|
| |
Saturday, June 14, 2003
"The Importance of Treatment
Alliance"
A Collaborative Approach to the Treatment
Alliance
Video | Audio
(Length: 18 min.)
Michael Berk, M.D., Ph.D.
Bibliography
M. Berk
University of Melbourne, Melbourne, Australia
Bipolar disorder has been understood as a primarily biological and genetic
disorder resulting in the need to establish a pharmacological basis for
treatment. Recent research into psychosocial risk factors highlights the
complexity of individual etiology and presentation. The importance of
psychosocial factors is highlighted when considering that despite medication,
bipolar disorder is a recurrent disorder in about 90% of sufferers and, the more
episodes one has the greater possibility of relapse. In addition, the
psychosocial morbidity (even between episodes), the financial burden and
mortality associated with bipolar disorder stress the urgent need to find
treatment variables that may influence course of illness and quality of life. An
initial qualitative study of consumers, careers and service providers stressed
the importance of the treatment alliance between doctor and patient. The
building of a collaborative treatment alliance which focuses on the patient as
an active participant and a person that is more that his or her diagnosis, is
considered to be an important treatment variable. The collaborative
treatment alliance locates the individual within the complex psychosocial arena
maximizing individual resources and minimizing risk factors. The approach to
progress is one of “collaborative empiricism” whereby medications and strategies
are tried out in the real world. This alliance is concerned with more than the
eradication of symptoms of illness. With the support and knowledge of the
clinician, the patient is encouraged to take responsibility for maintaining
his/her wellness and engaging in life within the limits of his/her illness. In
this process, self-regulation of illness facilitates increasing engagement in
life and psychosocial functionality enhancing quality of life. In turn, enhanced
psychosocial functioning and quality of life empower and motivate the
self-management of the illness. This collaborative treatment alliance is
operationalized in a study currently in progress. This project aims to develop,
pilot and evaluate a comprehensive integrated collaborative model of treatment
for people with bipolar disorder. The study itself involves a collaborative
research design whereby the initial qualitative study looks at establishing
psychosocial need areas related to the collaborative self management of bipolar
disorder from consumers, service providers and careers themselves. This
information is used together with the literature to inform the development of a
group collaborative therapy manual and collaborative treatment journal used in
follow up to maximize the benefits of the therapy. A randomized controlled
design will be used to evaluate this treatment on a range of outcome measures.
This approach highlights the collaborative relationship between the internal
therapeutic capacity of the patient, the treating clinician and significant
others, peers or careers.
Combining Medication and Psychoeducation for the
Prevention of Relapse in Bipolar Disorder
Video | Audio
(Length: 21 min.)
Eduard Vieta, M.D., Ph.D.
Bibliography
E. Vieta, F. Colom
University of Barcelona, Barcelona, Spain
Although genetic and biological factors are crucial in the pathophysiology of
bipolar disorder, the importance of psychosocial factors in triggering or
mitigating relapses warrants the implementation of psychotherapeutic
interventions. Furthermore, although medication is crucial for the long-term
outcome of bipolar illness, poor adherence remains a big problem in the
management of the disease. Psychoanalysis, psychoeducation, group therapy,
family therapy, cognitive-behavioral therapy, social rhythm and interpersonal
therapy have been used in the long-term treatment of bipolar patients. To date,
none have established efficacy on their own in controlled clinical trials
regarding hospitalization, recurrences or suicidal behavior, as medication alone
does. However, psychoeducation combined with several cognitive-behavioral
techniques, either in group or individually, have started to yield the first
positive results in high standard, controlled trials on the combination of
medication plus psychosocial intervention versus medication alone. These
approaches focus primarily on information, treatment compliance, early detection
of relapse, and illness management skills. They basically reinforce treatment
alliance between the patient and the treating team, and provide a sense that
everybody –the patient, the psychiatrists, the psychologists, nurses and social
workers- make their efforts to improve the outcome of the disorder and the
well-being of the patient.
Top of Page
|
