2014, Number 2
<< Back Next >>
Salud Mental 2014; 37 (2)
La terapia cognitivo conductual en el tratamiento de la depresión del trastorno bipolar tipo I
Chávez-León E, Benitez-Camacho E, Ontiveros UMP
Language: Spanish
References: 24
Page: 111-117
PDF size: 266.54 Kb.
ABSTRACT
Although pharmacotherapy is the essential treatment for bipolar I disorder
depression, a significant percentage of patients continue experiencing
emotional episodes. Cognitive behavioral therapy (CBT),
interpersonal psychotherapy and social rhythm and focused family
therapy, as well as psychoeducation, share the emphasis on the empowerment
of the patient so she/he becomes an active participant in
treatment, becomes aware of the nature of the disorder who suffers,
and learns to recognize early symptoms of depressive episodes in
order to prevent its recurrence. The addition of the CBT aims to alleviate
depressive symptoms, restore the psychosocial functioning and
prevent the appearance of new affective episodes.
Objectives:
This paper aimed to demonstrate the importance and usefulness of the
CBT as an adjuvant of the pharmacological management of depression
in bipolar disorder type I in those areas which cannot be resolved by
pharmacological treatment (residual symptoms, adherence and compliance
with treatment, awareness and understanding of bipolar disorder,
identification of prodromal symptoms and developing coping skills).
Method:
Controlled clinical trials about the usefulness of CBT as an adjunctive
treatment of patient with depression due to bipolar disorder type I are
reviewed.
Results:
CBT increases adherence to drug therapy, decreases the frequency
of relapses, diminishes residual symptoms, the need for hospitalization,
and the duration time of depressive episodes; it also improves
psychosocial functioning. However, these effects diminish over time
and its results are lower in patients with more affective episodes and
greater comorbidity.
Conclusions:
There is evidence of the utility of the CBT as a useful tool to improve
the evolution of the condition in depressed patients due to bipolar
I disorder and of the need to extend the time of this and other psychosocial
interventions, since this disorder is a condition that lasts
a lifetime and causes significant impact on psychosocial functioning
of the person.
REFERENCES
Goodwin FK, Jamison KR. Manic depressive illness: Bipolar disorders and recurrent depression. Segunda edición. Nueva York: Oxford University Press; 2007; pp. 869.
Medina-Mora ME, Borges G, Lara-Muñoz C. Prevalencia de los trastornos mentales y uso de servicios: Resultados de la Encuesta Nacional de Epidemiología en México. Salud Mental 2003;26(4):1-16.
Asociación Psiquiátrica Americana. Manual Diagnóstico y Estadístico de los Trastornos Mentales. DSM-IV-TR. Cuarta edición. Texto revisado. Barcelona: Masson; 2002.
DSM-5. Bipolar and related disorders. http://www.dsm5.org/ProposedRevision/ Pages/BipolarandRelatedDisorders.aspx. Accesado el 4 de julio de 2012.
Beynon S, Soares-Weiser K, Woolacott N et al. Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials. Br J Psychiatry 2008;192(1):5-11.
Chávez-León E, Ontiveros Uribe MP. La depresión del trastorno bipolar tipo I: Bases de tratamiento farmacológico. Psiquiatría 2009;25(4):1-3.
American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revisión). Am J Psychiatry 2002;159(supl.):1–50.
Hirschfeld RMA. Guideline watch: Practice guideline for the treatment of patients with bipolar disorder. Arlington, VA: American Psychiatric Association; 2005. http://www.psych.org/psych_pract/ treatg/pg/prac_guide.cfm.
Freud S. Obras completas. Duelo y melancolía (1917 [1915]). Tomo XIV, Buenos Aires: Amorrortu; 2002.
Mansell W, Colom F, Scott J. The nature and treatment of depression in bipolar disorder: a review and implications for future psychological investigation. Clin Psychology Rev 2005;25:1076-1100.
Scott J, Paykel E, Morris R et al. Cognitive-behavioral therapy for severe and recurrent bipolar disorders: randomized controlled trial. Br J Psychiatry 2006;188:313-320.
Leahy RL. Cognitive therapy. En Johnson SL, Leahy RL. Psychological treatment of bipolar disorder. New York: The Guilford Press; 2004.
Ramirez Basco M, McDonald N, Merliock M, Rush AJ. A cognitivebehavioral approach to treatment of bipolar I disorder. En: Wright JH (ed.). Cognitive-behavior therapy (review of Psychiatric Series, Vol. 23; Oldham JM, Riba MB, series editores). Washington: American Psychiatric Publishing; 2004.
Wright JH. Cognitive-behavior therapy (review of Psychiatric Series, Vol. 23; Oldham JM, Riba MB, series editores). Washington: American Psychiatric Publishing; 2004.
Beck JS. Terapia cognitiva. Conceptos básicos y profundización. Barcelona: Gedisa; 2000.
Cochran SD. Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. J Consult Clin Psychology 1984;52(5):873-878.
Lam DH, Watkins ER, Hayward P, Bright J et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder. Arch Gen Psychiatry 2003;60(2):145-152.
Lam DH, Hayward P, Watkins ER, Wright K et al. Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. Am J Psychiatry 2005;162:324-329.
Scott J, Paykel E, Morriss R, Bentall R et al. Cognitive- behavioural therapy for severe and recurrent bipolar disorders. Br J Psychiatry 2006;188:313-320.
Zaretsky A, Lancee W, Miller C, Harris A et al. Is cognitive-behavioural therapy more effective tan psychoeducation in bipolar disorder? Can J Psychiatry 2008;53(7):441-448.
Miklowitz Dj, Otto Mw, Frank E, Reilly- Harrington NA et al. Psychosocial treatments for bipolar depression. A 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry 2007;64:419-427.
Meyer TD, Hautzinger M. Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Psychol Med 2012;42:1429-1439.
Miklowitz DJ. Adjunctive psychotherapy for bipolar disorder: state of evidence. Am J Psychiatry 2008;165:1408-1419.
Szentagotai A, David D. The efficacy of cognitive-behavioral therapy in bipolar disorder: a quantitative meta- analysis. J Clin Psychiatry 2010;71(1):66-72.