Miklowitz and Goldstein report that negative family attitudes (emotionally stressful, demanding, critical, overly intrusive) predispose patients to discontinuation of medication and relapse of old illnesses. Family behaviour management resulted from these findings. Preliminary results from nine discharged patients indicate that 61% of those taking only lithium and not receiving family behaviour management relapsed, while only 11% relapsed when both were treated together.
Although not a particularly effective treatment in itself, the National Depressive and Manic Depressive Association (NDMDA) has developed a good self-help programme. These self-help groups were established in the USA in 1986. The NDMDA provides personal support and education services for people with depression and bipolar disorder and their families, educating the public about the nature of these treatable conditions and how they are treated. Other organisations, such as the National Alliance on Mental Illness (NAMI), also provide education and self-help groups for patients and families. These groups work in conjunction with clinicians. People with bipolar disorder should be encouraged to seek the assistance of local groups who can provide basic treatment and support for patients.
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