BACKGROUND: Although diagnostically homogeneous group therapy is a generally accepted component of the outpatient treatment of persons with bipolar disorder, investigations into the use of this modality in the inpatient setting are preliminary.OBJECTIVES: The purpose of this study was to compare the effectiveness of the Self-Management Group Model with that of the Interactional Group Model in improving the ability of patients hospitalized with bipolar disorder to care for themselves when discharged.DESIGN: This study used a quasi-experimental, nonequivalent comparison group design with repeated measures that were administered before the intervention, after the intervention, and 3 months after discharge from the hospital. Instruments elicited data on self-reported mood states, behavior and symptom identification, coping resources, and satisfaction with the group services.RESULTS: One hundred twenty-two people participated at the first measurement period. No significant total score differences were found between the two groups on any of the four measurements. However, 3 months after hospitalization, Interactional Group Model participants reported significantly less difficulty with behaviors and symptoms at the 3-month measurement period when compared with their admission scores but less satisfaction with the groups than they had at discharge.CONCLUSIONS: Results suggest that each method has advantages; the optimal model may be one that combines elements of both methods within a self-management focus.

This preliminary study explored the perceptions of illness of people in a public hospital setting for treatment of bipolar disorder. Fifteen inpatients (5 African Americans, 5 Hispanics, and 5 European Americans) participated in audio-recorded, structured interviews. The interviews were designed to identify recurring themes and patterns in their perceptions of bipolar disorder and to assess their cognitive representations of the illness. The interviews were transcribed verbatim, and content analysis procedures were used to identify the illness perceptions and to compare them based upon ethnic orientation. Results indicated that most of the participants' group responses were more alike than they were different. However, discrete themes emerged among the individuals as their stories unfolded. These themes, and the perceived benefit of the interview itself, provide a beginning foundation for further research in the area, and have clinical relevance for health care providers working with this population.

This study assessed whether a secondary diagnosis of a substance use disorder in hospitalized people with bipolar disorder was associated with poorer outcomes on self-reported measures of mood (Profile of Mood States), subjective distress (Behavior and Symptom Identification Scale), and coping resources (Coping Resources Inventory), and with specific patient characteristics. Sixty-two patients with bipolar disorder and a secondary diagnosis of a substance use disorder and 60 patients with only a bipolar disorder diagnosis participated. Patients with bipolar disorder and a secondary diagnosis of a substance use disorder perceived significantly more impairment on all three measures than did patients without the secondary diagnosis. Moreover, the background characteristics of a history of violence, past or current involvement with the criminal justice system, and not having an antipsychotic medication prescribed during hospitalization had the strongest association with having a secondary diagnosis of a substance use disorder among the characteristics examined. These findings suggest the existence of a subgroup of patients with substance abuse and bipolar disorders who have substantial psychosocial impairment and probably require more intense treatment.

This descriptive study was designed to learn, from the perspective of dually diagnosed inpatients, what factors affect their maintenance of an aftercare program. Ten audio-recorded focus groups were conducted using a structured interview schedule; additionally, patients participated in structured brief individual interviews, and their medical records were reviewed for demographic data and chief complaints on admission. Despite the numerous obstacles encountered by this population intrapersonally, interpersonally, environmentally, and socially, participants were able to provide (a) specific information to increase the understanding of compliance from their perspective and (b) recommendations for health care professionals to facilitate adherence to aftercare treatment plans.

Addiction Education Groups for inpatients with dual diagnoses were developed out of an identified need on the dual diagnosis unit and were so well received by participants and staff that they were made available to adult patients with dual diagnoses through out the facility. The function of the groups was to educate people with substance abuse problems and mental illness about recovery from addiction within the context of having a concomitant mental illness. The session format varied depending on the day's topic. Methods included didactic components, readings, discussions, video cassettes, video tap ing, role playing, and the use of in-group worksheets. (J Am Psychiatr Nurses Assoc [1998]. 4, 121-127)

Group therapy for patients with bipolar disorder is recognized as beneficial but has not been studied in an inpatient population. In this study, content analysis procedures were used to describe the content and process issues in 40 short-term group psychotherapy sessions attended by 65 inpatients with bipolar disorder. Five core categories emerged from the content: understanding the disorder, relating with others, managing daily life, relating with self, and living in society. Guidance, universality, and self-understanding were described most frequently when patients identified the group event that was most personally important to them. Implications for practice include providing therapy and education to this population through a topic-oriented group model.

Groups for Inpatients with Bipolar Disorder