Bipolar Bozuklukta Psikoeğitim: Kısa Bir Bakış

Öz

Bipolar bozukluk, tekrarlayan mani, depresyon ve hipomani ataklarıyla karakterize edilen, bireyin duygusal, sosyal ve mesleki işlevselliğini önemli ölçüde bozan kronik ve karmaşık bir duygu durum bozukluğudur. Bu ataklar yoğunluk ve süre açısından değişiklik gösterebilir ve genellikle öngörülemez duygu ve davranış değişimlerine yol açarak hastaların istikrarlı bir yaşam kalitesi sürdürme yeteneğini zorlar. Mani atakları yüksek enerji, dürtüsellik ve öfori ile işaretlenirken, depresif ataklar derin üzüntü, halsizlik ve ilgi kaybını içerir. Hipomani atakları, daha az şiddetli olsa da, günlük işlevselliği yine de bozar. Duygu durum dengeleyiciler ve antipsikotikler gibi farmakolojik tedavilerdeki ilerlemelere rağmen, bipolar bozukluk önemli zorluklar yaratmaya devam etmekte; genellikle yaşam kalitesinin azalmasına, ilişkilerin gerilmesine ve üretkenliğin düşmesine neden olmaktadır. Bozukluğun kronik doğası, ilaç tedavisinin ötesine geçen kapsamlı yönetim stratejilerine duyulan ihtiyacı vurgular. Bipolar bozukluğun olumsuz etkilerini azaltmak için farmakoterapiyi psikososyal müdahalelerle birleştiren çok yönlü bir tedavi yaklaşımı gereklidir. Bu müdahaleler arasında psikoeğitim, hastaları ve ailelerini durumu daha iyi yönetmeleri için bilgi ve becerilerle güçlendirmeyi amaçlayan kritik bir tedavi stratejisi olarak öne çıkmıştır. Psikoeğitim, bipolar bozukluk hakkında yapılandırılmış, kanıta dayalı bilgiler sunmayı içerir; bu bilgiler belirtiler, tetikleyici faktörler, tedavi seçenekleri ve başa çıkma stratejilerini kapsar. Hastaların hastalıklarını daha iyi anlamalarını sağlayarak psikoeğitim, tedaviye katılımı artırır, reçeteli tedavilere uyumu iyileştirir ve işlevsel iyileşmeyi teşvik eder. Ayrıca ailelere sevdiklerine destek olma araçları sunarak damgalanmayı azaltır ve iletişimi iyileştirir. Psikoeğitim, bireysel ihtiyaçlara özel bireysel seanslar, akran desteğini teşvik eden grup ortamları veya ilişkisel dinamikleri güçlendiren aile odaklı programlar gibi çeşitli formatlarda sunulabilir.

Anahtar Kelimeler

• psikoeğitim
• bipolar bozukluk
• grup terapisi

Psychoeducation in Bipolar Disorder: A Brief Review

Öz

Bipolar disorder is a chronic and complex mood disorder characterized by recurring episodes of mania, depression, and hypomania, which significantly disrupt an individual's emotional, social, and occupational functioning. These episodes can vary in intensity and duration, often leading to unpredictable shifts in mood and behavior that challenge patients' ability to maintain a stable quality of life. Manic episodes are marked by elevated energy, impulsivity, and euphoria, while depressive episodes involve profound sadness, lethargy, and loss of interest. Hypomanic episodes, though less severe, still impair daily functioning. Despite advancements in pharmacological treatments, such as mood stabilizers and antipsychotics, bipolar disorder continues to pose substantial challenges, often resulting in diminished quality of life, strained relationships, and reduced productivity. The chronic nature of the disorder underscores the need for comprehensive management strategies that extend beyond medication to address its multifaceted impact. To mitigate the negative effects of bipolar disorder, a multimodal treatment approach is essential, combining pharmacotherapy with psychosocial interventions. Among these, psychoeducation has emerged as a critical therapeutic strategy aimed at empowering patients and their families with knowledge and skills to better manage the condition. Psychoeducation involves providing structured, evidence-based information about bipolar disorder, including its symptoms, triggers, treatment options, and coping strategies. By enhancing patients' understanding of their illness, psychoeducation fosters greater treatment participation, improves adherence to prescribed therapies, and promotes functional recovery. It also equips families with tools to support their loved ones, reducing stigma and improving communication. Psychoeducation can be delivered in various formats, including individual sessions tailored to personal needs, group settings that encourage peer support, or family-focused programs that strengthen relational dynamics.

Anahtar Kelimeler

• psychoeducation
• bipolar disorder
• group therapy

Kaynakça

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
2. Arendt, J. (1995). Melatonin and the mammalian pineal gland. Chapman & Hall.
3. Arnbjerg, C. J., Gishoma, D., Møller, P. K., Rémès, L. M., Carlsson, J., & Kallestrup, P. (2024). Effectiveness of structured group psychoeducation for people with bipolar disorder in Rwanda: A randomized open-label superiority trial. Journal of Affective Disorders, 356, 405–413. https://doi.org/10.1016/j.jad.2024.04.043
4. Barbeito, S., Vega, P., Ruiz de Azúa, S., González-Ortega, I., Alberich, S., & González-Pinto, A. (2023). Two-year evaluation of a multifamily psychoeducational program (PROTEC) in the family burden and prognosis of bipolar patients. Spanish Journal of Psychiatry and Mental Health, 16(2), 225–234. https://doi.org/10.1016/j.sjms.2023.05.002
5. Beck, A. T. (1979). Cognitive therapy of depression. Guilford Press.
6. Bilderbeck, A. C., Atkinson, L. Z., McMahon, H. C., Rendell, J. M., Harmer, C. J., Geddes, J. R., & Goodwin, G. M. (2016). Psychoeducation and online mood tracking for patients with bipolar disorder: A randomised controlled trial. Journal of Affective Disorders, 205, 245–251. https://doi.org/10.1016/j.jad.2016.07.015
7. Borbély, A. A. (1982). A two process model of sleep regulation. Human Neurobiology, 1(3), 195–204.
8. Camacho, E. M., Ntais, D., Jones, S., & Nielsen, L. (2017). Cost-effectiveness of structured group psychoeducation versus unstructured group support for bipolar disorder. Journal of Affective Disorders, 211, 27–36. https://doi.org/10.1016/j.jad.2017.01.007

9. Candini, V., Buizza, C., Ferrari, C., Caldera, M. T., Ermentini, R., Ghilardi, A., & Pioli, R. (2013). Is structured group psychoeducation for bipolar patients effective in ordinary mental health services? A controlled trial in Italy. Journal of Affective Disorders, 151(1), 149–155. https://doi.org/10.1016/j.jad.2013.05.069
10. Cardoso, T. A., Mondin, T. C., da Silva, G. D. R., Souza, L. D. M., da Silva, R. A., Jansen, K., & Magalhães, P. V. (2014). Brief psychoeducation for bipolar disorder: Impact on quality of life in young adults in a 6-month follow-up of a randomized controlled trial. Psychiatry Research, 220(3), 896–902. https://doi.org/10.1016/j.psychres.2014.10.005
11. Casarez, R. L., Tippett, J., Hidalgo, R., & Mican, L. M. (2021). Psychoeducation for caregivers of patients with bipolar disorder: Lessons learned from a feasibility study. Journal of Affective Disorders, 287, 367–371. https://doi.org/10.1016/j.jad.2021.03.052
12. Colom, F., & Vieta, E. (2006). Psychoeducation manual for bipolar disorder. Cambridge University Press.
13. Colom, F., Vieta, E., Martínez-Arán, A., Reinares, M., Goikolea, J. M., Benabarre, A., Torrent, C., Comes, M., Corbella, B., Parramon, G., & Corominas, J. (2003). A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Archives of General Psychiatry, 60(4), 402–407. https://doi.org/10.1001/archpsyc.60.4.402
14. Czeisler, C. A., & Gooley, J. J. (2007). Sleep and circadian rhythms in humans. Cold Spring Harbor Symposia on Quantitative Biology, 72, 579–597. https://doi.org/10.1101/sqb.2007.72.064
15. Ehlers, C. L., Frank, E., & Kupfer, D. J. (1988). Social zeitgebers and biological rhythms: A unified approach to understanding the etiology of depression. Archives of General Psychiatry, 45(10), 948–952. https://doi.org/10.1001/archpsyc.1988.01800340076012
16. Eker, F., & Harkın, S. (2012). Effectiveness of six-week psychoeducation program on adherence of patients with bipolar affective disorder. Journal of Affective Disorders, 138(3), 409–416. https://doi.org/10.1016/j.jad.2012.01.004
17. Erten, E., Uney, A., & Fıstıkcı, N. (2015). Bipolar bozukluk ve çocukluk çağı travması [Bipolar disorder and childhood trauma]. Psikiyatride Güncel Yaklaşımlar, 7(2), 118–136. https://doi.org/10.18863/pgy.84672
18. Foster, R. G., & Kreitzman, L. (2004). Rhythms of life: The biological clocks that control the daily lives of every living thing. Yale University Press.
19. Frank, E., Swartz, H. A., & Kupfer, D. J. (2000). Interpersonal and social rhythm therapy: Managing the chaos of bipolar disorder. Biological Psychiatry, 48(6), 593–604. https://doi.org/10.1016/s0006-3223(00)00969-0
20. González Isasi, A., Echeburúa, E., Limiñana, J. M., & González-Pinto, A. (2014). Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: A 5-year controlled clinical trial. European Psychiatry, 29(3), 134–141. https://doi.org/10.1016/j.eurpsy.2013.04.004
21. González-Ortega, I., Mosquera, F., Echeburúa, E., González-Pinto, A., & the PSICOTEC Group. (2016). Online psychoeducation in the treatment of bipolar disorder: Protocol of a randomized controlled trial. BMC Psychiatry, 16, 452. https://doi.org/10.1186/s12888-016-1159-0
22. Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: Bipolar disorders and recurrent depression (2nd ed.). Oxford University Press.
23. Harvey, N. S., & Peet, M. (1991). Lithium maintenance: 2. Effects of personality and attitude on health information acquisition and compliance. British Journal of Psychiatry, 158, 200–204. https://doi.org/10.1192/bjp.158.2.200
24. Hidalgo-Mazzei, D., Mateu, A., Reinares, M., Undurraga, J., Bonnín, C. M., Sánchez-Moreno, J., & Vieta, E. (2015). Self-monitoring and psychoeducation in bipolar patients with a smart-phone application (SIMPLe) project: Design, development and studies protocols. BMC Psychiatry, 15, 52. https://doi.org/10.1186/s12888-015-0437-6
25. Javadpour, A., Hedayati, A., Dehbozorgi, G. R., & Azizi, A. (2013). The impact of a simple individual psychoeducation program on quality of life, rate of relapse and medication adherence in bipolar disorder patients. Asian Journal of Psychiatry, 6(3), 208–213. https://doi.org/10.1016/j.ajp.2012.12.007
26. Jones, S., & Bentall, R. P. (2008). A review of potential cognitive and environmental risk markers in children of bipolar parents. Clinical Psychology Review, 28(7), 1083–1095. https://doi.org/10.1016/j.cpr.2008.03.002
27. Kallestad, H., Fosse, R., Scott, J., & Mueser, K. T. (2016). The long-term outcomes of an effectiveness trial of group versus individual psychoeducation for bipolar disorders. Journal of Affective Disorders, 202, 32–38. https://doi.org/10.1016/j.jad.2016.05.029
28. Konuk, N., Kıran, S., Tamam, L., Karaahmet, E., Aydın, H., & Atık, L. (2017). Duygudurum bozuklukları ölçeği’nin Türkçe uyarlamasının bipolar bozukluk taramasında geçerliği [Validity of the Turkish version of the Mood Disorder Questionnaire in screening for bipolar disorder]. Türk Psikiyatri Dergisi, 28(3), 1–8.
29. Lack, L. C., Gradisar, M., Van Someren, E. J. W., Wright, H. R., & Lushington, K. (2008). The relationship between insomnia and body temperature. Sleep Medicine Reviews, 12(4), 307–317. https://doi.org/10.1016/j.smrv.2008.02.003
30. Lam, D. H., & Wong, G. (2005). Cognitive behavioral therapy for bipolar disorder: A review of its efficacy. Journal of Affective Disorders, 84(2-3), 117–127. https://doi.org/10.1016/S0165-0327(03)00109-6
31. Lewy, A. J., Sack, R. L., Miller, L. S., & Hoban, T. M. (1987). Antidepressant and circadian phase-shifting effects of light. Science, 235(4786), 352–354. https://doi.org/10.1126/science.3798117
32. Madigan, K., Egan, P., Brennan, D., Hill, S., Maguire, B., Horgan, F., & Lawlor, E. (2012). A randomised controlled trial of carer-focused multi-family group psychoeducation in bipolar disorder. European Psychiatry, 27(4), 281–284. https://doi.org/10.1016/j.eurpsy.2010.12.008
33. Maurin, K. D., Biet, M., Roux, P., Chevance, A., & Llorca, P. M. (2020). Use of a serious game to strengthen medication adherence in euthymic patients with bipolar disorder following a psychoeducational programme. Journal of Affective Disorders, 262, 182–188. https://doi.org/10.1016/j.jad.2019.10.047
34. Miklowitz, D. J. (2008). The bipolar disorder survival guide: What you and your family need to know (2nd ed.). Guilford Press.
35. Moore, R. Y., & Eichler, V. B. (1972). Loss of a circadian adrenal corticosterone rhythm following suprachiasmatic lesions in the rat. Brain Research, 42(1), 201–206. https://doi.org/10.1016/0006-8993(72)90054-6
36. Morriss, R., Lobban, F., Riste, L., Davies, L., Holland, F., Long, R., ... & Jones, S. (2011). Pragmatic randomised controlled trial of group psychoeducation versus group support in the maintenance of bipolar disorder. BMC Psychiatry, 11, 114. https://doi.org/10.1186/1471-244X-11-114
37. Novick, D. M., & Swartz, H. A. (2019). Evidence-based psychotherapies for bipolar disorder. Focus, 17(3), 238–248. https://doi.org/10.1176/appi.focus.20190004
38. Otto, M. W., & Reilly-Harrington, N. A. (2003). Cognitive-behavioral therapy for bipolar disorder. Psychiatric Clinics of North America, 26(2), 379–398. https://doi.org/10.1016/s0193-953x(02)00113-8
39. Parikh, S. V., Zaretsky, A., Beaulieu, S., Yatham, L. N., Young, L. T., Patelis-Siotis, I., ... & Streiner, D. L. (2012). A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: A Canadian Network for Mood and Anxiety Treatments (CANMAT) study. Journal of Clinical Psychiatry, 73(6), 803–810. https://doi.org/10.4088/JCP.11m07343
40. Partonen, T., & Lönnqvist, J. (1998). Seasonal affective disorder. The Lancet, 352(9137), 1369–1374. https://doi.org/10.1016/S0140-6736(98)01015-0
41. Peet, M., & Harvey, N. S. (1991). Lithium maintenance: 1. A standard education programme for patients. British Journal of Psychiatry, 158, 197–200. https://doi.org/10.1192/bjp.158.2.197
42. Pozza, A., Bossini, L., Ferretti, F., Moretti, P., Pimpinella, G., & Dèttore, D. (2020). Enhancing adherence to antipsychotic treatment for bipolar disorders: Comparison of mobile app-based psychoeducation, group psychoeducation, and the combination of both. Clinical Therapeutics, 171(1), e87–e93. https://doi.org/10.1016/j.curtheres.2020.04.006
43. Reid, K. J., & Zee, P. C. (2009). Circadian rhythm disorders. Sleep Medicine Clinics, 4(4), 585–598. https://doi.org/10.1016/j.jsmc.2009.08.003
44. Reinares, M., Pacchiarotti, I., Solé, B., García-Estela, A., Rosa, A. R., Bonnín, C. M., ... & Colom, F. (2020). A prospective longitudinal study searching for predictors of response to group psychoeducation in bipolar disorder. Journal of Affective Disorders, 274, 1113–1121. https://doi.org/10.1016/j.jad.2020.06.019
45. Roenneberg, T., Wirz-Justice, A., & Merrow, M. (2003). Life between clocks: Daily temporal patterns of human chronotypes. Journal of Biological Rhythms, 18(1), 80–90. https://doi.org/10.1177/0748730402239679
46. Schwartz, J. R., & Roth, T. (2008). Neurophysiology of sleep and wakefulness: Basic science and clinical implications. Current Neuropharmacology, 6(4), 367–378. https://doi.org/10.2174/157015908787386050
47. Scott, J., & Colom, F. (2005). Psychosocial treatments for bipolar disorders. Psychiatric Clinics of North America, 28(2), 371–384. https://doi.org/10.1016/j.psc.2005.01.002
48. Simpson, S., Barnes, E., Griffiths, E., Hood, K., Cohen, D., Craddock, N., ... & Smith, D. J. (2009). The Bipolar Interactive Psychoeducation (BIPED) study: Trial design and protocol. BMC Psychiatry, 9, 50. https://doi.org/10.1186/1471-244X-9-50
49. Smith, D., Jones, I., & Simpson, S. (2010). Psychoeducation for bipolar disorder. Advances in Psychiatric Treatment, 16(2), 147–154. https://doi.org/10.1192/apt.bp.108.006403
50. Souza, M. S., Guimarães, R. A., de Araújo Vilela, D., de Souza, J. G., & de Almeida, K. M. (2016). Six-session caregiver psychoeducation on bipolar disorder: Does it bring benefits to caregivers? International Journal of Social Psychiatry, 62(4), 377–385. https://doi.org/10.1177/0020764016635178
51. Terman, M., & Terman, J. S. (2005). Light therapy for seasonal and nonseasonal depression: Efficacy, protocol, safety, and side effects. CNS Spectrums, 10(8), 647–663. https://doi.org/10.1017/s1092852900019611
52. Torrent, C., Bonnin, C. M., Martínez-Arán, A., Valle, J., Amann, B. L., González-Pinto, A., ... & Vieta, E. (2013). Efficacy of functional remediation in bipolar disorder: A multicenter randomized controlled study. American Journal of Psychiatry, 170(8), 852–859. https://doi.org/10.1176/appi.ajp.2012.12070971
53. van Dijk, S., Jeffrey, J., & Katz, M. R. (2013). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders, 145(3), 386–393. https://doi.org/10.1016/j.jad.2012.05.054
54. van Gent, E. M., & Zwart, F. M. (1991). Psychoeducation of partners of bipolar-manic patients. Journal of Affective Disorders, 21(1), 15–18. https://doi.org/10.1016/0165-0327(91)90015-5
55. Van Someren, E. J. W. (2000). Circadian and sleep disturbances in the elderly. Experimental Gerontology, 35(9-10), 1229–1237. https://doi.org/10.1016/S0531-5565(00)00191-1
56. Wirz-Justice, A., Benedetti, F., & Terman, M. (2009). Chronotherapeutics for affective disorders: A clinician's manual for light and wake therapy. Karger.
57. Yılmaz, G. T., Güriz, S. O., Kahiloğulları, A. K., Kokurcan, A., & Örsel, S. (2020). Bipolar bozuklukta grup psikoeğitim uygulamasının etkinliği [The effectiveness of group psychoeducation practice in bipolar disorder]. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 9(2), 73–81.
58. Young, J. W., & Dulcis, D. (2015). Investigating the mechanism(s) underlying switching between states in bipolar disorder. European Journal of Pharmacology, 759, 151–162. https://doi.org/10.1016/j.ejphar.2015.03.019
59. Yurtsever, Ü. E., Kutlar, T., Tarlacı, N., Kamberyan, K., & Yaman, M. (2001). Ruh hastalıkları tedavisinde psikososyal bir boyut: Psikoeğitimsel bir model [A psychosocial dimension in the treatment of mental illnesses: A psychoeducational model]. Düşünen Adam, 14(1), 33–40.