雙極症病患接受人際社會節奏治療之成效－系統性文獻回顧

Effectiveness of the Interpersonal and Social Rhythm Therapy for Bipolar Disorder: A Systemic Review

許倍甄(Pei‐Chen Hsu) ； 李明峰(Ming‐Feng Lee) ； 陸汝斌(Ru‐Band Lu) ； 林靜蘭(Esther Ching‐Lan Lin)

《護理暨健康照護研究》 11卷3期 (2015/09) Pp. 234-241

https://doi.org/10.6225/JNHR.11.3.234

摘要

背景：雙極症為嚴重精神疾病，經常造成個人、家庭及社會等多層面影響，實證研究支持藥物治療應合併心理社會介入方能達到較佳的臨床成效，其中人際社會節奏治療為具有理論基礎的心理社會治療模式。目的：採用系統性文獻回顧方法，評析雙極症病患接受人際社會節奏治療之成效。方法：以系統性文獻回顧搜尋1988年至2014年期間發表於Cochrane Library、EBSCO-CINAHL、MEDLINE、PsycINFO、PsycARTIClES、PubMed及CEPS（Chinese Electronic Periodical Services）等資料庫的實證文獻，使用關鍵字bipolar disorder／雙極症、interpersonal and social rhythm therapy（IPSRT）／人際社會節奏治療，建立檢索範圍，共得76篇，選取符合篩選標準及排除重複出現的文獻，最後納入3篇隨機臨床試驗及2篇單組前後測研究。以Modified Jadad Scale及Oxford Centre for Evidence-Based Medicine評定其研究品質及證據等級。結果：五篇研究之研究品質介於4至7分、證據等級為2b至1b，屬於中高品質實證研究。人際社會節奏治療以個別形式居多，介入時間約半年至兩年，內容包括疾病與症狀因應、維持社會節奏的穩定性、人際衝突與失落的處理，治療成效以穩定情緒症狀為主。結論／實務應用：整體而言，人際社會節奏治療對雙極症病患具有穩定情緒的潛力，但目前實證證據的品質與數量仍待加強，且研究場域仍侷限於美國地區，建議未來研究宜朝向更為嚴謹的研究設計，並進一步探討其於不同地區或族群的實證成效。

關鍵字

雙極症 ； 人際社會節奏治療 ； 系統性文獻回顧

並列摘要

Background: Bipolar disorder is a severe mental illness that leads to personal, family, and social difficulties. Evidence has shown that combined pharmacological and psychosocial interventions help optimize the clinical effectiveness of therapy. Interpersonal and social rhythm therapy (IPSRT) is an effective psychosocial treatment model based on Interpersonal Psychotherapy. Purpose: To examine the effectiveness of IPSRT for patients with bipolar disorder using a systematic review of the literature. Methods: Seven Chinese and English electronic databases were searched: Cochrane Library, EBSCO‐CINAHL, MEDLINE, PsycINFO, PsycARTIClES, PubMed, and CEPS (Chinese Electronic Periodical Services). Articles with the keywords ＂bipolar disorder＂ and ＂interpersonal and social rhythm therapy (IPSRT)＂ published between January 1988 and October 2014 were targeted. Seventy‐six articles were initially identified. After excluding duplicates and filtering using the inclusion criteria, 3 randomized clinical trials and 2 single pre‐post tests were retained for analysis. Research quality was assessed using the Modified Jadad Scale (MJS) and the Oxford Centre for Evidence‐Based Medicine (OCEBM). Results: Middle‐to‐high‐quality levels of evidence were rated 4-7 (MJS) and 1b-2b (OCEBM). Results showed that IPSRT: was used primarily in individualized formats for a period of time ranging from 6-24 months; consisted of symptom management and of stabilizing social and biological rhythms; and dealt with interpersonal conflicts or loss. Outcome indicators were assessed using symptom assessment and relapse, social rhythm, global assessment of function, medication adherence, and patient satisfication criteria. Evidence‐supported IPSRT for patients with bipolar disorder improved clinical symptoms and stabilized social rhythm. Conclusions/Implications for Practice: The studies examined in this literature review support that IPSRT benefits patients with bipolar disorder by stabilizing their mood symptoms and social rhythms. However, the published evidence related IPSRT is rare and limited to patients in the USA. Future studies should use more rigorous research designs and explore the effectiveness of this intervention in different national/ethnic settings.

並列關鍵字

bipolar disorder ； interpersonal and social rhythm therapy ； systematic review

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