Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder
Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder
复制标题
DOI：
10.1001/archpsyc.62.9.996
复制
发表时间：
2005-09-01
影响因子：
--
通讯作者：
Monk, T
中科院分区：
文献类型：
--
作者：
Frank, E;Kupfer, DJ;Monk, T
背景：大量研究指出，预防与药物治疗单独在双相I型障碍的治疗失败。最近的调查表明，在药物治疗中增加心理教育或心理治疗对这一人群有益。目的：比较人际与社会节律治疗（IPSRT）和强化临床管理（ICM）两种社会心理干预方法对双相I型障碍的治疗效果。设计：随机对照试验涉及4种治疗策略：急性和维持性IPSRT (IPSRT/ IPSRT)，急性和维持性ICM (ICM/ICM)，急性IPSRT后维持性ICM (IPSRT/ICM)，或急性ICM后维持性IPSRT （ICM/ IPSRT）。预防性维护阶段持续2年。环境：大学医学中心的研究诊所。参与者：从住院和门诊、临床转诊、关于双相情感障碍的公开演讲和其他公共信息活动中招募了175名急性双相情感障碍I患者。干预措施：人际和社会节奏治疗，对kleerman和Weissman的人际心理治疗的改编，其中增加了社会节奏调节成分，以及ICM。主要观察指标：急性期稳定时间，维持期复发时间。结果：我们观察到两种治疗策略在稳定时间上没有差异。在控制了生存时间的协变量后，我们发现，无论维持治疗分配如何，在急性治疗阶段分配IPSRT的参与者在没有新的情感发作的情况下存活的时间更长（P = 0.01）。急性治疗结束时，IPSRT组患者的社会节律规律性更高（P < 0.001）。在急性治疗期间增加社会节律规律性的能力与维持期复发的可能性降低相关（P = 0.05）。结论：人际和社会节律治疗似乎增加了双相I型障碍管理的临床装备，特别是在预防新发作方面。
Context: Numerous studies have pointed to the failure of prophylaxis with pharmacotherapy alone in the treatment of bipolar I disorder. Recent investigations have demonstrated benefits from the addition of psycho-education or psychotherapy to pharmacotherapy in this population.Objective: To compare 2 psychosocial interventions: interpersonal and social rhythm therapy (IPSRT) and an intensive clinical management (ICM) approach in the treatment of bipolar I disorder.Design: Randomized controlled trial involving 4 treatment strategies: acute and maintenance IPSRT (IPSRT/ IPSRT), acute and maintenance ICM (ICM/ICM), acute IPSRT followed by maintenance ICM (IPSRT/ICM), or acute ICM followed by maintenance IPSRT (ICM/ IPSRT). The preventive maintenance phase lasted 2 years.Setting: Research clinic in a university medical center.Participants: One hundred seventy-five acutely ill individuals with bipolar I disorder recruited from inpatient and outpatient settings, clinical referral, public presentations about bipolar disorder, and other public information activities.Interventions: Interpersonal and social rhythm therapy, an adaptation of Klerman and Weissman's interpersonal psychotherapy to which a social rhythm regulation component has been added, and ICM.Main Outcome Measures: Time to stabilization in the acute phase and time to recurrence in the maintenance phase.Results: We observed no difference between the treatment strategies in time to stabilization. After controlling for covariates of survival time, we found that participants assigned to IPSRT in the acute treatment phase survived longer without a new affective episode (P = .01), irrespective of maintenance treatment assignment. Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment (P < .001). Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05).Conclusion: Interpersonal and social rhythm therapy appears to add to the clinical armamentarium for the management of bipolar I disorder, particularly with respect to prophylaxis of new episodes.