A
period of 1 year after an episode of BP, only 30% of individuals have returned to their
previous level of social and vocational functioning. Interpersonal relationships may be
damaged or lost as a consequence of behaviours during a manic episode and/or the
individual may struggle to overcome guilt or shame related to such acts. The above
psychological and social sequelae identify a need for general psychological support for an
individual with BP.
However, there is a difference between the general non-specific benefits of combined
pharmacotherapy and psychotherapy and the unique indications for psychosocial
interventions, see details in table 2. For a specific psychological therapy to be indicated as an
adjunct to medication in BP it is necessary to identify a psychobiosocial model of relapse
that:
i. Describes how psychological and social factors may be associated with episode onset.
For example, social rhythm disrupting life events may precipitate BP relapse and so
stabilizing social rhythms is a key additional element in Interpersonal Therapy as
applied in BP.
ii. Provides a clear rationale for which interventions should be used in what particular set
of circumstances. For example, the use of Family Focused Therapy (FFT) is supported
by research demonstrating that a negative affective style of interaction and high levels
of expressed emotion in a family are associated with an increased risk of relapse in an
individual with BP.
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