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Purpose and effectiveness of psychoeducation in patients with bipolar

disorder in a bipolar clinic setting

Article  in  Acta Psychiatrica Scandinavica · May 2013

DOI: 10.1111/acps.12118

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Acta Psychiatr Scand 2013: 127 (Suppl. 442): 11–18 © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd
All rights reserved ACTA PSYCHIATRICA
DOI: 10.1111/acps.12118
SCANDINAVICA

Clinical overview
Purpose and effectiveness of psychoeducation in
patients with bipolar disorder in a bipolar clinic
setting
Stafford N, Colom F. Purpose and effectiveness of psychoeducation in N. Stafford1, F. Colom2
patients with bipolar disorder in a bipolar clinic setting. 1
Leicestershire Partnership NHS Trust, Adult Mental
Health Services, Leicestershire, UK and 2Bipolar
Objective: This article reviews psychological therapies in the treatment Disorders Unit, IDIBAPS-CIBERSAM-Hospital Clinic
of bipolar disorder, in particular psychoeducation, and how the Barcelona, Barcelona, Spain
inclusion of four fundamental principles – patient/therapist
communication, flow of information, patient involvement and a
trusting relationship – can improve patient outcomes.
Method: The content of this article is based on the proceedings of a
1-day standalone symposium in November 2011 exploring how to
establish a bipolar clinic within the context of existing services in the
UK’s National Health Service.
Results: Certain psychological interventions have emerged as beneficial
add-on treatments to pharmacotherapy in bipolar disorder and are
associated with greater stabilisation of symptoms, fewer relapses and
longer time to relapse. Psychoeducation is a simple approach to support
prevention of future episodes by delivering behavioural training to
improve illness insight, early symptom identification and development Key words: psychoeducation; bipolar disorder; patient
of coping strategies. Empowering patients to actively participate in their involvement; quality of life; bipolar clinic
treatment provides independence, counteracts the current disconnect of Nick Stafford, Leicestershire Partnership NHS Trust,
therapist and patient, and increases awareness and understanding of the Cedars Centre, Cedars Avenue, Wigston, Leicestershire
challenges of living with and treating bipolar disorder. LE18 2LA, UK.
E-mail: nicholas.stafford@leicspart.nhs.uk
Conclusion: Psychoeducation enables patients to understand bipolar
disorder, get actively involved in therapy planning, and be aware of
methods for episode prevention, therefore effectively contributing to
improved treatment outcomes and patient quality of life.

Clinical recommendations
• To improve treatment, patients should have the opportunity to voice their expectations and to
participate in the decision-making process.
• Psychoeducation is a flexible intervention that is adjusted based on patient needs and recovery
progression in the long-term management of bipolar disorder.
• Bipolar clinics provide a setting that allows patients to actively contribute to their care plan.

Additional comments
• It may be difficult for patients to seek professional help during acute episodes.
• Inclusion of family and carers in psychoeducation programmes ensures regular monitoring of patient
recovery and early identification of relapse symptoms.
• Patients with marked cognitive decline may have difficulties in understanding and implementing the
goals of psychoeducation sessions.

11
Stafford and Colom
Introduction
Psychological treatments and their effect on patients with bipolar
disorder
Bipolar disorder is a chronic illness that impacts
on patient quality of life (QoL) and global func-
tioning. To improve care, the role of both the
patient and the specialist during the treatment
needs to change and requires more integrative care
rather than pharmacotherapy alone. Therefore,
the current therapeutic approach for bipolar
disorder includes the combination of psychophar-
macological and psychological interventions (1, 2).
Psychological interventions have emerged in
response to studies that have shown associations
between socio-environmental stressors and remis-
sion–relapse cycles of bipolar disorder. Controlled
trials indicate that adjunctive family therapy (3, 4),
individual cognitive behavioural therapy (CBT)
(5), and interpersonal and social rhythm therapy
(IPSRT) (6) are associated with greater stabilisa-
tion of symptoms, improved adherence to medica-
tion, fewer hospital admissions, lifestyle regularity,
habits modification and a stable social rhythm
than comparison interventions involving medica-
tion and – sometimes – active clinical management.
It has to be mentioned, however, that not all
psychological interventions are equally powerful in
the treatment of bipolar disorder. Several have
been successful in the treatment of unipolar
depression and subsequently been adapted for
bipolar disorder, and although efficacy may be
displayed (5), effectiveness and long-term out-
comes in bipolar disorder are less convincing (7, 8).
Psychological interventions are essential during
the maintenance phase, because most cognitive
and behavioural therapy targets that allow patients
to achieve good social, interpersonal and occupa-
tional functioning may only be reached once
the patient is euthymic (9, 10). In addition, the
effectiveness of psychological interventions heavily
relies on content and delivery. In a simplified way,
these interventions can be divided into simple and
complex therapies. Complex therapies tend to have
a strong theoretical background, have their own
model of understanding of the disorder to be trea-
ted, and require complex training and a highly
skilled therapist, whereas simple therapies do not
require a highly developed theoretical background,
lack complexity for patient and therapist, fit easily
into the clinical setting and target very specific and
limited therapeutic goals (11).
Among the simple therapies, psychoeducation
is efficacious in unipolar depression, as well as
bipolar disorder. A study based on a simple inter-
vention of training patients on early warning sign
12
detection was associated with a significant increase
in time to first manic relapse, as well as a 30%
decrease in the number of manic episodes and
improvement in social functioning and employ-
ment over 18 months (12). However, the same
approach failed to show any significant changes in
a larger study with a longer follow-up (13), indicat-
ing that early warning sign recognition is only a
part of the scope of topics psychoeducation needs
to address (11). Not only does psychoeducation
help to improve adherence to lithium in patients
with bipolar disorder (14), adherent patients also
benefit from the intervention (15). Family psycho-
education has proven to be highly efficacious in
preventing manic but not depressive episodes
(Table 1) (4).
What is psychoeducation?
Psychoeducation is a simple approach aimed at
improving the treatment outcome of patients with
bipolar disorder and enhancing the prevention of
future episodes. This type of psychological therapy
can be offered as adjunctive treatment to standard
pharmacotherapy (11) and delivers information-
based behavioural training aimed at adjusting
patient lifestyle and strategies of coping with
bipolar disorder, including enhancement of illness
awareness, treatment adherence, early detection of
relapses and avoidance of potentially harmful
factors such as substance misuse and sleep depriva-
tion (16). Psychoeducation is an intervention that
seeks to empower patients with tools that allow
them to be more active in their therapy process.
However, it does not represent a therapy option
that is based on patient self-help, owing to it being
highly structured and requiring a directive
Table 1. Content of the Barcelona Bipolar Disorder Programme psychoeducational
intervention for caregivers of patients with bipolar disorder
Programme sessions
Understanding the nature of the illness
Main symptoms and early identification of prodromes: manic and hypermanic
episodes
Main symptoms and early identification of prodromes: depressive and mixed
episodes
Identification of triggering factors
Treatment: mood stabilisers
Treatment: antipsychotics and antidepressants
Family and treatment: enhancing adherence
Planning of coping strategies
Emergencies: suicidal thoughts, hospitalisation, pregnancy and counselling on
genetics
Prevention and management of family stress: communication skills training
Prevention and management of family stress: problem-solving training
Legal and social resources
Taken from Reinares et al. (4).

influence by a therapist. The Barcelona Bipolar
Unit was the first clinic to provide structured,
manualised and evidence-based psychoeducation
therapy in a set of modular sessions (Table 2),
which have been used to develop further psycho-
education programmes adapted to satisfy the needs
of other bipolar clinics (17), allowing its implemen-
tation in rather diverse countries including Spain,
UK, Denmark, Norway, France, Greece, Portugal,
Poland, Turkey, Italy, Chile, Argentina, Mexico,
Columbia, Canada, Australia, China and Japan.
Despite reports of its prophylactic efficacy, psycho-
education is not effective in treating acute episodes
and may have limitations for use in patients with a
higher number of previous manic episodes due,
probably, to neuropsychological impairment (18).
Furthermore, it should always be considered an
adjunctive treatment to pharmacotherapy (19).
Aims of the study
This article reviews psychological therapies in the
treatment of bipolar disorder, in particular
psychoeducation, and how the inclusion of four
fundamental principles – patient/therapist commu-
nication, flow of information, patient involvement
and a trusting relationship – can improve patient
outcomes.
Material and methods
The content of this article is based on the
proceedings of a 1-day standalone symposium in
Table 2. Content of the psychoeducation programme (Barcelona Bipolar Disorders
Programme, The Barcelona Bipolar Clinic)
Programme sessions
Introduction
What is bipolar illness?
Causal and triggering factors
Symptoms (I): mania and hypomania
Symptoms (II): depression and mixed episodes
Course and outcome
Treatment (I): mood stabilisers
Treatment (II): antimanic agents
Treatment (III): antidepressants
Serum levels: lithium, carbamazepine and valproate
Pregnancy and genetic counselling
Psychopharmacology vs alternative therapies
Risks associated with treatment withdrawal
Alcohol and street drugs: risks in bipolar illness
Early detection of manic and hypomanic episodes
Early detection of depressive and mixed episodes
What to do when a new phase is detected?
Regularity
Stress management techniques
Problem-solving techniques
Final session
Taken from Colom et al. (17).
Psychoeducation in bipolar clinics
November 2011 and supplemented with the rele-
vant literature. The symposium was designed to
give an overview of the natural history of bipolar
disorder, the importance of monitoring the physi-
cal health of patients on pharmacotherapy, the
importance of psychoeducation as part of standard
treatment for bipolar disorder and an example of a
bipolar clinic currently in operation. The objective
of the workshop and the meeting was to educate
UK-based healthcare professionals (HCPs) about
the opportunities, challenges and expectations
associated with setting up a bipolar clinic with the
resources available in their own clinical practices.
Results
Efficacy of psychoeducation in the management of bipolar
disorder
The efficacy of pharmacological treatment of
bipolar disorder has, on occasion, led clinicians to
forget psychological interventions as a treatment
option. However, group-based psychoeducation
shows efficacy far beyond that usually seen by the
mere supportive role of the group. Psychoeduca-
tion is effective as an add-on to maintenance
pharmacotherapy in the prevention of recurrences
in bipolar disorder – in particular, episodes of
mania/hypomania, mixed episodes and depression
(17). Psychosocial interventions are by no means
substitutes for pharmacotherapy, but they may
complement mood stabilisers in protecting patient
symptom deterioration, as well as enhance adher-
ence to maintenance treatments (3, 14).
Evidence thus far has shown that psychoeduca-
tion in combination with pharmacotherapy is
more effective than pharmacotherapy alone in a
number of parameters. Long-term psychoeducation
(6 months) demonstrated a positive effect on
patient adherence to lithium (14) and a significantly
lower number of hospitalisation and days spent in
hospital up to 2 years, compared with patients
receiving a combination of pharmacological treat-
ment and non-structured group meetings (17).
Additionally, the number of total episodes, but also
the number of manic, depressive and mixed epi-
sodes individually, was significantly lower in
patients receiving psychoeducation both at 2-year
(17) and 5-year (20) follow-up. A major reason why
psychoeducation appears to be so effective and
widely used in bipolar patients is that the interven-
tion reflects a medical model of the illness, thus
disregarding stigmatisation and perceptional issues;
therefore, psychoeducation may appeal to a
wider patient population due to its straightforward
delivery and common-sense approach (16).
13
Stafford and Colom
Delivering psychoeducation in a bipolar clinic setting – who
should deliver psychoeducation?
There is an increasing need to provide educa-
tional therapy not only on a specialist level, but
in a primary-care setting. Bipolar clinics offer an
environment in which the patient interacts with a
variety of HCPs, ranging from mental-health
nurses to psychologists, psychiatrists, occupa-
tional therapists and pharmacists. Such resources
are not available in a primary-care setting, where
many patients with bipolar disorder are diag-
nosed and treated (21). Therefore, it is important
that general practitioners (GPs) are aware of the
impact that psychoeducation can have on the
recovery process and the improvement in patient
QoL. It is not necessary for the GP to provide
psychoeducation; however, they should be willing
to recommend this type of therapy to their
patients.
A major advantage of psychoeducation is its
relevance and applicability beyond the field of
mental health, owing to its simple approach and
the fact that most skills required to provide the
intervention are transferable to a myriad of other
illnesses. The simplicity of psychoeducation allows
implementation without long, complex and
thorough training of the therapist. Although the
therapist needs to be a clinician (e.g. psychiatrist,
psychologist, nurse), he/she should have specific
clinical experience in the field of bipolar disorders,
rather than being an expert on a certain type of
psychotherapy. Due to the nature of the delivery
of psychoeducation programmes – that is, a group
setting – it is important for the therapist to have
experience in group work and have certain per-
sonal characteristics including a sense of humour,
flexibility and interpersonal skills (11).
What is the proper setting?
Although psychoeducation follows a simple rather
than a skilled approach, it is often not easy to
implement in an overworked and overwhelmed
clinical setting. Psychoeducation based on a
diverse team of specialists (including psychiatrists,
psychologists, and nurses) is a simple approach for
both clinicians and patients, does not require a
highly developed theoretical background, and
promotes interpersonal skills. This strategy trans-
forms the traditional model of a healing profes-
sional and a passive patient into one of a trusting
relationship between patient and clinician, empow-
ering the patient to participate in the treatment
process and the clinician to have respect for the
patient’s decisions.
14
Psychoeducation is meaningful in settings where
a multidisciplinary team effort is available. A team
structure enhances the availability of a member in
the patient’s team in moments of crisis and ensures
that each intervention – for example, assessing the
early warning signs, changing a medical prescrip-
tion, controlling sleep habits or performing an
urgent determination of mood stabiliser serum
levels – is performed by a different specialist within
the team. By increasing patients’ ability to manage
their disorder, the goal is to instil a proactive atti-
tude into the patient and help them to develop
awareness for when to seek help. The frequency of
patients’ appointments with their treating psychia-
trist should follow an open-door policy, which
allows for fewer arranged appointments, but
complete flexibility for unscheduled visits or
on-call availability upon suspicion of a new epi-
sode. In addition, psychoeducation should not be a
static treatment, but improved upon on a regular
basis, and adjusted in content and application
depending on the patient progression, all assessed
through a regular review regimen (11).
When should a bipolar patient receive psychoeducation?
Adequate timing and type of psychological inter-
vention are essential for successful treatment out-
come. Patient characteristics, such as current
symptom levels or an extensive past history of
recurrent bipolar episodes, may imply that the
patient cannot engage with therapy or learn to
utilise the skills being taught (9, 18). The individ-
ual’s needs dictate the type of therapy that is used,
with patients potentially gaining more benefit from
short-term targeted interventions, such as adher-
ence therapy or relapse prevention training. These
therapies address problems, including adapting to
bipolar disorder, adhering to medication or identi-
fying and self-managing early warning signs of
relapse. Psychoeducation should be attempted
when a patient is stable to be able to make full use
of the opportunity to participate in adaptive
coping strategies involving their peers in a struc-
tured treatment setting (9).
Discussion
What are the core issues to be addressed by psychoeducation?
The intention of psychoeducation sessions is to
promote changes in patient behaviours and atti-
tudes in the following areas: the individual’s
awareness and understanding of bipolar disorder;
their adherence to the treatment regimen; the
stability of their social and sleep rhythms; reducing

any misuse of drugs and/or alcohol; and the
individual’s ability to recognise and manage the
prodrome of bipolar relapse or the internal and
external stressors that may increase their vulnera-
bility to future relapse. Often-cited psychosocial
influences are stressful life events, family conflict
(including high levels of expressed emotion),
chronobiological instability (such as social and
circadian rhythm disruption) and treatment
non-adherence (9).
Non-adherence to medication is a common
feature among bipolar patients and is the major
reason for symptom recurrence. Non-adherence
may result from the patient feeling ‘under drug
control’, illness denial, or patients missing their
manic periods. Patients with underlying personal-
ity disorders may not be aware of their prodromal
symptoms or have difficulties following treatment
advice; thus, a diagnosis of personality disorder
correlates with an increased possibility of
non-adherence (22). Therefore, it is important to
educate patients about the consequences of non-
adherence, the effect this has on their own QoL, as
well as the effect on their family and friends.
Psychoeducation, more than being a technique,
is an attitude when treating the patient, with the
underlying aim of improving the relationship
between patient and therapist to a level that allows
both parties to readjust responsibilities and expertise
in the treatment process. This intervention does
not cure bipolar disorder, but aids in the elimina-
tion of incomprehension and denial, alleviates
stigma, deals effectively with guilt and prevents
learned helplessness (16), factors that seriously
impede a patient’s physical and mental wellness.
Empowering patients with bipolar disorder and improving their
quality of life
Psychoeducation is based on the principle that to
improve care, the role of both the patient and the
specialist during the treatment needs to change.
When seeking control over their condition,
patients value an emphatic and continuing
therapeutic relationship with professionals (23). To
improve patient treatment, patients should have
the opportunity to voice their expectations and to
participate in the decision-making process. There
are four core issues that need to be considered
when developing the treatment plan: communica-
tion, flow and amount of information, patient
involvement in their treatment plan and the estab-
lishment of a trusting patient–HCP relationship.
Communication. Listening to patients and
responding to their needs helps to break down the
Psychoeducation in bipolar clinics
wall between patients and professionals. Patients
have important insights and priorities that doctors
and other HCPs lack (24). In a survey performed
by the Care Quality Commission, 8% of patients
felt that they had not been given enough time to
discuss their treatment and condition, 7% did not
trust or have confidence in their HCP and 5% felt
that their personal views were not taken into
account. However, only a small percentage of
surveyed patients felt that they were not treated
with respect and dignity (2%) or were not carefully
listened to (3%) (25).
Information. A lack of information and communi-
cation can lead to ineffective treatment, leaving
both the HCP and the patient frustrated. Inade-
quate follow-up of patients on a new treatment,
lack of information about the purpose of a new
medication, potential side-effects and disregard of
patient opinion often leads to patients being unpre-
pared for adverse events, potentially disruptive
dosing regimens and possible lack of treatment
efficacy (26). These are only some of the factors
that contribute to 90% of HCPs suggesting that
non-adherence is the main reason for treatment
failure (25), a situation that could be fundamen-
tally improved by a good patient–HCP dialogue.
Evidence suggests that when patients are
adequately educated about their illness and sup-
ported to participate in the decision-making pro-
cess, healthcare outcomes are better, services are
used more appropriately, patient satisfaction is
higher and there is less risk of litigation (27). This
suggests a bidirectional flow of information, not
just from HCP to patient, but inadvertently from
patient to HCP. Psychoeducation programmes
have been devised (17, 28) to enable patients to
gather information about various aspects of their
disorder. However, only 50% of patients have been
introduced to the concept of psychoeducation, and
a staggering 86% failed to voice their desire to
participate (25). Patients are more inclined to
search for information on the internet or obtain
information from psychiatrists, user support
groups, mental-health nurses and internet chat
rooms, than their pharmacist or GP (26). This
poses a problem as many patients with bipolar
disorder are diagnosed and treated in a primary-
care setting (21). In fact, as many as 90% of
patients struggle to understand the complexity of
bipolar disorder, whereas HCPs have the impres-
sion that their patients are well educated and may
not see the need for improvement in information
provision on topics such as symptoms of bipolar
disorder and their recognition, treatment
side-effects, treatment options, adherence issues,
15
Stafford and Colom
lifestyle and nutrition, and factors that improve
QoL (26). Receiving help with issues that are not
directly related to medical treatment could improve
the QoL of patients with bipolar disorder; however,
up to 50% of patients do not receive information
about financial advice or benefits, and how to find
and keep work and accommodation (29).
Questionnaires are often used to assess patient
status and recovery. However, most of those
questionnaires have been designed by psycholo-
gists, health service researchers, social scientists
and health economists, leaving little room for
patient input (30). In order to improve patient
experiences when being treated for any illness, it is
of importance to establish priorities for patients
regarding their treatment and overall care, which is
a difficult task as patient priorities are subjective,
change over time, and vary between trusts depend-
ing on services provided, age, gender, and also type
of illness (27). In a European-wide study by the
European Task Force on Patient Evaluations of
General Practice (EUROPEP), patients rated
receiving a quick service in cases of urgent situa-
tions as an absolute requirement of good general
care, along with the possibility of making appoint-
ments within short notice under normal circum-
stances, a GP who also provides adequate
information on the illness and on the diagnostic
and treatment procedures necessary, and guaran-
tees confidentiality of the patient’s information.
Furthermore, patients’ priorities include the
following: a GP who is able to relieve symptoms
quickly; does not only cure diseases, but also offers
services in order to prevent disease; is well
educated and attends courses regularly; takes time
to listen and gives the patient the feeling of being
able to freely discuss problems; is willing to check
health regularly; and the possibility of seeing the
same GP at each visit (27).
Involvement. There is a need for greater patient
involvement in their personal treatment care plan,
as well as in the shaping of a more patient-oriented
approach in overall care on a national level.
A staggering 55% of patients with bipolar disorder
do not have a care plan; of the 45% that do, 17%
do not understand it. This is partly due to patient
views not being taken into account; but, mainly, it
is due to the lack of patient education, which dis-
ables them from participating in the preparation of
a care plan. Patient involvement is further impeded
by the preparation of a care plan that is removed
from their needs and personal situation. Desired
patient behaviour in a crisis, setting of personal
goals and ways/services to achieve these are omitted
from many care plans and many patients do not
16
have a written copy for their reference (29).
Regular care reviews and adjustments of the care
plan are required to adapt to the changing needs of
the patient. However, a large proportion of
patients with or without a care programme
approach do not have an annual review process
(29) or the opportunity to communicate with their
care coordinator before the review. Under such cir-
cumstances, getting involved in their treatment is
difficult, and therefore, patient inclusion and
involvement needs to start at treatment outset.
The National Association for Patient Participa-
tion (NAPP) aims to introduce a Patient Participa-
tion Group in every GP practice based on the
mutual interests of the primary-care team and the
practice patients (www.napp.org.uk). NAPP encour-
ages patients to take responsibility for their own
health and that of their family and to join network-
ing groups to exchange experiences locally, region-
ally and on a national level. It further supports the
development of forums in the community for
patients, carers and health service staff, and recog-
nises the need to address serious health inequalities
that persist across the United Kingdom. Through
the NAPP, patients can directly get involved in
influencing national policy debates and make their
voice heard to ensure that the patient perspective is
incorporated into commissioning decisions.
Relationship. A good patient–HCP relationship is
fundamental to successful therapy. Factors that
can influence this relationship are a lack of interest
in the patient’s point of view and a shortage of
specialist care, in particular, as patients report a
more satisfying relationship with a psychiatrist
than a GP or mental-health nurse. Patients have
high expectations when seeing a HCP, which are
often disappointed at the first hurdle – the correct
diagnosis. Following incorrect diagnoses (38% of
patients are misdiagnosed for 4 years) – a ‘trial
and error’ method for finding adequate treatment
and facing a disconnect between patients and
HCPs when it comes to advice on lifestyle choices
and nutritional supplements – and estimation of
QoL, it is not surprising that relationships between
HCPs and patients have not been the most trusting
in the past.
Patient QoL is a subjective measure and there-
fore needs to be evaluated on an individual basis.
There is controversy as to whether full recovery
from bipolar disorder is possible or whether QoL
is a measure of recovery and defined by the ability
of the patient to manage ongoing symptoms.
Therefore, the HCP should provide as much
support as possible to the patient to ensure that
the patient experiences independence throughout

the treatment, but also has a contact in case of
emergency. Psychoeducation could provide the
basis for a better understanding of the other
person’s role during the treatment process and
acceptance of increased patient involvement.
Bipolar UK
Established in 1983, Bipolar UK is the only
national user-led charity in England and Wales
that specifically provides support for individuals
whose lives are affected by bipolar disorder. This
often misunderstood and devastating condition
affects every aspect of life, and the charity aims to
help patients take control of their disorder and
incorporate it into their daily routine. Services
offered by this independent charity include the
following: information about the disorder; guid-
ance and publications; advocacy groups against
discrimination; promoting social inclusion and the
rights of people affected by bipolar disorder; a
national network of self-help groups; a dedicated
helpline for members of the charity; a self-manage-
ment training programme; an annual conference; a
comprehensive website, including an e-community;
and the quarterly bipolar journal Pendulum.
Furthermore, the charity is involved in projects
such as the Bipolar Link, which allows the charity
to directly work with psychiatric units in Wales,
and London Youth, a pilot project with direct
interactions with young people. The charity also
seeks to combat the stigma and prejudice experi-
enced by those affected by bipolar disorder. Cam-
paigning for the improvement in patient services to
promote recovery, providing a forum for members
to express their views and experiences, develop-
ment of partnerships with other organisations
concerned with mental health, and education of
employers, HCPs and local communities about the
disorder are all important parts of this effort
(http://www.bipolaruk.org.uk).
There is a significant disconnect between the
patient’s experience of living with and being
treated for bipolar disorder and the HCP percep-
tion of that experience. However, the opportunity
exists to improve the dialogue between patients
and HCPs to meet the needs voiced by patients
with bipolar disorder. This includes increased
involvement of patients in their care plan, as well
as psychoeducation for the patient, families and
the public, which has the potential to dramatically
improve the patients’ QoL. Psychoeducation in
combination with pharmacotherapy is an effective
treatment option and is an important factor in
addressing the causes for treatment non-adherence
in patients with bipolar disorder. The aims of
Psychoeducation in bipolar clinics
psychoeducation programmes are to empower the
patient to understand bipolar disorder, to get
actively involved in therapy planning and to be
aware of methods of episode prevention/reduction.
The development of bipolar clinics will improve
the access to psychoeducation and greatly assist in
achieving those aims.
Acknowledgements
The meeting on which this supplement is based was supported
by Bristol-Myers Squibb, Uxbridge, UK. Editorial support for
the preparation of this manuscript was provided by Ogilvy
Healthworld Medical Education, London, UK; funding was
provided by Bristol-Myers Squibb. Nick Stafford would like to
thank the Leicestershire Partnership NHS Trust for its continued
assistance and support in developing psychoeducation
programmes in Leicestershire and for their partnership working
with Bipolar UK in patient involvement programmes. Francesc
Colom would like to thank the support and funding of the Spanish
Ministry of Health, Instituto de Salud Carlos III, CIBER-SAM.
Dr Colom is also funded by the Spanish Ministry of Science and
Innovation, Instituto Carlos III, through a ‘Miguel Servet’
postdoctoral contract (CP08/00140) and a FIS (PS09/01044).
Declarations of interest
This manuscript is a result of a 1-day educational standalone
symposium sponsored with an unconditional educational grant
by Bristol-Myers Squibb, who also sponsored this publication.
Dr Nick Stafford has received honoraria, educational grants
and research funds from the following pharmaceutical compa-
nies: AstraZeneca, Otsuka, Bristol-Myers Squibb, Glaxo-
SmithKline, Pfizer Inc, Eli Lilly, Lundbeck, Servier
Laboratories and GW Pharma. He owns a small publishing
house, My Mind Books Ltd, which publishes mental health and
wellbeing books for the general public.
Dr Francesc Colom has served as advisory or speaker for
the following companies: Adamed, AstraZeneca, Bristol-
Myers Squibb, Eli Lilly, GlaxoSmithKline, Lundbeck,
MSD-Merck, Otsuka, Pfizer Inc, Sanofi-Aventis, Shire and
Tecnifar. He has received copyright fees from Cambridge
University Press, Solal Ed., Ars Medica, Giovani Fioriti Ed.,
Medipage, La Esfera de Los Libros, Morales i Torres Ed,
Panamericana, Mayo Ed. & Columna.
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