Psychotherapy Of B.A.D

Introduction:

Bipolar Disorder can be regarded as a multidimensional phenomenon, involving a complex and dynamic interaction between biological and psychosocial factors.
It is clear that medication alone is not enough for adequate treatment of Bipolar Disorder. Medications can not alone, foster acceptance of chronic illness, it can not nurture anticipation, teach preventive strategies, or foster coping when those strategies failed, and it can not alone rebuild lives that have been thrown into choase because of an illness that affects judgment, insight and choice.

Social and Occupational Functioning are impaired and difficulties in these areas are often hamper the recovery process.

There are high rates of family dysfunction and marital difficulties that place stress not only on the patient but on the individual's social network as well.

Life events were shown to have a significant effect on the course of the disorder. There is often a considerable denial, and this may result in non-adherence to medical regimens. Every patient with Bipolar Disorder need to learn about the illness, its medications and side effects, early warning signs and symptoms and general management of time, sleep and structure against destabilization.

Treatment require that the therapist be flexible able to move between pharmacological and psychotherapeutic models, and be able to use a variety of psychotherapeutic techniques.

Although there has been resistance to treating Bipolar Disorder with psychotherapy in the past, because of its perceived biologic basis, recently it has been recognized that in combination with drug therapy, psychotherapy can assists patients compliance with drug therapy, psychotherapy can assists patients in adjusting to the illness, modify social risk factors, increase patient and family acceptance of the disorder and reduce suicidal risk.

The US Department of Veterans (VA) Guideline module for Depression recommended starting with an evaluation for on going psychotherapy and/or psychosocial rehabilitation at the same time that mood stabilizers are initiated or optimized.

Review of Studies:

There hasn't been enough research for us to know exactly what the effects of psychotherapy might be on the course of Bipolar Disorder.
Psychotherapy studies are very difficult to do, they are very expensive, and they take a long time to get results.

Zaretsky etal (1999) used CBT in the treatment of (11) patients with Bipolar Disorder. They found a significant reduction in depressive symptoms after a (20) CBT sessions.
Rucci and colleague found that psychotherapy appeared to enhance the effect of lithium in decreasing the rate of suicide attempts. (3-fold reduction during the acute phase and 17.5-fold decrease during the maintenance phase).
Scott and Colleagues found 60% decrease in relapse rate in patients treated with cognitive therapy.
Miklawitz and associates found that family intervention were more effective than crisis management.
Johsan and Miller: found that the recovery process was three times as long in individuals who reported the most server negative life events as compared with those who did not report significant negative events.
Hunt and Associates study: 2-year study more patients were noted to relapse if a negative event occurs in the month prior to the episode.
Terrie Mffitt (2004-Lancet-Neurology) findings reinforce the idea that mental illness can best be explained by interactions between genes and environmental factors, rather than either one alone.


Dr. Ahid Husni
Consultant Psychiatrist
Analytic Psychotherapist

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