When you were diagnosed as bipolar, what information did you get from your doctor? If you changed your treatment, were you well informed about the reasons for the change, the side effects, or the type of treatment? Were you involved in decision making?
In short, do you have the impression of being an actor in your disease, of being considered as a partner by your doctor?
Personally, I realized that 25 years after his diagnosis, my father was unaware that there were different types of bipolarity, and therefore had never been informed what type he was suffering from.
This testimony is recurrent, and shows how the importance of informing the patient has not yet entered psychiatric culture.
However, it is a fundamental right to be informed as a patient about their illness. In France, it has been a legal obligation since 2002 that the patient be informed of his disorder, its consequences, treatments and effects.
In addition, it has been shown that in patients receiving appropriate drug therapy, relapse rates remain very high. One year after a manic episode, the relapse rate is around 50% and 70-85% at 5 years without treatment. With pharmacological treatment, the relapse rate at 1 year is approximately 40% and approximately 75% at 5 years. The differences in relapse rates are therefore very small. In addition, patients have residual symptoms between thymic episodes in...% of cases.
Relapse factors?
The relapse factor best identified by psychiatrists is the lack of adherence to treatments, which are particularly high in populations with bipolar disorders (...). Indeed, the significant side effects of medications can push patients to stop their treatment.
But even with good adherence to treatments, relapse rates remain very high.
Environmental stress (life events, surroundings, arguments) can quickly generate relapses, as well as the disruption of the rhythm of life (sleep, travel, etc.) and the consumption of stimulants (alcohol, coffee, drugs, etc.) and the consumption of stimulants (alcohol, coffee, drugs and other pleasures).
In this context, the importance of disease education and the change in lifestyle habits appear to be essential. There was clearly a lack in this area in the therapeutic arsenal.
For this reason, researchers were interested in psychoeducation, a complementary treatment that has been proven to be effective for schizophrenia and bipolarity.
This term was used in 1980 by Anderson, Hogarty, and Reiss, in the field of schizophrenia. The purpose of psychoeducation was to better control stressful situations by family members through better communication and to develop strategies to solve life problems.
For schizophrenic patients receiving individual therapies and drug therapy, or drug therapy alone, the relapse rates over a year were 30-40%. Whereas for those participating in a family psychoeducation program, this rate was only 15%. Psychoeducation has therefore slowly been seen as an interesting complement to medication.
Since the end of the 1990s, the use of psychoeducation has then been extended to other psychological disorders such as eating disorders, bipolar disorders, panic attacks and agoraphobia or post-traumatic stress.
Psychoeducation is a therapeutic approach that does not focus on diagnosis, prescriptions, or treatments but on setting goals, transmitting skills, patient satisfaction, and reaching their goals. [^6]
[^6]: Authier, 1977
Psychoeducational interventions are diverse and can be practiced by professionals from different disciplines or by peer helpers. They can be carried out with people suffering from psychological disorders or their loved ones in individual or group sessions.
The concepts taught generally relate to the natural evolution of disorders, the treatments available, the management of crises, the establishment of boundaries for loved ones and the search for social support in the community.
They have in common a foundation for educating the patient about the disease.
Since 1998, WHO has issued recommendations on patient education, specifying the definition of:
“Therapeutic patient education is an ongoing process that is integrated into care and patient-centered. It includes organized awareness-raising, information, learning and psychosocial support activities that relate to the disease, prescribed treatment and care facilities, as well as the health and illness behaviors of the patient. It aims to help the patient and their loved ones to understand the disease and the treatment, to cooperate with caregivers, to live as healthy as possible and to maintain or improve the quality of their life. Education should enable the patient to acquire and maintain the resources needed to optimally manage their life with the disease.”
Education is the necessary prerequisite for any psychoeducation program, as it is the theory on which practical learning is based. This phase lasts an average of X sessions.
It also makes it possible to improve the self-esteem of patients by considering them as capable of understanding and acting for their well-being.
There are three types of psychoeducation programs:
Cognitive-behavioral therapy consists in identifying negative thoughts and maladaptive behaviors in order to replace them with thoughts and reactions that are in line with reality.
The two main models in behavioral and cognitive therapies for bipolar disorders are individual programs and group therapies.
They were the first to combine educational and therapeutic tools into a program. It consists of 20 individual sessions, divided into 4 phases:
This program is based on the stress-vulnerability model. It is followed in groups of about ten people and includes twenty sessions, spread over 3 months. The therapy consists of 3 phases:
The effectiveness of this method has been proven through several studies, including “Relapse Prevention in Patients With Bipolar Disorder: Cognitive therapy Outcome after 2 Years” in 2005.
The use of TCCs makes it possible to ensure:
Along with the application of behavioral and cognitive therapy and psychoeducation, another major intervention specific to bipolar disorder emerged in the 90s: interpersonal therapy, supplemented a few years later by social rhythm therapy (Frank). et al., 2000).
As seen in one of the previous articles on the inheritance of bipolarity, the disease causes a genetic vulnerability with complex transmission whose genes are not yet clearly identified. However, it is certain that the neuromediators involved in bipolar disorders (serotonin, dopamine, noradrenaline, GABA) are also involved in chronobiological systems (= biological clocks) and the circadian system.
It is therefore important for any bipolar person to understand their rhythms and to monitor them to limit relapses.
This form of therapy focuses on the patient's interpersonal difficulties and chronobiological rhythms, in order to regulate them. It lasts about 24 sessions and should ideally start during the acute episode.
It has 3 phases:
This program, developed by M. Bauer and L. McBride in 1996, is a structured group therapy designed for bipolar patients, based on cognitive and behavioral theories and problem-solving techniques.
The program is composed of two phases:
Across 8 studies, there was a 40% reduction in the relapse rate in bipolar patients following a psychoeducation program, compared to those following only pharmacological treatment.
However, there is no clear difference in effectiveness between the various programs.
It is therefore at the discretion of the psychiatrist or the patient that the type of program can be chosen, in particular according to the patient's problems. For example, family therapies will not be suitable for patients living alone.
In most psychoeducation studies, patients are recruited while they are euthymic. But there are still a lot of questions to know which patients this or that therapy will be the most suitable for, and especially when it will be most effective to do so. Can this be done during a depressive phase for example? If not, how long has it been in the euthymic phase? Is it also effective for type 1 or 2 bipolarity?
Now there is the question of access to these programs. This will be the subject of a future article.
http://www.psychosocial.com/IJPR_11/Theories_Mech_Benefits_PS_Ed_Griffiths.html
Psychoeducation: definition, history, interest and limits (PDF Download Available). Available from: https://www.researchgate.net/publication/270968582_Psychoeducation_definition_historique_interet_et_limites [accessed Dec 14 2017].
