Cappleman, Reed and Smith, Ian and Lobban, Fiona (2014) Managing bipolar moods without medication : a qualitative investigation. PhD thesis, Faculty of Health and Medicine.
Abstract
This thesis begins with a literature review examining whether family interventions for people diagnosed with Bipolar Disorder (BD) lead to better outcomes for their relatives, who often exhibit greater service utilisation and greater distress than the general population. Following a systematic search of the quantitative literature, ten papers were identified, analysed for relevant data, and assessed for their methodological rigour. Results indicated that family interventions may improve relatives’ feelings of carer burden and psychological distress, but that these conclusions must be treated with caution given methodological issues in the evidence base. Suggestions are made as to which type of family intervention clinicians should consider offering, and which priorities future researchers in this area may wish to address. Decisions not to use medication among people diagnosed with BD are often viewed as indicative of a ‘lack of insight’ into the nature of bipolar moods and medication. However, research has not examined the individual’s experiences once they decide to manage bipolar moods without medication. The empirical paper presented here seeks to elucidate the processes by which people manage bipolar moods without medication by using grounded theory methods. Ten participants were interviewed and a model developed from their data. This model suggests participants engaged in a complex decision-making process as to how to manage their moods, frequently with reference to beliefs they held about themselves and their mood, suggesting that the ‘lack of insight’ model may be inadequate for understanding the processes involved in managing bipolar moods without medication. On the basis of the model developed from the data, suggestions are made regarding clinical interventions and future research. There then follows a critical appraisal of the work conducted in the empirical paper, focussing on challenges in the area of recruitment, in the hope that reflections provided will aid future researchers in this area.