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Der Nervenarzt

, Volume 78, Issue 11, pp 1248–1260 | Cite as

Psychotherapie bei bipolaren affektiven Störungen

Ein systematischer Überblick kontrollierter Interventionsstudien
  • M. Hautzinger
  • T.D. Meyer
Übersichten

Zusammenfassung

Stimmungsstabilisierende Medikamente weisen bei der Phasenprophylaxe manisch-depressiver Störungen überzeugende empirische Evidenz auf. Dennoch erleiden Betroffene trotz Mitarbeit unverändert Rückfälle. Es ist daher nahe liegend, psychologische Interventionen unterstützend und ergänzend zur Einstellungs- und Verhaltensänderung heranzuziehen, um so entweder Rückfälle und Hospitalisierungen zu vermeiden oder zumindest ihre Häufigkeit zu reduzieren sowie das soziale Funktionieren und die soziale Integration zu fördern.

Gegenstand dieser Übersicht ist es, den aktuellen Forschungsstand zur Psychotherapie bei bipolar affektiven Störungen zusammenzutragen und daraus Schlussfolgerungen für die Praxis und die weitere Forschung zu ziehen. Eine Literaturrecherche erbrachte insgesamt 461 Arbeiten, wovon letztlich 28 kontrollierte Studien verblieben. Schließt man Doppelungen aus, dann wurden insgesamt 2294 Patienten mit fast ausschließlich (über 90%) Bipolar-I-Störungen eingeschlossen. Die Psychotherapien sind meist kognitiv orientierte Verhaltenstherapie in Form der Einzelbehandlung, aber auch der Gruppen- bzw. Familientherapien. Alle Studien unterstreichen die Bedeutung psychoedukativer Maßnahmen, wobei sie meist als Bestandteil einer umfassenderen psychotherapeutischen Betreuung verstanden wird. Es gibt Evidenzen dafür, dass durch Psychotherapie (vor allem verhaltensorientierte und kognitive Interventionen) die Häufigkeit, die Schwere und die Dauer symptomatischer (vor allem depressiver) Phasen (d=0,39) reduziert, die erkrankungsfreie Zeit (d=0,71) verlängert und die soziale Anpassung verbessert werden kann. Offene Fragen drehen sich um die Indikation, die Prädiktion, die Spezifizität, die angemessene Länge und Dauer, die Wirkmechanismen, die Langfristigkeit der Effekte, den idealen Zeitpunkt der Psychotherapie sowie um die Frage der Prävention bei Risikogruppen.

Schlüsselwörter

Psychotherapie Bipolare affektive Störungen Kognitiv orientierte Verhaltenstherapie Psychoedukative Maßnahmen 

Psychotherapy for bipolar disorder

A systematic review of controlled studies

Summary

Mood stabilisers show convincing evidence of relapse prevention in patients suffering from bipolar affective disorder. However, despite continuous medication the majority of patients suffer from relapses. It seems logical to apply principles of psychological intervention to bipolar patients. Elements of psychotherapy are: psychoeducation about symptoms, prodromal states, and course of illness; symptom monitoring; and influencing cognitive and behavioural strategies to improve symptomatology, social functioning, compliance, and relapse prevention. The goal of this review is to summarise the current status of controlled studies including psychological approaches to bipolar patients, to describe the efficacy of psychotherapy, and to address lack of knowledge and future trends in this clinical field. We located 461 reports about psychological interventions with bipolar patients but identified only 28 controlled and methodologically sound studies. In those studies 2294 patients were treated. Almost all (over 90%) fulfilled bipolar I criteria. All psychotherapies include psychoeducation and information about bipolar affective disorders and ask patients to self-monitor daily symptoms and other daily events. The majority of psychotherapies are cognitive-behaviorally oriented and treat patients in a one-to-one setting, but family oriented approaches and group settings were also prevalent. Studies show evidence that psychotherapy in combination with mood stabilizers improved depressive (to less extent manic) symptoms (d=0.39) and almost doubled the period of time between two episodes (d=0.71). Open questions are: indicators and predictors of successful outcome, length and intensity of treatment, essential elements of helpful intervention, long-term follow-up, and prevention of bipolar disorders in high-risk groups.

Keywords

Bipolar affective disorders Cognitive behavioural therapy Pschoeducational measures Psychotherapy 

Notes

Danksagung

Die eigenen Forschungsarbeiten und die Erstellung dieser Übersicht wurden durch die freundliche Unterstützung der Deutschen Forschungsgemeinschaft ermöglicht.

Interessenkonflikt

Keine Angaben

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Abteilung Klinische und Entwicklungspsychologie, Psychologisches InstitutEberhard-Karls-UniversitätTübingenDeutschland

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