Should family be involved in managing bipolar I?

What are the benefits of helping patients to feel that they're involved in their own treatment?

I think one of the great beneficial changes in medicine and mental healthcare has been to include patients, service users and carers much more in the whole process, from the design of services to research. We certainly do this in my service and it’s done widely in different parts of the world and it’s difficult to think of a downside to this. Of course the people involved have got to be representative and there’s a responsibility for those service user representatives and carers to actually be aware of that but I think involving people and sharing knowledge about the illness for bipolar disorder is particularly helpful. I've been involved in a number of patient organisations and self-help groups and the people are really very keen to learn as much as possible about the illness and sometimes very quickly can become very expert and sometimes more expert than their doctors.

What do you feel specifically is the role of the family and the carer in diagnosis of mania with depressive symptoms?

It's long been standard teaching practice at Maudsley hospital where I work that one should get a full history not only from the person involved but also from a significant other and indeed as wide a history as possible and this can be very important because it can provide other important information which is often more important in bipolar disorder than in other illnesses. Bipolar disorder is multi-phasic where you may present with depression in one episode and mania in the next, mania with depressive symptoms and so on and so forth and sometimes the history of the past can be lost in the turmoil of the present so people who are depressed for example can forget ever having an elevated episode of mood. So as full and complete a history as possible and getting one from relatives is very important often very simple judgements such as is the person well or are they qualitatively different from their normal self is important.

Can you just tell us in a few words why you think it might be helpful for the family to be involved in the process?

Absolutely, I think involving the family in the process is usually very helpful. There is the occasional time when patients don't want the family involved or they may not want the family involved for the whole interview but generally involving the whole family and making them feel involved is beneficial. It's been pointed out by patients, service users and families that bipolar disorder isn't just an isolated illness that affects the individual but it effects all of the person's family, loved ones, contacts and so on and so forth. When people have mania with depressive symptoms they can become paranoid and can suspect that their loved ones are not really their loved ones and they can be sometimes hostile and aggressive to the people who they’re closest to because of the effects of the illness and I think understanding that is very important from the family's point of view so that they can understand the inherent nature of this illness and how to try and help the person with it.