雙相情緒障礙症病患之照護

Care of Individuals With Bipolar Disorders

10.6224/JN.000036

許倍甄(Pei-Chen Hsu)；陳幸琪(Hsin-Chi Chen)；盧美柔(Mei-Jou Lu)；陸汝斌(Ru-Band Lu)；林靜蘭(Esther Ching-Lan Lin)

雙相情緒障礙症 ； 藥物治療 ； 心理社會治療 ； 盪鞦韆團體 ； bipolar disorder ； pharmacological treatments ； psychosocial treatments ； BalancingMySwing group

護理雜誌

64卷3期（2017 / 06 / 01）

19 - 26

繁體中文

雙相情緒障礙症（簡稱雙相症）為具有慢性化、高度復發性及不穩定性，及高自殺率之嚴重精神疾病。實證研究支持遺傳及基因因素、神經發炎反應與社會節奏失衡，彼此之間惡性循環為其重要病因。因此，雙相症的急性期照護應以藥物治療為主，後續維持期則需合併藥物治療及心理社會治療，方能有效協助該族群病患規則服藥及處理情緒起伏症狀，促進其疾病自我管理及社會功能，終而降低復發及再住院，並達到較佳穩定狀態。本文首先介紹雙相症之疾病特性、病因假說、實證照護模式與成效，再以「盪鞦韆團體」為例，簡介國人雙相症實證照護模式的初步發展。期藉由這些實證照護知識的統整與分享，做為臨床工作者照護此族群病患的參考，更且，由於目前探討國人雙相症心理社會相關因素之研究仍十分欠缺，發展該族群病患合適的心理社會治療模式亦刻不容緩，盼望藉由本文拋磚引玉，以引發相關決策單位與健康照護者對於此臨床問題的關切。

Bipolar disorder (BD) is a severe mental illness that is characterized by chronicity, pervasive instability, and relatively high rates of recurrence and suicide. Current evidence supports that adverse circles among hereditary and genetic factors, neuroinflamation, and social rhythm constitute a crucial etiology. Pharmacological treatment is the first priority for BD patients during the acute stage. Pharmacological and psychosocial treatments should be combined during the maintenance stage in order to help patients self-manage medication, effectively control mood swings, enhance disease selfmanagement and social functions, decrease the risks of relapse and re-hospitalization, and stabilize overall health. The present article firstly introduces the characteristics and etiological assumptions related to BD, the related evidence-based care models and their effects, and the early development of an evidence-based care model, the BalancingMySwing group, for BD patients in Taiwan. This article provides updated information to clinicians who are involved in caring for this population. Moreover, the existing data related to biological and psychosocial factors for BD in Taiwan is insufficient and developing individual-tailored psychosocial intervention is urgently needed. The authors hope that this article will elicit greater concern for this issue from policy decision-makers and healthcare providers.

1. American Psychiatric Association、台灣精神醫學會譯(2013)。DSM-5 精神疾病診斷準則手冊。新北市=New Taipei City, Taiwan, ROC:合記圖書=Ho-Chi Book。
2. Berk, M.,Dandash, O.,Daglas, R.,Cotton, S. M.,Allott, K.,Fornito, A.,Yücel, M.(2017).Neuroprotection after a first episode of mania: A randomized controlled maintenance trial comparing the effects of lithium and quetiapine on grey and white matter volume.Translational Psychiatry,7(1),e1011.
3. Chakrabarti, S.(2016).Treatment-adherence in bipolar disorder: A patient-centred approach.World Journal of Psychiatry,6(4),399-409.
4. Chang, Y. H.,Chen, S. L.,Chen, S. H.,Chu, C. H.,Lee, S. Y.,Yang, H. F.,Angst, J.(2012).Low anxiety disorder comorbidity rate in bipolar disorders in Han Chinese in Taiwan.Progress in Neuro-Psychopharmacology and Biological Psychiatry,36(1),194-197.
5. Chatterton, M. L.,Stockings, E.,Berk, M.,Barendregt, J. J.,Carter, R.,Mihalopoulos, C.(2017).Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: Network meta-analysis.The British Journal of Psychiatry,210(5),333-341.
6. Chen, P. S.,Peng, G. S.,Li, G.,Yang, S.,Wu, X.,Wang, C. C.,Hong, J. S.(2006).Valproate protects dopaminergic neurons in midbrain neuron/glia cultures by stimulating the release of neurotrophic factors from astrocytes.Molecular Psychiatry,11(12),1116-1125.
7. Conus, P.,Macneil, C.,McGorry, P. D.(2014).Public health significance of bipolar disorder: Implications for early intervention and prevention.Bipolar Disorders,16(5),548-556.
8. Craddock, N.,Sklar, P.(2013).Genetics of bipolar disorder.The Lancet,381(9878),1654-1662.
9. Dell'Osso, B.,Shah, S.,Do, D.,Yuen, L. D.,Hooshmand, F.,Wang, P. W.,Ketter, T. A.(2017).American tertiary clinic-referred bipolar II disorder versus bipolar I disorder associated with hastened depressive recurrence.International Journal of Bipolar Disorders,5,2.
10. Faurholt-Jepsen, M.,Vinberg, M.,Frost, M.,Christensen, E. M.,Bardram, J. E.,Kessing, L. V.(2015).Smartphone data as an electronic biomarker of illness activity in bipolar disorder.Bipolar Disorders,17(7),715-728.
11. Frank, E.(2005).Treating bipolar disorder: A clinician's guide to interpersonal and social rhythm therapy.New York, NY:Guilford Press.
12. Frey, B. N.,Andreazza, A. C.,Houenou, J.,Jamain, S.,Goldstein, B. I.,Frye, M. A.,Young, L. T.(2013).Biomarkers in bipolar disorder: A positional paper from the International Society for Bipolar Disorders Biomarkers Task Force.Australian and New Zealand Journal of Psychiatry,47(4),321-332.
13. Goodwin, G. M.,Haddad, P. M.,Ferrier, I. N.,Aronson, J. K.,Barnes, T.,Cipriani, A.,Young, A. H.(2016).Evidencebased guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology.Journal of Psychopharmacology,30(6),495-553.
14. Grande, I.,Berk, M.,Birmaher, B.,Vieta, E.(2016).Bipolar disorder.The Lancet,387(10027),1561-1572.
15. Grandin, L. D.,Alloy, L. B.,Abramson, L. Y.(2006).The social zeitgeber theory, circadian rhythms, and mood disorders: Review and evaluation.Clinical Psychology Review,26(6),679-694.
16. Harvey, A. G.(2008).Sleep and circadian rhythms in bipolar disorder: Seeking synchrony, harmony, and regulation.American Journal of Psychiatry,165(7),820-829.
17. Hong, J.,Reed, C.,Novick, D.,Haro, J. M.,Windmeijer, F.,Knapp, M.(2010).The cost of relapse for patients with a manic/mixed episode of bipolar disorder in the EMBLEM study.PharmacoEconomics,28(7),555-566.
18. Hsiao, C. Y.,Van Riper, M.(2010).Research on caregiving in Chinese families living with mental illness: A critical review.Journal of Family Nursing,16(1),68-100.
19. Hu, X.,Zhou, H.,Zhang, D.,Yang, S.,Qian, L.,Wu, H. M.,Hong, J. S.(2012).Clozapine protects dopaminergic neurons from inflammation-induced damage by inhibiting microglial overactivation.Journal of Neuroimmune Pharmacology,7(1),187-201.
20. Judd, L. L.,Akiskal, H. S.,Schettler, P. J.,Endicott, J.,Leon, A. C.,Solomon, D. A.,Keller, M. B.(2005).Psychosocial disability in the course of bipolar I and II disorders: A prospective, comparative, longitudinal study.Archives of General Psychiatry,62(12),1322-1330.
21. Kempton, M. J.,Geddes, J. R.,Ettinger, U.,Williams, S. C. R.,Grasby, P. M.(2008).Meta-analysis, database, and meta-regression of 98 structural imaging studies in bipolar disorder.Archives of General Psychiatry,65(9),1017-1032.
22. Lam, D. H.,Jones, S. H.,Hayward, P.(2010).Cognitive therapy for bipolar disorder: A therapist's guide to concepts, methods and practice.West Sussex, UK:Wiley-blackwell.
23. Leclerc, E.,Mansur, R. B.,Brietzke, E.(2013).Determinants of adherence to treatment in bipolar disorder: A comprehensive review.Journal of Affective Disorders,149(1-3),247-252.
24. Lee, H. J.,Lin, E. C. L.,Chen, M. B.,Su, T. P.,Chiang, L. C.(2016).Randomized, controlled trial of a brief familycentred care programme for hospitalized patients with bipolar disorder and their family caregivers.International Journal of Mental Health Nursing
25. Lee, S. Y.,Chen, S. L.,Chang, Y. H.,Chen, P. S.,Huang, S. Y.,Tzeng, N. S.,Hong, J. S.(2013).Add-on memantine to valproate treatment increased HDL-C in bipolar II disorder.Journal of Psychiatric Research,47(10),1343-1348.
26. Lin, E. C. L.,Berk, M.,Hsu, P. C.,Lu, R. B.(2017).A nurseled psychoeducational program BalancingMySwing improves medication adherence among Taiwanese Han-Chinese with bipolar II disorder.Neuropsychiatry,7(4),302-309.
27. Rapoport, S. I.,Basselin, M.,Kim, H.-W.,Rao, J. S.(2009).Bipolar disorder and mechanisms of action of mood stabilizers.Brain Research Reviews,61(2),185-209.
28. Reinares, M.,Bonnin, C. M.,Hidalgo-Mazzei, D.,Sánchez-Moreno, J.,Colom, F.,Vieta, E.(2016).The role of family interventions in bipolar disorder: A systematic review.Clinical Psychology Review,43,47-57.
29. Salcedo, S.,Gold, A. K.,Sheikh, S.,Marcus, P. H.,Nierenberg, A. A.,Deckersbach, T.,Sylvia, L. G.(2016).Empirically supported psychosocial interventions for bipolar disorder: Current state of the research.Journal of Affective Disorders,201,203-214.
30. Wilson, L.,Crowe, M.,Scott, A.,Lacey, C.(2017).Psychoeducation for bipolar disorder: A discourse analysis.International Journal of Mental Health Nursing
31. Ye, B. Y.,Jiang, Z. Y.,Li, X.,Cao, B.,Cao, L. P.,Lin, Y.,Miao, G. D.(2016).Effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated metaanalysis with randomized controlled trials.Psychiatry and Clinical Neurosciences,70(8),351-361.
32. 林靜蘭(2015)。國人雙極症心理社會治療模式之發展與成效評值。第卅一次護理研究論文發表會暨兩岸護理學術交流，台南市=Tainan, Taiwan, ROC.:
33. 許倍甄、李明峰、陸汝斌、林靜蘭(2015)。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。護理暨健康照護研究，11(3)，234-241。
34. 許倍甄、林靜蘭(2015)。青年期第一型雙相症患者疾病經驗之探究：前驅研究。第卅一次護理研究論文發表會暨兩岸護理學術交流，台南市=Tainan, Taiwan, ROC.:
35. 陳惠君、吳羿諠、許民憲、高靖雯、陳秀蘭、陸汝斌(2008)。第一型與第二型雙極症臨床表徵及生活品質之比較。實證護理，4(4)，307-317。

1. 許佳茵,翁紹綺,李佳容(2023)。運用正念認知療法於一位雙相情緒障礙症鬱症發作個案之護理經驗。精神衛生護理雜誌，18(1)，44-50。
2. 賴美玉,馮雅琪,余文雯(2020)。一位雙相情緒障礙症引發自殺企圖之護理經驗。嘉基護理，20(1)，35-45。
3. 張馨文,李安瑜(2021)。運用認知行為策略於雙相情緒障礙患者無效性因應能力之護理經驗。精神衛生護理雜誌，16(3)，46-53。
4. (2024)。運用認知行為治療結合服藥結盟策略於一位雙相情感疾患個案之照護經驗。若瑟醫護雜誌，18(1)，99-114。