title: Functional impairment, stress, and psychosocial intervention in bipolar disorder.
abstract: The longitudinal course of bipolar disorder (BD) is highly impairing. This article reviews recent research on functional impairment in the course of BD, the roles of social and intrafamilial stress in relapse and recovery, and the role of adjunctive psychosocial interventions in reducing risk and enhancing functioning. Comparative findings in adult and childhood BD are highlighted. Life events and family-expressed emotion have emerged as significant predictors of the course of BD. Studies of social information processing suggest that impairments in the recognition of facial emotions may characterize both adult- and early-onset bipolar patients. Newly developed psychosocial interventions, particularly those that focus on family and social relationships, are associated with more rapid recovery from episodes and better psychosocial functioning. Family-based psychoeducational approaches are promising as early interventions for children with BD or children at risk of developing the disorder. For adults, interpersonal therapy, mindfulness-based strategies, and cognitive remediation may offer promise in enhancing functioning.
authors.affiliation: Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Behavior, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Room 58-217, Los Angeles, CA 90024-1759, USA. dmiklowitz@mednet.ucla.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy*; D002648:Child; D019260:Expressed Emotion; D005190:Family / Q000523:psychology; D005196:Family Therapy; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D011613:Psychotherapy / Q000379:methods*; D013315:Stress, Psychological