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Resumen
La relación entre el médico y su paciente debe evolucionar hacia una mayor interactividad y fomentar la proactividad. Para ello, es imprescindible contar con programas de educación terapéutica de los pacientes. El pronóstico de muchas patologías no psiquiátricas (cardiopatías, enfermedades respiratorias, diabetes, asma) mejora claramente con estas intervenciones, y lo mismo ocurre con las psiquiátricas, como el trastorno bipolar. Los primeros programas psicoeducativos se centraban en la información, mientras que los actuales hacen énfasis en un enfoque más terapéutico, que incluye trabajar con el significado de la enfermedad, identificar los desencadenantes individuales y los pródromos, manejar los síntomas y superar los problemas de adherencia a los fármacos. Hoy la psicoeducación forma parte de las rutinas de tratamiento del trastorno bipolar, y encaja en su modelo médico. Así mismo, ha mostrado su eficacia en la profilaxis de todo tipo de recaídas a los dos y a los cinco años, con lo cual se ha reducido de forma notoria la duración de los episodios, las hospitalizaciones y los problemas de adherencia. Además, no pierde eficacia con el paso del tiempo, algo que sí ocurre con otras psicoterapias, y su implementación conlleva un ahorro de recursos sanitarios. No obstante, se recomienda implementar este tipo de programas lo antes posible en el curso de la enfermedad. El presente artículo presenta una serie de evidencias y reflexiones prácticas acerca de la implementación de la psicoeducación, que es a la psicoterapia del trastorno bipolar lo que el litio es a su farmacoterapia.
Palabras clave:
Trastorno bipolar
psioeducación
adherencia
prómodo
prevención
Summary
The physician–patient relationship must evolve towards greater interactivity and the promotion of pro-activity. For such a purpose, it is indispensable to have therapeutic educational programs for patients. Prognosis of many non-psychiatric pathologies i.e., cardiopathies, breathing diseases, diabetes, asthma) clearly improves with such programs and the same happens with psychiatric pathologies, such as bipolar disorder. The first psycho-educational programs were focused on information, while current approaches have a much more therapeutic focus, including work on the disease significance, identifying personal triggers as well as prodromes, managing symptoms and overcoming problems of adherence to pharmaceutical drugs. Today, psycho-education is part of the routine of bipolar treatment, suitable to the physician's model. Psycho-education has likewise demonstrated its efficiency in the prophylaxis of all sorts of two and five-year relapses, remarkably reducing episode duration, hospitalizations and adherence problems. Besides, as time passes, its efficiency is maintained, something that does not occur with other sorts of psycho-therapies. Furthermore, its implementation saves health resources. However, this type of programs is recommended as soon as possible, in the course of the disease. This article introduces a series of evidences and practical considerations on the implementation of psycho-education, which in the bipolar disorder psychotherapy has the same role than lithium in pharmacotherapy.
Key words:
Bipolar disorder
pychoeducation
adherence
prodroms
prevention
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Conflictos de interés: El autor manifiesta que no tiene conflictos de interés en este artículo.
Agradecimientos y fuentes de financiación: El autor agradece el apoyo y la financiación del Ministerio de Ciencia e Innovación (Gobierno de España), Instituto de Salud Carlos III y CIBERSAM. Este trabajo ha sido financiado por los fondos “Miguel Servet” (CP08/00140) y FIS (PS09/01044).
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