Academic journal article Indian Journal of Psychiatry

Management of Bipolar Disorders in Women by Nonpharmacological Methods

Academic journal article Indian Journal of Psychiatry

Management of Bipolar Disorders in Women by Nonpharmacological Methods

Article excerpt

Byline: Sujit. Naik

Several reasons justify the need for nonpharmacological interventions for bipolar disorder (BD) in women. This review focuses on psychosocial therapies for BDs in women. The research evidence for a wide range of psychosocial interventions for the management of BDs in women has been presented. All the interventions have some common components like targeting disease management, information regarding illness, and coping skills. There also are distinctive features like cognitive restructuring and self-rated mood charts in cognitive behavior therapy, regulation of sleep/wake cycles and daily routines in interpersonal sleep regulation therapy, and communication skill training in family treatments. Many psychosocial interventions hold promise as adjunctive therapies for bipolar patients. In India, there is a considerable dearth of literature in this area due lack of skilled staff for psychosocial interventions. Future trials need to: Clarify which populations are most likely to benefit from which strategies; identify putative mechanisms of action; systematically evaluate costs, benefits, and generalizability of effects, and record adverse effects.

Introduction

The emergence of medical model of treatment for bipolar disorder (BD) for more than three decades has led to various somatic interventions, including pharmacologic agents and nonpharmacologic interventions such as electroconvulsive therapy, magnetic seizure therapy, magnetic stimulation, bright light therapy, sleep deprivation, and psychosocial interventions. These are documented to be efficacious in treatment. This review focuses on the psychosocial interventions because there is growing interest in the field evident by increasing number of studies providing support for their efficacy in improving the outcome of bipolar illness.

Is there a need for psychosocial interventions?

The need for psychosocial interventions for BD arose due to the following reasons:

*Despite treatment, up to half of the patients did not achieve recovery from an acute episode [sup][1] *Up to half of the recovered patients experienced recurrences during a 2-year follow-up [sup][1] *A significant population of women with BD (37% during pregnancy and 14% during both pregnancy and postpartum) experience mood episodes [sup][2] and the risk of relapse is up to 61.5% in women not receiving prophylactic treatment following 3 months after delivery [sup][3] *There is incomplete inter-episodic recovery and marked impairment with only 25% achieving full recovery of function [sup][4] *Adding to this, is the problem of poor compliance with treatment which is shown by the finding that only about 40% of patients are fully adherent to medication regimens in the year following the episode [sup][5] *The course of BD is strongly affected by life events, [sup][6] life stress, [sup][7] social support, [sup][8] expressed emotion (EE) [sup][9] and modulation of these factors are likely to result in better outcome *Mixed episodes and rapid cycling are more common in women which are difficult to manage even with available medications [sup][10],[11] *The decisions regarding the treatment of BD during pregnancy must balance the risks associated with untreated depression or mania versus possible teratogenic effects of mood-stabilizing medications. [sup][12] *A study reported 35% of affected participants having a strong family history of BD were "not willing to have children" or "less willing to have children" as a result of perceived stigma [sup][13] *The estimated cost of BD in 1991 in the USA was estimated to be [pounds sterling]45 billion and [pounds sterling]2 billion in a study in the United Kingdom (UK). [sup][14],[15] Although limited work has been carried out in India on the economic burden of mental illness, a study of small sample of BD in the urban area found that the costs incurred for medicines and consultations for patients were Rs. 558 and the caregiving costs varied from Rs. …

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