Address for correspondence: Dr. Muralidharan K, Medical Superintendent &
Professor of Psychiatry, National Institute of Mental Health and Neuro Sciences,
Karnataka, Bangalore- 560029, India
“People with bipolar disorder experience more suffering than most – they did not ask for it. Our job is to reduce their suffering, irrespective of what we call our medications and to find new treatments” – Nierenberg, 2017
The above statement aptly summarizes what clinicians must do for persons with bipolar disorder (BD). BD is a chronic mental health disorder characterized by pathological changes in mood varying from excessive happiness (mania) to extreme sadness (depression) that persists for weeks or months. The prevalence of BD is at about 1-2% of the general population. The national mental health survey pegged the prevalence of BD in the Indian population at about 0.5% which translates into 65 lakh individuals with this disorder, with a treatment gap of more than 70%. Suicide is fairly common in BD.
The challenges that clinicians face in treating BD include different polarity of mood episodes, frequent relapses and recurrences, incomplete recovery or remission, residual symptoms between episodes, presence of psychotic symptoms and comorbidities. An ideal mood stabilizer remains elusive despite newer additions to the treatment armamentarium, with lithium still being the mainstay of treatment. Non-adherence to treatment is the biggest challenge to treatment. From a patient perspective, the major challenges include denial or reluctance to accept the diagnosis, stigma, misconceptions about the illness, inadequate support from the health systems and poor awareness about the disorder among patients and their families leads to poor adherence.In addition, intolerance to side-effects also impacts treatment adherence negatively. The economic burden of the disorder is significantly high (Nestsiarovich, 2017).
Health education or psychoeducation is an important component of treatment in patients with BD. There is sufficient evidence that health education enhances recovery and improves treatment outcomes in BD. One of the earliest reports on group psychoeducation in 120 remitted BD subjects reported significantly reduced the number of relapsed patients and the number of recurrences per patient, and increased the time to depressive, manic, hypomanic, and mixed recurrences. The number and length of hospitalizations per patient were also lower (Colom, 2003). Group psychoeducation that focussed on caregivers also reduced the rates of recurrence for manic/hypomanic episodes (Reinares, 2008). Further, group psychoeducation was shown to reduce any recurrence and increase the time to recurrence of mood episodes over a five-year period (Colom, 2016).
A review article concluded that “psychoeducation, used alone or as a component of more complex interventions, makes it possible to improve the course of the illness, notably by increasing the patients’ and their families’ knowledge of the disorder and of treatment options, by decreasing the risk of (hypo)manic or depressive relapse and of hospitalization and by improving treatment compliance and psychoeducation should be part of the integrated treatment of BD”. It is with this objective of creating awareness about BD and its treatment, that world bipolar day is being observed every year on March 30. Let’s educate and empower our patients with BD.
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