[Psychotherapeutic interventions in bipolar disorder: a review].

Jul 21, 2007Neuropsychiatrie : Klinik, Diagnostik, Therapie und Rehabilitation : Organ der Gesellschaft Osterreichischer Nervenarzte und Psychiater

Psychotherapy treatments for bipolar disorder: a review

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Abstract

Psychotherapeutic interventions combined with pharmacotherapy may prolong time to relapse and reduce symptom severity in bipolar disorder treatment.

Monotherapy with psychopharmacological interventions has shown unsatisfactory outcomes for bipolar disorder.
Cognitive behavioural therapy (CBT), psychoeducation, modified interpersonal psychotherapy (IPSRT), and family focused therapy (FFT) may enhance treatment effectiveness when used alongside medication.
Better outcomes from psychotherapeutic interventions are observed when patients are stable (euthymic) at the beginning of treatment.
Prevention of manic episodes appears to be more effective than prevention of depressive episodes.
The effectiveness of psychoeducation may diminish over time, and the potential benefits of booster sessions are still under investigation.
Further research is necessary to identify which patients may respond well to psychotherapeutic interventions.

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The treatment of bipolar disorders is a demanding task involving patients, therapists and relatives. As bipolar disorders are associated to multiple psychosocial disturbances, the management of a bipolar disease should focus on psychosocial interventions. Despite an exploding literature on this topic, psychopharmacological interventions applied as a monotherapy have shown unsatisfactory outcomes. In order to enhance outcome, psychotherapy, such as cognitive behavioural therapy (CBT), psychoeducation, a modified form of interpersonal psychotherapy (IPSRT) or family focussed psychotherapy (FFT) were investigated. When used in conjunction with pharmacotherapy, these interventions may prolong time to relapse, reduce symptom severity, and increase medication adherence. These combinations are currently considered being the golden standard in the treatment of bipolar disorders. Psychotherapeutic interventions as an add-on strategy exert better effects when patients are euthymic at entry. Prevention of manic episodes seems to be more successful as compared to the prevention of depressive episodes. There are currently no hints for a method specific efficacy. Efficacy of psychoeducation seems to be rather short lived. Currently not yet evaluated booster-sessions might help. More data are needed in order to identify patients with a putative good response to psychotherapeutic interventions.

[Psychotherapeutic interventions in bipolar disorder: a review].

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