Résumés
Résumé
Le trouble bipolaire II (BP II) est une pathologie psychiatrique fréquente, récurrente et débilitante. Pourtant, peu d’études ont évalué quelles étaient les meilleures approches pour le traitement de cette maladie. La psychothérapie interpersonnelle et des rythmes sociaux (PTIRS) [Interpersonal and Social Rythm Therapy] a démontré une utilité dans le traitement du trouble bipolaire I, en association avec la médication. Contrairement au trouble BP I, le trouble BP II est caractérisé par des épisodes atténués, non psychotiques, de manie (hypomanie), de sorte qu’il ne semble pas y avoir de contre-indications à l’emploi de la PTIRS en monothérapie. Cette approche combine une approche comportementale visant à augmenter la régularité des routines quotidiennes, avec une psychothérapie interpersonnelle qui aide les patients à mieux gérer les multiples problèmes psychosociaux associés à cette pathologie chronique. Une description est faite des conceptions théoriques sous-tendant l’utilisation de la PTIRS dans le trouble bipolaire. Une brève description du trouble BP II est faite. Plusieurs modifications sont apparues nécessaires, dans notre expérience, pour adapter la PTIRS au traitement du trouble BP II (en comparaison avec le trouble BP I), en raison des caractéristiques cliniques particulières de cette population, notamment l’instabilité du tableau clinique, la difficulté à repérer le type d’épisode en cours parce que les symptômes sont souvent mixtes (intrication entre symptômes d’activation et de dépression), et également en raison du chevauchement symptomatique ou de la comorbidité avec le trouble de personnalité borderline. Il existe également une comorbidité fréquente avec le trouble d’abus ou de dépendance aux substances psychoactives. Des vignettes tirées de notre expérience clinique tentent d’illustrer diverses problématiques courantes rencontrées dans la thérapie de cette population, et qui sont reliées aux caractéristiques ci-haut mentionnées du trouble BP II. La PTIRS apparaît être un ajout important et intéressant aux approches de traitement du trouble BP II parce qu’elle tient compte des divers aspects de cette pathologie ; cette approche nous est apparue efficace dans cette étude préliminaire et nous sommes d’avis que des études systématiques ultérieures sont requises et permettront d’évaluer de façon plus formelle son efficacité dans le traitement du trouble bipolaire II.
Abstract
Bipolar II (BP II) disorder is a common, recurrent, and disabling psychiatric illness. Individuals suffering from this disorder comprise a large segment of the outpatient mental health treatment population, and yet little is known about how best to manage it. Psychotherapy, although untested in this population, represents a potentially important treatment modality for individuals suffering from this disorder. Because BP II disorder is characterized by subsyndromal, non-psychotic, episodes of mania (hypomania), there are no clear contraindications to the use of psychotherapy as monotherapy in BP II disorder (in contrast to BP I disorder where the risk of mania makes medication the sine qua non of treatment). In addition, unlike medication, psychotherapy has the potential to help patients address the multiple psychosocial problems associated with this chronic illness. Thus, an effective psychotherapy for BP II disorder may provide an appealing alternative for patients, especially for those who prefer to avoid the risks and discomfort associated with current pharmacotherapeutic options. Interpersonal and social rhythm therapy (IPSRT), a treatment combining a behavioral approach to increasing the regularity of daily routines with interpersonal psychotherapy (IPT), has demonstrated efficacy BP I disorder when in combination with medication. The current report gives brief overviews of BP II disorder and IPSRT, describes the process of adapting IPSRT for the treatment of BP II disorder, and then presents a series of vignettes based on our experience using IPSRT as monotherapy for the acute treatment of BP II depression. We argue that IPSRT warrants further systematic study to formally assess its efficacy as a treatment for BP II disorder.
Resumen
El trastorno bipolar II (BPII) es una patología psiquiátrica frecuente, recurrente y debilitante. Sin embargo, pocos estudios han evaluado cuáles son los mejores enfoques para el tratamiento de esta enfermedad. La psicoterapia interpersonal y de ritmos sociales (PTIRS) ha demostrado ser útil en el tratamiento del trastorno bipolar I, en asociación con la medicación. Contrariamente al trastorno BP I, el trastorno BP II se caracteriza por episodios atenuados, no psicóticos, de manía (hipomanía), de manera que no parece haber contraindicaciones para el empleo de la PTIRS en monoterapia. Este enfoque combina un enfoque comportamental que busca aumentar la regularidad de las rutinas cotidianas, con una psicoterapia interpersonal que ayuda a los pacientes a gestionar mejor los múltiples problemas psicosociales asociados a esta patología crónica. Se realiza una descripción de las concepciones teóricas subyacentes a la utilización de la PTIRS en el trastorno bipolar y una breve descripción del trastorno BP II. Varias modificaciones parecen necesarias, en nuestra investigación, para adaptar la PTIRS al tratamiento del trastorno BP II (en comparación con el trastorno BP I), en razón de las características clínicas particulares de esta población, específicamente la inestabilidad del cuadro clínico, la dificultad de localizar el tipo de episodio en curso porque los síntomas son con frecuencia mixtos (intrincación entre síntomas de activación y de depresión), e igualmente la razón de la superposición sintomática o de la comorbilidad con el trastorno de personalidad límite. Existe también una comorbilidad frecuente con el trastorno de abuso o dependencia a sustancias psicoactivas. Las viñetas tomadas de nuestra experiencia clínica intentan ilustrar diversas problemáticas comunes encontradas en la terapia de esta población y que están relacionadas con las características del trastorno BP II mencionadas anteriormente. La PTIRS parece ser una adición importante e interesante a los enfoques de tratamiento del trastorno BP II porque toma en cuenta los diversos aspectos de esta patología. Este enfoque nos parece eficaz en este estudio preliminar y somos de la opinión que se requieren estudios sistemáticos posteriores que permitirán evaluar de manera más formal su eficacia en el tratamiento del trastorno bipolar II.
Resumo
O transtorno bipolar II (BP II) é uma patologia psiquiátrica freqüente, recorrente e debilitante. Entretanto, poucos estudos avaliaram quais eram as melhores abordagens para o tratamento desta doença. A psicoterapia interpessoal e de ritmos sociais (TIPRS) demonstrou uma utilidade no tratamento do transtorno bipolar I, associado à medicação. Ao contrário do transtorno BP I, o transtorno BP II é caracterizado por períodos atenuados, não psicóticos, de mania (hipomania), de maneira que não parece ter contra-indicações no emprego da TIPRS em monoterapia. Esta abordagem associa uma abordagem comportamental visando a aumentar a regularidade das rotinas cotidianas, com uma psicoterapia interpessoal que ajuda os pacientes a melhor gerir os múltiplos problemas psicossociais associados a esta patologia crônica. É feita uma descrição dos conceitos teóricos que subentende a utilização da TIPRS no transtorno bipolar. Uma breve descrição do transtorno BP II é feita. Várias modificações mostraram-se necessárias, em nossa experiência, para adaptar a TIPRS ao tratamento do transtorno BP II (em comparação com o transtorno BP I), por causa das características clínicas particulares desta população, principalmente com respeito à instabilidade do quadro clínico, à dificuldade de perceber o tipo de episódio em curso porque os sintomas são freqüentemente mistos (combinação entre sintomas de ativação e de depressão), e igualmente, por causa da acumulação sintomática ou da comorbidade com o transtorno de personalidade borderline. Existe também uma co-morbilidade freqüente com o transtorno do abuso ou de dependência às substâncias psicoativas. Os exemplos tirados de nossa experiência clínica tendem a ilustrar diversas problemáticas correntes encontradas na terapia desta população, e que são relacionadas às características acima mencionadas do transtorno BP II. A TIPRS parece ser um acréscimo importante e interessante às abordagens de tratamento do transtorno BP II porque ela leva em consideração diversos aspectos desta patologia; esta abordagem nos parece eficaz neste estudo preliminar, e nós acreditamos que estudos sistemáticos futuros são necessários e permitirão avaliar de maneira mais formal sua eficácia no tratamento do transtorno bipolar II.
Parties annexes
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