Bipolar I patients need allies

“The family is now seen as a strong ally. Partners and family often take part in our treatment and we all see this as a good direction,” said clinical psychologist Dr David Miklowitz, Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute and a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University, at the International Society of Bipolar Disorders (ISBD)* 2015 in Toronto, Canada.

‘Engaging families in the treatment of bipolar disorder’ was the topic of one of the opening sessions at ISBD 2015 on the first full day of the conference. Within the session, it became quickly apparent that both the audience and the speakers were strongly committed to the positive effects of involving family in the management of bipolar disorder. This is a strategy potentially of particular importance in bipolar I in which the danger of attempted suicide is a high risk during mixed states of mania with depression.¹

Muffy Walker, chairman and co-founder of the International Bipolar Foundation and psychiatric nurse, is also a mother of a son who struggles with bipolar disorder. Explaining the history of her challenge as one embraced as a family unit which includes her husband and two other children, Walker said: “We have all been involved in my son’s bipolar disorder from very early on so that we could understand what he was going through and how we could help and this included all of us understanding his condition and his medications regimen. As his disease progressed so did our need for updated information. We also shared what we knew with my son’s friends so that they could help to spot the warning signs and understand his behaviour. It was vital for all of us to do this and my son’s bipolar has been managed all the better for it,” said Walker.

Next to speak was Daniel Farb, a peer support worker in the Family Matters Program at the Mood Disorders Association of Ontario (MDAO). The MDAO assists individuals with mood disorders in communicating effectively with family members as part of their own recovery, and on helping family members maintain wellness while supporting a relative with mood difficulties.

Farb has piloted a “Dealing with Family” program for individuals with chronic and recurrent mood disorders to help strengthen family relationships, talk about self-stigma and shame, and develop assertiveness and self-advocacy skills.

Avoiding exacerbating symptoms

“Mental health issues are family issues. This doesn’t happen in isolation, it affects the entire family. Family members often don’t know how to respond or how to deal with a loved one experiencing mental health challenges. Families can be a powerful support in their loved one’s recovery but they can also sometimes contribute to or exacerbate problems,” said Farb.

Statements such as “snap out of it” or “get over it” are classic mistakes that families need to avoid as well as trying to control the person with bipolar disorder and tell them what they should do. Highlighting some of the things family members should do, Farb listed the following:

• Check in with the other person and ask how they’re doing
• Express your observations and concerns (in a non-judgemental manner)
• Ask them what they need and enquire if there’s anything you can do to help
• If they are open to it, provide options for support, recovery and treatment
• Do your best to be compassionate, patient, and understanding

Carer burden

The session ended with an overview of family focussed treatment by Miklowitz. All immediate family members are included, and therapy consists of several stages, beginning with psychoeducation about the symptoms and etiology of bipolar disorder and the need for medication adherence. Families are taught to respond early to emergent symptoms, and provided with training about the best coping responses. Then, drawing on the evidence that overly negative family interactions (expressed emotion) can trigger relapse of bipolar disorder, families learn communication and problem-solving skills for reducing conflict and resolving family problems. Treatment typically consists of 12 to 21 sessions over 4 to 9 months.