The Facts about Bipolar Disorder: Risk Factors, Interventions, and Psychoeducation

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By Nicole Mori RN, MSN, APRN-BC Nurse Practitioner, Lindner Center of Hope

What is Bipolar Disorder?

Bipolar disorder is a chronic psychiatric disorder characterized by recurrent mood episodes with significant changes in behavior and function.

How Common in Bipolar Disorder?

The prevalence of bipolar disorder is estimated at around 1-3% of the population. Around eight million adults in the US have bipolar disorder, which has an adverse effect on function and quality of life and is associated with 12-14 years of lost life expectancy. 

What are the Symptoms of Bipolar Disorder?

Bipolar disorder is identified by extreme shifts in mood, energy, and functioning that can be subtle or dramatic. The characteristics can vary greatly among individuals and even throughout the course of one individual’s life.

How is Bipolar Disorder Treated?

Most patients with bipolar disorder require some sort of lifelong treatment once the disorder is correctly identified. While medication is one key in successful treatment, psychotherapy, support, and education about the illness are also essential parts of treatment.

Treatment for Residual Symptoms of Bipolar Disorder

Residual symptoms have been identified as a significant risk factor for relapse and as an important target for therapeutic intervention (Perlis et al., 2006). Evidence-based treatment guidelines recommend adjunctive interventions to address residual symptoms and optimize treatment outcomes for bipolar disorder.

These treatments for residual symptoms include:

  • Specialized psychotherapies. Require highly skilled providers (e.g., Cognitive Behavioral Therapy), which have limited accessibility due to cost and a shortage of qualified providers.
  • Psychoeducation. A simpler intervention. Both specialized psychotherapies and psychoeducation have been shown to improve medication adherence, depressive symptoms, and decrease the risk for relapses and hospitalization (Miklowitz et al., 2021). 

However, a shortage of qualified providers, excessive costs, and limited resources are significant barriers to access, and patients with bipolar disorder already bear a disproportionate burden of direct and indirect costs of illness.

Lack of access to adjunctive psychosocial interventions hinders patients’ ability to take an active role in their recovery and has a negative impact symptom burden, risk for exacerbation and quality of life. Interventions targeting disease management and medication adherence are needed to decrease the costs of bipolar disorder.

Challenges in Treating Bipolar Disorder

Bipolar disorder can have a variety of presentations, including depressive, manic, hypomanic, mixed episodes or remitted phases, and is associated with concomitant functional and cognitive deficits. This complexity poses challenges in diagnosis and treatment.

Despite the availability of effective pharmacotherapies addressing mood instability, failure to achieve full recovery, significant residual symptoms and relapses are common. Incomplete response and undertreatment are frequent, making bipolar disorder a leading cause of morbidity, disability, and high medical costs.

Moreover, psychiatric, substance use disorder and medical comorbidity are common in this population, further contributing to increased morbidity and mortality (McIntyre et al., 2020). Although the estimates for direct and indirect costs of bipolar disorder vary according to methodology, it is one of the costliest medical conditions, where patients bear a disproportionate burden in cost sharing.

Psychoeducation: Learning Tools for Managing Bipolar Disorder

In settings with limited resources, psychoeducation focusing on self-management can be a feasible way of improving outcomes in patients with bipolar disorder, particularly when the programs are integrated into mental health systems by technology. Evidence-based practice guidelines recommend psychoeducation as a first-line adjunct to medication for bipolar disorder (Yatham et al, 2018). 

Psychoeducation intervention focused on improving health literacy and enhancing self-management skills in patients with bipolar disorder has demonstrated effectiveness with:

  • Improved adherence
  • Clinical outcomes
  • Function
  • Quality of life (Levrat et al, 2024)

Moreover, psychoeducation addresses unmet needs in diagnosis literacy, adherence, promotes increased autonomy and self-management, and is seen by patients as less stigmatizing than group psychotherapy. Psychoeducation can improve clinical outcomes in a cost-effective way and reduce the overall costs of bipolar disorder. 

Telehealth and Technology Tools for Treating Bipolar Disorder

Recent developments in information technology have expanded the reach of mental health providers and promise to lower barriers to support and treatment. Multiple web-based and mobile tools for patient education and self-management of bipolar disorder have appeared on the market in recent years.

However, there are significant concerns over the quality, patient safety and confidentiality of these commercially-available applications. The evidence for the efficacy of mobile and web-based interventions is modest and more research is needed. Accessibility and ease of use are important considerations for these patients. 

Evidence supports the use of adjunctive interventions for bipolar disorder that have a simple interface and provide feedback. Telehealth delivery of mental health services, including group therapy, has grown in popularity in recent years and has demonstrated efficacy in delivery of treatment for bipolar disorder and is associated with high levels of patient satisfaction (Farrell et al., 2022).

In a setting with limited resources and barriers to care, psychoeducation and the expansion of telehealth group therapy are promising strategies to meet the complex needs of an underserved population.

References

Farrell, A., George, N., Amado, S., & Wozniak, J. (2022). A systematic review of the literature on telepsychiatry for bipolar disorder. Brain and behavior, 12(10), e2743. https://doi-org.uc.idm.oclc.org/10.1002/brb3.2743

Levrat, V., Favre, S., & Richard-Lepouriel, H. (2024). Current practices of psychoeducation interventions with persons with bipolar disorders: a literature review. Frontiers in psychiatry, 14, 1320654. https://doi-org.uc.idm.oclc.org/10.3389/fpsyt.2023.1320654

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. Lancet (London, England), 396(10265), 1841–1856.

Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis. JAMA psychiatry, 78(2), 141–150. https://doi-org.uc.idm.oclc.org/10.1001/jamapsychiatry.2020.2993