Bipolar Disorders (David S. Janowsky, Section Editor)

Current Psychiatry Reports

, Volume 13, Issue 6, pp 504-512

Functional Impairment, Stress, and Psychosocial Intervention in Bipolar Disorder

  • David J. MiklowitzAffiliated withDivision of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Behavior, David Geffen School of Medicine at UCLA Email author 

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Abstract

The longitudinal course of bipolar disorder (BD) is highly impairing. This article reviews recent research on functional impairment in the course of BD, the roles of social and intrafamilial stress in relapse and recovery, and the role of adjunctive psychosocial interventions in reducing risk and enhancing functioning. Comparative findings in adult and childhood BD are highlighted. Life events and family-expressed emotion have emerged as significant predictors of the course of BD. Studies of social information processing suggest that impairments in the recognition of facial emotions may characterize both adult- and early-onset bipolar patients. Newly developed psychosocial interventions, particularly those that focus on family and social relationships, are associated with more rapid recovery from episodes and better psychosocial functioning. Family-based psychoeducational approaches are promising as early interventions for children with BD or children at risk of developing the disorder. For adults, interpersonal therapy, mindfulness-based strategies, and cognitive remediation may offer promise in enhancing functioning.

Keywords

Functional impairment Stress Bipolar disorder Expressed emotion Psychosocial treatment Psychosocial intervention Family therapy Interpersonal and social rhythm therapy Cognitive-behavioral therapy Mindfulness Vocational functioning Cognitive remediation