Effect of Psychoeducation on Relapses in Bipolar Disorder: A Systematic Review

Yıl 2014, Cilt: 6 Sayı: 4, 310 - 329, 06.11.2014

Gülşah Acar Kadriye Buldukoğlu

https://doi.org/10.5455/cap.20131215112300

Öz

This study is a systematic review of psychoeducation interventions which aims at preventing relapses in patients with bipolar disorder. This study has been condcuted in order to determine the effects of these interventions. In the present study national and international databases were screened to identify psycho-education initiatives and a total of seven articles that met the criteria for inclusion and exclusion were evaluated. All of the seven studies reviewed, focused on the effects of psy-choeducation on frequency of relapse and hospitalization, time spent as a patient, serum lithium levels and social functioning. The findings of the studies revealed that psychoeducation reduces the frequency of relapse and hospitalization and time spent as a patient. Besides, psychoeducation contributed to the protective levels of serum lithium levels and has a positive impact on the social functioning of bipolar patients. In conclusion, psycho-education programs have positive results on preventing relapse for patients with bipolar disorder.

Anahtar Kelimeler

Bipolar disorder, relapse prevention, psychoeducation

Bipolar Bozuklukta Psikoeğitimin Relapslara Etkisi: Sistematik Bir Derleme

Öz

Bu çalışma bipolar bozukluğu olan hastalarda relapsları önlemek için uygulanan psikoeğitim girişimlerini ve bu girişimlerin etkilerini belirlemek amacıyla yapılmış bir sistematik derlemedir. Çalışmada psikoeğitim girişimlerini belirlemek için ulusal ve uluslararası veritabanları taranmış ve dahil etme ve dışlama ölçütlerine uyan toplam yedi makale değerlendirmeye alınmıştır. İncelenen makalelerde, psikoeğitimin relaps sıklığı, hastaneye yatış sıklığı, hasta olarak geçirilen zaman, serum lityum düzeyleri ve sosyal işlevsellik üzerine etkisi değerlendirilmiştir. Çalışmalardan elde edilen bulgular incelendiğinde, psikoeğitimin relaps ve hastaneye yatış sıklığını, hasta olarak geçirilen süreyi azalttığı saptanmıştır. Bununla birlikte uygulanan psikoeğitimin, hastaların serum lityum düzeylerinin koruyucu düzeyde kalmasına etki ettiği ve hastaların sosyal işlevselliğini de olumlu yönde etkilediği görülmüştür. Sonuç olarak, değerlendirmeye alınan tüm çalışmalarda bipolar bozukluk hastalarına yönelik relapsları önleme amacıyla uygulanan psikoeğitim programlarının olumlu sonuçları olduğu görülmektedir.

Anahtar Kelimeler

Bipolar bozukluk, relaps önleme, psikoeğitim

Kaynakça

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IVTR). Washington, DC , American Psychiatric Publishing, 2000.
• López AD, Murray CJ. The global burden of disease. Nature Med 1998; 4: 1241–3.
• Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34–38 years. J Affect Disord 2002; 68: 167–81.
• Tsai SY, Kuo CJ, Chen CC, Lee HC. Risk factors for completed suicide in bipolar disorder. J Clin Psychiatry 2002; 63:469–76. Gündüz C, Akkaya C, Deniz G, Cangür Ş, Kırlı S. Bipolar bozuklukta dönem süreleri üzerine sosyodemografik ve klinik özelliklerin etkisi. Anatolian Journal of Clinical Investigation 2012; 6:251-255.
• Köroğlu E. Boylam Klinik Uygulamada Psikiyatri Tanı ve Tedavi Kılavuzları. HYB Basım Yayın. Ankara. 2009.
• Angst J, Gamma A, Neuenschwander M, Ajdacic-Gross V, Eich D, Rössler W et al. Prevalence of mental disorders in the Zurich Cohort Study: a twenty year prospective study. Epidemiol Psichiatr Soc 2005; 14:68–76.
• Gitlin MJ, Swendsen J, Heller TL, Hammen C. Relapse and impairment in bipolar disorder. Am J Psychiatry 1995; 152:163516
• World Health Organization Burden of Mental and Behavioural Disorders. World Health Organization, Geneva, Chapter 2. 2001; http://who.int/whr/2001/chapter2/en/index1.html (10 Eylül 2013’te ulaşıldı).
• Goldberg JF, Harrow M, Grossman LS. Course and outcome in bipolar affective disorder: A longitudinal follow-up study. Am J Psychiatry 1995; 52:379-384
• Revicki DA, Matza LS, Flood E, Lloyd A. Bipolar disorder and health-related quality of life: review of burden of disease and clinical trials. Pharmacoeconomics 2005; 23:583-94.
• Lam D, Wong G. Prodromes, coping strategies, insight and social functioning in bipolar affective disorders. Psychol Med 1997; 27;1091-100.
• Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea JM, Benabarre A et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003; 60:402-407.
• Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003; 60:904-912.
• Zaretsky AE, Rizvi S, Parikh SV. How well do psychosocialinterventions work in bipolar disorder? Can J Psychiatry 2007; 52:14-20.
• Rea MM, Tompson M, Miklowitz DJ, Goldstein MJ, Hwang S, Mintz J. Family focused treatment vs individual treatment for bipolar disorder: results of a randomized clinical trial. J Consult Clin Psychol 2003;71, 482–492.
• Beynon S, Soares-Weiser K, Woolacott N, Duffy S, Geddes JR. Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials. Br J Psychiatry 2008; 192:5-11.
• Brady KT, Sone SC. The relationship between substance abuse and mood disorder. J Clin Psychiatry 1995; 56:19-24.
• Menezes SL, de Mello E Souza MC. The implications of a psychoeducation group on the everyday lives of individuals with bipolar affective disorder. Rev Esc Enferm USP 2012; 46:124-31.
• Schmitz, JM, Averill P, Sayre S, McCleary P, Moeller FG, Swann A. Cognitive-behavioral treatment of bipolar disorder and substance abuse: A preliminary randomized study. Addict Disord Their Treat 2002; 1:17-24.
• Colom F, Lam D. Psychoeducation: improving outcomes in bipolar disorder. Eur Psychiatry 2005; 20: 359-64.
• Türkiye Cumhuriyeti Sağlık Bakanlığı. Hemşirelik Yönetmeliği. Resmî Gazete. Sayı:27515 http://www.resmigazete.gov.tr/eskiler/2011/04/20110419-5.htm (20 Ağustos 2013’te ulaşıldı).
• Dixon-Woods M, Bonas A, Booth A, Jones DR, Miller T, Sutton AJ et al. How can systematic reviews incorporate qualitative research? A critical perspective. Qual Res 2006; 6:27-44.
• Colom F, Vieta E, Sa´nchez-Moreno J, Martı´nez-Ara´n A, Torrent C, Reinares M et al. Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004; 6:294–298.
• Colom F, Vieta E, Sa´nchez-Moreno J, Martı´nez-Ara´n A, Reinares M, Goikolea JM et al. Stabilizing the stabilizer: group psychoeducation enhances the stability of serum lithium levels. Bipolar Disord 2005; 7:32–36.
• Colom F, Vieta E, Sa´nchez-Moreno J, Goikolea JM, Popova E, Bonnin CM et al. Psychoeducation for bipolar II disorder: An exploratory, 5-year outcome subanalysis. J Affect Disord 2009; 112: 30–35.
• Colom F, Vieta E, Sa´nchez-Moreno J, Palomino-Otiniano R, Reinares M, Goikolea JM et al. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry 2009; 194:260–265.
• D'Souza R, Piskulic D, Sundram S. A brief dyadic group based psychoeducation program improves relapse rates in recently remitted bipolar disorder: A pilot randomised controlled trial. J Affect Disord 2010; 120:272–276.
• Perry A, Tarrier N, Morriss R, McCarthy E, Limb K. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999; 318:149–153.
• Dunner DL, Stallone F, Fieve RR. Lithium carbonate and affective disorders. V: a double-blind study of prophylaxis of depression in bipolar illness. Arch Gen Psychiatry 1976; 33:117–120.
• Tondo L, Baldessarini RJ, Floris G. Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders. Br J Psychiatry 2001; 41:184–190.
• Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004; 161:217–222.
• Öztürk MO. Ruh Sağlığı ve Bozuklukları 10. Basım. Ankara, Nobel Yayınevi, 2004.
• Miklowitz DJ. A review of evidence-based psychosocial interventions for bipolar disorder. J Clin Psychiatry 2006; 67:28–33. Scott, J, Colom F, Vieta, E. A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders. Int J Neuropsychopharmacol 2007; 10:123–129.
• Soares-Weiser K, Bravo Vergel Y, Beynon S, Dunn G, Barbieri M, Duffy S et al. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technol Assess 2007; 11, iii–iv, ix–206.
• Simpson SG, Jamison KR. The risk of suicide in patients with bipolar disorders. J Clin Psychiatry 1999; 60: 53-56.
• Brady KT, Sone SC. The relationship between substance abuse and mood disorder. J Clin Psychiatry 1995; 56:19-24.
• Alataş G, Kurt E, Alataş ET, Bilgiç V, Karatepe HT. Duygudurum bozukluklarında psikoeğitim. Düşünen Adam 2007; 20:19620 Gülşah Acar, Araş. Gör., Akdeniz Üniversitesi Hemşirelik Fakültesi, Antalya; Kadriye Buldukoğlu, Prof.Dr., Akdeniz Üniversitesi Hemşirelik Fakültesi, Antalya. Yazışma Adresi/Correspondence: Gülşah Acar, Akdeniz Üniversitesi Hemşirelik Fakültesi, Antalya, Turkey. E-mail: [e-mail] Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no4/ Çevrimiçi yayım / Published online 2 Ocak/January 2, 2014; doi: 10.5455/cap.20131215112300