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Bipolar Disorder Treatment: What do you need to know? 

bipolar disorderBipolar 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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