双極性障害の家族介入
Abstract
Background
Pharmacological treatments are the principal intervention for bipolar disorder. Alone, however, they are not sufficient to control symptoms and maintain psychosocial functioning. Adjunctive psychosocial interventions may help to improve the patient's condition and the course of the illness. Family interventions are deserving of special attention, since they may help to relieve the burden of care borne by relatives and caregivers, which in turn may facilitate the task of supporting the patient.
Objectives
The objective of this review was to investigate the effectiveness of family interventions in the treatment of bipolar disorder compared with no intervention and other forms of intervention.
Search methods
We searched the electronic databases CCDANRCT‐Studies and CCDANCTR‐References on 1/8/2007, CENTRAL (2006‐3), MEDLINE (2006), EMBASE (2006) and LILACS (2006), and searched the reference lists of included studies. We also made personal contact with authors.
Selection criteria
We included randomised controlled trials (RCTs) and quasi‐randomised trials. Participants were people with bipolar disorder and their relatives or caregivers; family psychosocial interventions of any type were considered; primary outcomes were changes in the status of symptoms and relapse rates.
Data collection and analysis
Data were independently extracted by two review authors. Quality assessment of included studies was carried out. The findings were presented descriptively. Where there were sufficient studies, dichotomous data were combined using relative risk, and continuous data were combined using weighted mean difference, with their 95% CIs.
Main results
Seven RCTs were included in the review, involving a total of 393 participants. All of the included studies assessed psychoeducational methods, and one study also assessed a type of systems psychotherapy. In all trials, participants continued to receive pharmacotherapy treatment. Due to the diversity of interventions, outcome measures and endpoints used across studies, it was not possible to perform meta‐analyses for primary outcomes. Five studies compared a variety of family interventions, involving carers, families or spouses, against no intervention, with individual findings indicating no significant added effect for family interventions. Three studies compared one type or modality of family intervention against another family intervention, with inconsistent findings.
Authors' conclusions
To date there is only a small and heterogeneous body of evidence on the effectiveness of family oriented approaches for bipolar disorder, and it is not yet possible to draw any definite conclusions to support their use as an adjunctive treatment for bipolar disorder. Further well designed RCTs should be a research priority.
PICO
Plain language summary
双極性障害の家族介入
双極性障害における主要な治療法は薬物療法である。しかし、薬物療法だけでは、双極性障害を治療するのに十分ではない。統合失調症や不安障害などの精神疾患に対する心理社会的介入に関する研究では、心理社会的介入が効果的な治療法であることを明らかにしている。研究結果は、心理社会的介入が双極性障害を抱える人々にも効果がある可能性を示唆している。家族の役割は双極性障害を抱える人々の治療において重要であり、家族が効果的に機能することは当事者の心理的なバランスを維持することに役立つ。このシステマティックレビューでは、双極性障害を抱える人々、および/またはその家族と援助者に対する心理社会的な家族介入の有効性を調査した。7件のランダム化比較試験（393人の参加者）がこのレビューに含まれ、その全てが心理教育的介入を評価していた。5件の研究が、家族介入を家族介入なしと比較し、3件の研究が家族介入のある種類もしくは提供方法を別の家族支援を比較していた。調査で使用された評価基準、評価項目の違いにより、メタアナリシスを実行することができなかった。個々の研究の結果は、薬物療法に家族介入を加えた場合の有意な効果を示唆するものではなかったが、不十分ではあるが、日常の実践に一般化できる結論を導き出す程度の証拠を提供している。今回の十分に研究されていない重要なテーマにおいて、適切なランダム化比較試験の方法論を使用し、心理教育以外の家族介入を評価するさらなる研究が求められている。
