Peer Reviewed Article on Bipolar Disorder and Dysfunctional Family

• Research article
• Open Access
• Published: 08 February 2021

Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence

BMC Psychiatry volume 21, Commodity number:83 (2021) Cite this article

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Abstruse

Background

Bipolar disorder is a common psychiatric disorder with a massive psychological and social burden. Enquiry indicates that handling adherence is non good in these patients. The families' knowledge near the disorder is fundamental for managing their patients' disorder. The purpose of the present study was to investigate the knowledge of the family members of a sample of Iranian patients with bipolar I disorder (BD-I) and to explore the potential reasons for treatment non-adherence.

Methods

This study was conducted past qualitative content analysis. In-depth interviews were held and open-coding inductive analysis was performed. A thematic content analysis was used for the qualitative information assay.

Results

The viewpoints of the family members of the patients were categorized in five themes, including knowledge virtually the disorder, data about the medications, information well-nigh the handling and the corresponding role of the family, reasons for pharmacological handling non-adherence, and strategies applied by families to enhance handling adherence in the patients. The research findings showed that the family members did not have enough data virtually the nature of BD-I, which they attributed to their lack of grooming on the disorder. The families did not know what caused the recurrence of the disorder and did not accept sufficient cognition about its prescribed medications and treatments. Also, most families did not know near the etiology of the disorder.

Decision

The lack of knowledge among the family members of patients with BD-I can have a significant touch on relapse and treatment non-adherence. These issues need to exist further emphasized in the training of patients' families. The present findings can be used to re-design the guidelines and protocols in a way to improve treatment adherence and avoid the relapse of BD-I symptoms.

Peer Review reports

Groundwork

Bipolar I disorder (BD-I) is a chronic and recurrent psychiatric disorder in which a person has a manic episode for 1 calendar week, which may present earlier or after hypomanic or major depressive episodes [1].

BD-I is accompanied by chronic stress, inability, increased risk of sudden mood swings, higher rates of comorbid disorders and moral, financial, and legal bug. The disorder is ranked the 6th debilitating disease according to the World Wellness Organization (WHO). BD-I is considered the most expensive mental disorder in terms of the health and behavioral care required past the patients and the burden on governmental institutions and insurance companies [2,3,four]. According to a report by the Primal Bank of the Islamic Democracy of Islamic republic of iran, the average annual income of an Iranian household in 2012 was 209,050,000 Rials. The straight annual cost of one BD-I patient consists of 10% of this average family unit income [5].

BD-I affects the patient's life and has long-term consequences that are visible in the patient'southward social performance and quality of life [half dozen, 7]. Astringent impairment in job performance is observed in nigh xxx% of the patients with BD-I. In such cases, functional improvement falls essentially behind symptom comeback [i].

Pharmacological handling is the first-line treatment for BD-I. Evidence shows that nigh 40% of patients with BD-I practice not take expert medication adherence, which translates into a higher probability of symptom relapse, hospitalization, and increased suicide chance [8]. In a study in Tehran, Iran, poor treatment adherence was noticed in almost 30% of BD-I patients [9]. Some other report from Islamic republic of iran [10] also reported the prevalence of poor compliance in BD-I patients after the offset episode of mania as 38.1% during a 17-month follow-upwards period. Therefore, it is of keen importance to ameliorate sympathize and investigate the underlying reasons for treatment non-adherence in BD-I patients.

Given the changes implemented in health care systems over the last two decades and the resultant focus on customs-based services, the role of families in caring for BD-I patients has go more prominent [6]. The insufficient knowledge of families about the disorder, its symptoms, and medications has made the management of BD-I more difficult and somewhen imposes additional costs on them [half dozen]. The college is the cost imposed on the family, the more likely is it for the family members to bear witness adverse reactions to the BD-I patients, which itself leads to a higher chance of disorder relapse [three].

In Islamic republic of iran, the general public is acquainted with diverse types of psychiatric illnesses through mass media and public educational websites such every bit the website of the Iranian Psychiatric Association (https://iranmentalhealth.com) and other Farsi public written sources. Patients with BD-I and their families go familiar with the treatment process after consulting a general practitioner, a psychiatrist, or a psychologist, and, if necessary, the patients are admitted to the hospital through a psychiatrist. In addition to medical handling, they receive the necessary training and information about their handling procedure in the hospital. Furthermore, an association called ABR (Association of Mental Health Promotion), with an active website (http://abrcharity.ir), independently monitors patients, including those with bipolar disorder, after discharge.

Many studies have examined the views and roles of patients with BD-I and their caregivers and as well the importance of family sensation and its touch on medication adherence. Tacchi & Scott [xi] and Veligan et al. [12] propose that the family members' beliefs about the nature of BD-I and the information they have about the disorder affect the patient's medication adherence. The review of literature showed no precise studies conducted to explore the knowledge, information, and opinions of family members of BD-I patients virtually the disorder and the causes of their medication non-adherence.

In a previous study in Iran [13], the authors held qualitative interviews with the family members of patients with BD-I and reported that treatment non-adherence is a major trouble in these patients. They also reported that the patients and their families did not accept sufficient noesis nigh the nature of this disorder. Because these findings nearly the bereft noesis of the family members of BD-I patients and the high charge per unit of treatment non-adherence, it is necessary to comport more than studies to investigate the possible causes of handling non-adherence and families' knowledge and beliefs about this disorder in Islamic republic of iran. This study was thus carried out to explore the viewpoints of the family unit members of BD-I patients about the nature of this disorder and the potential causes of treatment non-adherence. The results tin be used for revising the psychoeducation guidelines for BD-I patients, as clinical guidelines mandate the inclusion of psychoeducation in the treatment program adopted for these patients. The results can as well exist used to design a protocol to address the disorder relapse, which tin have substantial consequences in terms of reducing healthcare costs.

Methods

The findings of this study are reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [xiv].

Study samples' characteristics

The participants were the family members of patients diagnosed with BD-I. The patients had been admitted to Iran Psychiatry Hospital in Tehran, Iran, and were receiving pharmacological treatments.

This report used purposive sampling to select the participants. From November 2017 to Apr 2018, 12 patients were interviewed by two psychiatrists based on the DSM-5 criteria [1] and received the diagnosis of BD-I. And then these diagnoses were confirmed by A.SH. and their families were invited to participate in the study.

None of the family members refused to participate in the report and they all completed the entire course of the study. The hateful age of the participants was l.83 years. There were iii male (25%) and nine female (75%) participants (Table one). Table 2 shows further details on patients' characteristics.

Tabular array 1 Participants' demographic characteristics

Full size tabular array

Table 2 patients' demographic and clinical characteristics

Total size table

Data collection

After diagnosing patients with BD-I, and obtaining the written consent of the family members of patients to participate in this study, data were collected by in-depth interviews from family members of patients, conducted at the hospital's conference hall. No one else was present at the time of the interviews except for the interviewer and the participant. Each interview lasted approximately 20 min and was digitally recorded for subsequent analyses. Two female PhD candidates (N. One thousand. and M. N.) in clinical psychology at the Academy of Social Welfare and Rehabilitation Sciences, Tehran, Iran, who had already received preparation on the implementation of qualitative studies, held the interviews. They did not know whatever of the participants. The interviewers introduced themselves to the participants earlier the beginning of each interview. The interview questions were provided by the authors. The interviews were held but once and were not repeated. Data saturation was reached with 12 participants, and no farther participants were interviewed afterward reaching this number. Data saturation occurs when no new information is obtained by conducting further interviews [fifteen].

Information analysis

Thematic assay was used for the qualitative information analysis [16, 17]. To this cease, the 6 steps proposed past Clark and Brown [17] were used.

The raw data derived from the interviews were used for the analysis. The content of the interviews were transcribed verbatim immediately after each interview. Field notes were made during the interviews and were reviewed in this stage. Three authors (Thou. N., N. Chiliad., and Z. T.) read the interviews several times for immersing in the data and getting familiar with it. Line-by-line coding was then applied to generate the initial codes. These steps were performed manually by the three authors without using any figurer programs. One author encoded each interview and the interview was and then read by another author and encoded once again. The individually-extracted codes were and then integrated and modified, if necessary.

In the adjacent footstep, by linking the codes together, their mutual patterns and concepts were extracted and potential themes and subthemes were identified, keeping the inquiry questions in mind. The data related to the themes were then collected and examined to verify the accurateness of the themes and subthemes, which resulted in v final themes.

Several statements were selected from the interviews every bit examples and are reported in the results section. To preserve participants' anonymity, their names and ages are not mentioned in the results; instead, they are represented by random numbers.

Results

Taking into business relationship comprehensiveness, homogeneity, and overlap, the components of the family members' viewpoints on the nature of the disorder and the reasons for pharmacological treatment non-adherence were categorized into v themes, including knowledge about the disorder, information about the medications, information about the treatment and the respective role of the family, reasons for pharmacological treatment non-adherence, and strategies applied by families to enhance treatment adherence in the patients.

Each of the themes contained several subthemes, which were themselves fabricated up of some open codes. These subthemes independent recurrent codes and concepts that shared a mutual meaning.

Table 3 presents the themes, subthemes and examples of some of the codes.

Table 3 Categories of perspectives of families with type one bipolar disorder concerning the nature of the affliction and not-adherence to treatment

Total size table

Theme one: knowledge well-nigh the disorder

Nearly interviewees did not have sufficient or accurate noesis virtually the nature of BD-I, the signs and symptoms of depression and mania cycles, and the outcome of the disorder. They mentioned the lack of training or inadequate preparation (peculiarly by healthcare providers) as the main cause of insufficient knowledge almost BD-I. Additionally, most families did not have a good understanding of the etiology of BD-I.

Some of them considered BD-I as a genetic abnormality, while others considered factors such as boyish maltreatment, parents' unusual conditions during sexual intercourse, and the lack of proper training before parenthood every bit potential causes of BD-I.

Participant No. 5 (a patient's married woman): "I was told that he has a nervous problem."

Participant No. 3 (a patient's mother): "I have a theory about having babies. I call up that non anybody should accept children. The husband and wife should be screened and monitored for 2 years to run across if they understand the thing conspicuously. Practice y'all see these anomalies now? ... These shameful movies they watch … The person is not feeling well when raising their kid … From an Islamic signal of view, from a human'due south betoken of view, both the husband and wife need to be monitored. Their food and other things should also be monitored to run across if they tin have a good for you infant."

Participant No. 7 (a patient's mother): "Because this boy is always impressed by me, sometimes I tell myself, maybe I didn't fully understand him during his puberty. Sometimes I blame myself, equally he has said this many times. I always blame myself … .

Sometimes he says, 'You did this to me, that'due south why I'm sick now and have drugs'. For example, when hitting puberty, in the showtime or 2nd yr of high school, he used to get up late and so he got to school very late. So the schoolhouse'south master complained to me, 'Why is he late once more?' And he says, 'Why did you wake me up early in the morn? You did this to me."

Participant No. 10 (a patient'southward mother), referring to her son's divorce: "That's why he's so broken."

Participant No. eleven (a patient's sister): "Bipolar disorder has a genetic background. I call back there would exist no one out there who suffered from the disorder unless they got the genes. It is a genetic disorder, but it emerges when a patient experiences a serial of shocking events. Well, some have higher potentials, such as those who get very angry. I mean, the anger itself is not part of the disorder, merely in aroused people, shocking events touch the patient more than quickly."

Theme 2: information about the medications

Many family unit members had a misconception virtually the handling of the disorder and the effects of psychotropic medications on the patients. In other words, they were unable to accurately identify the therapeutic furnishings of the administered medications and the time it took for the patients to bear witness signs of improvement. Also, some participants were unaware of the side-effects of the prescribed medications. Some mentioned side-effects like memory loss and drug addiction; however, virtually all the participants believed that pharmacological handling is necessary for the patients despite the side-effects.

Participant No. ane (a patient'south mother): "The problem of her running away from home with her boyfriend was a large burden for u.s.a., but as the prescribed meds began to prove their effectiveness, this trouble was gradually solved and we finally managed to put up with her aggressiveness and other bug. That is, we were saying to ourselves, 'This is a period of angriness; we had meliorate not said this, not washed that'... Nosotros thought the medication was working. But now they've told me, 'No, your patient has non recovered at all, has not been cured."

Participant No. 1 (a patient's mother): "Her showtime psychiatrist, who has been visiting her for eight years, was frequently asking if she studies, watches Boob tube or goes to work at all. 'Whenever she goes dorsum to these routines, so she has recovered,' the therapist would say. Recently, she's e'er been saying, 'I would love to become to work' so on. In one case, her employer told her to exercise some cleaning, and she had responded, 'I'k not your servant.' She suddenly bankrupt information technology off and said, 'I won't go to work anymore.' She didn't sleep at all, saying, 'I piece of work so much, but I don't feel exhausted at all.' We were also excited and thought 'Yeah, so this doctor's meds have been good; she's getting dorsum to normal, she's working,' She was frequently organizing her cupboard, like an obsession."

Participant No. 3 (a patient's mother): "I can't remember the side-effects but I've heard almost them in classes. My daughter is taking lithium now but she gets these chills. Her stomach is not well. Its side-effects are such that they affect her memory. However, when nosotros compare the pros and cons, we have to take it. "

Theme three: data about the treatment

The regular intake of medications, stress control, work, practise, regular visits to a psychiatrist or psychologist, and the need to provide insight into the patient'southward illness through education were noted by the families in this part. Some participants believed that psychotherapy sessions cannot assistance care for this disorder while some had completely false or superstitious beliefs virtually treatment of the disorder.

Participant No. 4 (a patient's son): "Our patient doesn't accept justifications. When you bring them to classes and convince them that 'You are sick, and you accept to take this medication because of this and that, and we take testify that you lot take this disorder,' and so we evidence it to them, prove it like in the movies, say that this disorder is serious because of so and and so reasons, I think, it would be much easier."

Participant No. 1 (a patient'southward female parent): "They sent usa to get counseling. Of form, my daughter did not cooperate and didn't come with. So, I got an engagement under my proper noun to get information and find out how to deal with this disorder. Then the psychologist said, 'No, your daughter is diagnosed with bipolar disorder; this is an astute illness. Counseling does non piece of work for her. She should take medications –a lot of them. And since the doc said those words, we withdrew from counseling altogether."

Participant No. v (a patient'due south wife): "My female parent-in-law says, 'If God gives him a infant, he'll be fine.' Because his ex-wife besides failed to bear a child for him."

Theme four: information about the role of the family unit in the treatment

Almost families defined their role as helping the patient recover and adhere to their treatment, reminding them to take the medications, encouraging them to go to the doctor, not leaving them alone, and doing whatever they wanted to exercise so that things went every bit the patient wished. The patients also appeared to experience guilty when their families tried to comfort them, and this pattern was observed in several of the participants in this study.

Participant No. 6 (a patient's husband): "We should put upwardly with her, love her, not argue about what she says, listen to her, go her to do practise to keep busy. I'thou here now and I brought her with me too instead of leaving her alone to think virtually stuff."

Participant No. 2 (a patient'due south mother): "You should be good to them, listen to them, make home a peaceful environs, and non contend."

Participant No. 8 (a patient's wife): "I don't know. If he simply thinks that everything is okay, all will be okay; just such feelings don't last forever."

Participant No. two (a patient'south mother): "I tell him to take his meds on fourth dimension … Say, 'Let's become to the park to have a look around ... Don't stay at home too much. God is merciful; it won't be that bad' … I talk to him, I comfort him sometimes, tell him that I'thousand ill too because I feel your pain.' I really practise. I've been crying solitary at home many times. God, what will happen at the stop?"(She cries).

Theme five: reasons for pharmacological treatment non-adherence

Equally for this theme, the participants noted issues that were mostly most the comments made by other people, including relatives or care-providers, such as doctors or specialists in other disciplines. An interesting observation was made by a participant who mentioned a glory talking on Television receiver about the inefficiency of medications; following these comments, the patient had stopped taking his medications. Another issue was that the families' constant changing of the patient's physician contributed to their medication non-adherence. Another reason noted for non-adherence was that the patients did not suffer from mania symptoms and found that it was not then crucial for them to accept the medications. Additionally, some patients reported the physical discomfort and weakness (e.thou., impotence) experienced as side-effects of the prescribed medications a reason for their medication non-adherence.

Participant No. 2 (a patient'south mother): "She didn't take the meds for vii to viii months. Her friend had told her 'Your optics await different. When you lot have the medicine, your optics turn into a strange shape. Get rid of them.' After vii months, her disease relapsed."

Participant No. six (a patient's husband): "If we go to a party somewhere and someone asks her, 'Oh, y'all take drugs?' … But that person is non aware of the thing, cause she might await all well, and that person doesn't know what's actually happening in my wife's mind, who then has to admit that she is alright."

Participant No. 7 (a patient'due south mother): "At ane signal at work, some colleagues told him, 'Yous will become addicted to the medicines, you volition get sick.' And so, he put the medicines bated and became pessimistic nearly his piece of work. 'This job has made me sick,' so he said and left his task of a sudden. He had a great job, non a difficult one. He could manage it by himself very easily."

Participant No. 3 (a patient's mother): "My son had gone to a doctor to remove the corn on his feet. The doctor had checked his medicine prescriptions and asked, 'What are these you're taking? Yous won't be able to excogitate a baby in the future. It'll affect you poorly' and and then on. My son keeps repeating what the doc told him."

Participant No. one (a patient'south mother): "That emergency nurse who came to our house told u.s.a. to change her doctor. Since then, she has kept repeating this judgement. She threw out all her medicines."

Participant No. 3 (a patient's mother): "Since the beginning of the new year, he's began to no longer take his medications. In Khandevaneh, ^{Footnote i} Mr. Mehran Ghafourian (a famous Iranian role player) said, 'I was in a bad mood ... I had depression. I put the medications aside and started exercising.' My son stopped taking his medicines on hearing those words. I asked him many times to get come across a doctor but he said no. He continued to not take his medicines and so his disorder worsened. He was frequently beating us up until we took him to the hospital with the aid of the police."

Participant No. 3 (a patient'due south female parent): "There was a child psychiatrist on a Goggle box talk. We took our son to her office. Nosotros used to visit a advisor too. The psychiatrist prescribed him some medications. We didn't know what the medications were. He was taking his medicines. In the middle of therapy, nosotros stopped it. Then, my son-in-law, who is a medico, said 'Dr. A -his professor- is a very good dr..' My son used to become to Dr. A. earlier when he was a college student. He was taking medicines and he believed in him so much. And so again, my eldest daughter, who is a md, said 'Dr. B. is a very helpful therapist. All the doctors, engineers, and educated people go to visit him.' And so he went there ... And two years ago, I took him to Dr. S. too, to help him become rid of his substance corruption." (This participant named seven dissimilar doctors).

Participant No. iv (a patient's son) discussed the reasons for the patient's refusal to have the medications and said: "Well, he doesn't actually believe in the disorder being a real one (in the manic episode). Maybe now he takes the pill in forepart of you, simply yous know that it is not something that bothers him. You accept pills more easily if you accept actual pain, only when you lot don't, you lot inquire yourself 'Why do I have to take all these pills?"

Participant No. eleven (a patient'south sister): "We tin note the poor behaviors of those effectually him. He considers whatever weaknesses he experiences (e.g., sexual issues) a side-consequence of the medicines he'due south taking. And he's linking everything to the medicines and thinking they're going to brand him unlike from the others."

Discussion

The findings of this study regarding the viewpoints of the family unit members of patients with BD-I were categorized into 5 themes. Although qualitative studies do not allow for the identification of the extent and relative importance of every condition, recurrent themes and concepts stated by the participants at different private and social levels were extracted.

Inquiry suggests that there is a relationship between families' knowledge and beliefs well-nigh the disorder and the patients' medication adherence [12]. The attitudes and knowledge of the family members have a significant influence on the patient's ain beliefs and attitudes and affect the patient's decision about treatment compliance [xviii]. In understanding with previous studies [19, 20], the family caretakers in this written report were shown to lack sufficient data and knowledge about the nature of BD-I. In addition, many participants had inaccurate or false information and insisted on these false beliefs. A review study on handling acceptance constitute that brief interventions focused on relapse prevention and psychoeducation-based interventions have the greatest affect on relapse prevention [21]. Maintaining the patients' circadian rhythms (especially sleep rhythm), controlling activeness levels, verifying and controlling initial symptoms of mania and depressive episodes, and not using narcotics or stimulants have been recommended in approved psychotherapy protocols for bipolar patients [22]. Nonetheless, the participants in this report did not discuss whatsoever of these important factors. The lack of knowledge about these of import issues among families can have a significant impact on relapse and treatment non-adherence in the patients. These points need to be further emphasized in grooming patients' families.

In a qualitative study on bipolar patients and their families, Peters, Pontin, Lobban, and Morriss [23] found that the viewpoints of patients and their families play an important role in managing the disorder; however, the families usually get despondent nearly participating in this process, and their perception was that some mental health workers believe that family unit interest makes their work more complicated. Meanwhile, the present report showed that, in Iran, families do not have plenty data about their part in preventing disorder relapse and aspect their patient's relapse only to factors such every bit medication withdrawal, unemployment, lack of community support, and financial issues. Nearly of them believed that if everything goes as the patient wishes, the disorder will not relapse.

Furthermore, the participants did non accept adequate information nigh the non-pharmacological treatment options available for this disorder and the role that psychologists tin can play in helping the patients enhance their medication adherence and prevent the symptoms of relapse. A multifariousness of behavioral, cognitive, and emotion-focused interventions are used in the direction of bipolar disorders [22]. All the same, the participants did not accept sufficient knowledge about these treatments. The ascertainment that many psychologists in Iran appear unwilling to participate in the handling of bipolar disorder patients seems to play a part in this lack of cognition. According to Farhoudian et al. [24], only almost 1.5% of all the studies on psychiatric disorders conducted in Iran between 1973 and 2003 involved bipolar and cyclothymic patients. In a qualitative study on bipolar-II patients and their families, Fisher et al. [25] found that the number of resources available to patients for deciding virtually their handling has increased and their priorities take been given increasing attending; however, the patients' and their families' preferences are not fully considered.

Similar to the studies carried out by Jönsson, Wijk, Skärsäter & Danielson [26] and Shamsaei, Mohamad Khan Kermanshahi, and Vanaki [27], in the present study, the patients and their families were struggling with the acceptance, understanding, and management of the disorder. Co-ordinate to the participants, the families' lack of insight into the patients' disorder contributed significantly to their medication non-adherence. This finding is in line with Scott and Pope's [28] enquiry, but Delmas, Proudfoot, Parker, and Manicavasagar [29] stated that the rejection of treatment is a circuitous issue that depends on various factors.

Some of the results of this study are consequent with the findings reported by Clatworthy, Bowskill, Rank, Parham, and Horne [eight], who noted that deliberate treatment not-adherence is associated with factors such as patients' concerns about the prescribed medications and their side-furnishings in the example of continuous consumption. Proudfoot et al. [thirty] stated that the side-effects of medications, coping with unpleasant symptoms, the extent of awareness well-nigh the nature of the disorder, and the reactions to it as well as the stigma associated with the disorder affect the patient'southward life path. Besides, these symptoms take a permanent impact on the disorder relapse [31]. The findings showed that the interaction of the disorder, patient, medications, psychiatric attitude, and cultural mental attitude with non-compliance is very complex [32].

In addition to the themes mentioned, there were some interesting results concerning the response process in all the interviews. For instance, the bulk of the participants but reported symptoms of the manic episode, while two major studies [33, 34] have shown that people with bipolar I and Ii (especially type Ii) disorders spend well-nigh of their symptomatic days with depression. Patients suffer profoundly during the depressive episodes just have elevated or irritable moods during the manic episode; in contrast, families find the mania symptoms more than annoying and disruptive to themselves. This duality tin can negatively impact reaching a common understanding with the patient almost visiting the doctor and taking medications. Moreover, the fact that some families do non take enough information nearly the depressive episode can eventuate in neglecting the patient'southward need to take medications during this phase, which tin can so adversely affect medication adherence. These results are somewhat contradictory to the results of a previous written report [29], which reported that both patients and their family members report symptoms of mania and hypomania to their physicians less often, as some of them enjoy the manic symptoms. Family members feel relieved when they see that their patient is happy and shows mania symptoms. A major cause of this discrepancy in findings may be the differences in the written report populations. While Delmas et al. [29] studied patients with bipolar I and Two, the present study examined simply patients with BD-I. The discrepancy may also partially originate from cultural differences. It seems that when there is a design of greater attention to objective and apparent symptoms, very of import mental symptoms such as suicidal thoughts, whether during the mania or depressive episode, are neglected by families.

This written report showed that families with a higher educational and socioeconomic status tend to seek psychiatric care from dissimilar psychiatrists. Frequently changing the treating psychiatrist can cause handling not-adherence in the patients. Furthermore, as the family members of such patients falsely think that they have greater medical information, they are more than likely to encourage the patient to terminate taking their prescribed medications.

A major limitation of this study was that most participants were the mothers of the patients, as it was difficult to notice other family members of the patients to participate in the study. For example, only one child of a patient and one sister were among the participants. Also, all the participants were from Tehran and were selected from ane hospital; therefore, the generalization of the results to other cities in Iran should be pursued with caution.

Conclusion

The authors suggest using the findings of this qualitative study regarding the knowledge of the family unit members of patients with bipolar I disorder (BD-I) also as the dominating cultural behavior to pattern further quantitative studies. The quantitative cess of individual, familial, and social reasons for treatment not-adherence is as well a recommendation for future enquiry. Conducting similar studies on the family members of patients with other types of bipolar disorder with an attending to the unlike processes and outcomes involved is likewise recommended. Since there are different ethnicities and subcultures in Iran, the results obtained by examining the residents of the country'southward capital urban center cannot exist generalized to the population of other cities and towns, and it is necessary to repeat the study in other populations in social club to go familiar with other viewpoints in Islamic republic of iran.

Overall, the results of this report contribute to the emerging qualitative enquiry on bipolar disorder and provide the readers with an insight into the viewpoints of the family members of patients with BD-I. Some inaccurate data might have been observed in participants' statements due to some deeply-rooted cultural attitudes and beliefs and their correction may require extensive interventions.

The results of this study can be used to compile educational content for patients with bipolar disorder and their families too equally for psychologists, psychiatrists, psychiatry assistants, and hospital health workers.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Notes

1. A popular one-act show on Iranian television

References

1. Diagnostic and statistical manual of mental disorders. 5th edition (DSM-5). Arlington: American Psychiatric Clan; 2013.

2. Kaushik P, Bhatia M. Burden and quality of life in spouses of patients with schizophrenia and bipolar disorder. Delhi Psychiatry J. 2013;16(i):83-9.

3. Maji KR SMSRKS, Maji KR, Sood M, Sagar R, Khandelwal SK. No Title. 2012 Mar 18 [cited 2020 mar 16];58(2). Bachelor from: http://world wide web.ncbi.nlm.nih.gov/pubmed/21421638.

4. Zergew A, Hailemariam D, Alem A, Kebede D. A longitudinal comparative assay of economic and family caregiver brunt due to bipolar disorder. Afr J Psychiatry. 2008;11(3):191–8.

   Article  Google Scholar

5. Shirkhoda SA. The investigation of the corporeality of toll for bipolar disorder type I and its related factors during the 1-year follow-upwards for the hospitalized patients in Iran educational-therapeutic psychiatric middle [dissertaion]. Iran University of Medical Sciences ;2014.

6. Jönsson PD, Skärsäter I, Wijk H, Danielson E. Experience of living with a family member with bipolar disorder. Int J Ment Health Nurs. 2011;20(1):29–37.

   Article  Google Scholar

7. Shabani A, Ahmadzad-Asl One thousand, Zangeneh Thou, Teimurinejad S, Kokar S, Taban 1000, et al. Quality of life in patients with bipolar I disorder: is it related to disorder outcome? Acta Med Iran 2013:51(6):386-93.

8. Clatworthy J, Bowskill R, Rank T, Parham R, Horne R. Adherence to medication in bipolar disorder: a qualitative study exploring the part of patients' behavior nigh the condition and its treatment. Bipolar Disord 2007;9(6):656-64.

9. Sharifi A, Shabani A, Ahmadzadasl M. The pattern of adherence in patients with bipolar I disorder; an 8 weeks report: Iranian Periodical of Psychiatry and Behav Sci 2009;iii(two):39-43.

10. Shabani A, Eftekhar Yard. Non Compliance After First Episode of Manic or Mixed Mood State: A 17-Month Follow-upwards. 2007;1(2):46-49.

11. Tacchi Grand-J, Scott J. Improving adherence in schizophrenia and bipolar disorders: Wiley; 2005;7:24-31.

12. Velligan D, Weiden P, Sajatovic M, Scott J, Carpenter D, Ross R, et al. Expert Consensus Panel on Adherence Bug in Serious and Persistent Mental Illness. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry 2009;seventy(suppl iv):i-46.

13. Shabani A, Sobhani South, Tahmasebi N, Ghahramani S, Dejman M: How family unit caregivers of patients with bipolar disorder conceptualize caring problems: a qualitative study, unpublished.

14. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative inquiry (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;xix(vi):349-57.

15. Fusch PI, Ness LR. Are we in that location yet? Data saturation in qualitative research. Qual Rep. 2015;20(9):1408.

16. Clarke Five, Braun V. Using thematic assay in counselling and psychotherapy enquiry: A critical reflection. Couns Psychother Res 2018;18(2):107-10.

17. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101.

18. Chakrabarti S. Treatment-adherence in bipolar disorder: a patient-centred approach. World J Psychiatry 2016;6(4):399.

19. Shamsaei F, Mohammadkhan Kermanshahi South, Vanaki Z. Survey of Family Caregiver Needs of Patients with Bipolar Disorder. Avicenna J Clin Med 2010;17(3):57-63.

20. Rahmani F, Ebrahimi H, Ranjbar F, Asghari E. The issue of group psychoeducational program on attitude toward mental affliction in family caregivers of patients with bipolar disorder. Hayat. 2016;21(4):65-79.

21. MacDonald Fifty, Chapman Due south, Syrett M, Bowskill R, Horne R. Improving medication adherence in bipolar disorder: A systematic review and meta-analysis of 30 years of intervention trials. J Affect Disord 2016;194:202-21.

22. Wright JH. Cognitive-behavior therapy for severe mental affliction: An illustrated guide: American Psychiatric Pub; 2009.

23. Peters S, Pontin E, Lobban F, Morriss R. Involving relatives in relapse prevention for bipolar disorder: a multi-perspective qualitative study of value and barriers. BMC Psychiatry 2011;11(1):172.

24. Farhoudian A, Rad Goodarzi R, Rahimi Movaghar A, Sharifi 5, Mohammadi MR, Sahimi Izadian E, et al. Trend of Researches in the Field of Psychiatric Disorders in Iran. Islamic republic of iran J Psychiatry Clin Psychol 2007;12(4):327-36.

25. Fisher A, Manicavasagar V, Sharpe L, Laidsaar-Powell R, Juraskova I. A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder. J Ment Health 2018;27(i):66-79.

26. Jönsson PD, Wijk H, Skärsäter I, Danielson Due east. Persons living with bipolar disorder—their view of the illness and the time to come. Issues Mental Wellness Nurs 2008;29(11):1217-36.27.

27. Shamsaei F, Mohamad khan Kermanshahi Southward, Vanaki Z. Meaning of Health from the Perspective of Family Member Caregiving to Patients with Bipolar Disorder. Journal of Mazandaran Academy of Medical Sciences. 2012;22(90):52-65.

28. Scott J, Pope Grand. Nonadherence with mood stabilizers: prevalence and predictors. J Clin Psychiatry 2002;63(five):384-390.

29. Delmas K, Proudfoot J, Parker G, Manicavasagar Five. Recoding by experiences: A qualitative study of how patients and family members arrange to the diagnosis of bipolar disorder. J Nerv Ment Dis 2011;199(2):136-9.

30. Proudfoot JG, Parker GB, Benoit 1000, Manicavasagar Five, Smith M, Gayed A. What happens afterwards diagnosis? Understanding the experiences of patients with newly-diagnosed bipolar disorder. Health Await 2009;12(ii):120-9.

31. Crowe M, Inder M, Carlyle D, Wilson 50, Whitehead L, Panckhurst A, et al. Feeling out of control: a qualitative assay of the impact of bipolar disorder. J Psychiatr Ment Health Nurs 2012;19(4):294-302.

32. Weiss RD, Greenfield SF, Najavits LM, Soto JA, Wyner D, Tohen M, et al. Medication compliance among patients with bipolar disorder and substance apply disorder. J Clin Psychiatry 1998;59(4):172-4.

33. Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59(6):530-7.

34. Judd LL, Schettler PJ, Akiskal HS, Maser J, Coryell W, Solomon D, et al. Long-term symptomatic condition of bipolar I vs. bipolar II disorders. Int J Neuropsychopharmacol 2003;vi(two):127-37.

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Acknowledgements

The authors express their gratitude to all the staff of Iran Psychiatry Hospital for their generous cooperation in the study.

Funding

This research is funded by the Mental Health Research Center of Islamic republic of iran University of Medical Sciences (grant number 95–01–121-27963).

The views expressed are those of the authors and not necessarily those of the Mental Health Research Center of Iran Academy of Medical Sciences. The funders had no office in the study blueprint, data drove and assay, interpretation, determination to publish or the writing and preparation of the manuscript.

Author information

Affiliations

1. Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

   Nasim Mousavi & Marzieh Norozpour

2. Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Islamic Commonwealth of Iran

   Zahra Taherifar

3. Kinesthesia of Behavioral Sciences and Mental Health, Tehran Psychiatry Establish, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran

   Morteza Naserbakht & Amir Shabani

Contributions

NM, MN and ASH conceived the study thought and pattern. NM, and MN conducted the interviews. NM, MN and ZT conducted transcription and data analysis. NM, MNA and ZT interpreted and presented the results, and contributed to the manuscript. ASH supervised the research activities and contributed to the interpretation of results. NM, MN and ZT wrote the manuscript. All authors take read, edited and approved the terminal manuscript for submission.

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Correspondence to Marzieh Norozpour.

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This inquiry has been canonical by the Research Ethics Committee of Iran University of Medical Sciences (Lawmaking of Ideals: IR.IUMS.REC 1395.95–01–121-27963). Written informed consent was obtained from all the research participants prior to participating in the study.

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Not applicative every bit no personal information is provided in the manuscript.

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The authors declare that they take no competing interests.

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Mousavi, N., Norozpour, M., Taherifar, Z. et al. Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence. BMC Psychiatry 21, 83 (2021). https://doi.org/x.1186/s12888-020-03008-x

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• Received: twenty March 2020

• Accustomed: 08 December 2020

• Published: 08 February 2021

• DOI : https://doi.org/10.1186/s12888-020-03008-x

Keywords

• Bipolar I disorder
• Treatment non-adherence
• Family psychological instruction
• Qualitative written report

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