2000;48(6):593–604CrossRefGoogle ScholarPubMed
Frank, E, Swartz, HA, Mallinger, AG, Thase, ME, Weaver, EV, Kupfer, DJ. Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality. J Abnorm Psychol 1999;108(4):579–87CrossRefGoogle ScholarPubMed
Gonzalez-Pinto, A, Gonzalez, C, Enjuto, S, Fernandez, DC, Lopez, P, Palomo, J, et al. Psychoeducation and cognitive-behavioral therapy in bipolar disorder: an update. Acta Psychiatr Scand 2004;109(2):83–90.CrossRefGoogle ScholarPubMed
Hamilton, M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6(4):278–96CrossRefGoogle ScholarPubMed
Honig, A , Hofman, A, Hilwig, M, Noorthoom, E, Ponds, R. Psychoeducation and expressed emotion in bipolar disorder: preliminary findings. Psychiatry Res 1995;56(3):299–301CrossRefGoogle ScholarPubMed
Honig, A, Hofman, A, Rozendaal, N, Dingemans, R. Psycho-education in bipolar disorder: effect on expressed emotion. Psychiatry Res 1997; 72(1):17–22CrossRefGoogle ScholarPubMed
Jamison, KR, Gemer, RH, Goodwin, FK. Patient and physician attitudes toward lithium: relationship to compliance. Arch Gen Psychiatry 1979;36(8 Spec No):866–9CrossRefGoogle ScholarPubMed
Kim, EY, Miklowitz, DJ. Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy. J Affect Disord 2004;82(3):343–52Google ScholarPubMed
Kleindienst, N, Greil, W. Are illness concepts a powerful predictor of adherence to prophylactic treatment in bipolar disorder? J Clin Psychiatry 2004;65(7):966–74CrossRefGoogle ScholarPubMed
Lam, DH, Bright, J, Jones, S, Hayward, P, Schuck, N, Chisholm, D, et al. Cognitive therapy for bipolar illness—a pilot study of relapse prevention. Cognit Ther Res 2000;24:503–20CrossRefGoogle Scholar
Lam, DH, Watkins, ER, Hayward, P, Bright, J, Wright, K, Kerr, N, et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003;60(2): 145–52CrossRefGoogle ScholarPubMed
Lingam, R, Scott, J. Treatment non-adherence in affective disorders. Acta Psychiatr Scand 2002; 105(3): 164–72CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Frank, E, George, EL. New psychosocial treatments for the outpatient management of bipolar disorder. Psychopharmacol Bull 1996;32(4):613–21Google ScholarPubMed
Miklowitz, DJ, George, EL, Richards, JA, Simoneau, TL, Suddath, RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003;60(9):904–12CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Goldstein, MJ. Behavioral family treatment for patients with bipolar affective disorder. Behav Modif 1990;14(4):457–89CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Goldstein, MJ, Nuechterlein, KH, Snyder, KS, Mintz, J. Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry 1988;45(3):225–31CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Richards, JA, George, EL, Frank, E, Suddath, RL, Powell, KB, et al. Integrated family and individual therapy for bipolar disorder: results of a treatment development study. J Clin Psychiatry 2003;64(2):182–91CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Simoneau, TL, George, EL, Richards, JA, Kalbag, A, Sachs-Ericsson, N, et al. Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol Psychiatry 2000;48(6):582–92CrossRefGoogle ScholarPubMed
Mino, Y, Shimodera, S, Inoue, S, Fujita, H, Tanaka, S, Kanazawa, S. Expressed emotion of families and the course of mood disorders: a cohort study in Japan. J Affect Disord 2001 ;63(l-3):43–9CrossRefGoogle ScholarPubMed
O'Connell, RA, Mayo, JA, Flatow, L, Cuthbertson, B, O'Brien, BE. Outcome of bipolar disorder on long-term treatment with lithium. Br J Psychiatry 1991;159:123–9CrossRefGoogle ScholarPubMed
Parikh, SV, Kusumakar, V, Haslam, DR, Matte, R, Sharma, V, Yatham, LN. Psychosocial interventions as an adjunct to pharmacotherapy in bipolar disorder. Can J Psychiatry 1997;42(Suppl 2):74S–78SGoogle ScholarPubMed
Patelis-Siotis, I, Young, LT, Robb, JC, Marriott, M, Bieling, PJ, Cox, LC, et al. Group cognitive behavioral therapy for bipolar disorder: a feasibility and effectiveness study. J Affect Disord 2001;65(2):145–53CrossRefGoogle ScholarPubMed
Peet, M, Harvey, NS. Lithium maintenance: 1. A standard education programme for patients. Br J Psychiatry 1991;158:197–200CrossRefGoogle ScholarPubMed
Perlick, DA, Rosenheck, RR, Clarkin, JF, Raue, P, Sirey, J. Impact of family burden and patient symptom status on clinical outcome in bipolar affective disorder. J Nerv Ment Dis 2001; 189(l):31–7CrossRefGoogle ScholarPubMed
Perry, A, Tarrier, N, Morriss, R, McCarthy, E, Limb, K. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999;318(7177): 149–53CrossRefGoogle ScholarPubMed
Priebe, S, Wildgrube, C, Muller-Oerlinghausen, B. Lithium prophylaxis and expressed emotion. Br J Psychiatry 1989;154:396–9CrossRefGoogle ScholarPubMed
Reinares, M, Colom, F, Martinez-Aran, A, Benabarre, A, Vieta, E. Therapeutic interventions focused on the family of bipolar patients. Psychother Psychosom 2002;71(1):2–10CrossRefGoogle ScholarPubMed
Reinares, M, Vieta, E, Colom, F, Martinez-Aran, A, Torrent, C, Comes, M, et al. Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients. Psychother Psychosom 2004; 73(5):312–9CrossRefGoogle ScholarPubMed
Schaub, A. Illness self-management programs in schizophrenia and severe affective disorder. In: Schaub, A, editor. New family interventions and associated research in psychiatnc disorders. Wien: Springer; 2002. p. 229–47CrossRefGoogle Scholar
Schaub, A , Bernhard, B, Ganck, L. Kognitiv-psychoedukative Therapie bei bipolaren Erkrankungen. Góttingen: Hogrefe: Ein Therapiemnual; 2004Google Scholar
Scott, J, Garland, A , Moorhead, S. A pilot study of cognitive therapy in bipolar disorders. Psychol Med 2001;31(3):459–67CrossRefGoogle ScholarPubMed
van Gent, EM, Zwart, FM. Psychoeducation of partners of bipolarmanic patients. J Affect Disord 1991;21(1):15–8CrossRefGoogle Scholar
Vieta, E, Colom, F. Psychological interventions in bipolar disorder: from wishful thinking to an evidence-based approach. Acta Psychiatr ScandSuppl 2004;422:34–8CrossRefGoogle Scholar
Yan, LJ, Hammen, C, Cohen, AN, Daley, SE, Henry, RM. Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients. J Affect Disord 2004;83(2-3):199–206CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133: 429–35CrossRefGoogle ScholarPubMed