Current Topic Review: Psychosocial Treatment of Bipolar Disorder

Elizabeth Steinhauer, MA, MD, FRCP(C)

Disclosures

June 23, 2003

In This Article

Interpersonal and Social Rhythm Therapy

Interpersonal and social rhythm therapy (IPSRT) was developed specifically for the treatment of bipolar disorder. It is based on the observation that disruptions of circadian rhythms and sleep deprivation may provoke or exacerbate affective symptoms. It combines interpersonal principles with behavioral techniques, such as self-monitoring, to help bipolar patients maintain regular routines of eating, sleeping, and daily activities. When combined with pharmacotherapy, this formalized therapy has been demonstrated to achieve gains in targeted lifestyle regularities, reduce manic and depressive symptoms, and increase days of euthymia. Withdrawal of IPSRT has been associated with significantly higher relapse rates.[18] It may reduce suicidal behavior in high-risk bipolar patients.[19] However, IPSRT was not associated with a faster recovery from either manic [20] or depressive episodes.[21]

It is universally accepted that bipolar disorder often disrupts family life and that family interactions can aggravate the course of bipolar illness. Families with high expressed emotion increase the propensity for poor outcomes in bipolar family members. Family-focused treatment in addition to pharmacotherapy has been shown to decrease depressive relapse rates when compared with controls receiving treatment as usual.[22] Other trials have demonstrated that family or marital treatments that combine psychoeducation, enhancement of problem-solving, and communication style substantially improve treatment adherence and overall functioning.[23]

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