Psychological Interventions for the Management of Bipolar Disorder

Abstract

Background: Bipolar disorder is a chronic relapsing and mostly severe psychiatric disorder accompanied with a significant psychiatric comorbidity, considerable role impairment, and significant risk of suicide attempts according to recent researches. Mood stabilizers and antipsychotic medications have proved to be effective in managing symptoms for many patients. Nevertheless, medication noncompliance for some patients is a raising concerns. Additional risk for increased symptom severity and relapse when subjected to high levels of psychosocial stress, such as living in a negative family environment has also been reported. Psychosocial treatments, such as cognitive-behavioral therapy (CBT) and family-focused therapy (FFT) were hence introduced in hope of an integrated strategy for the management of bipolar disorder. Objective of the Study: This article is intended to review the optimal approach for the management of bipolar disorder. Advances in biopsychosocial treatments are also briefly reviewed, including new health service models for providing care. Methods: Electronic search in the scientific database from 1960 to 2017– The studies in this comprehensive review were selected for inclusion based on clinical relevance, importance, and robustness of data related to diagnosis and treatment of bipolar disorder. The search terms that were initially used on MEDLINE/PubMed and Google Search terms included “bipolar disorder,” “mania,” “bipolar depression,” “mood stabilizer,” “atypical antipsychotics,” and “antidepressants.” High-quality, recent reviews of major relevant topics were included to supplement the primary studies. Results: Bipolar disorder is a major public health concern. Management includes a lifetime course of medication and attention to psychosocial issues for patients and their families. Standardized treatment guidelines for the management of acute mania have been developed. New potential treatments are being investigated. Conclusion: Bipolar disorder have a very dynamic and chronic nature and thus, careful selection of a treatment should be tailored to the phases of the disorder, together with the safety profile identified in clinical trials. Nevertheless, Psychosocial interventions, such as CBT and FFT should be employed in combination with pharmacological therapy for bipolar patients in order to increase medication compliance, decrease depressive symptoms and recognize early warning signs of an affective episode should ideally help to optimize the course and outcome of this devastating condition.