Implementing Psychoeducation for Bipolar Disorder Management in Psychiatric Ward

Running head: BSC MENTAL HEALTH NURSING
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Name of the Student
Name of the University
Author Note

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Table of Contents
1.0 Full Dissertation title............................................................................................................2
2.0 Key words............................................................................................................................2
3.0 Rationale/need for the project..............................................................................................2
4.0 Project Methodology............................................................................................................4
4.0.1 Aims..............................................................................................................................4
4.0.2 Literature search strategy..............................................................................................4
4.0.3 Literature review...........................................................................................................5
5.0 Change management..........................................................................................................14
5.0.1 Project initiation..........................................................................................................16
6.0 Conclusion..........................................................................................................................21
References................................................................................................................................22
Appendix..................................................................................................................................34

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1.0 Full Dissertation title
A proposal to introduce psychoeducation approaches for implementation by nursing
professionals to treat patients suffering from bipolar disorder. The proposal will be
implemented in the psychiatric ward.
2.0 Key words
P (population) Psychiatric ward patients suffering from
bipolar disorder
I (intervention) Psychoeducation
C (comparison) (No comparison)
O (outcome) Reduced relapse of symptoms, longer
relapse time, enhanced mental health
Table 1- PICO format for research question
3.0 Rationale/need for the project
Bipolar disorder, is commonly referred to as manic-depressive illness and the disorder
encompasses a plethora of brain disorders which are responsible for bringing about unusual
alterations in the mood, energy, mood, and levels of activity of a person, thus producing
difficulties in the capability to conduct daily undertakings (Faurholt-Jepsen et al., 2014).
Individuals diagnosed with the mental disorder are found to participate in poor decision
making, in relation to the immediate circumstances and also demonstrate a reduced want for
sleep. The affected persons also report negative discernments regarding life and fail to uphold
eye contact. The disorder is chiefly characterised by augmented risks of suicide among
individuals suffering from the complaint, in addition to raised rates of self-harm imposing
conduct (Yatham et al., 2013).

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There were an estimated 4 million cases of mood disorders that also comprised of
bipolar disorder among people living in the UK in 2013. Furthermore, the youth were also
found at an increased likelihood of suffering from bipolar disorder, when compared to their
older counterparts in 2014. While 3-4% of young people aged 16-24 years showed a positive
screening for the mental illness, only 0.4% of older adults aged 65-74 years reported the same
(Mental health foundation, 2015).
While the lifetime prevalence of bipolar disorder in the UK population is 1-2%, it
takes approximately 10.5 years for an affected person to obtain the correct health diagnosis
for the condition (Bipolar UK, 2018). Addiction is a major problem among people suffering
from bipolar disorder. Most patients diagnosed with the mental illness report attempts of self-
medication for reducing the severity of depression and often resort to the use of drugs and
alcohol, with the aim of promoting sleep. Mixed mood episodes that are primarily
characterised by the incidence of both hypomanic or manic and depressive symptoms, in
association with a rapid change of the symptom types, are being progressively recognised as
more prevalent among people diagnosed with bipolar disorder (Phillips & Kupfer, 2013).
Furthermore, there are several medications that are used for treating people suffering
from bipolar disorder. These medications are prescribed with the intent of reducing the
depressive and maniac symptoms (Bourne et al., 2013). Although valproic acid, lithium, and
lamotrigine are commonly used under such circumstances, it often becomes difficult for
nursing professionals and psychiatrists to determine the correct combination of medications
that would prove effective (Malhi, Adams & Berk, 2010). Patients suffering from bipolar
disorder also report an increased susceptibility to a plethora of other social and physical
problems (Piterman, Jones, & Castle, 2010). While the psychological comorbidities most
commonly assume the form of anxiety symptoms that get superimposed on depression or
hypomania, there is a need to detect the exact difference between them. Physical

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comorbidities also express in the form of cardiovascular complications, poor diet, obesity,
and hyperlipidaemia (Amann, Radua, Wunsch, König & Simhandl, 2017). Thus, it is
essential for the healthcare professionals to adapt to the use of other non-pharmacological
approaches as well for management of bipolar disorder symptoms among patients admitted to
a psychiatric ward. Thus, the proposal aims at implementing psychoeducation, an evidence-
based therapeutic intervention by nursing professionals for educating the people seeking
treatment for bipolar disorder, and effectively managing their illness and other comorbidities.
4.0 Project Methodology
4.0.1 Aims
The project will aim to implement a change strategy that focuses on psychoeducation
as an effective therapeutic tool that can be used by nursing professionals in a psychiatric ward
for the management of bipolar disorder symptoms among admitted patients. The change
management strategies will also be followed by recommendations that can help in operation
of the intervention in nursing practice.
4.0.2 Literature search strategy
The strategy used in this dissertation focuses on a narrative literature review that is
based upon previous findings, pertinent to the research question. Some keywords and search
phrases that were used along with specific boolean operators were ‘AND’ and ‘OR’. These
helped in either broadening or narrowing down the search results and facilitated extraction of
relevant scholarly pieces of literature (McGowan et al., 2016). Three electronic databases
namely, MEDLINE, CINAHL, and PubMed were used for the data extraction. Input of the
search terms were accompanied by addition of filters and limiters that narrowed down the
emphasis of the search, thus ensuring that the exploration was restricted in accordance to the
research question (Aromataris & Riitano, 2014) (refer to appendix). The Appraisal Skills

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Programme checklist (CASP) was also used to review the articles, with the aim of obtaining
appropriate and evidence-based literature on psychoeducation in mental health practice.
4.0.3 Literature review
Psychoeducation is defined as the procedure that encompasses the delivery of
education and pertinent information to people who seek or receive appropriate mental health
services (Chan, Yip, Tso, Cheng & Tam, 2009). This is usually required by individuals
diagnosed with different mental health condition and their family members. Zhao, Sampson,
Xia and Jayaram (2015) define psychoeducation as the education of a person who has been
diagnosed with a psychiatric disorder regarding the presenting complaints, symptoms,
prognosis and treatment of the illness. They also elaborated on the fact that brief
psychoeducation for any mental illness reports significant reduction in the relapse of the
illness in medium term, and also promotes medication compliance among the affected people
in short term. The statements are consistent with other articles that illustrated the importance
of psychoeducation in improving the compliance to schizophrenia symptoms and health
outcomes, without bringing about any noteworthy onset of adverse health effects (Bäuml et
al., 2016).
In other words, psychoeducation have been found beneficial in improving the
adherence to prescribed treatment regimen and also motivates the mentally ill patients to
accept the recommended maintenance therapy, as per the healthcare guidelines. The
information that is offered to patients seeking psychoeducation support often range from
educating the patients on the potential benefits of the prescribed medication to enhancing
their adherence, to complex, intensive interventions that cover all information related to drugs
and the illness. There often exists a considerable overlap between specific psychotherapies

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such as, interpersonal and social rhythm therapy (IPSRT), cognitive behavioural therapy
(CBT), and family-focused therapy (FFT) and psychoeducation (Lefley, 2009). D’Souza et
al. (2010) conducted a randomised controlled trial to determine the impacts of
psychoeducation program on the relapse rates of bipolar disorder among patients. Findings of
the RCT suggested that the intervention group participants showed reduced likelihood of
relapse symptoms and also had a longer relapse time (11 weeks), in comparison to the
treatment-as-usual group. Although the sample size was small, further improvements were
also associated with a reduction in the maniac symptoms and improved adherence to
medications, thus suggesting the utility of psychoeducation in bipolar disorder management.
However, Bond and Anderson (2015) argued that individual psychoeducation
programs were not much beneficial in preventing bipolar disorder relapse. Upon conducting a
systematic review of randomised controlled trials, the findings suggested that
psychoeducation was effective in averting any reversion of symptoms (n = 7; OR: 1.98–2.75;
number needed to treat (NNT): 5–7) and hypomanic or manic recurrence (n = 8; OR: 1.68–
2.52; NNT: 6–8). Showing consistency with previous findings, psychoeducation was found to
improve the short‐term medication knowledge and medication adherence. However, failure of
the psychoeducation interventions in preventing bipolar associated depressive symptom
relapse explained the presence of heterogeneity in the individual interventions.
Nonetheless, the interventions that focus on psychoeducation were found operational
in bringing about statistically momentous enhancement in the compliance to medications
among bipolar disorder patients in another RCT (P = 0.008). Upon subjecting patients to 50
minutes of psychoeducation sessions, lower cases of hospital admissions and disorder relapse
were also found in the intervention group, compared to the control group (P = 0.000)
(Javadpour, Hedayati, Dehbozorgi & Azizi, 2013). These were in contrast to the findings
presented by de Azevedo Cardoso et al. (2014) who conducted an RCT for assessing the

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effects of brief psychoeducation on bipolar disorder. While there was no statistically
significant difference in the quality of life of patients subjected to psychoeducation and
medication, and the usual care group, the improvement persisted during 6-month follow-up
period, thus establishing the fact that psychoeducation in addition to pharmacological
intervention might prove effective in enhancing quality of life of bipolar disorder patients.
In the words of Gumus, Buzlu and Cakir (2015) individual psychoeducation program
do not prove helpful in reducing recurrence rates of bipolar disorder and its comorbid
psychological symptoms. Although recurrence rate among patients in the experimental study
was 18.9% in intervention group, in comparison to 34.1% in the control group, failure to
achieve a statistical significance between the both made the researchers conclude that
although individual psychoeducation sessions produce positive impacts, they are ineffective
in the prevention of relapse. Besides, it was reinforced by other researchers that
psychoeducation programs in addition to pharmacotherapy are a potential treatment option
that can improve global functioning and medication adherence of bipolar disorder patients.
Increase in medication adherence score of the psycho-educational group from 6.27(0.88) to
7.92(1.38) provided evidence for the worth of psychoeducation as an intervention in mental
health settings (Bahredar, Farid, Ghanizadeh & Birashk, 2014).
Rahmani, Ebrahimi, Ranjbar, Razavi and Asghari (2016) also recommended the
implementation of interventions that focused on psychoeducation in clinical settings by
psychiatric nurses. Significant increase in the mean scores related to medication adherence in
the experimental group than the control group established the fact that educating the patients
on the benefits of the prescribed medications are a good strategy for increasing their
compliance, thus managing the bipolar disorder symptoms. Psychoeducation was confirmed
as the key component of collaborative models related to treatment of mental disorder that
campaigns the rights of all patients being informed about the proposed plan of treatment plan.