Zusammenfassung
Vor dem Hintergrund eines Vulnerabilitäts-Stress-Modells werden psychoedukative, kognitiv-verhaltenstherapeutische, familienorientierte und interpersonale Ansätze in der Psychotherapie bipolarer Erkrankungen erläutert. Es folgt ein Überblick randomisiert kontrollierter Wirksamkeitsstudien, die für den erfolgreichen Einsatz insbesondere von Psychoedukation, Kognitiver Verhaltenstherapie und Familienorientierter Therapie sprechen. Abschließend werden Lücken in den Wirksamkeitsnachweisen diskutiert sowie die Notwendigkeit, psychotherapeutische Programme zu manualisieren.
Abstract
On the basis of a vulnerability-stress-model psychoeducative, cognitive-behavioural, family-oriented and interpersonal approaches of psychotherapy for bipolar disorders are described. This is followed by a review of randomised controlled trials investigating the treatment efficacy of psychotherapeutic interventions. These studies show positive results particularly for psychoeducation, cognitive-behavioural therapy and family-oriented therapy. Finally, it is discussed in which respects evidence for the successful implementation of psychotherapy is still missing and why it is so important to move towards manualised psychotherapeutic programs.
Literatur
-
1
Angst J.
The emerging epidemiology of hypomania and bipolar II disorder.
J Affect Disord.
1998;
50
143-151
-
2
Dickson W, Kendell R.
Does maintenance lithium therapy prevent recurrences of mania under ordinary clinical conditions?.
Psychol Med.
1986;
16
521-530
-
3
Baldessarini R J, Tondo L.
Effects of lithium treatment in bipolar disorders and post-treatment-discontinuation recurrance risk.
Clin Drug Investig.
1998;
15
337-351
-
4
Maj M, Pirozzi R, Magliano L, Bartoli L.
Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic.
Am J Psychiatry.
1998;
155
30-35
-
5
Baldessarini R J, Tondo L, Viguera A.
Effects of discontinuing lithium maintenance treatment.
Bipolar Dis.
1999;
1
17-24
-
6
Keller M B, Lavori P W, Coryell W, Endicott J, Mueller T I.
Bipolar I: A five year prospective follow-up.
J Nerv Ment Dis.
1993;
181
238-245
-
7
Ellenberg J, Salamon I, Meaney C.
A lithium clinic in a community mental health center.
Hosp Community Psychiatry.
1980;
31 (12)
834-836
-
8
Cochran S.
Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders.
Journal of Consulting & Clinical Psychology.
1984;
52 (5)
873-878
-
9
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 Orthopsychiatry.
1977;
47
495-502
-
10 Wagner P, Bräunig P. Psychoedukation bei bipolaren Störungen. Ein Therapiemanual für Gruppen. Stuttgart; Schattauer 2004
-
11
Frank E, Kupfer D J, Ehlers C L, Monk T H, Cornes C, Carter S, Frankel D.
Interpersonal and Social Rhythm Therapy for bipolar disorder: Integrating interpersonal and behavioral approaches.
The Behavior Therapist.
1994;
17 (7)
143-149
-
12
Miklowitz D J, Goldstein M J, Nuechterlein K H, Snyder K S, Doane J A.
Expressed emotion, affective style, lithium compliance, and relapse in recent onset mania.
Psychopharmacol Bull.
1986;
22
628-632
-
13 Miklowitz D J, Goldstein M. Bipolar disorder: A family-focused treatment approach. New York; Guilford Press 1997
-
14
Huxley N A, Parikh S V, Baldessarini R J.
Effectiveness of psychosocial treatments in bipolar disorder: State of the evidence.
Harvard Review of Psychiatry.
2000;
8
126-140
-
15
Meyer T, Hautzinger M.
Psychotherapie bei bipolaren affektiven Störungen - Ein Überblick über den Stand der Forschung.
Verhaltenstherapie.
2000;
10
177-186
-
16
Gonzalez-Pinto A, Gonzalez C, Enjuto S, Fernandez de Corres B, Lopez P, Palomo J, Gutierrez M J, Mosquera F, Perez de Heredia J L.
Psychoeducation and cognitive-behavioral therapy in bipolar disorder: An update.
Acta Psychiatr Scand.
2004;
109
83-90
-
17
Gutierrez M J, Scott J.
Psychological treatment for bipolar disorders.
Eur Arch Psychiatry Clin Neurosci.
2004;
254
92-98
-
18
Jones S.
Psychotherapy of bipolar disorder: A review.
J Affect Disord.
2004;
80
101-114
-
19
Otto W, Miklowitz D J.
The role and impact of psychotherapy in the management of bipolar disorder.
CNS Spectrums.
2004;
9 (11, Suppl 12)
27-32
-
20
Sajatovic M, Davies M, Hrouda D R.
Enhancement of treatment adherence among patients with bipolar disorder.
Psychiatric Services.
2004;
55 (3)
264-269
-
21
Vieta E, Colom F.
Psychological interventions in bipolar disorder: From wishful thinking to an evidence-based approach.
Acta Psychiatr Scand.
2004;
110 (422)
34-38
-
22
Gent E M Van, Vida S L, Zwart F M.
Group therapy in addition to lithium therapy in patients with bipolar disorder.
Acta Psychiat Belg.
1988;
88
405-418
-
23
Gent E M Van, Zwart F M.
Ultra-short versus short group therapy in addition to lithium.
Patient Education and Counseling.
1993;
21
135-141
-
24
Honig A, Hofman A, Hilwig M, Noorthorn E, Ponds R.
Psychoeducation and expressed emotion in bipolar disorder: preliminary findings.
Psychiatry Research.
1995;
56
299-301
-
25
Honig A, Hofman A, Rozendaal N, Dingemans P.
Psycho-education in bipolar disorder: effect on expressed emotion.
Psychiatry Research.
1997;
72
17-22
-
26
Peet M, Harvey N.
Lithium maintenance: 1. A standard education programme for patients.
British Journal of Psychiatry.
1991;
158
197-200
-
27
Harvey N, Peet M.
Lithium Maintenance: 2. Effects of personality and attitude on health information acquisition and compliance.
British Journal of Psychiatry.
1991;
158
200-204
-
28
Gent E Van, Zwart F.
Psychoeducation of partners of bipolar-manic patients.
J Affect Disord.
1991;
21
15-18
-
29
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
149-153
-
30
Simon G, Ludman E, Unutzer J, Bauer M.
Design and implementation of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Dis.
2002;
4 (4)
226-236
-
31
Simon G E, Ludman E J, Unutzer J, Bauer M S, Operskalski B, Rutter C. et al .
Randomized trial of a population-based care program for people with bipolar disorder.
Psychological Medicine.
2005;
35 (1)
13-24
-
32 Bauer M, McBride L. Structured group psychotherapy for bipolar disorder. The Life Goals Program. New York; Springer Publishing Company 1996
-
33 Bauer M, McBride L. Structured group psychotherapy for bipolar disorder. The Life Goals Program. second ed. New York; Springer Publishing Company 2003
-
34
Dogan S, Sabanciogullari S.
The effects of patient education in lithium therapy on quality of life and compliance.
Arch Psychiatr Nurs.
2003;
17 (6)
270-275
-
35
Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea J M, Benabarre A, Torrent C, Comes M, Corbella B, Parramon G, Corominas J.
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
402-407
-
36 Basco M, Rush A J. Cognitive behavioral treatment of manic-depressive disorder. New York; Guilford Press 1996
-
37
Colom F, Vieta E, Reinares M, Martinez-Aran A, Torrent C, Goikolea J M, Gasto C.
Psychoeducation efficacy in bipolar disorders: Beyond compliance enhancement.
J Clin Psychiatry.
2003;
64 (9)
1101-1105
-
38
Colom F, Vieta E, Sanchez-Moreno J, Martinez-Aran A, Torrent C, Reinares M, Goikolea J M, Benabarre A, Comes M.
Psychoeducation in bipolar patients with comorbid personality disorders.
Bipolar Dis.
2004;
6
294-298
-
39
Reinares M, Vieta E, Colom F, Martinez-Aran A, Torrent C, Comes M, Goikolea J M, Benabarre A, Sanchez-Moreno J.
Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients.
Psychother Psychosom.
2004;
73
312-319
-
40
Lam D, Bright J, Jones S, Hayward P, Schuck N, Chisholm D, Sham P.
Cognitive therapy for bipolar illness - A pilot study of relapse prevention.
Cognitive Therapy and Research.
2000;
24 (5)
503-520
-
41 Lam D, Jones S, Hayward P, Bright J. Cognitive Therapy for Bipolar Disorder. A therapist's guide to concepts, methods and practice. Chichester; Wiley 1999
-
42
Scott J, Garland A, Moorhead S.
A pilot study of cognitive therapy in bipolar disorders.
Psychological Medicine.
2001;
31
459-467
-
43
Lam D, Watkins E R, Hayward P, Bright J, Wright K, Kerr N, Parr-Davis G, Sham P.
A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder. Outcome of the first year.
Arch Gen Psychiatry.
2003;
60
145-152
-
44
Lam D H, Hayward P, Watkins E, Wright K, Sham P.
Relapse prevention in patients with bipolar disorder: Cognitive therapy outcome after 2 years.
Am J Psychiatry.
2005;
162 (2)
324-329
-
45
Clarkin J F, Glick I, Haas G L, Spencer J H, Lewis A, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V.
A randomized clinical trial of inpatient family intervention. V. Results for affective disorders.
J Affect Disord.
1990;
18
17-28
-
46
Clarkin J F, Carpenter D, Hull J, Wilner P, Glick I.
Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses.
Psychiatr Serv.
1998;
49
531-533
-
47
Miklowitz D J, Simoneau D L, George E L, Richards J A, Kalbag A, Sachs-Ericsson N, Suddath R L.
Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy.
Biol Psychiatry.
2000;
48
582-592
-
48
Miklowitz D J, George E L, Richards J A, Simoneau T L, Suddath R L.
A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder.
Arch Gen Psychiatry.
2003;
60
904-912
-
49
Simoneau T L, Miklowitz D J, Richards J A, Saleem R, George E L.
Bipolar disorder and family communication: Effects of a psychoeducational treatment program.
Journal of Abnormal Psychology.
1999;
108
588-597
-
50
Rea M M, Miklowitz D J, Tompson M C, Goldstein M J, Hwang S, Mintz J.
Family-focused treatment versus individual treatment for bipolar disorder: Results of a randomized clinical trial.
Journal of Consulting & Clinical Psychology.
2003;
71 (3)
482-492
-
51
Hlastala S A, Frank E, Mallinger A G, Thase M E, Ritenour A, Kupfer D.
Bipolar depression: An underestimated treatment challenge.
Depress Anxiety.
1997;
5
73-83
-
52
Frank E, Hlastala S A, Ritenour A, Houck P, Tu X M, Monk T H, Mallinger A G, Kupfer D.
Inducing lifestyle regularity in recovering bipolar disorder patients: Results from the Maintenance Therapies in Bipolar Disorder Protocol.
Biol Psychiatry.
1997;
41
1165-1173
-
53
Frank E, Swartz H A, Mallinger A G, Thase M E, Weaver E V, Kupfer D.
Adjunctive psychotherapy for bipolar disorder: Effects of changing treatment modality.
J Abnorm Psychol.
1999;
108 (4)
579-587
-
54
Zaretsky A E, Segal Z V, Gemar M.
Cognitive therapy for bipolar depression: A pilot study.
Can J Psychiatry.
1999;
44
491-494
-
55
Satterfield J.
Adjunctive cognitive-behavioral therapy for rapid-cycling bipolar disorder: An empirical case study.
Psychiatry.
1999;
62
357-369
-
56
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 Psychiatry.
2000;
61
361-367
-
57
Swartz H A, Pilkonis P A, Frank E, Proietti J M, Scott J.
Acute treatment outcomes in patients with bipolar I disorder and co-morbid borderline personality disorder receiving medication and psychotherapy.
Bipolar Dis.
2005;
7
192-197
-
58
Miklowitz D J, George E L, Axelson D A, Kim E Y, Birmaher B, Schneck C, Beresford C, Craighead W E, Brent D A.
Family-focused treatment for adolescents with bipolar disorder.
J Affect Disord.
2004;
82
113-128
-
59
Pavuluri M N, Graczyk P A, Henry D B, Carbray J A, Heidenreich J, Miklowitz D J.
Child- and Family-Focused Cognitive-Behavioral Therapy for pediatric bipolar disorder: Development and preliminary results.
J Am Acad Child Adolesc Psychiatry.
2004;
43 (5)
528-537
-
60
Fristad M A, Goldberg-Arnold J, Gavazzi S M.
Multi-Family Psychoeducation Groups (MFPG) for families of children with bipolar disorder.
Bipolar Dis.
2002;
4
254-262
-
61
Fristad M A, Goldberg-Arnold J, Gavazzi S M.
Multi-Family Psychoeducation Groups in the treatment of children with mood disorders.
Journal of Marital and Family Therapy.
2003;
29 (4)
491-504
-
62
Sachs G S, Thase M E, Otto M, Bauer M, Miklowitz D J, Wisniewski S R, Lavori P, Lebowitz B, Rudorfer M, Frank E, Nierenberg A A, Fava M, Bowden C, Ketter T, Marangell L, Calabrese J, Kupfer D, Rosenbaum J F.
Rationale, design, and methods of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
Biol Psychiatry.
2003;
53
1028-1042
-
63 Meyer T, Hautzinger M. Manisch-depressive Störungen. Kognitiv-verhaltenstherapeutisches Behandlungsmanual. Weinheim; Beltz Verlag 2004
-
64 Schaub B, Bernhard B, Gauck L. Kognitiv-psychoedukative Therapie bei bipolaren Erkrankungen. Ein Therapiemanual. Göttingen; Hogrefe 2004
Prof. Dr. med. habil. Peter Bräunig
Klinik für Psychiatrie und Psychotherapie · Vivantes Humboldt-Klinikum Berlin · Akademisches Lehrkrankenhaus der Charité · Universitätsmedizin Berlin
Am Nordgraben 2
13509 Berlin
Email: peter.braeunig@vivantes.de
