Commentary

Bipolar disorder is a chronic illness for which there are limited effective treatment options, particularly when it onsets during adolescence. Pharmacotherapy is the foundation for the management of acute episodes and for prophylaxis against recurrences but leaves much to be desired. This study is a welcome attempt at studying the role of family therapy as adjunctive treatment. In spite of the study design limitations (variable severity of illness, uncontrolled for number of treatment contacts, lack of standardised pharmacotherapy), it reinforces the importance of trying to understand and shape the social context of the disorder. Results from the few studies of family therapy for bipolar illness show that adjunctive family interventions prolong periods of wellness between episodes, decrease rehospitalisation rates due to relapse and decrease time spent in depressive episodes.^1 2 Family approaches appear to have less of an impact on mania but may be particularly helpful for dysfunctional families.³

In assessing outcome, it is also important to focus on quality of life, social and work functioning, sense of personal well being as well as course of illness variables. Clinical care should focus on ways to cope with and manage the illness, given the chronic nature of bipolar illness, and a 50–75% relapse rate within 1 year, despite optimal treatment. There are many practical questions that await results from future studies. When should the family become engaged in treatment? During the acute episode or during remission? Should family therapy be provided for single families or in a multifamily group format? Is there a particular family approach that is generally more effective than others? Are there specific clinical situations that are more amenable to a particular family approach? Should there be a templated sequential treatment algorithm or should each family be treated for their particular problems? Does the number of treatment sessions matter? Where should the treatment take place, in the patient’s home or in an outpatient office? How many therapists need to be involved? Are there adverse events associated with family therapy?