Life Charts Track Bipolar Disorder Over Time

By: Kathryn Demott, Senior Writer

[Clinician News 25(12):27, 1997. © 1997 International Medical News Group.]

WASHINGTON -- To the therapist trying to anticipate the course of a bipolar patient's disorder and decide how to intervene, a life chart can prove invaluable, said Gabriele S. Leverich, director of longitudinal studies at the National Institutes of Mental Health, Bethesda, Md.

Using a life chart, the therapist can map on a time line a patient's retrospective and current experience with bipolar disorder. Duration and severity of a patient's manic and depressive episodes, pharmaceutical regimens, and life events--such as menarche, marriage, or the death of a loved one would all be entered, Ms. Leverich said at a conference on mood disorders sponsored by Georgetown University Medical Center.

For the mental health care provider, life charts help systematically assess how pharmacology, life events, and stress converge to induce episodes. In addition, life charts help spot cyclical triggers, such as patterns associated with seasonal changes.

Establishing such a time line can help determine the optimal course of psychotherapy for the bipolar patient during different phases of the illness, according to a report by Ms. Leverich (Curr. Rev. Mood Anxiety Disord. 1[1]:48-61, 1996).

From earlier studies, cognitive-behavioral therapy appears most effective during periods of frequent or continuous cycling. Supportive therapy is more appropriate during ultradian stages of the illness, when several fluctuations between mania and depression can occur within a single day, Ms. Leverich said.

By giving patients a framework for understanding their symptoms and what they mean, life charts can help create a warning system for the patient that an episode is beginning.

"Patients with bipolar disorders spend so much time sick, they often lose sight of the big picture of their illness and just go day by day," said Monica Ramirez Basco, Ph.D., of the University of Texas Southwestern Medical Center at Dallas.

With life charts, many patients for the first time are able to see clear connections between their behavior and their illness, instead of just seeing life as a series of isolated events, Dr. Basco said. Patients can relate lithium noncompliance to an episode of mania months later, or the loss of a job to a manic episode weeks before.

Dr. Basco considers life charts so important that everyone she trains learns how to use them. In addition to educating patients and families, providers can rely on them for diagnostic purposes to differentiate bipolar illness from schizoaffective disorder.

Nearly 100 years ago, rudimentary life charts first were used to distinguish bipolar disorder from schizophrenia.

Since then, the National Institutes of Health has fine-tuned a life chart template that includes details on psychopharmaceuticals and their dosage, psychosocial stress, sleep patterns, and refined mania and depression severity scales.

A patient self-evaluation version is available, and a computerized clinical version is forthcoming.

Mental health care professionals are encouraged to use the NIMH life chart templates and to report their findings to the Stanley Foundation Bipolar Treatment Outcome Network, a nationwide effort to track bipolar treatment outcomes.