| PurposeBipolar disorder(BD)is a recurrent severe mental illness and the sixth leading cause of human disability.It has the characteristics of high prevalence,high recurrence rate,high disability rate,high suicide rate,high disease burden,etc.The incidence of suicidal deaths in patients with bipolar disorder is 20-30 times that of the general population.Even when the symptoms are relieved,patients often have obvious impulsive aggressive behaviors,which seriously threaten the safety of themselves and others.The study pointed out that up to 80%of patients with bipolar disorder relapse within 2 years,and only 40%of patients can fully comply with the drug treatment plan in the first year after the attack.Patients’ poor medication compliance,unstable social rhythm and stressful life events all increase their risk of emotional seizures,leading to the recurrence of bipolar disorder.Assisted psychotherapy is widely used abroad in the treatment of BD.Among them,interpersonal and social rhythm therapy is an evidence-based psychotherapy method specifically for bipolar disorder.To prevent the relapse of the disease by taking medication compliance,stabilizing its social rhythm,and improving interpersonal relationship quality and social role performance.However,the current psychological intervention for bipolar disorder in China is still in its infancy,and there is a lack of empirical research on interpersonal and social rhythm therapy.Therefore,this study intends to localize and revise the program of interpersonal and social rhythm therapy,and to preliminary evaluate the effectiveness of this therapy in Chinese patients with BD,with a view to alleviating the symptoms of BD patients and reducing their risk of killing people,preventing disease recurrence,and reducing the burden of social diseases.At the same time,it can also provide targeted,efficient and feasible practical operation tools for the clinical treatment of domestic bipolar disorder,enrich the domestic methods of auxiliary psychological intervention for BD,and provide theoretical basis and method reference for targeted intervention research with BD.Methods1.Through the literature search and practice summary,translation of foreign interpersonal and social rhythm therapy materials,case studies and pre-revisions,thematic discussion and revisions,to localize and revise interpersonal and social rhythm therapy and form a localized interpersonal and social rhythm therapy manual.2.Using a quasi-experimental method,34 patients with bipolar disorder in the non-acute phase(YMRS<12,HAMD<14)were randomly assigned to the experiment group(n=16,conventional drugs combined with IPSRT)and a control group(n=18,undergoing conventional drug therapy).Using the revised interpersonal and social rhythm therapy,the patients in the experiment group were treated with bipolar disorder once a week,about 60 minutes each time,and 12 consecutive psychological interventions.Before and after the intervention,all patients were pre-tested and post-tested on the scale,combined with quantitative evaluation and qualitative analysis to initially verify the interpersonal and social rhythm therapy intervention effects.Quantitative assessment scale include:Hamilton Depression Scale(HAMD-17),Young Mania Rating Scale(YMRS),The Social Rhythm Metric(SRM),Pittsburgh Sleep Quality Index(PSQI),Chinese Version of Patients Compliance Scale,Chinese version of Buss&Perry aggression questionnaire(AQ-CV),Patient Health Questionnaire(PHQ-9).Results1.This study revised a manual on IPSRT for patients with BD.The manual is scientifically and rigorously formed,with a complete structure and strong operability.The structure of the manual mainly includes eight parts:preface,treatment goals,users of the manual,applicable objects(subjects),manual implementation process,the specific content,effect evaluation and appendix.The manual includes 8 topics including symptom evaluation and introduction of IPSRT,medical history collection,interpersonal relationship investigation,interpersonal relationship problems and symptoms,social rhythm and symptoms,intervention in the field of interpersonal problems,stability of social rhythm,and end of treatment,with a total of 12 treatments.2.Intervention effect of IPSRT in patients with BD:(1)Differences between the two groups:(a)There were no significant differences between the two groups in the pre-tested depression and mania symptoms scores,as well as the total score of sleep quality and the scores in all dimensions(p>0.05);(b)After receiving IPSRT treatment,the dimension scores of sleep quality(z=-2.29*),time to fall asleep(z=-2.15*)and sleep time(z=-2.10*)measured in the experiment group were significantly lower than the control(p<0.05).(2)Comparison of the differences within the two groups:(a)After receiving IPSRT treatment,the depression(z=-2.94**)and manic symptoms score(z=-2.11*)of the experiment group were significantly lower than their pre-test scores,the difference was statistically significant(p<0.05),The clinical symptoms of patients show a declining trend with the progress of treatment.(b)The post-test social rhythm score of the experiment group was significantly higher than the pre-test scores(z=-2.33*),and there was no significant difference between the pro-test score of the experiment group and the healthy control norm(p>0.05).The social rhythm of patients showed a rising trend during treatment and gradually stabilized.(c)Compared with the pre-test of the experiment group,the post-test patient compliance score(z=-0.56)increased,while the total aggressiveness score(t=0.51),verbal attack score(t=0.43),anger score(t=0.64),self-attack score(t=1.73)and the suicide idea item score(z=-1.67)decreased,but all the difference did not reach statistical significance(p>0.05).(d)Compared with the pre-test of the control group,the post-test patient compliance scale score(z=-1.05)decreased,while the score of aggressiveness scale(t=-0.06)and each dimension,also the suicide idea item score(z=-1.00)increased,but all the difference did not reach statistical significance(p>0.05).(3)Qualitative analysis results:Five therapeutic factors for interpersonal and social rhythm therapy were identified through thematic analysis,which were monitoring emotional symptoms,stabilizing social rhythm,recognizing bipolar disorder,self-awareness and interpersonal communication training.Qualitative text analysis results:Five therapeutic factors for interpersonal and social rhythm therapy were identified through topic analysis,which wereConclusions1.The handbook of IPSRT revised in this study can provide a structured treatment manual with operability and guidance for the treatment of bipolar disorder in China.2.The IPSRT revised in this study showed a good intervention effect in patients with bipolar disorder,which is suitable for the population of patients with BD in China.3.IPSRT combined with medical treatment can effectively relieve the clinical symptoms,stabilize the social rhythm,improve sleep quality and compliance with medication,increase the social support,reduce the aggression and the frequency of suicidal thoughts of patients with BD.IIPSRT is an effective specific psychotherapy for bipolar disorder.Highlight1.At present,the psychological intervention of BD in China is still in its infancy.Evidence-based psychotherapy for bipolar disorder,which has been widely used abroad,is rarely reported.Based on translating and reading related professional books and literature,this study revised the IPSRT manual for patients with bipolar disorder,combining case studies and panel discussions.The manual is detailed and operable,which enriches the empirical research on specific psychological interventions for patients with BD,and provides clinical guidance and experience for psychological treatment of patients with bipolar disorder.2.This study verified the intervention effect of conventional medical treatment combined with IPSRT in bipolar patients,and confirmed that the treatment method can alleviate the clinical symptoms of depression and mania,stabilize social rhythm,improve sleep quality and so on.The study provides a reference for the follow-up assisted psychological treatment of BD.Limitation and Future Recommendation1.This research is in the stage of revision and preliminary exploration of IPSRT.There is no other auxiliary psychotherapy control group for bipolar disorder,so it is difficult to show the advantages of IPSRT over other treatment.Subsequent research can add other auxiliary psychological treatments as a control group,and deeply explore the effect of IPSRT on patients with BD.2.A total of 11 patients with BD completed the intervention in this study,all from the School mental health Center,so the sample maybe not representative enough.However,based on the litmited human and material resources of our research group,in order to ensure that each patient receives a complete interpersonal and social rhythm treatment once a week for about 60 minutes each time for 12 weeks,this study has expanded the scope of sample acquisition to the greatest extent in the preliminary stage of exploratory research.In the subsequent research,the sample size can be further expanded,and the revised interpersonal and social rhythm therapy can be applied to outpatient and inpatients with bipolar disorder to further verify the intervention effect of the therapy.3.At this stage of the study,IPSRT interventions have been set up with two time points before and after testing,but long-term follow-up of the research subjects has not been completed.In the future,we will continue to follow up reports in order to obtain the recurrence of the patients with BD,the interval between attacks,and the continuous intervention effect of IPSRT. |
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