Therapeutic Interventions Focused on the Family of Bipolar Patients

Abstract

Background: Although genetic and biological factors are crucial in the pathophysiology of bipolar disorder, the importance of psychosocial and familial factors in triggering or mitigating relapses warrants the implementation of psychotherapeutic interventions. The authors review and criticize the role of family intervention in bipolar disorder. Methods: The main computerized databases (Medline, Psychological Abstracts, Current Contents) have been searched for the terms ‘family intervention’, ‘family management’, ‘family therapy’, ‘psychotherapy’, ‘psychoeducation’ and ‘bipolar disorder’. Results: Some studies have associated high expressed emotion in relatives and poorer outcome in bipolar disorder. Studies on families of bipolar patients seem to support that family intervention as adjunctive therapy to pharmacological treatment may reduce the number of relapses and hospitalizations, improving familial, occupational and social functioning. However, controlled studies are scarce and most of them have a great number of methodological pitfalls such as small sample size, uncontrolled pharmacological treatment, absence of long follow-up and biased populations, among others. Conclusions: Both bipolar patients and their relatives could benefit from family intervention as adjunctive treatment to pharmacotherapy. Nevertheless, it would be necessary to design further investigations avoiding some of the limitations listed above, and controlling additionally for psychopathology in family members, and the influence of life events. It would be important to distinguish between causes and effects, studying which factors are involved in family attitudes and determining whether the interactive patterns are variable or stable according to the clinical state of the patient. Finally, it would be useful to design viable, effective and measurable interventions for the accurate delimitation of the role of family intervention in the treatment of bipolar disorder.

Do Cognitive Complaints in Euthymic Bipolar Patients Reflect Objective Cognitive Impairment?

“…Cognitive deficits may act as an intermediate between clinical variables and psychosocial functioning, so these dysfunctions might have an impact on the patient’s daily life. The impact of cognitive dysfunctions on the functional outcome of bipolar patients point to the usefulness of psychological interventions as an add-on therapy, especially in order to prevent relapses, improve subsyndromal symptomatology and maintain adherence to medication [39, 40, 41, 42, 43, 44], including adapted rehabilitation programs to improve cognitive impairments in these patients [8]. Psychotherapeutic approaches should take into account these cognitive disturbances to evaluate their benefits in patients with difficulties to learn and manipulate new information [9].…”

Impact of a Psychoeducational Family Intervention on Caregivers of Stabilized Bipolar Patients

“…Providing information about bipolar disorder and useful coping strategies to the patients’ cohabitants might contribute to the relapse prevention and, in the case of their occurrence, would facilitate early identification of and intervention in prodromal symptoms [23], which may precede the full syndrome by weeks or months [38, 39, 40]. …”

“…All these findings suggest a need to introduce psychoeducational interventions on the relatives as a part of bipolar patients’ treatment [23]. Although family interventions may have a considerable effect on the burden of psychiatric patients’ relatives [24], as far as we know there is only one study [25]reporting data on bipolar patients’ caregivers; however, the sample used was small.…”

Management of Bipolar I Disorder through CBT (Cognitive Behaviour Therapy): A Case Report

“…Given the chronicity and severity of bipolar disorder, along with its long lasting impact on society, it is imperative that adequate, empirically supported interventions are available for patients diagnosed with bipolar disorder. Growing body of literature exist which suggest that combined psychosocial interventions and psychopharmacological are best for treatment of adults having Bipolar disorder [30].…”