The development and adaptation of treatment approaches for both unipolar and bipolar disorders continues to gather pace. In the area of unipolar disorders, there are now well-established pharmacotherapeutic treatments that continue to be added to with new generations of antidepressants (see Chapter 7). Psychological treatments such as CBT and IPT have been shown to be efficacious in randomised, controlled trials in adults (see Chapters 8 and 9). The main challenge now for psychosocial approaches, and one that Markowitz (Chapter 9) details most clearly, is how these effective psychosocial treatments can be adapted for use with different populations such as adolescents (see also Chapter 5), older adults (see also Chapter 19), and specific disorder groups such as suicidal patients (see also Chapter 18).
In some ways, perhaps the most exciting area for the development of psychosocial treatments is now the neglected area of the bipolar disorders. Kay Redfield Jamison's writings, both her autobiography (1995) and her accounts of other famous sufferers (1993), have been at the forefront of drawing both lay and scientific attention to the bipolar disorders. In large part, the development of psychological treatments is a consequence of her major contributions. In Chapter 14, Schwannauer outlined the recent development of CBT approaches to bipolar disorders; in particular, the work of Newman et al. (2001) and Lam et al. (1999). Swartz and colleagues (Chapter 15) have shown one way in which IPT can be adapted to bipolar work. Both the CBT and the IPT adaptations have highlighted specific aspects of the disorder to focus on. For the CBT adaptation, the work on early warning signs that has proven fruitful in CBT work with schizophrenia (e.g., Birchwood, 2000) provides an important new clinical tool. When such early warning signs are identifiable, we have the possibility for sufferers and carers of alternative management strategies (see Chapter 16). A problem arises when early warning signs do not occur, as when there is a rapid transition into the disordered state. In these cases, perhaps the adapted IPT approach, IPSRT, with its focus on disrupted circadian rhythms, may provide an additional clinical strategy. However, because these CBT and IPT approaches are at an early stage of development, they are currently being compared with each other, and with pharmacotherapy, in a substantial NIMH-funded randomised controlled trial. Ultimately, though, one suspects that the best psychosocial approaches to the management of these difficult and tragic disorders will require combined pharmacotherapy, CBT, IPT, and family approaches (e.g., Miklowitz & Goldstein, 1997) as appropriate (see Chapter 13).
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