Erin Walczykowski, Involving Family Caregivers in Bipolar Disorder Treatment
As part of our Overcoming Challenges of Bipolar Disorder educational series, we interviewed Erin Walczykowski, APRN, PMHNP-BC. Ms. Walczykowski is a BThe following is Part One of a two-part interview.
In what ways do you involve family caregivers when treating someone living with bipolar disorder?
The family has a major role in the treatment process, as they are an additional set of eyes and ears for the broader healthcare team. But, it’s important from the outset to ensure that the person living with bipolar disorder signs consent forms for communication between providers and identified family members. Ways that I like to involve family caregivers when treating someone living with bipolar disorder include inviting them to medication management appointments, providing education about bipolar disorder to the family (i.e., from both the caregiver and loved one’s perspectives), holding treatment team meetings as needed, and ensuring the family has contact information for those mental health clinicians involved in care, including crisis management. I also recommend connecting the family and loved one with a therapist that specializes in family therapy, particularly in the management of bipolar disorder. It is also important to engage the family in a manner that takes ethnic and cultural factors into consideration, as this can influence their perception of what mental illness is, looks like, and how it should be treated.
Family members can also be a conduit for care by learning to recognize their loved one’s patterns of onset of illness and how to help manage stressors and triggers. These triggers could include any major change, including the breakup of a relationship, loss of a job, death of a loved one, etc. Families can learn from past episodes as symptoms of bipolar disorder often have warning signs. Family members or friends can recognize early symptoms which often follow very specific patterns. This helps to prevent a serious episode of the illness before it happens by planning ahead (e.g., how to intervene and who to contact). It is also important that the family understands the process for hospitalization, should the acuity of symptoms warrant this. I like to explain in advance to family members the limitations of outpatient care, and how inpatient care can be of help to stabilize the loved one and prevent harm or irreparable social and financial damage.
What should family caregivers know about the treatment process?
Family caregivers should know that due to the chronic nature of bipolar disorder, treatment will be ongoing. This means making a lifelong commitment to seeing a provider for medication management and other mental health providers as needed for ongoing support. Treatment recommendations manage the symptoms, but do not cure the illness, so it is important to establish realistic treatment goals. Equally important to identification of the symptoms of bipolar disorder, is ruling out other co-occurring conditions with similar symptoms as we need to consider any chronic medical conditions that can exacerbate the symptoms of bipolar disorder. Also of significance is understanding the importance of medication adherence, the implications of substance use, maintenance of a good consistent sleep schedule, and potential psychosocial stressors.
There is no one approach to treatment, but instead a varied combination of approaches as unique as the person being treated. The treatment recommendations, particularly as it relates to medication, can vary over the course of time depending on whether the person living with bipolar disorder is experiencing manic or depressive episodes. Deciding what medications are best used during an acute episode versus the maintenance phase must also be considered. Review and adjustments to medications will be considered based on tolerability of side effects and efficacy, and as different types of bipolar disorder may respond better to a particular type of medication.
Side effects can vary between medications, and it may take time to discover the best regimen. Discussions about the criteria that need to be met in order for a loved one to be hospitalized are crucial. Family caregivers also need to be educated about loved ones living with bipolar disorder sometimes attempting to self-regulate their mood by using drugs and alcohol, which should be avoided as drugs and alcohol can not only result in mood instability, but also interact with prescribed medications.
What would you say to someone who is reluctant to involve their family member(s) in treatment decisions?
If there is reluctance on the loved one’s part to involve family in their treatment, I would first try to gather information as to the nature of their relationship with specific family members, as some relationships are estranged or chaotic, and thus could further exacerbate mood lability and impede or complicate the treatment plan. I would also educate the patient about the nature of the illness, including depressive episodes, and especially the risky, impulsive and reckless behaviors associated with manic episodes. I would highlight the importance of having family, or any identified responsible person to be involved.
It is best if it is someone they trust to relay information to the person living with bipolar disorder or clinicians, as insight and judgement can be impaired. If there is no family or loved one available, then connecting the person living with bipolar disorder with a mental health clinician or peer-support contact who can work to build a rapport would be advantageous. Having as many supportive individuals as possible also helps to minimize any legal, financial and social consequences. Accepting support from family members or friends who can recognize early symptoms is vital as the loved one can lack insight into an impending episode.
- Read Part Two of our interview with Ms. Walczykowski where she discusses how families can navigate more extreme circumstances when a loved one has bipolar disorder.
- Check out our list of resources for overcoming challenges of bipolar disorder.
- Watch our Bipolar Disorder: Beyond the Basics webinar.