Commentary: Patients' Caregivers Deserve Our Attention

By Galynker, Igor; Briggs, Jessica | Clinical Psychiatry News, December 2013 | Go to article overview

Commentary: Patients' Caregivers Deserve Our Attention


Galynker, Igor, Briggs, Jessica, Clinical Psychiatry News


It is impossible to underestimate the extent to which bipolar disorder affects the family members and caregivers of our patients.

First of all, bipolar disorder has a strong genetic component. Up to 67% of children with at least one affected parent will go on to develop an affective disorder (Bipolar Disord. 2001;3:325-34; Bipolar Disord. 2006;8:710-20). In bipolar disorder, multiple neurotransmitter systems as well as the limbic corticostriatal systems are dysfunctional. The dysfunction of the latter is manifested by increased activity in the amygdala and decreased activity in frontal cortical regions (Annu. Rev. Clin. Psychol. 2006;199-235), which might impair the brain's capacity to regulate emotion. The extremely high prevalence of affective disorders in the children of affected parents might be attributable to this dysfunction.

Second, bipolar disorder affects the family members and caregivers of patients through the family environment. About 90% of family members of patients with bipolar disorder experience subjective burden (for example, feelings of emotional distress) that correlates with the severity of the patient's illness symptoms (Bipolar Disord. 2007;9:262-73). Family members with higher subjective burden are less likely to practice appropriate health behaviors and, as a result, are in poorer physical health than are family members of patients without mental illness.

Because of this high subjective burden and other factors such as objective (financial) burden, stigma, and turmoil in bipolar families, family members of patients with bipolar disorder exhibit high rates of depression, anxiety, and other psychiatric symptoms.

Also since these depressed or anxious family members usually appear in psychiatrists' offices in their caregiver roles for their relatives with bipolar disorder, their psychiatric disability is often either unappreciated or unnoticed by clinicians (Bipolar Disord. 2010;12:627-37).

This is unfortunate, because rates of psychiatric disability in family members of patients with bipolar disorder are high (J. Affect. Disord. 2010;121:10-21). Specifically, up to 40% of caregivers qualify for more than one current psychiatric diagnosis, while 60%-80% had at least one lifetime psychiatric diagnosis. Of note, nonbiological relatives had substantially higher rates of psychiatric disability than did biological relatives, indicating that partners of patients with bipolar disorder were more likely to have a familial mental illness themselves. This indicates that patients with bipolar disorder might tend to choose partners who also suffer from mental illness, a pattern known as assortative mating. …

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