Psychological treatment of psychiatric disorders

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Очень интересный EBM-обзор по "псайколоджикал тритмент'у" в отношении психиатрических расстройств.

Привожу наиболее с моей точки зрения интересные цитаты - и список источников.

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Psychological treatment of psychiatric disorders
Jennifer Gafford, PhD
H Russell Searight, PhD, MPH

MAJOR DEPRESSION
A broad range of psychological interventions have been found to be effective for the treatment of depression [8]. Behavior therapy (BT), cognitive-behavioral therapy (CBT), and interpersonal therapy (IPT) are well established, evidence-based interventions for the treatment of major depression [9-12]. Support has also been generated for the efficacy of brief dynamic therapy [13], marital therapy, and family therapy [14,15].

Guidelines developed by the Depression Guideline Panel of the Agency for Health Care Policy and Research (AHCPR) in 1993 concluded that the efficacy of cognitive therapy, behavior therapy, and interpersonal therapy was 46, 55, and 52 percent, respectively, in psychiatric patients with major depression [16]. Subsequent studies in primary care patients have noted similar results, and found similar benefits with problem-solving treatment (PST), and treatments involving collaboration with other professionals, such as nurses, as part of the primary care team [17-19].

Similar efficacy for drug therapy and psychotherapy for depressed patients in the primary care setting have been shown in multiple studies [8,11,17,18,22,23]. Behavioral activation, a specific behavioral therapy for depression, was superior to pharmacotherapy with an SSRI in percentage of patients with severe depression achieving remission and percentage of patients retained in treatment [24].

BIPOLAR DISORDER
As an example, a randomized trial in 103 patients with bipolar disorder found that adding CT to mood stabilizers and psychiatric follow-up resulted in a significantly lower rate of relapse over one year (43.8 versus 75 percent) [33].

GENERALIZED ANXIETY DISORDER
Treatment of generalized anxiety disorder (GAD) may consist of psychotherapy, drug therapy, or both. (See "Overview of generalized anxiety disorder"). Patients with anxiety disorders have traditionally been treated with psychodynamic psychotherapy.

PANIC DISORDER
Treatment effects were greater among the subset of cognitive-behavioral interventions utilizing exposure. Effect sizes for cognitive-behavior therapy and exposure, cognitive-behavior therapy alone, combined treatments, and pharmacological treatments were 0.88, 0.68, 0.56, and 0.47, respectively.

BULIMIA NERVOSA
Cognitive behavioral therapy (CBT) is a first line treatment for bulimia nervosa (BN) [56]. (See "Eating disorders: Treatment and outcome"). Studies comparing CBT to antidepressant medication suggest that patients with BN find CBT more acceptable and have a lower rate of treatment drop-out [56].

A systematic review of the literature found that cognitive behavioral therapy, other psychotherapies, antidepressant medication, and combination treatment with an antidepressant and psychotherapy are all likely to be beneficial for bulimia nervosa [60]. Combination therapy probably does not significantly enhance improvement in the core features of BN, but rather aids in treating comorbid depression [56].

Interpersonal therapy (IPT) may also be effective in the treatment of BN. In a randomized clinical trial comparing CBT, BT, and IPT, all three therapies were equally effective at posttreatment in reducing binge eating, with mean reductions of 71 percent for CBT, 62 percent for BT and 62 percent for IPT [61].

SCHIZOPHRENIA
Numerous studies support the efficacy of social skills training in patients with schizophrenia [64]. In a randomized clinical trial involving stable outpatients with chronic schizophrenia, patients who received social skills training in addition to maintenance pharmacotherapy significantly improved their social skills, generalized these skills to real life settings, and maintained gains at one year follow-up [65]. At two year follow-up, the patients with social skills training exhibited significantly better social functioning and quality of life [66].

INSOMNIA
Evidence from clinical trials and meta-analyses suggests that CBT for insomnia is as effective as sedative hypnotics for acute treatment, and more effective for longterm therapy [73-75].

SUMMARY
The efficacy of psychotherapy has been established for a number of psychiatric disorders that are commonly seen in the primary care setting.

[pliz]

8. Robinson, LA, Berman, JS, Neimeyer, RA. Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research. Psychol Bull 1990; 108:30.
9. Jacobson, NS, Dobson, KS, Truax, PA, et al. A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol 1996; 64:295.
10. Dobson, KS. A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psychol 1989; 57:414.
11. Elkin, I, Shea, MT, Watkins, JT, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Arch Gen Psychiatry 1989; 46:971.
12. Craighead, WE, Craighead, LW, Illardi, SS. Psychosocial treatments for major depressive disorder. In: A Guide to Treatments that Work, Nathan, PE, Gorman, JM (Eds), Oxford University Press, New York 1998. p.226.
13. Leichsenring, F. Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clin Psychol Rev 2001; 21:401.
14. Gallagher-Thompson, D, Steffen, AM. Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. J Consult Clin Psychol 1994; 62:543.
15. Prince, SE, Jacobson, NS. A review and evaluation of marital and family therapies for affective disorders. J Marital Fam Ther 1995; 21:377.
16. Depression Guideline Panel. Depression in Primary Care: Treatment of Major Depression: Clinical Practice Guideline. US Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR publication 93-0551, Rockville, MD 1993.
17. Mynors-Wallis, LM, Gath, DH, Lloyd-Thomas, AR, Tomlinson, D. Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ 1995; 310:441.
18. Schulberg, HC, Block, MR, Madonia, MJ, et al. Treating major depression in primary care practice. Eight-month clinical outcomes. Arch Gen Psychiatry 1996; 53:913.
19. Unutzer, J, Katon, W, Callahan, CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002; 288:2836.
22. DeRubeis, RJ, Hollon, SD, Amsterdam, JD, et al. Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry 2005; 62:409.
23. Chilvers, C, Dewey, M, Fielding, K, et al. Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms. BMJ 2001; 322:772.
24. Dimidjian, S, Hollon, SD, Dobson, KS, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol 2006; 74:658.
33. Lam, DH, Watkins, ER, Hayward, P, et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003; 60:145.
56. Wilson, GT, Fairburn, CG. Treatments for eating disorders. In: A Guide to Treatments that Work, Nathan, PE, Gorman, JM (Eds), Oxford University Press, New York 1998. p.501.
61. Fairburn, CG, Norman, PA, Welch, SL, et al. A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Arch Gen Psychiatry 1995; 52:304.
64. Kopelowicz, A, Liberman, RP. Psychosocial treatments for schizophrenia. In: A Guide to Treatments that Work, Nathan, PE, Gorman, JM (Eds), Oxford University Press, New York 1998. p.190.
65. Eckman, TA, Wirshing, WC, Marder, SR, et al. Technique for training schizophrenic patients in illness self-management: a controlled trial. Am J Psychiatry 1992; 149:1549.
66. Marder, SR, Wirshing, WC, Mintz, J, et al. Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia. Am J Psychiatry 1996; 153:1585.
73. Perlis, ML, Jungquist, C, Smith, MT, Posner, D. Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide. Springer Science and Business Media, Inc, New York 2005.
74. Sivertsen, B, Omvik, S, Pallesen, S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 2006; 295:2851.
75. Wu, R, Bao, J, Zhang, C, et al. Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychother Psychosom 2006; 75:220.

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