Екіұшты тәртіптік бұзылысты емдеуде интерперсональдық және әлеуметтік ритм терапиясы

Treatment for people with bipolar disorder
Interpersonal and social rhythm therapy (IPSRT) is an intervention for people with bipolar disorder (BD). Its primary focus is stabilizing the circadian rhythm disruptions that are common among people with bipolar disorder (BD). IPSRT draws upon principles from interpersonal psychotherapy, an evidence based treatment for depression and emphasizes the importance of daily routine (rhythm). IPSRT was developed by Ellen Frank, PhD at the University of Pittsburgh who published a book on her theories: Treating Bipolar Disorder, a Clinician's Guide to Interpersonal and Social Rhythm Therapy. Her research on IPSRT has shown that, in combination with medication, solving interpersonal problems and maintaining regular daily rhythms of sleeping, waking, eating, and exercise can increase quality of life, reduce mood symptoms, and help prevent relapse in people with BD. TOC

Goals of IPSRT are to stabilize social rhythms (e. g., eating meals with other people) while improving the quality of interpersonal relationships and satisfaction with social roles. Grief – This refers to symptoms resulting from incomplete mourning or unresolved feelings about the death of an important person. This can also refer to grief for the loss of a healthy self (i. e., the person before the illness or the person one could have become, if not for BD). Strategies include encouraging expression of painful feelings about lost hopes, ruined relationships, interrupted careers, and passed opportunities. This is followed by encouragement to develop new relationships, establish new, more realistic goals, and focus on future opportunities. Interpersonal role disputes – This refers to any close relationship in which there are nonreciprocal expectations, such as in marital conflict and arguments with parental figures. Strategies include learning how to be more patient, tolerant, and accepting of limitations in self and others. IPSRT was studied as one of three intensive psychosocial treatments in the NIMH funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP BD). STEP BD was a long term outpatient study investigating the benefits of psychotherapies in conjunction with pharmacotherapy in treating episodes of depression and mania, as well as preventing relapse in people with bipolar disorder. Patients were 1.58 times more likely to be well in any study month if they received intensive psychotherapy (cognitive behavioral therapy, family focused therapy, or IPSRT) than if they received collaborative care in addition to pharmacotherapy.

IPSRT was adapted to be delivered to adolescents with BD (IPSRT A). In an open trial (N=12), feasibility and acceptability of IPSRT A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent rated satisfaction scores were high. IPSRT A participants experienced significant decreases in manic, depressive, and general psychiatric symptoms over the 20 weeks of treatment. Participants’ global functioning increased significantly as well. In an open trial aimed at prevention, adolescents (N=13) who were identified as high risk for bipolar disorder, due to having a first degree relative with BD, received IPSRT. Significant changes in sleep/circadian patterns (i. e. less weekend sleeping in and oversleeping) were observed. Families reported high satisfaction with IPSRT, yet, on average, participants attended about half of scheduled sessions. Missed sessions were primarily associated with parental BD illness severity.

IPSRT was adapted for a group therapy setting; administered over 16 sessions, in a semi structured format. Patients (N=22) made interpersonal goals, reflected on how they managed their illness, and empathized with fellow group members. Patients were encouraged to react to each other from their own experience, express their feelings about what was said, and to give constructive feedback. Patients spent significantly less time depressed in the year following treatment than they did in the year prior to treatment. In another small trial, patients with BD who experiencing a depressive episode (N = 9) received six IPSRT G sessions across two weeks. Topics of discussion in group included defining interpersonal focus area, defining target times for daily routines, discussing grief and medication adherence, addressing interpersonal disputes and role transitions, and reviewing IPSRT strategies and relapse prevention. Depressive symptoms improved significantly at the end of the treatment; improvements were maintained 10 weeks following treatment end.