PDF herunterladen
Fortschr Neurol Psychiatr 2013; 81(S 01): S22-S29
DOI: 10.1055/s-0033-1335246
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Psychotherapie bei bipolaren Störungen – Therapiekonzepte, ihre Inhalte und Wirksamkeit

Psychotherapeutic Interventions in Bipolar Disorders – Treatment Programmes, their Contents and Effectiveness
A. Schaub
1   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
,
N. Neubauer
2   Praxis für Psychotherapie, München
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
16. Mai 2013 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Kognitiv-behaviorale Interventionen haben in der Kombination mit Pharmakotherapie bei der Behandlung bipolarer Erkrankungen an Bedeutung gewonnen. Basierend auf dem Vulnerabilitäts-Stress-Instabilitäts-Modell werden psychoedukative, kognitiv-behaviorale, interpersonelle und familienbezogene Interventionen durchgeführt. Dieser Beitrag gibt einen Überblick über Therapieansätze und ihre Schwerpunkte. Die Wissensvermittlung über die Erkrankung und ihre Behandlung, die Modifikation dysfunktionaler Kognitionen, das Symptommanagement und die Rückfallprävention durch Förderung eines ausgeglichenen Lebensstils sind von zentraler Bedeutung. Mehrere kontrolliert randomisierte Studien mit mehrjährigen Katamnesen aus dem englischen und dem deutschen Sprachraum belegen die Wirksamkeit eines derartigen Vorgehens. Im deutschen Sprachraum liegen seit 2004 manualisierte Therapiekonzepte vor, die sich klinisch bewährt haben.

Abstract

Cognitive-behavioural interventions combined with pharmacotherapy have gained importance in the treatment of bipolar disorders. Based on the vulnerability-stress instability model psychoeducational, cognitive-behavioural, interpersonal and family interventions are provided. This paper gives an overview of treatment programmes and their foci. They include providing knowledge about the illness and its treatment, modifying dysfunctional cognitions and symptom management as well as relapse prevention by promoting a stable life style. There are several English- and German-based randomised controlled follow-up studies in English-speaking countries which provide support for the efficacy of combined treatment. Since 2004 German-based manualised treatment programmes have become available and have been shown to be clinically feasible and promising.

Schlüsselwörter

Kognitiv-behaviorale Therapie - Psychoedukation - psychologische Therapieansätze - Wirksamkeit - bipolare Störung

Key words

cognitive-behavioural therapy - psychoeducation - psychological treatment programmes - effectiveness - bipolar disorder
 

  • Literatur

  • 1 Scott J, Pope M. Self-reported adherence to treatment with mood stabilizers, plasma levels and psychiatric hospitalization. Am J Psychiat 2002; 159: 1927-1992
    CrossrefPubMedSuche in Google Scholar
  • 2 Svarstad B, Shireman T, Sweeney J. Using drug claims data to assess the relationship of medication adherence with hospitalition and costs. Psychiatric Services 2001; 52: 805-811
    CrossrefPubMedSuche in Google Scholar
  • 3 Fitzgerald R. Mania as a message: treatment with family therapy and lithium carbonate. Am J Psychother 1971; 26: 547-555
    PubMedSuche in Google Scholar
  • 4 Shakir SA, Volkmar FR, Bacon S et al. Group psychotherapy as an adjunct to lithium maintenance. Am J Psychiat 1979; 136: 455-456
    PubMedSuche in Google Scholar
  • 5 Peet M, Harvey NS. Lithium maintenance. 1. A standard education programme for patients. Br J Psychiat 1991; 158: 197-200
    CrossrefPubMedSuche in Google Scholar
  • 6 Anderson CM, Hogarty G, Reiss DJ. Family treatment of adult schizophrenic patients: a psychoeducational approach. Schiz Bulletin 1980; 6: 490-505
    PubMedSuche in Google Scholar
  • 7 Bäuml J, Pitschel-Walz G. Psychoedukation bei schizophrenen Erkrankungen. 2. Auflage; Stuttgart: Schattauer; 2008
    Suche in Google Scholar
  • 8 DGBS e. V. und DGPPN e.V. S3-Leitlinie zur Diagnostik und Therapie Bipolarer Störungen. Langversion 1.0, Mai 2012
    PubMed
  • 9 Strotzka H. Psychotherapie und Tiefenpsychologie. Berlin: Springer; 1975
    Suche in Google Scholar
  • 10 Grawe K, Donati R, Bernauer F. Psychotherapie im Wandel. Von der Konfession zur Profession. Göttingen: Hogrefe; 1994
    Suche in Google Scholar
  • 11 Basco MR, Rush AJ. Cognitive-behavioral therapy for bipolar disorder (2nd ed). New York: Guilford; 2005
    Suche in Google Scholar
  • 12 Bauer MS, McBride L. Structured group psychotherapy for bipolar disorder: The life goals program (2nd ed.). New York : Guilford; 2003
    Suche in Google Scholar
  • 13 Frank E. Treating bipolar disorder: a clinicians’ guide to interpersonal and social rhythm therapy. New York: Guilford Publications; 2005
    Suche in Google Scholar
  • 14 Lam DH, Jones S, Bright J et al. Cognitive therapy for bipolar disorder: A therapist’s guide to concepts, methods and practice. Wiley: Chichester; 1999
    Suche in Google Scholar
  • 15 Newman CF, Reilly-Harrington N, Leahy RL. Bipolar disorder: A cognitive approach. Washington: American Psychological Association; 2002
    CrossrefSuche in Google Scholar
  • 16 Colom F, Vieta E. Psychoeducation Manual for Bipolar Disorder. Cambridge: Cambridge University Press; 2006
    CrossrefSuche in Google Scholar
  • 17 Miklowitz DJ, Goldstein MJ. Bipolar disorder. A family-focused treatment approach. New York: Guilford; 1997
    Suche in Google Scholar
  • 18 Miklowitz DJ. Bipolar disorder. A family-focused treatment approach. New York: Guilford; 2nd edition 2008
    Suche in Google Scholar
  • 19 Beck AT, Rush AJ, Shaw BF et al. Kognitive Therapie der Depression (4. Aufl.). Weinheim: BeltzPVU; 1994
    Suche in Google Scholar
  • 20 Schaub A, Andres K, Schindler F. Psychoedukative und bewältigungsorientierte Gruppentherapien in der Schizophreniebehandlung. Psycho 1996; 22: 713-721
    PubMedSuche in Google Scholar
  • 21 Süllwold L, Herrlich J. Psychologische Behandlung schizophren Erkrankter. Stuttgart: Kohlhammer; 1990
    Suche in Google Scholar
  • 22 Goodwin EK, Jamison KR. Manic-depressive illness. New York Oxford: University Press; 2nd edition 2007
    Suche in Google Scholar
  • 23 Leverich GS, Post RM. The NIMH life chart manual for recurrent affective disorder: The NIMH-LCM-S (Self version). Bethesda: MD: Biol. Psychiat. Res. Bran. Monogr. Revised.; 2002
    PubMedSuche in Google Scholar
  • 24 Meyer TD, Hautzinger M. Manisch-depressive Störungen. Kognitiv-verhaltens-therapeutisches Behandlungsmanual. Weinheim: BeltzPVU; 2004
    Suche in Google Scholar
  • 25 Schaub A, Bernhard B, Gauck L. Kognitiv-psychoedukative Therapie bei bipolaren Erkrankungen. Ein Therapiemanual. Göttingen: Hogrefe; 2004
    Suche in Google Scholar
  • 26 Wagner P, Bräunig P. Psychoedukation bei bipolaren Störungen. Ein Therapiemanual für Gruppen. Stuttgart: Schattauer; 2004
    Suche in Google Scholar
  • 27 Jelley R, Elmer OM. HOPE – Handlungsorientierte Psychoedukation bei Bipolaren Störungen. Tübingen: DGVT; 2005
    Suche in Google Scholar
  • 28 Erfurth A, Dobmeier M, Zechendorff M. Kurzpsychoedukation bei bipolaren Erkrankungen. Stuttgart: Thieme; 2005
    Suche in Google Scholar
  • 29 Bock T, Koesler A. Bipolare Störungen. Manie und Depression erkennen und behandeln. Bonn: Psychiatrie-Verlag; 2005
    Suche in Google Scholar
  • 30 Schöttle D, Huber CG, Bock T et al. Psychotherapy for bipolar disorder: a review of the most recent studies. Current Opinion in Psychiatry. 2011; 24: 549-555
    PubMedSuche in Google Scholar
  • 31 Scott I, Colom F, Vieta E. A meta-analysis of relapse rates with adjunctive psychological therapy compared to usual psychiatric treatment for bipolar disorders. Neuropsychopharmacology 2007; 10: 123-129
    CrossrefPubMedSuche in Google Scholar
  • 32 Hautzinger M, Meyer TD. Psychotherapie bei bipolaren affektiven Störungen. Ein systematischer Überblick kontrollierter Interventionsstudien. Nervenarzt 2007; 78: 1248-1260
    PubMedSuche in Google Scholar
  • 33 Meyer TD, Hautzinger M. Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year folllow-up. Psychological Medicine 2012; 42: 1429-1439
    CrossrefPubMedSuche in Google Scholar
  • 34 Lenz G, Berg A, Breit-Gabauer B et al. Psychoeducation (PE) in bipolar disorder: a randomized controlled study. Bipolar Disord 2009b 11: 11
    PubMed
  • 35 Miklowitz DJ, Simoneau TL, George EL et al. Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol Psychiatry 2000; 48: 582-592
    CrossrefPubMedSuche in Google Scholar
  • 36 Miklowitz DJ, George EL, Richards JA et al. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003; 60: 904-912
    CrossrefPubMedSuche in Google Scholar
  • 37 Rea MM, Tompson MC, Miklowitz DJ et al. Family- focused treatment versus individual treatment for bipolar disorder: Results of a randomized clinical trial. J Consult Clin Psychol 2003; 71: 482-492
    PubMedSuche in Google Scholar
  • 38 Perry A, Tarrier N, Morriss R et al. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. Br Med J 1999; 318: 149-153
    CrossrefPubMedSuche in Google Scholar
  • 39 Lobban F, Taylor L, Chandler C et al. Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial. British Journal of Psychiatry 2010; 196: 59-63
    CrossrefPubMedSuche in Google Scholar
  • 40 Colom F, Vieta E, Martinez-Aran 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
    CrossrefPubMedSuche in Google Scholar
  • 41 Colom F, Vieta E, Sanchez-Moreno J et al. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry 2009; 194: 260-265
    CrossrefPubMedSuche in Google Scholar
  • 42 Lam DH, Watkins ER, Hayward P et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar disorder: Outcome of the first year. Arch Gen Psychiatry 2003; 60: 145-52
    CrossrefPubMedSuche in Google Scholar
  • 43 Lam DH, Hayward P, Watkins ER et al. Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. Am J Psychiatry 2005; 162: 324-329
    CrossrefPubMedSuche in Google Scholar
  • 44 Castle D, White C, Chamberlain J et al. Group-based psychosocial intervention for bipolar disorder: randomised controlled trial. Br J Psychiatry 2011; 196: 383-388
    PubMedSuche in Google Scholar
  • 45 Frank E, Kupfer DJ, Thase ME et al. Two-year outcomes of interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005; 62: 996-1004
    CrossrefPubMedSuche in Google Scholar
  • 46 Frank E, Soreca H, Swartz HA et al. The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar 1 disorder. Am J Psychiatry 2008; 165: 1559-1565
    CrossrefPubMedSuche in Google Scholar
  • 47 Simon GE, Ludman EJ, Unnützer J et al. Randomized trial of a polulatoin-based care program for people with bipolar disorder. Psychol Med 2005; 35: 13-24
    CrossrefPubMedSuche in Google Scholar
  • 48 Simon GE, Ludman J, Bauer MS et al. Long-term effectiveness and cost of a systematic care program for bipolar disorder. Arch Gen Psychiatry 2006; 63: 500-508
    CrossrefPubMedSuche in Google Scholar
  • 49 Ball JR, Mitchell PB, Corry JC et al. A randomised controlled trial of cognitive therapy for bipolar disorder: Focus on long-term change. J Clin Psychiatry 2006; 67: 277-286
    CrossrefPubMedSuche in Google Scholar
  • 50 Young JE. Cognitive therapy for personality disorder: A schema focused Approach. Sarasota, Fla: Professional Ressource Press; 1994
    Suche in Google Scholar
  • 51 Greenberg LS. Emotionsfokussierte Therapie. Tübingen: dgvt-Verlag; 2006
    Suche in Google Scholar
  • 52 Scott J, Paykel E, Moriss R et al. Cognitive-behavioral therapy for severe and recurrent bipolar disorders. Br J Psychiat 2006; 188: 313-320
    CrossrefPubMedSuche in Google Scholar
  • 53 Weber B, Jermann F, Gex-Fabry M et al. Mindfulness-based cognitive therapy for bipolar disorder: A feasibility trial. Eur Psychiat 2010; 25: 334-337
    PubMedSuche in Google Scholar
  • 54 Williams JMG, Alatiq Y, Crane C et al. Mindfullness-based cognitive therapy (MBCT) in bipolar disorder: Preliminary evaluation of immediate effeccts on between-episode functioning. J Affect Disorders 2008; 107: 275-279
    CrossrefPubMedSuche in Google Scholar
  • 55 Miklowitz D, Otto MW, Frank E et al. Psychosocial treatments for bipolar disorder: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry 2007; 64: 419-427
    CrossrefPubMedSuche in Google Scholar
  • 56 Reinares M, Colom F, Sanchez-Moreno J et al. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomised controlled trial. Bipolar Disord 2008; 10: 511-519
    CrossrefPubMedSuche in Google Scholar
  • 57 Perlick DA, Miklowitz DJ, Lopez N et al. Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disorders 2010; 12: 627-637
    CrossrefPubMedSuche in Google Scholar
  • 58 Goldstein MJ. Psychosocial strategies for maximising the effects of psychotropic medications for schizophrenia and mood disorder. Psychopharmacol Bull 1992; 28: 237-240
    PubMedSuche in Google Scholar
  • 59 Johnson SL, Cuellar AK, Ruggero C et al. Life events as predictors of mania and depression in Bipolar I Disorder. J Abnorm Psychol 2008; 177 (02) 268-277
    PubMedSuche in Google Scholar
  • 60 Colom J, Vieta E, Reinares M et al. Psychoeducation efficacy in bipolar disorder: beyond adherence enhancement. J Clin Psychiat 2003; 44: 1101-1105
    PubMedSuche in Google Scholar
  • 61 Miklowitz DJ, Scott J. Psychosocial treatments for bipolar disorder: cost-effectiveness, mediating mechanisms, and future directions. Bipolar Disord 2009; 11 (Suppl. 02) 110-122
    PubMedSuche in Google Scholar
  • 62 Scott J, Pope M. Cognitive styles in individuals with bipolar disorder. Psychol Med 2003; 33: 1081-1088
    CrossrefPubMedSuche in Google Scholar
  • 63 Lam D, Wright K, Smith N. Dysfunctional assumptions in bipolar disorders. J Affect Disord 2004; 79: 193-199
    CrossrefPubMedSuche in Google Scholar
  • 64 Brieger P, Bode L, Urban R et al. Versorgung von Menschen mi bipolar affektiven Störungen in Deutschland. Welche Relevanz hat die S3-Leitlinie?. Nervenarzt 2012; 5: 595-603
    PubMedSuche in Google Scholar
  • 65 Hautzinger M, Meyer T. Bipolar affektive Störungen. Fortschritte der Psychotherapie. Band 43. Göttingen: Hogrefe; 2011
    Suche in Google Scholar
  • 66 Berk M, Brnabic A, Dodd S et al. Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention. Bipolar Disorders 2011; 13: 87-98
    CrossrefPubMedSuche in Google Scholar