Family's View of Bipolar Disorder Affects Outcome

Article excerpt

BOSTON -- Family-focused therapy is an effective adjunct to pharmacologic treatment in the stabilization and maintenance of patients with bipolar disorder, David J. Miklowitz, Ph.D., said at an industry-sponsored symposium held at the American Psychiatric Association's Institute on Psychiatric Services.

"There's a great need for patients and family members to be on the same page after an acute episode," said Dr. Miklowitz, professor of psychology and director of clinical training at the University of North Carolina, Chapel Hill.

It's crucial for family members to understand bipolar disorder, recognize the triggers and early warning signs of a newly developing acute episode, and understand the need for ongoing pharmacotherapy, he said at the symposium, which was sponsored by AstraZeneca.

Previous data from his group suggest that relapse among bipolar patients was more likely if their family members demonstrated critical, hostile, or highly emotionally overinvolved attitudes toward them. Such family members tend to believe that the patient is more capable of controlling bipolar disorder symptoms than he or she may actually be (Arch. Gen. Psychiatry 45[3]:225-31, 1988; J. Abnorm. Psychol. 109[4]:792-6, 2000).

"Family members often assume that the patient is doing it on purpose. This attitude might be amenable to modification," he said.

Family-focused therapy (FFT), developed by Dr. Miklowitz and his former associates at the University of Colorado at Boulder and the University of California, Los Angeles, is designed to educate relatives and patients about bipolar disorder. The program, made up of 21 outpatient sessions over a 9-month period, involves three critical elements:

1. Psychoeducation about bipolar disorder, including symptoms, early recognition, treatment, and self-management.

2. Communication enhancement training, involving role-playing of effective speaking and listening strategies. …

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