Bipolar Disorder in Young Women

Quantitative Research Questions: In young women with bipolar disorder. What is the likelihood of family intervention, cognitive -behavioral therapy, and psychoeducation or psychotherapy be more effective treatment than with psychotropic medication? Alternatively, Can Family intervention, psychotherapy, and cognitive -behavioral therapy be more effective in the treatment of young women diagnosed with bipolar disorder than psychotropic medication?

The qualitative research questions what is the experience of using psychotherapy, cognitive- psychotherapy and family intervention different from treatment with medication in young women diagnosed with bipolar (11- 45 years old.

Bipolar Disorder in Young Women

Introduction

Bipolar disorder presents a very challenging condition to treat, especially in women. It is often characterised by an increased degree of mixed episodes. In many cases, the process of recovery from the bipolar disorder is greatly affected mainly as a result of medical and psychiatric co-morbidity in women. It is worth mentioning that these co-morbidity effects are more frequent in women, and include disorders such as obesity, migraine, anxiety, and thyroid disease. Also, whereas pregnancy and lactation periods present significant challenges in the treatment of Bipolar Disorder, study findings have revealed that pregnancy neither protects, nor aggravates Bipolar Disorder. 

Literature Review

This study reviews the work of Abigail K Mansfield, Jennifer A Dealy and Gabor Keitner who wrote a paper on ‘Family interventions for Bipolar Infections’. They recorded that pharmacotherapy is a treatment method that is widely and commonly used to treat bipolar disorder, Bird et al.(2010). This, however, is not what most patients solely depend on since it does not fully remit symptoms. They also recorded that family-based psycho-education is a more effective way of minimizing relapse of manic symptoms although more studies should be done to determine which types of interventions will be more effective in bipolar treatment.

Their findings on Problem-Centred systems therapy of the family (PCSTF) covered the efficacy for patients with bipolar disorder and their family members. The samples were 92 inpatients with current bipolar disorder I using the SCID III-R criteria combined with an inpatient psychiatrist’s evaluation. The age of these patients was between 18 and 65. The patients also had relatives or partners who were willing to participate in the research. These people were then picked at random for the procedures: PCSTF, pharmacotherapy and multifamily group psychoeducation, or maybe to pharmacotherapy alone. These multifamily group psychoeducation intervention took one and a-half months to provide them education on bipolar education, adherence to the medication and how one is supposed to respond to a patient’s bipolar episodes and techniques in which they could enhance communication about the disease within all family members.

This was followed by a 28-month period where outcomes such as mania severity and depression; family functioning; functional impairment and social support. Their results did not show any group differences in the severity of the symptoms. Patients who had received pharmacotherapy alone, however, experienced a smaller number of depressions recurrences for the patients who came from families that had high levels of baseline dysfunction (Anderson et al., 2012). This was within the follow-up period in both of the family interventions groups. They also experienced the episodes for a shorter period. It is also important to note that attrition was relatively high in this study with 34% of participants in who had pharmacotherapy alone. The patients in PCSTF had 36% while the ones in the multifamily group psychoeducation had 33% dropping out within the six months active treatment phase with 51% who dropped out before the one-year assessment period.

Their findings from the psychoeducation of patient’s relatives were also carried out (Lauder et al., 2010).  They carried out four studies on them. One study had 14 spouses of these patients as diagnosed by two independent psychiatrists using the DSM-III-R criteria took part in sessions for psychoeducation. 12 of these spouses received no treatment but completed questionnaires. For the psychoeducation sessions that were focused on education about bipolar disorder, early symptoms identification and education about agents of pharmacology and data about enhancing satisfaction in life, (Bodén et al., 2012). This study was carried out in 12 months.

The results of this research included adherence to medication, finding solutions for problems and knowledge on bipolar disorder, lithium pharmacology and severity of symptoms. This research found that partners in the intervention group had more knowledge about social strategies, lithium pharmacology as well as bipolar knowledge that the partners who were in the control group. The findings of the intervention of symptoms of bipolar were not clearly shown, (Crump et al., 2013).

In a different study, 52 participants who had bipolar I or II as determined by diagnosis of referring psychiatrist, had diagnoses in medical records and family members’ reports took part in a research of multifamily group psychoeducation in Netherlands, (Brietzke et al., 2011). The main results were family levels of the emotions they expressed. They indicated that the treatment group had larger reductions in their expressed emotions than those in the wait-list control group. These observations of lower expressed emotions were as a result of lower hospitalization rates but it was not very clear if the intervention groups visited hospitals less than those in the control group.

Conclusion

Eventually, from the research, we can get the general idea that family intervention, cognitive-behaviour therapy and psychoeducation is more effective compared to psychotropic medication. This can be seen in the findings from the above studies, especially the second study where the participants in the intervention group had more knowledge about social strategies, lithium pharmacology as well as bipolar knowledge of the partners who were in the control group.

References

Anderson, I. M., Haddad, P. M., & Scott, J. (2012). Bipolar disorder. Bmj, 345, e8508.

Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., &Kuipers, E. (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. The British Journal of Psychiatry, 197(5), 350-356.

Bodén, R., Lundgren, M., Brandt, L., Reutfors, J., Andersen, M., &Kieler, H. (2012). Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. bmj, 345, e7085.

Brietzke, E., Moreira, C. L., Toniolo, R. A., &Lafer, B. (2011). Clinical correlates of eating disorder comorbidity in women with bipolar disorder type I. Journal of affective disorders, 130(1-2), 162-165.

Crump, C., Sundquist, K., Winkleby, M. A., &Sundquist, J. (2013). Comorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA psychiatry, 70(9), 931-939.

Lauder, S. D., Berk, M., Castle, D. J., Dodd, S., & Berk, L. (2010). The role of psychotherapy in bipolar disorder. Medical Journal of Australia, 193, S31-S35.

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