Evaluación a 2 años de un programa psicoeducativo multifamiliar (PROTEC) en la carga familiar y el pronóstico de pacientes bipolares

Abstract

INTRODUCTION\nBipolar disorder causes a significant burden on the lives of patients and their families. The family is one of the targets for therapeutic intervention, related to the prognosis in patients with bipolar disorder.\n\n\nAIM\nTo assess the effectiveness of a multifamily psychoeducational program for people with bipolar disorder, in the family burden: objective and subjective and in the variables related to the course of the patients with bipolar disorder (symptoms, adherence, functionality, hospitalizations), comparing it with a group control.\n\n\nMATERIAL AND METHOD\n148 relatives of bipolar patients and 148 bipolar patients were recruited. The sample was randomized (experimental group: E.G and control group: C.G) and with single- blind evaluations (baseline, at 5 months and one year). Clinical and sociodemographic variables were collected from families and patients (ECF:Family burden self-report scale, Strauss Carpenter Scale, GAF; global assessment of functioning, Morisky Green adherence Scale). Both, E.G and C.G received 8 multifamily sessions, applied exclusively on the relatives of patients with bipolar disorder, but in the E.G a psychoeducational treatment was carried out and in the C.G only playful and current topics were discussed. Bivariate and logistic regression models were used, among others.\n\n\nRESULTS\nThe caregivers and patients of the E.G and C.G did not differ in any of the baseline variables (sociodemographic and clinical) (p> 0.001). In the total sample, the baseline objective burden was light (: 0.6 ± 0.4) and the subjective ones was medium-moderate (: 1.1 ±0.3). During the follow-up, in relation to the variables of the caregivers, there was a greater reduction in the objective burden in the E.G compared to the C.G (5 months: p: 0.006; 1 year: p: 0.002). It was found that the objective burden (p: 0.006) and the subjective burden (p: 0.003) were significantly reduced over a year in E.G but not in the C.G. During the follow-up, the patients whose caregivers belonged to the E.G showed a greater increase in the frequency of social activity (p: 0.008), in the work activity (p: 0.002), global functioning (p:0.002), and reduced their symptoms (p: ≤ 0,001). Longitudinal analyses, over a year, showed that patients in the E.G had a greater improvement in functionality compared to patients in the C.G (p: 0.001). After the intervention, adherence to pharmacological treatment improved more in E. G than in the C. G (p: ≤ 0.001). Regarding hospitalizations, any patients in the C.G were hospitalized during the 5 months after the intervention, while 27.8% of the patients in the C.G were hospitalized (p: ≤ 0.001); the difference between groups remained significant in the long term (1 year: p: ≤ 0.001; 2 years: p: ≤ 0.001). There were no significant differences between groups in the pharmacological treatment of the patients in any of the evaluations.\n\n\nCONCLUSIONS\nThe multifamily psychoeducational intervention group improved the family burden after the intervention. Likewise, bipolar patients, whose families attended the E.G, improved significantly, over a year, the functionality, the frequency of social contacts, the work status, the adherence to treatment, and reduced their symptoms. In addition, in the E.G., the percentage of hospitalizations during the two years of follow-up was significantly reduced.