Non-adherence in the treatment of bipolar disorder is a very common phenomenon, which has been addressed by various researchers. The negative consequences may include relapse, hospitalization, impairment in everyday functioning, and it can be costly.
In a recently published pilot study by Wenze, Armey, and Miller (2014), the improvement of treatment adherence in bipolar disorder was tested using Personal Digital Assistants (PDAs). More specifically, the investigators wanted to test whether an intervention that utilized mobile technology and assisted the monitoring of bipolar disorder would be feasible and acceptable by bipolar patients.
In our clinical work at BipolarLab, we often come across bipolar patients who seek help when they are depressed. Depression may be the most common symptom, and the most frequent episode of bipolar disorder, but it is not always the most urgent phase to treat. Manic episodes may be more urgent, and more dangerous. Nevertheless, it takes an experienced, and a well trained bipolar patient to seek help once manic. Depressive episodes with increased suicidal ideation or psychotic symptoms can be equally urgent, but for the most common depressive episodes urgency is a matter of choice.
Bipolar disorder is a condition characterized by recurrent episodes of depression and/or abnormally elevated mood (known as mania) that interfere with psychosocial functioning (see our guide). Depressive symptoms, along with cognitive difficulties in planning, problem solving, attention and memory, are known to be related to low psychosocial functioning and in particular occupational functioning (Bauer et al., 2001; Goldstein & Burdick, 2008).
Treatment of bipolar disorder includes medication, which aims at mood stabilization, and various forms of psychotherapy (e.g. Family Focused Therapy, Cognitive Behavioral Therapy and Interpersonal and Social Rhythm Therapy). Nevertheless, until recently, these therapies couldn’t deal with the cognitive symptoms of the disorder in patients who were in remission. These symptoms are called residual or subsyndromal and can be equally problematic for some patients.
In other fields of medicine, this may not be the case, but in the mental health world, evidence based practice is a relatively new development.
“Evidence-based practice” means we conduct our clinical practice based on evidence that we’ve acquired from clinical research. Similar to drug research, your doctor will usually prescribe medications that’ve been tested thoroughly through many trials, and have been proven to benefit your health condition. Once upon a time, your therapy could’ve been based on Dr. Ego’s clinical expertise, big name or great insights, but thankfully these days such practices are slowly becoming a nightmare of the past (although, drug companies still invest on armies of Dr. Egos “aka opinion leaders” to influence your local doctor’s prescription practices).
However, evidence-based practice is a fairly recent development in the field of mental health, and especially in the field of psychotherapy. The rise of behavioral therapy in the 60s, partly as a reaction to the psychoanalytic status quo, and later its marriage with cognitive therapy, have given us a remarkable new tradition of true evidence-based psychotherapeutic practice.