Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-07T18:40:44.622Z Has data issue: false hasContentIssue false
  • English
  • Français

Psicoeducación: mejorar la evolución en el trastorno bipolar

Published online by Cambridge University Press:  12 May 2020

Francesc Colom  and
Dominic Lam
Francesc Colom
Affiliation:
Programa de Trastomos Bipolares, IDIBAPS, Centro de Investigatión Médica Stanley de Barcelona, Barcelona, España
Dominic Lam
Affiliation:
Henry Wellcome Building (P077), Departamento de Psicología, Instituto de Psiquiatría, De Crespigny Park, LondresSE5 8AF, Reino Unido
Get access

Resumen

Antecedentes

Hace algunos años se initió un cambio significativo de paradigma en el tratamiento del trastorno bipolar; hallazgos cruciales sobre la utilidad de las intervenciones psicológicas apoyan claramente el cambio de un enfoque terapéutico exclusivamente farmacológico a un modelo combinado pero jerárquico en el que la farmacoterapia desempeña un papel central pero las intervenciones psicológicas pueden ayudar a salvar la separación que existe entre la eftcacia teórica y la eficacia en el “mundo real”. En el presente trabajo revisamos la eficacia de varias psicoterapias accesorias en el tratamiento de mantenimiento de los pacientes bipolares.

Metodos

Se realizó una revisión sistemática de las publicaciones sobre la cuestión utilizando las bases de datos Medline y Current Contents. Se introdujo como palabras clave: “bipolar”, “psicoterapia”, “psicoeducación”, “cognitivo-conductual” y “prevención de recaídas”.

Resultados

Los tratamientos psicológicos diseñados específicamente para la prevención de recaídas en el trastorno afectivo bipolar son herramientas útiles en conjunción con los estabilizadores del estado de ánimo. La mayoría de estudios de psicoterapia publicados recientemente comunica resultados positivos en el mantenimiento como tratamiento complementario y eficacia en el tratamiento de los episodios depresivos. Resulta interesante que varios grupos de todo el mundo hayan comunicado resultados positivos similares y alcanzado conclusiones muy similares; casi todas las intervenciones examinadas contienen elementos psicoeducativos importantes que incluyen la mejora del cumplimiento y además la identificatión temprana de los signos prodrómicos -haciendo hincapié en la importancia de la regularidad del estilo de vida- y exploran las creencias de salud y la conciencia de la enfermedad de los pacientes.

Conclusiones

La utilidad de la psicoterapia para mejorar el cumplimiento del tratamiento y la evolutión clínica de los pacientes bipolares es incuestionable en la actualidad, y las directrices de tratamiento futuras deben promover su uso regular entre los profesionales clínicos. Como profesionales clmicos, nuestro deber principal es ofrecer el mejor tratamiento disponible a nuestros pacientes y esto incluye tanto los programas psicoeducativos basados en la evidencia como los nuevos agentes psicofarmacológicos.

Keywords

Trastorno bipolarPsicoeducaciónCogniciónPsicoterapia
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 13 , Issue 1 , February 2006 , pp. 24 - 30
Copyright
Copyright © European Psychiatric Association 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Colom F, Lam D. Psychoeducation: improving outcomes in bipolar disorder. Eur Psychiatry 2005;20:359-364.

References

Bibliografía

Altman, ES, Rea, MM, Mintz, J, Miklowitz, DJ, Goldstein, MJ, Hwang, S. Prodromal symptoms and signs of bipolar relapse: a report based on prospectively collected data. Psychiatry Res 1992; 41: 1–8.CrossRefGoogle ScholarPubMed
Angst, F, Stassen, HH, Clayton, PJ, Angst, J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord 2002; 68: 167–81.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Sellaro, R, Lavori, PW, Zhang, H. Recurrence of bipolar disorders and major depression: a life-long perspective. Eur Arch Psychiatry Clin Neurosci 2003; 253: 236–40.CrossRefGoogle ScholarPubMed
Bieling, PJ, MacQueen, GM, Marriot, MJ, Robb, JC, Begin, H, Joffe, RT, et al. Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms. Bipolar Disord 2003; 5: 14–21.Google Scholar
Black, DW, Winokur, G, Hulbert, J, Nasrallah, A. Predictors of immediate response in the treatment of mania: the importance of comorbidity. Biol Psychiatry 1988; 24: 191–8.CrossRefGoogle ScholarPubMed
Calabrese, JR, Kasper, S, Johnson, G, Tajima, O, Vieta, E, Yatham, LN, et al. International consensus group on bipolar I depression treatment guidelines. J Clin Psychiatry 2004; 65: 571–9.Google Scholar
Colom, F, Vieta, E. Non-adherente in psychiatric disorders: misbehavior or clinical feature? Acta Psychiatr Scand 2002; 105: 161–3.Google ScholarPubMed
Colom, F, Vieta, E, Martínez, A, Jorquera, A, Gastó, C. What is the role of psychotherapy in the treatment of bipolar disorder? Psychother Psychosom 1998; 67: 3–9.CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E, Martínez-Arán, A, Reinares, M, Benabarre, A, Gasto, C. Clinical factors associated to treatment non-compliance in euthymic bipolar patients. J Clin Psychiatry 2000; 61: 549–54.CrossRefGoogle Scholar
Colom, F, Vieta, E, Martínez-Arán, A, Reinares, M, Goikolea, JM, Benabarre, A, et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003; 60: 402–7.Google Scholar
Colom, F, Vieta, E, Reinares, M, Martínez-Arán, A, Torrent, C, Goikolea, JM, et al. Psychoeducation efficacy in bipolar disorders beyond compliance enhancement. J Clin Psychiatry 2003; 64: 1101–5.Google Scholar
Colom, F, Vieta, E, Sánchez-Moreno, J, Reinares, M, Martínez-Arán, A, Torrent, C, et al. Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2005; 6: 294–8.Google Scholar
Dunayevich, E, Sax, KW, Keck, PE Jr, McElroy, SL, Sorter, MT, McConville, BJ, et al. Twelve-month outcome in bipolar patients with and without personality disorders. J Clin Psychiatry 2000; 61: 134–9.Google Scholar
Duma, Z, Ozcan, S. Evaluation of self-management education for asthmatic patients. J Asthma 2003; 40: 631–43.Google Scholar
Goetzel, RZ, Hawkins, K, Ozminkowski, RJ, Wang, S. The health and productivity cost burden of the “top 10” physical and mental health conditions affecting six larga US employers in 1999. J Occup Environ Med 2003; 45: 5–14.CrossRefGoogle Scholar
Goodwin, GM, for the British Association for Psychopharmacology. Evidence-based guidelines for treating recommendations from British Association for Psychopharmacology. J Psychopharmacol 2003; 17: 149–73.Google ScholarPubMed
Harvey, NS, Peet, M. Lithium maintenance: effects of personality and attitude on health information acquisition and compliance. Br J Psychiatry 1991; 158: 200–4.CrossRefGoogle ScholarPubMed
Keitner, Gl, Solomon, DA, Ryan, CE, Miller, IW, Mallinger, A, Kupfer, DJ, et al. Prodromal and residual symptoms in bipolar I disorder. Compr Psychiatry 1996; 37: 362–7.Google Scholar
Ketter, TA, Calabrese, JR. Stabilization of mood from below versus above baseline in bipolar disorder: a new nomenclatura. J Clin Psychiatry 2002; 63: 146–51.CrossRefGoogle Scholar
Lam, D, Wright, K, Sham, P. Sense of hyper-positive self and response to cognitive therapy for bipolar disorder. Psychol Med 2005; 35: 69–77.CrossRefGoogle ScholarPubMed
Lam, DH, Jones, S, Hayward, P, Bright, J. Cognitive therapy for bipolar disorder: a therapist's guide to the concept, methods and practice. Wiley and Son Ltd; 1999.Google Scholar
Lam, DH, Watkins, E, Hayward, P, Bright, J, Wright, K, Kerr, N, et al. A randomised controlled study of cognitive therapy of relapse prevention for bipolar affective disorder—outcome of the first year. Arch Gen Psychiatry 2003; 60: 145–52.Google Scholar
Lam, DH, Wong, G. Prodromes, coping strategies, insight and social functioning in bipolar affective disorders. Psychol Med 1997; 27: 1091–100.CrossRefGoogle ScholarPubMed
Lam, DH, Wong, G, Sham, P. Prodromes, coping strategies and course of illness in bipolar affective disorders—a naturalistic study. Psychol Med 2001; 31: 1397–402.CrossRefGoogle Scholar
Lavori, PW, Dawson, R, Mueller, TI, Warstaw, M, Swartz, A, Leon, A. Analysis of course of psychopathology: transitions among states of health and illness. Int J Methods Psychiatr Res 1996; 6: 321–34.3.3.CO;2-I>CrossRefGoogle Scholar
Leverich, GS, Altshuler, LL, Frye, MA, Suppes, T, Keck, PE Jr, McEIroy, SL, et al. Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry 2003; 64: 506–15.Google Scholar
Linden, W. Psychological treatments in cardiac rehabilitation: review of rationales and outcomes. J Psychosom Res 2000; 48: 443–54.CrossRefGoogle ScholarPubMed
Lopez, AD, Murray, CJ. The global burden of disease. Nat Med 1998; 4: 1241–3.CrossRefGoogle 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: 904–12.CrossRefGoogle 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: 182–91.Google Scholar
Molnar, GJ, Feeney, MG, Fava, GA. Duration and symptoms of bipolar prodromes. Am J Psychiatry 1998; 145: 1576–8.Google Scholar
Morselli, PL, Elgie, R. The BEAM survey: Information on current and post treatment of bipolar disorder generated by a patient questionnaire. Bipolar Disord 2002; 4(Suppl. 1): 131.Google Scholar
Olmsted, MP, Daneman, D, Rydall, AC, Lawson, ML, Rodin, G. The effects of psychoeducation on disturbed eating attitudes and behavior in young women with type 1 diabetes mellitus. Int J Eat Disord 2002; 32: 230–9.CrossRefGoogle ScholarPubMed
Peet, M, Harvey, NS. Lithium maintenance: 1. A standard education program for patients. Br J Psychiatry 1991; 158: 197–200.Google 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: 149–53.CrossRefGoogle ScholarPubMed
Prien, RF, Potter, WZ. NIMH workshop report on treatment of bipolar disorder. Am J Psychiatry 1990; 146: 840–8.Google Scholar
Rucci, P, Frank, E, Kostelnik, B, Fagiolini, A, Mallinger, AG, Swartz, HA, et al. Suicide attempts in patients with bipolar I disorder during acute and maintenance phases of intensive treatment with pharmacotherapy and adjunctive psychotherapy. Am J Psychiatry 2002; 159: 1160–4.Google Scholar
Scott, J, Tacchi, MJ. A pilot study of concordance therapy for individuals with bipolar disorders who are non-adherent with lithium prophylaxis. Bipolar Disord 2002; 4: 386–92.CrossRefGoogle ScholarPubMed
Smith, JA, Tarrier, N. Prodromal symptoms in manic-depressive psychosis. Soc Psychiatry Psychiatr Epidemiol 1992; 27: 245–8.CrossRefGoogle ScholarPubMed
Tsai, SY, Kuo, CJ, Chen, CC, Lee, HC. Risk factors for completad suicide in bipolar disorder. J Clin Psychiatry 2002; 63: 469–76.CrossRefGoogle ScholarPubMed
Van Gent, EM. Follow-up study of 3 years group therapy with lithium treatment. Encephale 2000; 26: 76–9.Google ScholarPubMed
Vieta, E, Colom, F, Corbella, B, Martinez-Aran, A, Reinares, M, Benabarre, A, et al. Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord 2001; 3: 253–8.Google Scholar