How can families help their loved ones with bipolar disorder?

It is really important for family members to remain involved in their bipolar family member's care. This means the family member should come at least to the first doctor's appointment. I need the information from the family member from the beginning. Some family members come to the meetings often with the bipolar patient. Usually it is very helpful for them to be involved on an ongoing basis. The older psychiatric care protocol just treated the patient and ignored the family, but now we encourage family members to help manage treatment. Family members have valuable insight into the symptoms and help patients comply with their medication.

One half of bipolar patients stop taking their medication or rarely take their medication. They need family support to remain compliant. Research has shown that a supportive family environment greatly improves the outcome of bipolar disorder. Families need to help, become very educated about treatment, and ensure the patient is not misdiagnosed.

What should families do if they think someone is manic and are fearful?

First of all, very few bipolar patients are dangerous. Only half of patients with mania have psychotic symptoms at some point in their lifetime. Without treatment, manic episodes are very brief and usually only last a few weeks to a few months maximum. With medication, manic episodes only last a few weeks. Usually these manic symptoms are not dangerous or scary.

If the patient is dangerous, usually it means the patient is not well and is not taking medication, or the medication isn't working. So, family members need to get the patient into medical treatment. This may sometimes mean calling the police or trying to get guardianship for involuntary treatment. It is very hard, if not impossible, to convince someone that they have bipolar disorder if they lack insight completely. Being supportive, nonjudgmental, but also being willing to intervene when necessary - this is the difficult balance families have to keep. There is no easy answer, but I think the bottom line is a balance between keeping some kind of alliance or at least communication with the patient and at the same time making judgments about what is in the patient's best interest even if the patient disagrees.

Above questions answered by Dr. S. Nassir Ghaemi, the director of the Bipolar Disorder Research Program at Cambridge Hospital

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Reviewed: 04/2006