PSYCHOEDUCATION, PSYCHOTHERAPY AND LIFE STYLE CHANGES

As bipolar disorder is not only a life-long condition that can have multiple recurrences, high morbidity and 10-15% mortality through suicide, but also responds well in many instances to robust long-term mood stabilizer treatment, the clinician and team should focus on developing an effective therapeutic alliance with the patient and his/her family and friends. This alliance should form the basis for psychoeducation, psychotherapy, biological treatments and regular monitoring (Miklowitz, 1996).

Understanding and acknowledging the disorder by the subject, family and friends is associated with improved treatment adherence in depression (Kusumakar et al, 1996) and bipolar disorder (Miklowitz, 1996). Attention should be paid to regulating social and bio rhythms and avoiding or regulating alcohol or substance use. Lack of sleep can provoke a hypomanic or manic episode. Substance use, including nicotine and caffeine, may exacerbate a mood disorder, particularly rapid cycling and mixed states. Patients with bipolar disorder appear to not only report more adverse life events but also are significantly reactive to stress, including high expressed negative emotions within the family. Hence, proactively dealing with interpersonal conflict, high expressed negative emotions, and loss while promoting healthy functioning and realistic self-esteem should be regular interventions along with biological treatments (Miklowitz, 1996). Specific strategies to monitor moods, reduce or contain suicidality, and improve medication adherence can all promote a better prognosis. There is no empirical evidence for the efficacy of psychoanalytic psychotherapy in the treatment of biphasic mood dysregulation.

Good "meducation", information and education about medications, can be invaluable in promoting a collaborative therapeutic relationship and treatment adherence. Interventions conducted in the context of the patient’s family or supportive social network have a higher chance of producing desirable outcomes when compared with interventions that only focus on the patient. Negative attitudes towards medication in the patient, key family member or friend, or a member of the health care team can have adverse effects on compliance.

References
Kusumaker V, Kennedy S. 1996. Promoting Therapeutic Alliance and Adherence to Medication Treatment in Depression. The Canadian J of Diagnosis. Suppl Oct. 1-9.

Miklowitz, DJ. 1996. Psychotherapy in Combination with Drug Treatment for Bipolar Disorder. J Clin Psychopharmacology. 16:2. Suppl 1. 56S-66S.