Background: Environmental stress has an important role in the course of bipolar disorder. Some findings have shown that family beliefs about the illness could predict family burden, and this burden could influence the outcome of bipolar disorder. To the best of our knowledge, there is scant information about the effects of family intervention on the caregiver’s burden in bipolar disorder. The aim of this study was to assess the effects of psychoeducational family intervention on bipolar patients’ caregivers, including the assessment of the caregiver’s burden. Methods: 45 medicated euthymic bipolar outpatients were randomized into an experimental and a control group. Relatives of patients from the experimental group received 12 psychoeducational, 90-min sessions about bipolar disorder and coping skills. The caregivers’ knowledge of bipolar disorder, the relationship subscales of the Family Environment Scale, and the family burden subscales from an adapted version of the Social Behavior Assessment Schedule were assessed for both caregiver groups before and after the intervention. Results: Psychoeducated caregivers significantly improved their knowledge of bipolar disorder and reduced both the subjective burden and the caregiver’s belief about the link between the objective burden and the patient. No significant differences were found in the objective burden nor in the family relationship subscales. Conclusions: These preliminary results suggest that psychoeducational intervention on caregivers of bipolar patients may improve the caregiver’s knowledge of the illness, reduce their distress or subjective burden and alter their beliefs about the link between the disruptions in their life and the patient’s illness.

Colom F, Vieta E, Martínez A, Jorquera A, Gastó C: What is the role of psychotherapy in the treatment of bipolar disorder? Psychother Psychosom 1998;67:2–9.
Scott J, Garland A, Moorhead S: A pilot study of cognitive therapy in bipolar disorders. Psychol Med 2001;31:459–467.
Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr N, Parr-Davis G, Sham P: A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder. Arch Gen Psychiatry 2003;60:145–152.
Miklowitz DJ, Goldstein MJ: Behavioral family treatment for patients with bipolar affective disorder. Behav Modif 1990;14:457–489.
Miklowitz DJ, Simoneau TL, George EL, Richards JA, Kalbag A, Sachs-Ericsson N, Suddath R: Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol Psychiatry 2000;48:582–592.
Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL: A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003;60:904–912.
Perry A, Tarrier N, Morriss R, McCarthy E, Limb K: Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999;318:149–153.
Colom F, Vieta E, Martínez-Arán A, Reinares M, Goikolea JM, Benabarre A, Torrent C, Comes M, Corbella B, Parramon G, Corominas J: A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003;60:402–407.
Priebe S, Wildgrube C, Müller-Oerlinghausen B: Lithium prophylaxis and expressed emotion. Br J Psychiatry 1989;154:396–399.
Honig A, Hofman A, Hilwig M, Noorthoorn E, Ponds R: Psychoeducation and expressed emotion in bipolar disorder, preliminary findings. Psychiatry Res 1995;56:299–301.
Honig A, Hofman A, Rozendaal N, Dingemans P: Psycho-education in bipolar disorder: Effect on expressed emotion. Psychiatry Res 1997;72:17–22.
Mino Y, Shimodera SH, Inoue SH, Fujita H, Tanaka SH, Kanazawa S: Expressed emotion of families and the course of mood disorders: A cohort study in Japan. J Affect Disord 2001;63:43–49.
O’Connell RA, Mayo JA, Flatow L, Cuthbertson B, O’Brien BE: Outcome of bipolar disorder on long-term treatment with lithium. Br J Psychiatry 1991;159:123–129.
Miklowitz DJ, Goldstein MJ, Nuechterlein KH, Snyder KS, Mintz J: Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry 1988;45:225–231.
Reinares M, Vieta E: The burden on the family of bipolar patients. Clin Approaches Bipolar Disord, in press.
Struening EL, Perlick DA, Link BG, Hellman F, Herman D, Sirey JA: Stigma as a barrier to recovery. The extent to which caregivers believe most people devalue consumers and their families. Psychiatr Serv 2001;52:1633–1638.
Targum SD, Dibble ED, Davenport YB, Gershon ES: The Family Attittudes Questionnaire. Patients’ and spouses’ views of bipolar illness. Arch Gen Psychiatry 1981;38:562–568.
Fadden G, Bebbington P, Kuipers L: Caring and its burdens: A study of the spouses of depressed patients. Br J Psychiatry 1987;151:660–667.
Chakrabarti S, Kulhara P, Verma SK: Extent and determinants of burden among families of patients with affective disorders. Acta Psychiatr Scand 1992;86:247–252.
Perlick D, Clarkin JF, Sirey J, Raue P, Greenfield S, Struening E, Rosenheck R: Burden experienced by care-givers of persons with bipolar affective disorder. Br J Psychiatry 1999;175:56–62.
Dore G, Romans SE: Impact of bipolar affective disorder on family and partners. J Affect Disord 2001;67:147–158.
Perlick DA, Rosenheck RR, Clarkin JF, Raue P, Sirey PH: Impact of family burden and patient symptom status on clinical outcome in bipolar affective disorder. J Nerv Ment Dis 2001;189:31–37.
Reinares M, Colom F, Martínez-Arán A, Benabarre A, Vieta E: Therapeutic interventions focused on the family of bipolar patients. Psychother Psychosom 2002;71:2–10.
Cuijpers P: The effects of family interventions on relatives’ burden: A meta-analysis. J Ment Health 1999;8:275–285.
Clarkin JF, Glick ID, Haas GL, Spencer JH, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V: A randomized clinical trial of inpatient family intervention. 5. Results for affective disorders. J Affect Disord 1990;18:17–28.
First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders – Clinician Version (SCID-CV). Washington, American Psychiatric Press, 1997.
First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin L: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, American Psychiatric Press, 1997.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
Ramos-Brieva JA, Cordero Villafáfila A: Validación de la versión castellana de la Escala de Hamilton para la Depresión. Actas Luso Esp Neurol Psiquiatr Cienc Afines 1986;14:324–334.
Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: Reliability, validity and sensibility. Br J Psychiatry 1978;113:429–435.
Colom F, Vieta E, Martínez-Arán A, García M, Reinares M, Torrent C, Goikolea JM, Banús S, Salamero M: Versión española de una escala de evaluación de la manía: Validez y fiabilidad de la escala de Young. Med Clin (Barc) 2002;119:336–371.
Goldman HH, Skodol AE, Lave TR: Revising axis V for DSM-IV: A review of measures of social functioning. Am J Psychiatry 1992;149:1148–1156.
Platt S, Weyman A, Hirsch S, Hewett S: The Social Behaviour Assessment Schedule (SBAS): Rationale, contents, scoring and reliability of a new interview schedule. Soc Psychiatry 1980;15:43–55.
Otero V, Navascues D, Rebolledo S: Escala de desempeño psicosocial. Adaptación Española del SBAS (Social Behavour Assessment Schedule). Psiquis 1990;XI:395–401.
Moos R, Moos BS: Family Environment Scale: Manual. Palo Alto, Consulting Psychologists Press 1981.
Fernández-Ballesteros R, Sierra B: Escalas de Clima Social: Familia, Trabajo, Instituciones Penitenciarias, Centro Escolar. Madrid, Sección de Estudios TEA Ediciones, 1984.
Van Gent EM, Zwart FM: Psychoeducation of partners of bipolar manic patients. J Affect Disord 1991;21:15–18.
Molnar G, Feeney MG, Fava GA: Duration and symptoms of bipolar prodromes. Am J Psychiatry 1988;145:1576–1578.
Fava GA, Kellner R: Prodromal symptoms in affective disorders. Am J Psychiatry 1991;148:823–830.
Fava GA: Subclinical symptoms in mood disorders: Pathophysiological and therapeutic implications. Psychol Med 1999;29:47–61.
Goodwin FK, Jamison KR (eds): Manic-Depressive Illness. London, Oxford University Press, 1990.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.