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      Abordagens psicoterápicas no transtorno bipolar Translated title: Psychoterapeutic approach in bipolar disorder

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          Abstract

          Embora o tratamento farmacológico seja essencial para o tratamento do transtorno bipolar, apenas 40% de todos os pacientes que aderem às medicações permanecem assintomáticos durante o período de seguimento, o que tem levado ao desenvolvimento de intervenções psicoterápicas associadas. O objetivo deste artigo é examinar as evidências atuais da eficácia de intervenções psicoterápicas no tratamento do transtorno bipolar. Foi realizada uma pesquisa bibliográfica por meio do MedLine, PsychoINFO, Lilacs e Cochrane Data Bank, até o ano de 2004, em que foram procurados artigos originais e revisões sobre as abordagens psicoterápicas utilizadas no tratamento do transtorno bipolar. Há várias abordagens que podem se mostrar úteis no tratamento do transtorno bipolar. A psicoeducação e a terapia cognitivo-comportamental apresentam as evidências mais consistentes e são as técnicas mais amplamente estudadas. As intervenções envolvendo familiares e a terapia interpessoal e de ritmo social se mostram tratamentos eficazes em determinadas situações. Há alguns estudos empregando a terapia psicodinâmica no transtorno bipolar, mas são estudos com limitações metodológicas. Apesar de haver evidências demonstrando a eficácia de determinadas abordagens psicoterápicas no transtorno bipolar, ainda é necessária a realização de estudos posteriores que comprovem tais dados e que desenvolvam tratamentos baseados em modelos etiológicos e que identifiquem tratamentos específicos para as diferentes fases e tipos de transtorno bipolar.

          Translated abstract

          Although pharmacological treatment is essential for treating bipolar disorder, less than half of all medication compliant patients are non-symptomatic during follow-up, which has led to developments of adjunctive psychosocial interventions. This paper examines the current evidence for effectiveness of psychotherapeutic interventions in the treatment of bipolar disorder. Searches were undertaken through MedLine, PsychoINFO, Lilacs, and Cochrane Data Bank, up to the year 2004. Psychotherapeutic approaches to the treatment of bipolar disorders were searched in original and review articles. Various approaches are useful in the treatment of bipolar disorders. Psychoeducation and cognitive-behavioral therapies show the best available evidence and are the most studied techniques. Family interventions and interpersonal and social rhythm therapy show efficacy in particular treatment phases. Studies with psychodynamic psychotherapies showed methodological limitations. Although there are some current evidence for effectiveness of psychosocial interventions for bipolar disorders, there is still a need for further studies to confirm these data. There is also a need to develop treatments based on etiological models, and particular treatments for the different phases and types of the bipolar spectrum.

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          Most cited references 31

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          Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment.

          To determine the efficacy of teaching patients with bipolar disorder (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. Single blind randomised controlled trial with matching on four baseline variables using a minimisation algorithm. Mental health services in four NHS trusts (one teaching, three non-teaching). 69 patients with bipolar disorder who had had a relapse in the previous 12 months. Seven to 12 individual treatment sessions from a research psychologist plus routine care or routine care alone. Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardised interviews every six months for 18 months. 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and control groups (log rank 7.04, df=1, P=0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P=0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P=0.003) and employment (mean difference 0.7 (0.1 to 1.3), P=0.030) by 18 months. Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.
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            Psychoeducation of partners of bipolar-manic patients

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              Cognitive-behavioral management of patients with bipolar disorder who relapsed while on lithium prophylaxis.

              The application of cognitive-behavioral treatment (CBT) to patients with bipolar disorder who had an affective episode while on lithium prophylaxis has received little research attention. The aim of this preliminary study was to test whether reduction of residual symptomatology by cognitive-behavioral methods could yield long-term beneficial effects in patients with bipolar disorder, as was found to be the case in recurrent unipolar depression.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                rpc
                Archives of Clinical Psychiatry (São Paulo)
                Arch. Clin. Psychiatry (São Paulo)
                Faculdade de Medicina da Universidade de São Paulo (São Paulo )
                1806-938X
                2005
                : 32
                : suppl 1
                : 98-104
                Affiliations
                [1 ] Universidade Federal do Rio Grande do Sul Brazil
                [2 ] Universidade Federal do Rio Grande do Sul Brazil
                Article
                S0101-60832005000700014
                10.1590/S0101-60832005000700014
                Product
                Product Information: website
                Categories
                MEDICINE, GENERAL & INTERNAL
                PSYCHIATRY

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