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Bipolar disorder
treatment: What do you need to know?
 Bipolar
disorder treatments are usually categorized as acute or directed
toward maintenance. Acute bipolar disorder treatments are more geared
toward resolution of specific episodes and maintenance programs are
more directed toward preventing future episodes. Treatments for
bipolar disorder can also be considered along several other lines such
as intervention, psychotherapy and intensity, which includes a
division into whether either inpatient or outpatient treatment is
necessary. Even the treatment intensity aspect may often be blurred,
as outpatient programs of several intensities such as partial hospital
programs and intensive outpatient programs, are now considered viable
options for bipolar disorder treatment.
As a general rule
of thumb, a higher level of intensity and structure is used (such as
full or partial hospitalization) if individuals are more likely to
hurt themselves or others. Also of consideration, is whether other
mental disorders or general medical conditions would make outpatient
management dangerous, or if more aggressive management is desired and
is not easily available on an outpatient basis. Another important
consideration although it is not frequently discussed, is that social
factors play an important role in the decision to hospitalize an
individual with bipolar disorder in the real world. Of consideration
would be whether an individual has adequate social support to assist
with the individual being compliant with their medication regimen.
Also of consideration should be whether there are social stresses
aggravating symptoms and making compliance difficult such as living in
a hostile living situation, or even whether transportation is
available to frequent outpatient appointments during an acute illness
phase. Unfortunately, in this era of managed care, a person's
insurance plan may cover inpatient but not outpatient mental health
treatment, which may force the individual into expensive inpatient
care while a less costly, time-limited intensive outpatient program
would be sufficient treatment for bipolar disorder.
Bipolar disorder
treatments can also be categorized according to their goals.
Treatment may be focused on improving clinical outcomes (symptoms and
episodes) or more functional outcomes (occupational or social
functioning, or health-related quality of life). Although this
appears to be straightforward it is frequently not quite so obvious.
For example, it may be an erroneous assumption to assume that the
option of focusing on symptoms would be strictly related to
pharmacotherapy and that a functional outcome would be the goal of
psychotherapy. It is obvious that stabilization related to
medications will also contribute to improve role functioning. Also,
treatments that improve one domain may also cause reduced functioning
in another. For example, effective maintenance with the medication
lithium may cause hand tremor, which then may have a negative effect
on an individual's work functioning, or cause embarrassment in social
situations.
Balancing the
costs and benefits of specific bipolar disorder treatments require us
to have the active participation of the individual with bipolar
disorders as well as their family. Psychoeducation, social support
and building alliances to maintain medication compliance are all
important bipolar disorder treatment goals.
From DSM-IV-TR Mental
Disorders: Diagnosis, Etiology and Treatment by Michael B. First and
Allan Tasman
Additional information and
webpage by
Paul Susic MA Licensed Psychologist Ph.D Candidate
(Health Psychology)
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