Use individual and family resources for therapeutic success

The active trialogical participation of the persons concerned, relatives and practitioners represents the equal rights and communication on an equal footing and strengthens the self-determination of the patients and their relatives. The goal is to involve loved ones in the direction of successful therapy so that individual and family resources can be better utilized. The new guideline is therefore the basis for lasting improvement in the care of patients with bipolar disorder. In addition, the S3 guideline focuses on bipolar disorder prevention and early detection. In order to better manage the affected young adults, the clinic led by Professor Bauer opens a day clinic in October.

One in three people in 100 suffers from bipolar disorder during their lifetime. Patients with such a psychiatric disorder often suffer from so-called manic and depressive phases, which alternate. Manic episodes are characterized by an inappropriate mood and obviously high or irritated. The depressive phases, on the other hand, are characterized by a depressed mood, a lack of interest and a reduction of motivation. In the disease, one distinguishes different degrees of gravity and evolution. Patients often suffer from severe psychosocial disorders. For example, a temporary or permanent disability to take early retirement with an average of 42 years, a sequence of illness that has important implications for both the patient and loved ones, as well as for the employer and the system health. Most patients become ill in early adulthood and have to live all their lives with recurring periods of major depression and mania. The lifespan and the need for recurrent treatment entail high costs. However, the much more threatening disease sequence is suicide linked to the disease. About 10 to 15% of patients with bipolar disorder commit suicide. Patients have a suicide risk 20 times higher than the general population. However, because of its complexity, the disease is often correctly diagnosed and treated with significant delay.

S3 guidelines are developed using studies (evidence) and experts (consensus) and are therefore the most advanced stage of development of medical treatment recommendations. The bipolar disorder directive focuses not only on the full description, classification and diagnosis of the disease, but also on treatment options and care, as well as its importance to the health system. "Together, we have developed a guideline in German for the treatment of bipolar disorder, which meets the strictest international methodological standards and is now the subject of its first complete update after six years," said Professor Bauer. On the basis of studies and expert opinions, recommendations are formulated in guidelines that apply primarily to the treating physician. But affected people and their loved ones can also learn about the recommendations made about the disease in a specific and independent way. The guideline aims to ensure the best possible care for patients – from the point of view of all those involved in care.

"This version of the guideline, which has a total of 234 recommendations, reflects the current state of knowledge critically appraised by several hundred scientific studies conducted by numerous experts, associations and organizations," emphasizes Professor Andrea Pfennig, coordinator of the project as well as the department of psychiatry and psychotherapy. active, the underlying complexity of the methods used in this S3 directive. The development and updating have not only incorporated the expertise of experts, but also the people concerned and their loved ones could bring significant experience to their experience. In particular, family members often have an important role to play in the daily prevention of crises and coping strategies, while experts bring their therapeutic know-how and patients are "experts in their own right". These skills are shared by the trilogue. "Fortunately, this triad is recognized and implemented in the S3 directive." Karl Heinz Möhrmann, board member of the Bavarian Mental Illness Association and a member of the German Society for Bipolar Disorders, explains Karl Heinz Möhrmann. With 10 years of experience, he has already worked on various guidelines related to mental illness.

The inclusion of family members in the process of treating those affected is essential because they have to deal with everyday life and prevent relapse by allowing a regular daily routine. "When the people affected can not act alone, we take on responsibilities and daily tasks such as cooking, shopping or paying bills," explains Karl Heinz Möhrmann. For example, family members need to learn to recognize the warning signs of illness so that they can see the GP on time. For loved ones, the pressure of suffering in times of crisis is often very strong, which is why they must learn how to cope with the illness of those affected. This requires professional support. It is only that if it is possible to plan and execute treatment on an equal footing by integrating as naturally as possible family members that individual and family resources can be better used. The active trialogic participation of the persons concerned, relatives and therapists in the direction of an obvious and equal cooperation allows a better mutual understanding at the level of the eyes and thus strengthens the self-determination of the patients and their relatives.

The evidence-based and consensus-based S3 guideline offers considerable potential for sustained improvement in care. The people concerned at the University Hospital of Dresden are already treated according to the latest version of the recommendations of the directive according to a concept of intersectoral treatment. To this end, the Department of Psychiatry and Psychotherapy offers a special outpatient clinic for bipolar illnesses. In addition, patients will be treated on a center of gravity specialized in depression and mania.

The prevention of bipolar disorder is an important aspect of the S3 Directive. This work mainly concerns the staff of the Early Detection Center for Mental Disorders "Dresden early on!", Which targets young people aged 18 to 35 (www.ddfruehdran.de). For parents, the Department of Psychiatry and Psychotherapy regularly holds self-help group meetings led by the Bipolar Disease Treatment Team. This self – help group, held every 14 days, offers family members the opportunity to learn about the disease and exchange information. From October 2019, the creation of a day clinic for young patients with bipolar disorder will complement the already very wide range of treatments offered by the University Hospital Dresden.

The financial commitment of the German society for bipolar disorder e. V. (DGBS) and the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN), it is thanks to this project that it has been implemented according to the guidelines of the Association of Societies of Scientific Medicine (AWMF).

scientific contact:
Carl Gustav Carus University Hospital and TU Dresden Faculty of Medicine
Clinic and polyclinic psychiatry and psychotherapy
Director: Prof. Dr. med. med. Dr. Dürer. nat. Michael Bauer
Phone: 0351 458 2760
Fax: 0351 458 4324
Email: michael.bauer@uniklinikum-dresden.de

Original publication:
The guideline with registry number 038-019 is available to the public on the AWMF home page: https://www.awmf.org/leitlinien/detail/ll/038-019. html

idw 2019/07