Gli adattamenti dell’IPT al disturbo bipolare e al disturbo distimico
4.2 L’IPT nel trattamento del disturbo distimico
Il trattamento del disturbo distimico (DD) solitamente prevede una terapia
farmacologica antidepressiva. L’andamento del disturbo è cronico e prevede spesso la ricomparsa dei sintomi alla sospensione della farmacoterapia (Bellino, 2012). Alcuni ricercatori della Cornell University Medil College hanno “manualizzato” l’IPT per il disturbo distimico (IPT-DD). Gruppi di trial clinici hanno testato la combinazione di IPT a terapie di tipo farmacologico, specie con sertralina, in pazienti distimici (Markovitz, 2007), notando come nel caso della distimia i benefici della terapia che si notano al follow-up, constano nella diminuzione della richiesta di assistenza sanitaria e sui costi ad essa associati, il che rende utile l’intervento con IPT in combinazione alla farmacoterapia.
Uno degli obiettivi dell’IPT-DD è quello di far comprendere al paziente che l’attuale sintomatologia è legata ad un disturbo psichico cronico, e che non fa parte della propria personalità. Infatti in questi pazienti la caratteristica comune è quella di pensare che i loro sintomi siano parte integrante del loro modo di essere. L’IPT- DD permette di aiutare il paziente a mettere in luce l’“egosintonicità” sviluppata nei confronti del disturbo.
Nonostante il trattamento farmacologico sia una “conditio sine qua non” nel trattamento dei pazienti distimici, in quanto agisce sulle dinamiche neurotrasmettitoriali alla base dei sintomi principali del disturbo, ricerche che
verificano l’efficacia ed i benefici apportati dall’IPT ne sostengono l’utilità, soprattutto nel risolvere le difficoltà nelle relazioni interpersonali.
La psicoterapia interpersonale (IPT) vede la sua elaborazione grazie a Klerman e Weissman che, nel 1974, partendo dai limiti dei modelli psicoterapici fino ad allora utilizzati per il trattamento del disturbo depressivo maggiore, individuano la necessità di “far entrare” nel setting terapeutico gli elementi psico-sociali che circondano il paziente; questo ha permesso non solo di comprendere i fattori che talvolta rappresentano le cause scatenanti del disturbo, ma anche di individuare i fattori di mantenimento. Alla luce dei risultati nel campo del disturbo depressivo maggiore nei pazienti adulti non psicotici, l’IPT viene adattata alla depressione nell’adolescente ed ancora nel periodo post-partum.
Il modello tradizionale dell’IPT viene successivamente adattato al disturbo bipolare (IPTSRT), rappresentando un’efficacie risposta alle continue sfide che il trattamento impone. L’IPSRT, infatti, permette, mediante la sincronizzazione dei ritmi circadiani del paziente, insieme ad un adeguato trattamento farmacologico, di allungare il periodo che intercorre tra un episodio ed un altro.
Più esigui sono i risultati nel campo dell’efficacia dell’IPT nel trattamento del disturbo distimico; infatti, dagli studi analizzati è emerso che l’IPT-DD ha il vantaggio di diminuire la richiesta di assistenza sanitaria, ma non agisce direttamente sulla riduzione dei sintomi, per i quali è necessario un trattamento farmacologico.
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