Patients' perceptions of their bipolar illness in a public hospital setting.

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.

Coping resources of African-American and white patients hospitalized for bipolar disorder.

Forty-two African-American and 80 white patients hospitalized for bipolar disorder completed the Coping Resources Inventory. Total resource scores of the African Americans were significantly higher than scores of the whites, although differences in background variables between the two groups were not evident. The African-American group also scored significantly higher than the whites on the three scales indicating internal resources-cognitive, emotional, and spiritual-philosophical. No statistically significant differences were found for the two groups on the social and physical scales. Cultural orientations influencing personal life philosophies may explain the differences between the African-American and white patients on perceptions of their coping resources.

Perceptions of problems in people hospitalized for bipolar disorder: implications for patient education.

This study explored the perceptions of people hospitalized for bipolar disorder in regard to their difficulties in functioning and the most important problem with which they would like the hospital's help. One-hundred-twenty-two patients diagnosed with bipolar disorder completed the Behavior and Symptom Identification Scale (BASIS-32) at the beginning of their hospitalization. The relationships between subjective distress (measured by the BASIS-32 scores) and background characteristics were examined. In addition, participants' perceptions of their most important problems were coded as (1) psychiatric problems, (2) social or physical problems, or (3) no problems, and examined with respect to background characteristics. Race, admission status, and a secondary diagnosis of a substance use disorder were significantly related to overall subjective distress; a substance use disorder diagnosis was significantly related to all five BASIS subscale scores. No background variable was significantly related to the problems with which participants reported wanting the hospital's help, although admission status and race were of borderline significance.

Patient satisfaction with two models of group therapy for people hospitalized with bipolar disorder.

The purpose of this study was to (a) compare participants' evaluations of two models of inpatient group therapy for people with bipolar disorder and (b) develop a taxonomy of patient satisfaction with such groups. The sample of 110 people included 59 participants in the self-management groups and 51 participants in the interactional groups. Results indicated that although neither of the models was clearly preferred by participants, the responses were useful in identifying needed changes, and the benefits of providing inpatient diagnostically homogeneous groups for this population were evident. A refined self-management model that incorporates agenda setting in the format, and a taxonomy for use in future research, are presented.

Dually diagnosed inpatients' satisfaction with addiction groups.

1. This clinical report presents evaluations from 50 hospitalized dually diagnosed patients of the Addiction Education Group, a part of the inpatient dual diagnosis treatment program. 2. Patient satisfaction with the group was evaluated using the Client Satisfaction Questionnaire, an eight-item tool that measures reported satisfaction with services. 3. Generally, the patients were able to focus on issues of recovery as a group, provide and receive feedback from each other, and perceive the experience as beneficial.

Demystifying the Betty Ford Clinic: an immersion experience.

1. The purpose of the Betty Ford Clinic (BFC) Professional in Residence (PIR) Inpatient Program is to increase participants' understanding and awareness of chemical dependency and its treatment. 2. Current alcoholism treatment is a combination of medical, psychosocial, psychological, and spiritual modalities interacting in a framework designed to help the individual achieve and sustain sobriety (Collins, 1993); all of these treatment components are evident in the BFC Model. 3. Double-blind studies are not conducted at the BFC for ethical reasons, which are one of the many difficulties inherent in the use of conventional control designs for assessing the treatment effectiveness of residential drug abuse programs (De Leon, Inciardi, & Martin, 1995).

Inpatients with bipolar disorder: their quest to understand.

1. The quest to understand how to live with the recurrent, major mental illness of bipolar disease is a pursuit not to be undertaken lightly. 2. Studies related to informational search in any clinical population, medical or psychiatric, are scant. 3. Individual and group work with this population needs to include discussion of how to obtain self-management information when out of the hospital, potential barriers that may be encountered in the pursuit of such information, and adaptive and maladaptive responses to barriers.

Inpatient self-management of bipolar disorder.

As part of a grounded theory study of the self-management informational needs and activities of inpatients with bipolar disorder, an analysis was conducted to describe how hospitalized people with bipolar disorder manage their illness. Thirty-three people participated in semistructured, audiorecorded interviews that included questions about their self-management. Findings related to three areas: (a) factors that affect self-management, (b) patient-initiated self-management interventions, and (c) information believed by the participants to be important for other people with the disorder. Advances in the understanding of the self-management of people with bipolar disorder are pivotal to the development of strategies that may reduce, and perhaps one day prevent, relapse.

Information seeking among people with manic-depressive illness.

OBJECTIVE: To develop a descriptive theory of the information seeking states of hospitalized people with manic-depressive illness, as the first step in generating a substantive theory of the self-management informational needs and activities of this population. DESIGN: Exploratory, using grounded theory methodology. POPULATION, SAMPLE, SETTING: Predominantly indigent and ethnically-diverse population in one 250-bed, university-managed, county- and state-funded acute psychiatric facility in the Southwestern U.S.A. A convenient sample of 20 women and 13 men hospitalized for manic-depressive illness were interviewed from December 1992 through December 1993. METHODS: Interviews with participants and review of medical records. Interview transcriptions were analyzed using conceptual coding and the constant comparative method. FINDINGS: The core variable of information-seeking states was acceptance of having manic-depressive illness. Three groups are: information seekers, information receivers, and information rejectors. Seven informational states are: novice, recent acceptor, veteran, passive acceptor, acknowledged denier, acknowledged rejector, and complete rejector. An individual's information-seeking state is not necessarily constant, and may shift to another state depending upon various factors. CONCLUSIONS: This typology of information-seeking states is the first part of a substantive grounded theory of the self-management informational needs and activities of people trying to cope. CLINICAL IMPLICATIONS: Results of this study suggest that patient education should address a person's current information-seeking state. The proposed typology can be used to develop a self-assessment tool for completion by a patient before participating in educational or therapy programs.

Informational needs of patients hospitalized for bipolar disorder.

Thirty-three inpatients (20 women and 13 men) with bipolar disorder participated in audiotaped, semi-structured interviews that focused on their informational needs in six areas: self-management of the disorder, understanding bipolar disorder, managing daily life, living in society, relating to others, and relating to self. The interviews were transcribed and systematically analyzed to produce a typology of needs, which was evaluated by the interviewees as it evolved. The typology is useful for structuring psychoeducational programs. The findings attest to the importance of providing education for persons with bipolar disorder in all health care settings in which they seek treatment.

Striving for stability with bipolar disorder despite barriers.

A conceptual model was developed during interviews with 33 participants that depicts the processes of information search and self-management of hospitalized people with bipolar disorder. Grounded theory methodology guided data collection and analysis. Barriers were reported as encountered throughout the processes; denial of the disorder was the most prevalent obstacle. Critical areas of intervention are helping the person accept the disorder and achieving the basis to be motivated for self-management. Recommendations are for relapse reduction programs to be structured on the awareness that relapse is most likely to occur when barriers are encountered, and that people with the disorder perceive barriers to be everywhere.

Treatment of inpatients with bipolar disorders: a role for self-management groups.

1. Group therapy for outpatients with bipolar disorders is perceived as an effective adjunct to psychopharmacotherapy. Although medications to treat bipolar disorders have been well characterized and compliance usually results in good control of symptoms, the value of a group intervention program focusing on self-management has been ignored in inpatient treatment. 2. A patient workbook is being planned. This workbook is intended to impart additional information concerning self-management and free the therapist from devoting group time to individual didactic instruction. 3. Inpatients with bipolar disorders have responded favorably to diagnostically homogeneous group therapy. The data accumulated from their reports helped to formulate the Self-Management of Bipolar Disorder Group Model and this new model must be compared with the original model to ascertain effectiveness.

How do inpatients with bipolar disorder evaluate diagnostically homogeneous groups?

1. The results of this study suggest that inpatients with bipolar disorder consider diagnostically homogeneous group therapy to be beneficial. All the patients who responded to the overall helpfulness criterion indicated that the group was helpful to them, and most indicated that it was very helpful. 2. Although relating with others may have been important to participants, it is easy to appreciate that understanding the disorder would be a top priority for inpatients. 3. Inpatients with bipolar disorder might benefit from groups that are structured to include topic-oriented didactic and discussion components.

Self-perceptions of interpersonal and sexual functioning in women with mood disorders: a preliminary report.

Women with mood disorders are faced with the complex interpersonal issues that confront all women, as well as the potential disruption in their interpersonal functioning related to the nature of their disorder and the medical treatment required. The purposes of this study were to describe the self-perceptions of 34 women being treated medically for mood disorders regarding (a) their interpersonal and sexual functioning, (b) the causal explanations for perceived disruptions in interpersonal and sexual functioning, and (c) the effect their mood disorder has had on their functioning in these areas. A structured questionnaire was used to conduct the in-depth interviews. Results indicated that 76.5% (n = 26) of the women perceived that they were experiencing interpersonal disruption, and 55.9% (n = 19) perceived that they were experiencing sexual disruption at the time of the interviews. Moreover, 88.2% (n = 30) reported that their mood disorder had an effect on their interpersonal relationships, and 79.4% (n = 27) reported that their mood disorder adversely affected their sexual relationships. Causal explanations related to the perceived disruptions in functioning were explored.

Content analysis of groups for inpatients with bipolar disorder.

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.

Problem-solving group therapy: two inpatient models based on level of functioning.

Hospitalized psychiatric patients frequently have deficits in their problem-solving abilities. An inpatient problem-solving group provides a therapeutic experience in which patients learn and apply the problem-solving process to practical and interpersonal difficulties they are presently experiencing. Two problem-solving group models, derived from cognitive-behavior theory, are suggested to accommodate diverse levels of inpatient functioning. Implications for nursing practice and recommendations are addressed.