تاثیر یک برنامه آموزش روانی فردی ساده بر روی کیفیت زندگی، میزان عود و پایبندی دارو در بیماران مبتلا به اختلال دو قطبی

Abstract Introduction Bipolar disorder is one of ten most debilitating diseases in the world, leading to a lessened quality of life amongst its sufferers. This randomised control trial demonstrates the effectiveness of psycho-education intervention along with a patient support system in the management of this disorder. Methodology In this trial, 108 patients, divided equally into two groups, were randomly assigned to receive either pharmacotherapy alone (control group) or psycho-education along with pharmacotherapy treatment (intervention group) for a two year period. Each individual patient in the “intervention” group received eight, fifty-minute sessions of psychological education, followed by monthly telephone follow-up care and psychological support in the subsequent 18 months. Each group was evaluated, once every 6 months for a period of 18 months, in the areas of “quality of life”, “symptoms of relapse”, “pharmacotherapy compliance” and “number of hospital admission for recurrence of bipolar disorder”.

1. Introduction Bipolar disorder (BpD) is a well-established and one of the oldest diagnoses of mental disorders in the field of psychiatry. This disorder is the sixth cause of disability amongst the older population of the world (Colom and Vieta, 2009). Even after putting behind the acute periods, one may still suffer the destructive consequences of bipolar disorder. Sufferers generally complain about dissatisfaction with personal and social life, employment and education related difficulties, and are susceptible to other psychological and physiological indispositions. On the other hand, as reported by Lacro et al. (2002), it is known that the rate of individual bipolar patients routinely and consciously taking the prescribed medicines is only 35%, which is much lower than that of schizophrenics at 50–60%. Since it is apparent that betterment of a system of pharmacotherapy assists in decreasing the frequency of relapse and in increasing the quality of life, various interventional methods have been employed to assist in potentiating the procedures of treatment. (Pharmacotherapy, in this context, is a reference to each individual patient's self-motivation to make a conscious decision to follow procedurally a prearranged treatment program, put together by the healthcare professional, i.e. adherence to taking the prescribed pharmaceutical medication on one's own accord armed with the knowledge of the disease and indicators of relapse.) Selected review of research literature revealed that there was a positive relationship between different psychological interventions such as behavioural therapies, family reliant treatments, psychosocial education, and interpersonal therapies with adherence to medical psychotherapy (Bauer et al., 2006, Cakir et al., 2009, Colom et al., 2003, Even et al., 2007, Goodwin et al., 2003, Lincoln et al., 2007, Maczka et al., 2010, Miklowitz, 2008, Osterberg and Blaschke, 2005, Perry et al., 1999, Rouget and Aubry, 2007, Rucci et al., 2002, Simon et al., 2006, Simpson et al., 2011 and Zaretsky et al., 2007), as well as reduction in the number of relapses and hospitalizations. There are few studies in Iran on educational therapy for BpD patients (Ghadirian et al., 2009). This randomised control trial aims at evaluating the effectiveness of psychoeducational intervention along with a patient support system in management of this disorder.

5. Conclusion Psycho-education has an important role in management of BpD. Simple individual psycho-education along with pharmacotherapy followed by long term education with a telephone contact had a positive outcome for management of the disease processes. Although study about the cost effectiveness of this type of treatment was not performed, the positive treatment outcome of the intervention group overshadowed the associated cost of treatment. One of the strengths of this study was the advantage of individual psycho-education in patients who were unwilling to discuss their personal problems in group education. On the other hand, one of the weaknesses of this study was the limited number of patients who took part in the study. With regards to the high number of Bpd sufferers and high costs of treatment, the role of a preventative educational program becomes apparent in treatment of patients. Further comprehensive studies with better outlined strategies for conducting an individual psychoeducational program with a larger sample size are necessary to take an effective step in the promotion of psychological healthcare. Role of funding source This study was supported by Shiraz University of Medical Science under student grant number 2871. Conflict of interest None declared.