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Therapy of bipolar disorders

What therapies are available – A review

For bipolar patients, being a person is more strenuous than everything else. Their reaction to unfortunate experiences varies; the momentum of the soul, body and social environment may be clearer than for others. Accordingly, the therapy must also be quite varied.

bildThe medical treatment does not suffice as a rule. Therapeutic work on relationships can help to stabilise one's own self-esteem and the search for significance. It can help to investigate external expectations and to develop one's individual standards. It is imperative, here, that the person affected receive separate as well as integrational support, simply because close relatives run the risk of becoming involved in these dynamics. To leave them unnoticed is tantamount to malpractice.

Especially for bipolar disorders, it is not sufficient to merely carry out psychoeducational work. Psychotherapeutic individual and/or group therapies are all equally important to a treatment with medications. The group therapy represents the particular problem in this balance: In the group, patients can learn to understand their own phases better, so to speak as a reflection in the mirror of the others, and to thereby relativise and to stabilise themselves.

The therapeutic work should have an interdisciplinary structure, and patients should therefore be accompanied regardless of the state of their therapy. Only in this way can a complete perception be carried out successfully, and only in this way can an integration of the extremes be furthered and thereby be pushed toward a tendency near the middle.
A therapy should be begun as soon as possible. That is the case for the first bipolar phase as well as in cases of a renewed bipolar episode, that is to say, in the case of a relapse. According to the diverse momentum, it primarily involves a combination of psychological, social and medical therapies.

Knowledge concerning the individual therapeutic building blocks

1. Psychotherapy cannot be replaced by medication, although it is indispensible, because of the special psychological momentum of bipolar disorders, especially because of the

  • possible expression of an excessive adaptation of other guidelines, without having sufficiently developed one's own standards,
  • risk of self-invalidation in overcoming the depressive pattern,
  • problem involving disturbances in the perception of time, which can increase the distress during the depression and the irresponsibility during the mania.

2. Medication cannot replace psychotherapy, although it is important because of the special somatic momentum associated with the danger of a renewed phase.

  • Counteractions must be made against this, primarily through the early use of mood stabilisers and through an effective and tolerable therapy.
  • A continuous therapy with medication generally presupposes a therapeutic relationship.

3. Social experiences can influence the course of an illness and either have a favourable or unfavourable effect on healing. Here as well, the risk of a special social momentum must be taken into consideration.

  • Close relatives and acquaintances should be considered and supported independently so that they don't get pulled into the whirlpool and can provide support themselves.
  • Clarification against general and specific prejudices is necessary in order to reduce unfounded fears and to increase the chances for integration into the system.

Integrated care

In a phasic illness with times of stability and crises, the integration and continuity of the care becomes a particular challenge and a necessity:

  • Specific psychotherapeutic groups should primarily be laid out in an interdisciplinary manner so that ambulatory and stationary procedures are both available.
  • For the medication, continuity and flexibility must exist, so that a rapid change can be carried out.
  • The regulation of the beginning phases can be made to a greater degree than had been thought possible to date. Here, self-help and professional support must work together better.
  • The routine treatment by psychiatrists and psychotherapists in private practices is made all the more possible to handle the load, since additional resources are available, e.g. including the emergency services of institutions, which are able to react quickly in times of crises. Here, it appears to be especially beneficial to develop regional networks to handle the load.
  • The treatment of bipolar patients without involving individuals in their environment, and especially close family members, must be considered a professional error.

The following, frequently employed therapies are available

Medicinal therapies

  • These are primarily performed with so-called mood stabilisers (phase prophylactics), but also with the use of other medications, for the most part with antipsychotics, antidepressants, benzodiazepines and hypnotics.

Psychosocial therapies: Psychological individual and group therapies

  • Psychoeducation
  • Cognitive behavioural therapy (CBT)
  • Rhythm therapy
  • Depth psychological procedures, person-centred therapy
  • Addiction therapy

Biological therapies

  • Sleep deprivation therapy

Other therapies

  • Family therapy
  • Ergotherapy and work therapy
  • Sociotherapy
  • Social competency training (SCT)
  • Metacognitive training (MCT)
  • Art therapy
  • Dance therapy
  • CogPack
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