Psychoeducation for bipolar disorder: A discourse analysis

Discourse-based psychological intervention alleviates perioperative anxiety in patients with adolescent idiopathic scoliosis in China: a retrospective propensity score matching analysis

PURPOSE

To evaluate the effectiveness of a discourse-based psychological intervention on perioperative anxiety, pain and life satisfaction of patients with AIS.

METHODS

Between April 2018 and February 2021, 116 consecutive patients with AIS undergoing corrective surgery were enrolled in this study, including 51 with personalized psychological intervention (intervention group, IG) and 65 without (control group, CG). After propensity score matching (PSM), patient characteristics, perioperative scores of anxiety and life satisfaction, measured by values of Generalized Anxiety Disorder 7-item Scale (GAD-7) and Life Satisfaction Index Z scale (LSIZ), were recorded. Mixed linear models were used to estimate the influence of intervention group and time of measurement, as well as their interactions, in anxiety and life satisfaction. Data on post-surgical pain in both groups was also collected and analyzed.

RESULTS

After PSM, a total of 90 patients (IG, n = 45; CG, n = 45) were enrolled in this study, and the 2 groups were comparable in patients' demographic and baseline characteristics. There were no pre-intervention between-group differences in the degree of anxiety (IG: 3.98 ± 3.27 vs. CG: 3.93 ± 3.20, p = .948, Cohen's d = 0.015), and life satisfaction (IG: 6.56 ± 1.70 vs. CG: 6.67 ± 2.09, p = .783, Cohen's d = -0.058). After surgery, participants in both IG and CG showed improved the levels of anxiety (GAD-7: IG 2.18 ± 1.21; CG 2.87 ± 2.00) and life satisfaction (LSIZ: IG 9.84 ± 2.09; CG 9.02 ± 2.15). A stratified analysis of patients with generalized anxiety disorder showed improved anxiety (GAD-7: IG 3.50 ± 1.22 vs. CG 6.80 ± 2.05, p = .017, Cohen's d = -1.956) and lower pain level (VAS: IG 4.50 ± 1.76 vs. CG 7.00 ± 1.00, p = .017, Cohen's d = -1.747) in the IG than the CG after surgery.

CONCLUSIONS

Discourse-based psychological intervention before surgery can improve perioperative anxiety and life satisfaction, and postoperative painful condition, especially for patients with high-leveled pre-surgical anxiety.

The Effect of Psychoeducation on Internalized Stigma of the Hospitalized Patients with Bipolar Disorder: A Quasi-Experimental Study

Stigma is one of the common problems of patients with bipolar disorders, which impedes their recovery. This is a quasi-experimental study on 76 hospitalized patients with bipolar disorder (38 in each group) in Iran. The intervention group received six sessions of psychoeducation in a period of 2 weeks. Internalized stigma was measured by the Internalized Stigma of Mental Illness scale. The education significantly reduced the scores of alienation, discrimination experience, stigma resistance and total score of stigma in the intervention group. Hence, this education can be used as an accessible technique in hospitals to reduce the internalized stigma.

Effective care for Māori with bipolar disorder: A qualitative study

Māori have high rates of bipolar disorder (BD) and mental health service use. Despite the high prevalence and the impact on functioning and whānau (family), there is limited research on treatment interventions for Māori with bipolar disorder and indeed on Māori and indigenous mental health generally. A qualitative study combining individual interviews and focus groups was conducted with the aim to explore mental health clinicians' and Māori mental health workers' perspectives of effective treatment for Māori with BD. Sixteen participants took part in either individual interviews, focus groups or both. The study found the importance of a Māori worldview; tikanga Māori (rituals); understanding the whānau context, whakawhanaugatanga (connection), the powhiri (introduction) process, and whakarongo (listening) were key to working effectively with Māori who had BD. Both the interviews and focus groups identified similar concepts. The concept of whakawhanaungatanga (connection) captures the themes from the individual interviews and focus groups. The participants in this study identified the person and their culture rather than the psychiatric diagnosis as crucial to providing effective care to Māori with BD. Without a foundation in whakawhanaungatanga, engagement, diagnosis, treatment adherence, and the process of recovery are unlikely to be as effective for Māori with BD. It was evident from the findings that it was the person not the diagnosis that was central to therapeutic engagement.

Participation in decision-making about medication: A qualitative analysis of medication adherence

Rates of relapse in BD are high with medication nonadherence identified as an important contributor to relapse. Psychopharmacology remains a key component to the treatment of BD; therefore, increased understanding of medication use and ways to promote greater adherence is essential. The aim of the study was to identify how participants with BD experience taking prescribed medication. Participants had BD I or BD II, were users of specialist mental health services, aged 18-64 years, euthymic, mildly hypomanic or depressed, and on any combination of medication. Exclusion criteria were minimal. A semistructured interview was completed exploring patients' views of BD and factors influencing adherence based on the Subjective Experience of Medication Interview. An inductive thematic analysis was used to identify themes. The study participants (n = 36) had predominantly bipolar I (78%) and were female (69%), and of New Zealand European ethnicity (67%) with 14% Maori. The mean age was 41 years (SD: 12.0). Findings from the thematic analysis generated three themes: Learning about the clinical meaning of having BD, Understanding how to use medication, and Understanding what works for me. The qualitative nature of our study limits the generalizability of our findings to a broader population of individuals with BD. The participants developed confidence in being in charge of their BD through a process of learning about BD and medication and understanding what this meant for them. The findings support greater emphasis on collaborative approaches that recognize the expertise of the individual with BD and the clinician.

Staying well with bipolar disorder: A qualitative analysis of five-year follow-up interviews with young people

WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Bipolar disorder is a long-term condition which causes ongoing disruptions to the individual's life. Current evidence suggests that a combination of medication in combination with psychotherapy is more effective than medication alone. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: There are few published reports of the effects of interventions (pharmacological or psychotherapeutic) for treatment in bipolar disorder. While both psychotherapies provided a framework for understanding bipolar disorder each had specific strategies that participants identified as effective. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Because bipolar disorder is a long-term condition, its treatment needs to incorporate psychotherapeutic approaches that address the unique nature of its impact on each individual and provide individualized strategies for managing the disorder. Both Interpersonal and Social Rhythm Therapy and Specialist Supportive Care provide strategies that promote personal recovery.

ABSTRACT

Introduction The primary outcomes from this study of psychotherapy for young people with bipolar disorder identified that most participants had continued to remain well. Given that up to 80% of people relapse within 2 years, it was important to establish how these participants described the process of staying well. Aim To examine how participants in a psychotherapy for young people with bipolar disorder study at 5-year follow-up described their experiences of the intervention and its impact on living with the disorder. Methods This qualitative study was conducted 5 years after participants had completed a psychotherapy intervention in a randomized controlled trial for young people with bipolar disorder. Thirty people were recruited into this qualitative study and interviewed regarding their experiences. The data were analysed using an inductive thematic analysis. Findings Three themes were identified from the data: self-awareness in the context of bipolar disorder; understanding my bipolar disorder; and learning to stay well with bipolar disorder. Conclusions Mental health nurses can promote the factors that participants found helpful in learning to stay well self-awareness, understanding the unique characteristics of their disorder, learning to take care of the self and stabilization of social rhythms.