The article “When bipolar treatment fails” (Current Psychiatry, January 2008) states that 70% of patients with rapid cycling bipolar disorder have subclinical hypothyroidism, which leads me to wonder how many patients diagnosed as rapid cycling actually suffer from a medical problem that could cause dangerous complications if untreated. Psychiatrists need to rule out organic causes of affective instability.
As noted by the authors, psychotherapy could address the patient’s as well as the family’s emotional issues. Studies have established family therapy’s efficacy in reducing expressed emotions in the families of patients with schizophrenia, but there are no studies showing the same effect in bipolar affective disorder. Because high expressed emotions play a role in relapse of bipolar affective disorder, using family therapy to reduce these emotions could decrease relapse rates. Educating patients to recognize the early warning signs of a relapse and encouraging them to seek help could reduce the risk of relapse.
Clinicians also should address social issues such as housing, relationships, and employment, including working hours and workplace stress. The authors make it clear that using a biopsychosocial approach to managing bipolar affective disorder will help treat rapid cycling, which in turn will help reduce the relapse rate.
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