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Psychosocial Approaches to the Course and Treatment of Bipolar Disorder

Published online by Cambridge University Press:  03 July 2018

David J. Miklowitz
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Abstract

The course of bipolar disorder is marked by relapses and remissions, even when patients are maintained on appropriate pharmacotherapy. This variability in illness course may occur in part because the disorder is affected by socioenvironmental stressors, particularly significant life events and high-conflict family relationships. Considering these factors, clinicians have focused more attention on psychosocial treatments as useful adjuncts to pharmacotherapy. In this article, a psychosocial treatment program known as family-focused psychoeducational treatment (FFT) is described. Delivered in combination with pharmacotherapy during the postepisode stabilization period, FFT begins with an assessment of the family or marital environment. Then, in three consecutive, modules, participants receive education about the nature, causes, and treatment of bipolar disorder, communication enhancement training, and problem-solving skills training. The overall goals of the program are to restore family equilibrium and improve the patient's clinical functioning after the acute-illness episode. A case study illustrating the approach is presented, and the future directions of FFT are reviewed.

Type
Feature Article
Information
CNS Spectrums , Volume 3 , Issue 5: An Integrated Approach to the Treatment of Mood Disorders , May 1998 , pp. 48 - 52
Copyright
Copyright © Cambridge University Press 1998

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References

1. American Psychiatric Association. Practice guidelines for the treatment of patients with bipolar disorder. Am J Psychiatry. 1994;12(suppl):1–36.Google Scholar
2. Goodwin, FK, Jamison, KR. Manic-Depressive Illness. New York, NY: Oxford University Press; 1990.Google Scholar
3. keek, PE, McElroy, SL. Outcome in the phannacologic treatment of bipolar disorder. J Clin Psychopharmacol. 1996;16:15–23.Google Scholar
4. Silverstone, T, Romans-Clarkson, S. Bipolar affective disorder: causes and prevention of relapse. Br J Psychiatry: 1989;154:321–325.Google Scholar
5. Bowden, CL. Role of newer medications for bipolar disorder. J Clin Psychopharmacol. 1996;16(suppl l):48–55.Google Scholar
6. Calabrese, JR, Fatemi, SH, Kujawa, M, Woyshville, M. Predictors of response to mood stabilizers. J Clin Psychopharmacol. 1996;16(suppl 1):24–31.Google Scholar
7. Gelenberg, AJ, Kane, JN, Keller, MB, et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorders. N Engl J Med. 1989;321:1489–1493.Google Scholar
8. Marker, HR, Mander, AJ. Efficacy of lithium prophylaxis in clinical practice. Br J Psychiatry. 1989;155:496–500.Google Scholar
9. Shapiro, DR, Quitkin, FM, Fleiss, JL. Response to maintenance therapy in bipolar illness. Arch Gen Psychiatry. 1989;46:401–405.CrossRefGoogle ScholarPubMed
10. Gitlin, MJ, Swendsen, J, Heller, TL, Hammen, C. Relapse and impairment in bipolar disorder. Am J Psychiatry. 1995;152:1635–1640.Google Scholar
11. Harrow, M, Goldberg, JF, Grossman, LS, Meltzer, HY. Outcome in manic disorders: a naturalistic follow-up study. Arch Gen Psychiatry. 1990;47:665–671.Google Scholar
12. Jamison, KR, Akiskal, HS. Medication compliance in patients with bipolar disorders. Psychiatr Clin North Am. 1983;6:175–192.CrossRefGoogle Scholar
13. Shaw, E. Lithium noncompliance. Psychiatry Annals. 1986;16:583–587.Google Scholar
14. Lenzi, A, Lazzerini, F, Placidi, GF, Cassano, GB, Akiskal, HS. Predictors of compliance with lithium and carbamazepine regimes in the long-term treatment of recurrent mood and related psychotic disorders. Phamacopsychiatry. 1989;22:34–37.Google Scholar
15. Kukopulos, A, Reginaldi, D, Laddomada, P, Floric, G, Serra, G, Tondo, L. Course of the manic-depressive cycle and changes caused by treatment. Phamacopsychiatry. 1980;13:156–167.Google Scholar
16. Coryell, W, Scheftner, W, Keller, M, Endicott, J, Maser, J, Klennan, GL. The enduring psychosocial consequences of mania and depression. Am J Psychiatry. 1993;150:720–727.Google ScholarPubMed
17. Hammen, C, Burge, D, Burney, E, Adrian, C. Longitudinal study of diagnoses in chililren of women with unipolar and bipolar affective disorder. Arch Gen Psychiatry: 1990;47:1112–1117.Google Scholar
18. Cochran, SD. Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. J Consult Clin Psychol. 1984;52:873–878.Google Scholar
19. Frank, E, Kupfer, DJ, Ehlers, CL, et al. Interpersonal and social rhythm therapy for bipolar disorder: integrating interpersonal and behavioral approaches. Behavior Therapist. 1994;17:143–149.Google Scholar
20. Miklowitz, DJ, Goldstein, MJ. Bipolar Disorder: A Family-Focused Treatment Approach. New York, NY: Guilford Press; 1997.Google Scholar
21. Hammen, C, Gitlin, MJ. Stress reactivity in bipolar patients and its relation to prior history of disorder. Am J Psychiatry. 1997;154:856–857.Google ScholarPubMed
22. Johnson, SL, Roberts, JE. Life events and bipolar disorder: implications from biological theories. Psychol Bull. 1995;117:434–449.CrossRefGoogle ScholarPubMed
23. Miklowitz, DJ, Goldstein, MJ, Nuechlerlein, KH, Snyder, KS, Mintz, J. Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry. 1988;45:225–231.Google Scholar
24. Ellicolt, A, Hammen, C, Gitlin, M, Brown, G, Jamison, K. Life events and the course of bipolar disorder. Am J Psychiatry. 1990;147:1194–1198.Google Scholar
25. Johnson, SI, Miller, I. Life events and recovery from episodes of bipolar disorder. J Abnorm Psychol. 1997;106:449–457.Google Scholar
26. Johnson, S, Winett, C, Miller, I. Life events, medications and bipolar I disorder. Journal of Bipolar Disorder. 1998;1:37–40.Google Scholar
27. Post, RM. Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry. 1992;149:999–1010.Google Scholar
28. Cutler, NR, Post, RM. Life course of illness in untreated manic-depressive patients. Compr Psychiatry. 1982;23:101–115.CrossRefGoogle ScholarPubMed
29. Bulzlaff, RL, Hooley, JM. Expressed emotion and psychiatric relapse: a meta-analysis. Arch. Gen Psychiatry. In press.Google Scholar
30. Miklowitz, DJ. Family risk indicators in schizophrenia. Schizophr Bull. 1994;20:137–149.Google Scholar
31. Vaughn, CE, Leff, JP. The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenia and depressed neurotic patients. Br J Psychiatry. 1976;129:125–137.Google Scholar
32. Leff, J, Vaughn, C. Expressed Emotion in Families: Its Significance for Mental Illness. New York, NY: Guilford Press; 1985.Google Scholar
33. Miklowitz, DJ, Simoneau, TL, Sachs-Ericsson, N, Warner, R, Suddath, R. Family risk indicators in the course of bipolar aflective disorder. In: Mundt, C, Goldstein, MJ, Hahlweg, K, Fiedler, P, eds. Interpersonal Factors in the Origin and Course of Affective Disorders. London: Gaskell Books; 1996:201–217.Google Scholar
34. Priebe, S, Wildgrube, C, Muller-Oerlinghausen, B. Lithium prophylaxis and expressed emotion. Br J Psychiatry. 1989;151:396–399.Google Scholar
35. O'Connell, RA, Mayo, JA. Flatow, L, Cuthbertson, B, O'Brien, BE. Outcome of bipolar disorder on long-term treatment with lithium. Br J Psychiatry. 1991;159:123–129.Google Scholar
36. Hahlweg, K, Goldstein, MJ, Nuechlerlein, KH, et al. Expressed emotion and patient-relative interaction in families of recent-onset schizophrenics. J Consult Clin Psychol. 1989;57:11–18.CrossRefGoogle ScholarPubMed
37. Miklowitz, DJ, Goldstein, MJ, Doane, JA, et al. Is expressed emotion an index of a transactional process? I. parents' affective style. Fam Process. 1989;28:153–167.Google Scholar
38. Strachan, AM, Feingold, D, Goldstein, MJ, Miklowitz, DJ, Nuechterlein, KH. Is expressed emotion an index of a transaclional process? II. patient's coping style. Fam Process. 1989;28:169–181.Google Scholar
39. Simoneau, TL, Miklowitz, DJ, Saleem, R. Expressed emotion and interactional patterns in the families of bipolar patients. J Abnorm Psychol. In press.Google Scholar
40. Dausch, BM, Miklowitz, DJ, Richards, JA. A scale for the Global Assessment of Relational Functioning: II. reliability and validity in a sample of families of bipolar patients. Fam Process. 1996;35:175–189.CrossRefGoogle Scholar
41. Group for the Advancement of Psychiatry (GAP) Committee on the Family. Global Assessment of Relalional Functioning (GARF): I. background and rationale. Fam Process. 1996;35:155–172.Google Scholar
42. Falloon, IRH, Boyd, JL, McGill, CW. Family Care of Schizophrenia: A Problem-Solving Approach to the Treatment of Menial Illness. New York, NY: Guilford Press; 1984.Google Scholar
43. Marlatt, GA, Gordon, JR. eds. Relapse Prevention. New York, NY: Guilford Press; 1985.Google Scholar
44. Frank, E, Prien, RF, Jarrett, RB, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorde: remission, recovery, relapse, and recurrence. Arch Gen Psychiatry. 1991;48:851–855.Google Scholar
45. Weeke, A. Causes of death in manic-depressives. In: Schou, M, Stromgren, E. eds. Origins, Prevention and Treatment of Affective Disorders. London: Academic Press; 1979;289–299.Google Scholar
46. Miklowitz, DJ, Frank, E, Geoige, E. New psychosocial treatments for the outpatient management of bipolar disorder. Psychopharmacol Bull. 1996;32:613–621.Google ScholarPubMed
47. Goldstfin, MJ, Miklowitz, DJ. Family intervention for persons with bipolar disorder. In: Hatfield, AB, ed. Family Interventions in Mental Illness. San Francisco, Calif: Jossey-Bass; 1994;23–35.Google Scholar
48. McFarlane, WR, Lukens, E, Link, B, et al. Multiple-family groups and psychoeducation in the treatment of schizophrenia. Arch Gen Psychiatry. 1995;52:679–687.Google Scholar