Información del artículo
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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Referencias
[1]
W Linden.
Psychological treatments in cardiac rehabilitation: review of rationales and outcomes.
J Psychosom Res, 48 (2000), pp. 443-454
[2]
M Pladevall, C Brotons, R Gabriel, et al.
Multicenter cluster-randomized trial of a multifactorial intervention to improve antihypertensive medication adherence and blood pressure control among patients at high cardiovascular risk (the COM99 study).
Circulation, 122 (2010), pp. 1183-1191
[3]
S Bird, M Noronha, H Sinnott.
An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure.
Aust J Prim Health, 16 (2010), pp. 326-333
[4]
MP Olmsted, D Daneman, AC Rydall, et al.
The effects of psychoeducation on disturbed eating attitudes and behavior in young women with type 1 diabetes mellitus.
Int J Eat Disord, 32 (2002), pp. 230-239
[5]
RQ Wolever, M Dreusicke, J Fikkan, et al.
Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial.
Diabetes Educ, 36 (2010), pp. 629-639
[6]
D Nielsen, J Ryg, W Nielsen, et al.
Patient education in groups increases knowledge of osteoporosis and adherence to treatment: a two-year randomized controlled trial.
Patient Educ Couns, 81 (2010), pp. 155-160
[7]
Z Durna, S Ozcan.
Evaluation of self-management education for asthmatic patients.
J Asthma, 40 (2003), pp. 631-643
[8]
E Vieta, I Pacchiarotti, M Valentí, et al.
A critical update on psychological interventions for bipolar disorders.
Curr Psychiatry Rep, 11 (2009), pp. 494-502
[9]
F Colom.
Achieving remission and recovery in bipolar disorder.
J Clin Psychiatry, 71 (2010), pp. e32
[10]
NS Harvey, M Peet.
Lithium maintenance: Effects of personality and attitude on health information acquisition and compliance.
Br J Psychiatry, 158 (1991), pp. 200-204
[11]
M Peet, NS Harvey.
Lithium maintenance: I. A standard education program for patients.
Br J Psychiatry, 158 (1991), pp. 197-200
[12]
J Scott, F Colom.
Psychosocial treatments for bipolar disorders.
Psychiatr Clin North Am, 28 (2005), pp. 371-384
[13]
F Colom, D Lam.
Psychoeducation: improving outcomes in bipolar disorder.
Eur Psychiatry, 20 (2005), pp. 359-364
[14]
J Scott, F Colom.
Gaps and limitations of psychological interventions for bipolar disorders.
Psychother Psychosom, 77 (2008), pp. 4-11
[15]
LN Yatham, SH Kennedy, A Schaffer, et al.
Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009.
Bipolar Disord, 11 (2009), pp. 225-255
[16]
GM Goodwin, Consensus Group of the British Association for Psychopharmacology.
Evidence-based guidelines for treating bipolar disorder: revised second edition–recommendations from the British Association for Psychopharmacology.
J Psychopharmacol, 23 (2009), pp. 346-388
[17]
DI Velligan, PJ Weiden, M Sajatovic, et al.
Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines.
J Psychiatr Pract, 16 (2010), pp. 306-324
[18]
F Colom.
Keeping therapies simple: psychoeducation in the prevention of relapse in affective disorders.
Br J Psychiatry, 198 (2011), pp. 338-340
[19]
F Colom, E Vieta, A Martinez-Aran, 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, 60 (2003), pp. 402-407
[20]
F Colom, E Vieta.
Psychoeducation manual for bipolar disorder, University Press, (2007),
[21]
F Colom, E Vieta.
The need for publishing the silent evidence from negative trials.
Acta Psychiatr Scand, 123 (2011), pp. 91-94
[22]
DJ Miklowitz, MW Otto, E Frank, et al.
Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial.
Am J Psychiatry, 164 (2007), pp. 1340-1347
[23]
F Colom, E Vieta, J Sánchez-Moreno, et al.
Psychoeducation in bipolar patients with comorbid personality disorders.
Bipolar Disord, 6 (2004), pp. 294-298
[24]
F Colom, E Vieta, J Sánchez-Moreno, et al.
Stabilizing the stabilizer: group psychoeducation enhances the stability of serum lithium levels.
Bipolar Disord, 7 (2005), pp. 32-36
[25]
RH Perlis, GS Sachs, B Lafer, et al.
Effect of abrupt change from standard to low serum levels of lithium: a reanalysis of double-blind lithium maintenance data.
Am J Psychiatry, 159 (2002), pp. 1155-1159
[26]
F Colom, E Vieta, M Reinares, et al.
Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement.
J Clin Psychiatry, 64 (2003), pp. 1101-1105
[27]
F Colom, E Vieta, J Sánchez-Moreno, et al.
Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial.
Br J Psychiatry, 194 (2009), pp. 260-265
[28]
RW Kupka, WA Nolen, LL Altshuler, et al.
The Stanley Foundation Bipolar Network. 2. Preliminary summary of demographics, course of illness and response to novel treatments.
Br J Psychiatry Suppl, 41 (2001), pp. s177-s183
[29]
LL Judd, HS Akiskal, PJ Schettler, et al.
The long-term natural history of the weekly symptomatic status of bipolar I disorder.
Arch Gen Psychiatry, 59 (2002), pp. 530-537
[30]
RH Perlis, MJ Ostacher, JK Patel, et al.
Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
Am J Psychiatry, 163 (2006), pp. 217-224
[31]
F Colom, E Vieta, J Sánchez-Moreno, et al.
Psychoeducation for bipolar II disorder: an exploratory, 5-year outcome subanalysis.
J Affect Disord, 112 (2009), pp. 30-35
[32]
J Scott, F Colom, E Popova, et al.
Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis.
J Clin Psychiatry, 70 (2009), pp. 378-386
[33]
MS Bauer, L McBride.
Structured Group Psychotherapy for Bipolar Disorder: The Life Goals Program, 2nd ed., Springer Publishing Company, (2003),
[34]
GE Simon, E Ludman, J Unützer, et al.
Design and implementation of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord, 4 (2002), pp. 226-236
[35]
GE Simon, EJ Ludman, MS Bauer, et al.
Long-term effectiveness and cost of a systematic care program for bipolar disorder.
Arch Gen Psychiatry, 63 (2006), pp. 500-508
[36]
E Vieta, F Colom.
Psychological interventions in bipolar disorder: From wishful thinking to an evidence-based approach.
Acta Psychiatr Scand Suppl, (2004), pp. 34-38
[37]
LA Copeland, JE Zeber, IM Salloum, et al.
Treatment adherence and illness insight in veterans with bipolar disorder.
J Nerv Ment Dis, 196 (2008), pp. 16-21
[38]
CF Yen, CS Chen, JY Yen, et al.
The predictive effect of insight on adverse clinical outcomes in bipolar I disorder: a two-year prospective study.
J Affect Disord, 108 (2008), pp. 121-127
[39]
F Colom, E Vieta, A Martínez-Arán, et al.
Clinical factors associated with treatment noncompliance in euthymic bipolar patients.
J Clin Psychiatry, 61 (2000), pp. 549-555
[40]
F Colom, E Vieta, MJ Tacchi, et al.
Identifying and improving non-adherence in bipolar disorders.
Bipolar Disord, 7 (2005), pp. 24-31
[41]
M Sajatovic, RV Ignacio, JA West, et al.
Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic.
Compr Psychiatry, 50 (2009), pp. 100-107
[42]
RJ Baldessarini, R Perry, J Pike.
Factors associated with treatment nonadherence among US bipolar disorder patients.
Hum Psychopharmacol, 23 (2008), pp. 95-105
[43]
J Scott, M Pope.
Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization.
Am J Psychiatry, 159 (2002), pp. 1927-1929
[44]
M Hassan, MJ Lage.
Risk of rehospitalization among bipolar disorder patients who are nonadherent to antipsychotic therapy after hospital discharge.
Am J Health Syst Pharm, 66 (2009), pp. 358-365
[45]
A Martínez-Arán, J Scott, F Colom, et al.
Treatment nonadherence and neurocognitive impairment in bipolar disorder.
J Clin Psychiatry, 70 (2009), pp. 1017-1023
[46]
F Angst, HH Stassen, PJ Clayton, et al.
Mortality of patients with mood disorders: follow-up over 34-38 years.
J Affect Disord, 68 (2002), pp. 167-181
[47]
I Pacchiarotti, L Mazzarini, F Colom, et al.
Treatment-resistant bipolar depression: towards a new definition.
Acta Psychiatr Scand, 120 (2009), pp. 429-440
[48]
E Vieta, F Colom.
Therapeutic options in treatment-resistant depression.
Ann Med, (2011),
[49]
AM Kilbourne, LA Copeland, JE Zeber, et al.
Determinants of complementary and alternative medicine use by patients with bipolar disorder.
Psychopharmacol Bull, 40 (2007), pp. 104-115
[50]
SG Manwani, KA Szilagyi, B Zablotsky, et al.
Adherence to pharmacotherapy in bipolar disorder patients with and without co-occurring substance use disorders.
J Clin Psychiatry, 68 (2007), pp. 1172-1176
[51]
RH Perlis, MJ Ostacher, DJ Miklowitz, et al.
Clinical features associated with poor pharmacologic adherence in bipolar disorder: results from the STEP-BD study.
J Clin Psychiatry, 71 (2010), pp. 296-303
[52]
PL Morselli, R Elgie, BM Cesana.
GAMIAN-Europe/BEAM survey II: cross-national analysis of unemployment, family history, treatment satisfaction and impact of the bipolar disorder on life style.
Bipolar Disord, 6 (2004), pp. 487-497
[53]
F Colom, E Vieta.
Non-adherence in psychiatric disorders: misbehaviour or clinical feature?.
Acta Psychiatr Scand, 105 (2002), pp. 161-163
[54]
L Berk, KT Hallam, F Colom, et al.
Enhancing medication adherence in patients with bipolar disorder.
Hum Psychopharmacol, 25 (2010), pp. 1-16
[55]
RC Kessler, RM Crum, LA Warner, et al.
Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey.
Arch Gen Psychiatry, 54 (1997), pp. 313-321
[56]
JF Goldberg, JL Garno, AC Leon, et al.
A history of substance abuse complicates remission from acute mania in bipolar disorder.
J Clin Psychiatry, 60 (1999), pp. 733-740
[57]
RD Weiss.
Adherence to pharmacotherapy in patients with alcohol and opioid dependence.
Addiction, 99 (2004), pp. 1382-1392
[58]
BF Grant, DS Hasin, FS Stinson, et al.
Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions.
J Psychiatr Res, 39 (2005), pp. 1-9
[59]
DA Regier, ME Farmer, DS Rae, et al.
Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study.
JAMA, 264 (1990), pp. 2511-2518
[60]
KT Brady, S Casto, RB Lydiard, et al.
Substance abuse in an inpatient psychiatric sample.
Am J Drug Alcohol Abuse, 17 (1991), pp. 389-397
[61]
NM Simon, MW Otto, RD Weiss, et al.
Pharmacotherapy for bipolar disorder and comorbid conditions: baseline data from STEP-BD.
J Clin Psychopharmacol, 24 (2004), pp. 512-520
[62]
J Sánchez-Moreno, A Martínez-Arán, F Colom, et al.
Neurocognitive dysfunctions in euthymic bipolar patients with and without prior history of alcohol use.
J Clin Psychiatry, 70 (2009), pp. 1120-1127
[63]
CF Baldassano.
Illness course, comorbidity, gender, and suicidality in patients with bipolar disorder.
J Clin Psychiatry, 67 (2006), pp. 8-11
[64]
TV Lagerberg, OA Andreassen, PA Ringen, et al.
Excessive substance use in bipolar disorder is associated with impaired functioning rather than clinical characteristics, a descriptive study.
BMC Psychiatry, 10 (2010), pp. 9
[65]
M Sajatovic, MS Bauer, AM Kilbourne, et al.
Self-reported medication treatment adherence among veterans with bipolar disorder.
Psychiatr Serv, 57 (2006), pp. 56-62
[66]
RD Weiss, MJ Ostacher, MW Otto, et al.
Does recovery from substance use disorder matter in patients with bipolar disorder?.
J Clin Psychiatry, 66 (2005), pp. 730-735
[67]
CJ Teter, AE Falone, AM Bakaian, et al.
Medication adherence and attitudes in patients with bipolar disorder and current versus past substance use disorder.
Psychiatry Res, (2011),
[68]
RD Weiss, ML Griffin, ME Kolodziej, et al.
A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence.
Am J Psychiatry, 164 (2007), pp. 100-107
[69]
RD Weiss, ML Griffin, SF Greenfield, et al.
Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study.
J Clin Psychiatry, 61 (2000), pp. 361-367
[70]
A Perry, N Tarrier, R Morriss, et al.
Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment.
BMJ, 318 (1999), pp. 149-153
[71]
F Lobban, L Taylor, C Chandler, et al.
Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial.
Br J Psychiatry, 196 (2010), pp. 59-63
[72]
E Frank, S Hlastala, A Ritenour, et al.
Inducing lifestyle regularity in recovering bipolar disorder patients: results from the maintenance therapies in bipolar disorder protocol.
Biol Psychiatry, 41 (1997), pp. 1165-1173
[73]
E Frank, DJ Kupfer, ME Thase, et al.
Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder.
Arch Gen Psychiatry, 62 (2005), pp. 996-1004
[74]
F Colom, E Vieta.
A perspective on the use of psychoeducation, cognitive-behavioral therapy and interpersonal therapy for bipolar patients.
Bipolar Disord, 6 (2004), pp. 480-486
[75]
J Scott, E Paykel, R Morriss, et al.
Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial.
Br J Psychiatry, 188 (2006), pp. 313-320
[76]
M Reinares, E Vieta, F Colom, et al.
Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients.
Psychother Psychosom, 73 (2004), pp. 312-319
[77]
M Reinares, F Colom, J Sánchez-Moreno, et al.
Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial.
Bipolar Disord, 10 (2008), pp. 511-519
[78]
F Kapczinski, VV Dias, M Kauer-Sant'Anna, et al.
Clinical implications of a staging model for bipolar disorders.
Expert Rev Neurother, 9 (2009), pp. 957-966
[79]
M Reinares, F Colom, AR Rosa, et al.
The impact of staging bipolar disorder on treatment outcome of family psychoeducation.
J Affect Disord, 123 (2010), pp. 81-86
[80]
F Colom, M Reinares, I Pacchiarotti, et al.
Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post-hoc analysis.
Acta Neuropsych, 22 (2010), pp. 50-53
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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