Bipolar Bozuklukta Sosyal Ritim ve Sosyal Ritmi Düzenlemeye Yönelik Müdahaleler

Abstract

Bu derlemede, bipolar bozuklukta semptomları azaltmak, uykuyu düzenlemek ve işlevselliği artırmak için sosyal ritimleri ele alan müdahaleleri derlemek amaçlanmıştır. Bipolar bozuklukta nüksü etkileyen faktörler; stresli yaşam olayları, ilaç tedavisine uyumsuzluk ve sosyal ritimlerdeki bozulmalardır. Kronoterapötik müdahalalerden olan parlak ışık terapisi ile ilgili tutarsız sonuçlar olsa da bipolar bozukluğun özellikle depresif dönemlerinde etkili ve güvenli bir tamamlayıcı müdahale yöntemi olabileceği görülmektedir. Öte yandan, manik dönemlerde uygulanan karanlık terapisi ve mavi ışık filtreleyici gözlük kullanımı gibi müdahalelerin, manik semptomlarda azalma sağladığı, uyku kalitesini artırdığı ve farmakolojik tedavi gereksinimini azalttığı bulunmuştur. Psikoterapötik müdahaleler incelendiğinde ise, BDT-I uygulandıktan sonra, depresyon remisyon oranının daha yüksek olduğu, anksiyolitik kullanımında, uykusuzluk şiddetinde ve uykuya ilişkin olumsuz düşüncelerde azalma olduğu belirlenmiştir. BDTI-BD ise bipolar bozukluk tanısı olan bireylerde uykusuzluk şiddeti, manik/hipomanik atakların sıklığını ve uyku için psikotrop ilaç kullanımını azaltmıştır. Kişilerarası ilişkiler ve Sosyal Ritim Terapisinin de (KİSRT) hem bireysel hem de grup formatında uygulanarak, depresif ve manik semptomlarda azalma, sosyal ritim düzenliliğinde iyileşme ve işlevsellikte artış sağlayabildiği görülmektedir. Sonuç olarak, sirkadiyen ritmi hedef alan yaklaşımlar, özellikle farmakolojik tedavilere direnç gösteren bipolar bozukluk olgularında, hızlı etki göstermesi ve nörobiyolojik temellere dayanması açısından umut vaat etmektedir. Ancak, daha geniş örneklemli, müdahale protokollerinin standardizasyonu ve klinik etkilerin uzun dönem takibi gibi alanlarda daha fazla bilimsel veri gereklidir.

Keywords

• bipolar bozukluk
• sosyal ritim
• sirkadyen ritim

Social Rhythm in Bipolar Disorder and Interventions to Regulate Social Rhythm

Abstract

This review aims to compile interventions targeting social rhythms to reduce symptoms, regulate sleep, and improve functioning in bipolar disorder. Factors influencing relapse in bipolar disorder include stressful life events, nonadherence to pharmacological treatment, and disruptions in social rhythms. Although the findings are inconsistent, bright light therapy, as a chronotherapeutic intervention, appears to be an effective and safe adjunctive treatment, particularly during depressive episodes of bipolar disorder. On the other hand, interventions implemented during manic episodes, such as dark therapy and the use of blue light-blocking glasses, have been found to reduce manic symptoms, improve sleep quality, and decrease the need for pharmacological treatment. In terms of psychotherapeutic interventions, CBT-I has been associated with higher depression remission rates, reduced use of anxiolytics, decreased insomnia severity, and fewer maladaptive sleep-related cognitions. Furthermore, CBT-I adapted for bipolar disorder (CBT-I-BD) has been shown to reduce insomnia severity, the frequency of manic/hypomanic episodes, and the use of psychotropic medication for sleep among individuals diagnosed with BD. Interpersonal and Social Rhythm Therapy (IPSRT), whether delivered individually or in group formats, has been found to reduce both depressive and manic symptoms, improve social rhythm regularity, and enhance overall functioning. In conclusion, approaches targeting circadian rhythms show promise, particularly in treatment-resistant cases of bipolar disorder, due to their rapid effects and neurobiological basis. However, further scientific data are needed, especially in areas such as standardized intervention protocols, larger sample sizes, and long-term follow-up of clinical outcomes.

Keywords

• bipolar disorder
• social rhythm
• circadian rhythm

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