A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder
A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder
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DOI：
10.1001/archpsyc.60.9.904
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发表时间：
2003-09-01
影响因子：
--
通讯作者：
Suddath, RL
中科院分区：
文献类型：
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作者：
Miklowitz, DJ;George, EL;Suddath, RL
背景：即使在接受最佳药物治疗的情况下，双相患者仍有复发的风险。本研究旨在探讨维持治疗期间家庭集中治疗(FFT)与药物治疗相结合是否能提高患者的情绪稳定性。方法：在一项随机对照试验中，101例双相情感障碍患者被分配到FFT加药物治疗或较低强度的危机管理(CM)干预加药物治疗。结果评估每隔3~6个月进行一次，为期2年。受试者(平均+/-SD年龄，35.6+/-10.2岁)在躁狂、混合性或抑郁发作后从住院或门诊诊所转诊。FFT包括21个阶段的心理教育、沟通培训和解决问题的技能培训。危机管理由两次家庭教育加危机干预组成。根据需要进行会话。两种方案都持续了9个月。患者接受药物治疗2年。主要观察指标包括复发时间、抑郁和躁狂症状以及药物依从性。结果：FFT组(22/31，71%)和CM组(43/70，61%)的研究完成率没有差异。接受FFT的患者复发率(11/31，35%)低于接受CM的患者(38/70，54%；平均+/-SD，53.2+/-39.6周；风险比，0.38；95%可信区间，0.20-0.75；P=.003；意向治疗)，而生存期(平均+/-SD，73.5+/-28.8周)较长。接受FFT治疗的患者在2年内情绪障碍症状的减少和服药依从性均高于接受CM治疗的患者。结论：家庭心理教育与药物治疗相结合提高了双相情感障碍患者的后症状调整和药物依从性。
Background: Bipolar patients are at risk for relapses of their illness even when undergoing optimal pharmacotherapy. This study was performed to determine whether combining family-focused therapy (FFT) with pharmacotherapy during a postepisode interval enhances patients' mood stability during maintenance treatment.Methods: In a randomized controlled trial, 101 bipolar patients were assigned to FFT and pharmacotherapy or a less intensive crisis management (CM) intervention and pharmacotherapy. Outcome assessments were conducted every 3 to 6 months for 2 years. Participants (mean +/- SD age, 35.6 +/- 10.2 years) were referred from inpatient or outpatient clinics After onset of a manic, mixed, or depressed episode. FFT consisted of 21 sessions of psychoeducation; communication training, and problem-solving skills training. Crisis management consisted of 2 sessions of family education plus crisis intervention. sessions as needed. Both protocols lasted 9 months. Patients received pharmacotherapy for 2 study years. Main outcome measures included time to relapse, depressive and manic symptoms, and medication adherence.Results: Rates of study completion did not differ across the FFT (22/31, 71%) and CM groups (43/70, 61%). Patients undergoing FFT had fewer relapses (11/31, 35%) and longer survival intervals (mean+/-SD, 73.5 +/- 28.8 weeks) than patients undergoing CM (38/70, 54%; mean +/- SD, 53.2 +/- 39.6 weeks; hazard ratio, 0.38; 95% confidence interval, 0.20-0.75; P=.003; intent to treat). Patients under going FFT showed greater reductions in mood disorder symptoms and better medication adherence during the 2 years than patients undergoing CM.Conclusion: Combining family psychoeducation with pharmacotherapy enhances the postepisode symptomatic adjustment and drug adherence of bipolar patients.