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DOI: 10.1055/s-2002-34600
Effekte einer niedrigfrequenten, langzeitigen Paartherapie einzeln und in slow-open und geschlossenen Gruppen bei zyklothymen Patienten unter naturalistischen Bedingungen
Results of Low Frequency, Long-Term Marital Therapy Singly and in Slow-Open and Closed Groups with Patients Suffering from Bipolar Disorders Under Naturalistic SettingsPublication History
Publication Date:
09 October 2002 (online)
Zusammenfassung
Psychotherapie bei bipolaren affektiven Störungen beginnt nach Jahrzehnten als „forgotten treatment modality”, in den letzten Jahren zunehmend Interesse hervorzurufen; der Kenntnisstand ist aber nach wie vor völlig unzureichend. Vorgestellt werden die Ergebnisse zweier naturalistischer Behandlungsstudien bei zyklothymen Patienten mit ungünstigem Verlauf. Die Patienten wurden in einer Slow-open- oder in einer geschlossenen Gruppen- und Einzeltherapie von Paaren adjunktiv zur Medikation behandelt. In der Slow-open-Gruppe reduzierte sich die durchschnittliche Liegezeit pro Jahr nach im Mittel 5,6 Jahren Psychotherapie von 15,8 % auf 5,04 % (p < 0,005); gleichzeitig milderte sich ggf. die Schwere des Fehlverhaltens vorher und die Schwere der Erkrankung bei Wiederaufnahme signifikant ab. In der kleinen geschlossenen Gruppe kam es nach im Mittel 3,1 Jahren mit 8,49 % stationärer Behandlungstage/Jahr zu keiner Wiederaufnahme. Die Behandlungen werden beschrieben und mögliche Gründe für die Effekte diskutiert.
Abstract
After decades as a forgotten treatment modality bipolar disorders psychotherapy becomes of growing interest, although methodologically sound treatment studies are sparse. We present the results of two naturalistic treatment groups of patients with bipolar disorder. All patients had had a difficult course of their illness. Adjunctive to medication both groups were treated with a combined marital therapy in groups and alone. Group A was slow-open and had a therapeutic splitting. Group B was closed with one therapist for psychotherapy and medication. During follow-up of s = 5.6 years in group A the average in-patient-days/year were reduced from 15.8 % to 5.04 % (P < 0.005). Parallel psychosocial lapses and severity of illness prior to admission were reduced. In group B there was within s = 3.1 years no relapse, but 8.46 % days/year before psychotherapy. Possible reasons for this effect are discussed.
Schlüsselwörter
Bipolare Störungen - Gruppentherapie - Paartherapie - Verlauf
Key words
Bipolar Disorders - Group Therapy - Marital Therapy - Course of Illness
Literatur
- 1 Cohen M B, Baker G, Cohen R A, Fromm-Reichmann F, Weigert E V. An intensive study of twelve cases of manic-depressive psychosis. Psychiatry. 1954; 17 103-137
- 2 Demers R G, Davis L S. The influence of prophylactic lithium treatment on the marital adjustment of manic-depressives and theirs spouses. Compreh Psychiat. 1971; 12 348-353
- 3 Ablon S L, Davenport Y B, Gershon E S, Adland M L. The married manic. Am J Orthopsychiat. 1974; 45 854-866
- 4 Davenport Y B, Ebert M H, Adland M L, Goodwin F K. Couples group therapy as an adjunct to lithium maintenance of the manic patient. Am J Orthopsychiat. 1977; 47 495-502
- 5 Mayo J A. Martial therapy with manic-depressive patients treated with lithium. Comprehensive Psychiat. 1979; 20 19-426
- 6 Lesser A L. Hypomania and martial conflict. Can J Psychiat. 1983; 28 362-366
- 7 Weber G, Simon F B, Stierlin H, Schmidt G. Therapy for families manifesting manic-depressive behaviour. Fam Process. 1988; 27 33-49
- 8 Clarkin F J, Glick I D, Haas G l, Spencer J H, Lewis A B, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. A randomized clinical trial of inpatient family intervention. J Affek Disorders. 1990; 18 17-28
- 9 Benson R. The forgotten treatment modality in bipolar illness: Psychotherapy. Diseas nerv syst. 1975; 36 634-638
- 10 Shakir S A, Volkmar F R, Bacon S, Pfefferbaum A. Group psychotherapy as an adjunct to lithium maintenance. Am J Psychiat. 1979; 136 455-456
- 11 Cochran S D. Preventing medical noncompliance in the outpatients treatment of bipolar affective disorder. J Consult Clin Psychol. 1984; 52 873-878
- 12 Miklowitz D J, Goldstein M J, Neuchterlein K H, Snyder K S, Doane J A. Express emotion, affective style, lithium compliance, and relapse in recent onset mania. Psychopharmacol Bull. 1986; 22 628-632
- 13 Silverstone T, Romans-Clarkson S. Bipolar affective disorder: Causes and prevention of relapse. Brit J Psychiat. 1989; 154 321-335
- 14 Kahn D A. The use of psychodynamic psychotherapy in manic-depressiv illness. J Am Acad Psychoanal. 1993; 21 441-455
- 15 Wulsin L, Bachop M, Hoffman D. Group therapy in manic-depressiv illness. Am J Psychother. 1988; 52 (2) 263-271
- 16 Prien R F, Potter W Z. NIMH workshop report on treatment of bipolar disorder. Psychopharmacol Bull. 1990; 26 409-427
- 17 Kröber H L. Psychotherapie bei bipolar manisch-depressiven Erkrankungen - eine Übersicht. Fortschr Neurol Psychiat Abstacts DGPPN Statuskolloquium Psychotherapie in der Psychiatrie 1996: 14
- 18 Miklowitz D J, Simoneau T L, George E L, Richards J A, Kalbag A, Sachs-Ericsson N, Suddath R. Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol Psychiat. 2000; 48 (6) 582-592
- 19 Huxley N A, Parikh S V, Baldessarini R J. Effectivenes of psychosocial treatments in bipolar disorder: state of the evidence. Harv Rev Psychiat. 2000; 8 (3) 126-140
- 20 Swartz H A, Frank E. Psychotherapy for bipolar depression: a phase-specific treatment strategy?. Bipolar Disord. 2001; 3; 1 11-22
- 21 Colom F, Vieta E, Martinez A, Jorquera A, Gasto C. What is the role of psychotherapy in the treatment of bipolar disorder?. Psychother Psychosom. 1998; 67 (1) 3-9
- 22 Frank E, Swartz H A, Kupfer D J. Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biol Psychiat. 2000; 48(6) 593-604
- 23 Scott J. Cognitive therapy as an adjunct to medication in bipolar disorder. Brit J Psychiat. 2001; 41 (Suppl) 164-168
- 24 Frank E, Swartz H A, Malinger A G, Thase M E, Weaver E V, Kupfer D J. Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality. J Abnorm Psychol. 1999; 108 (4) 579-587
- 25 Fava G A, Bartolucci G, Rafanelli C, Mangelli L. Cognitive-behavioural management of patients with bipolar disorder who relapsed while on lithium prophylactics. J Clin Psychiat. 2001; 62 (7) 556-559
- 26 Patelis S I, Young L T, Robb J C, Marriott M, Bieling P J, Cox L C, Joffe R T. Group cognitive behavioural therapy for bipolar disorder: a feasibility and effectiveness study. J Affect Disord. 2001; 62 (2) 145-153
- 27 Haas G L, Glick I D, Clarkin F J, Spencer J H, Lewis A B, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. Inpatient family intervention: A randomized clinical trial: II. Results at hospital discharge. Arch Gen Psychiat. 1988; 45 217-224
- 28 v Gent E M, Vida S L, Zwart F M. Group therapy in addition to lithium therapy in patients with bipolar disorders. Acta psychiat belg. 1988; 88 405-418
- 29 Weiss R D, Griffin M L, Greenfield S F, Najavits L M, Wyner D, Soto J A, Hennen J A. Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study. J Clin Psychiat. 2000; 61 (5) 361-367
- 30 Adler L, Ulrich M, Meyer D, Yeon M H, Lehmann K, Kunert H J, Hajak G. Effekte einer kombinierten Einzel- und Paartherapie in Gruppen bei zyklothymen Patienten mit ungünstigem Verlauf. In: Mundt CH, Linden M, Barnett W (Hrsg). Psychotherapie in der Psychiatrie. Wien: Springer 1996: 111-117
- 31 Maneros A. Handbuch der Unipolaren und bipolaren Erkrankungen. Stuttgart: Thieme 1999
- 32 Graves J S. Living with mania: A study of outpatient group psychotherapy for bipolar patients. Am J Psychother. 1993; 47 113-126
- 33 Paykel E S. Psychotherapy, medication combinations, and compliance. J Clin Psychiat. 1995; 56 (Suppl 1) 24-30
- 34 Craighead W E, Miklowitz D J. Psychosocial interventions for bipolar disorder. J Clin Psychiat. 2000; 61 (Suppl) 1358-1364
- 35 Jamison K R, Goodwin F K. Psychotherapeutic issues in bipolar illness. Psychiatry update. 1984; 2 319-337
- 36 Miklowitz D J. Psychotherapy in combination with drug treatment for bipolar disorder. J Clin Psychopharmacology. 1996; 16 (Suppl) 56-66
PD Dr. L. Adler
Ökomenisches Hainich Klinikum
Pfafferode 102
99974 Mühlhausen
Email: ladler@t-online.de