Session 13 - Risks associated with treatment withdrawal

Summary

Goal

Poor adherence is a problem that affects all medical disciplines and quite especially psychiatry. In the case of bipolar patients whose awareness of the disorder is altered, poor adherence is one of the most frequent problems and the main cause for recurrence. This session, which closes the unit of adherence improvement, is designed to fix the contents of the unit and make the patients understand the risk of relapse associated with the abandonment of the treatment.

Procedure

• After the initial or warm-up conversation, we will review some of the life charts presented by our patients, especially those cases in which the patient abandoned the treatment at any point. We will use this to analyze what happens after abandoning the treatment, which in general is a recurrence. If we do not have enough life charts, or if poor adherence is not a relevant factor in any of them, we can use Example 4 in Session 6 (see p. 96).

• This is another one of those sessions that generate great interaction between patients. In our 10-year experience with psychoeducation groups of bipolar patients, it is a very rare group in which there is no patient who defends positions justifying poor adherence. Once again, it will be very positive if it is not the psychologist or psychiatrist who appears to be the only defender of the need to take medication, even though obviously he would already have taken this position in front of the group; it is appropriate for the patients themselves to advise good adherence.

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