Volume 28, Issue 5 (8-2021)                   RJMS 2021, 28(5): 145-156 | Back to browse issues page

Research code: 137
Ethics code: 137
Clinical trials code: 67

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Mahdavi N, Farahbakhsh K, Noorazar G, Motemi A. Coping with Adolescent Bipolar Disorder: A Phenomenological Study of the Family. RJMS 2021; 28 (5) :145-156
URL: http://rjms.iums.ac.ir/article-1-6583-en.html
Allameh Tabatabaei University, Tehran, Iran , azadi209@yahoo.com
Abstract:   (2311 Views)
Background & Aims: In recent years, the diagnosis of bipolar disorder in children and adolescents has received more attention, the rate of diagnosis of the disorder in this age group has increased and the percentage of children for whom the diagnosis has been made in the last 10 years has doubled (1). Some past studies have shown that bipolar disorder occurs in about 60% of adults, before the onset of symptoms before the age of 20 and in 10-20% before the age of 10 (2). Bipolar disorder at a very young age deprives patients of the opportunity for normal psychosocial development and is associated with high rates of hospitalization, suicide, psychosis, substance abuse, as well as behavioral, educational, social, and legal problems. Bipolar disorder in children and adolescents is more associated with successive changes in symptoms, variable course, and severity below the threshold to full-blown DSM-IV syndrome (3).
In the case of a disabling disorder such as bipolar disorder, on the one hand, the disease affects the patient's family members, and on the other hand, it affects the atmosphere and family environments associated with caregivers. 89% to 91% of family members, between 24% and 38%, score above the standard cut-off point, feel emotional pressure (mental exhaustion) in the self-report of depressive symptoms relative to the severity of the patient's symptoms (9).
With the experience of bipolar disorder by a family member, special conditions are created in the family and provide major changes in the life plan of each family member. Parents can help children with bipolar disorder adapt to new situations with specific strategies and focus on their basic needs.
Methods: The statistical population of this study is among the outpatients referred to specialized and sub-specialized clinics of medical sciences in Tabriz and the statistical sample of this study includes adolescents with bipolar disorder and both or at least one of their parents. And because the research was qualitative, the number of clients continued until the data was saturated. Based on this, 15 interviews were conducted with 15 adolescents with bipolar disorder and their families. The method was that among the patients who referred to the clinic and met the inclusion criteria for the diagnosis of bipolar disorder by a child and adolescent psychiatrist, through clinical interview according to DSM-5 criteria, to enter Research were selected.
The age of inclusion in the study was at least 12 and at most 20 years for bipolar adolescent patients. Family satisfaction with participating in the study and having the ability to read and write of at least one of the main caregivers to record signs and symptoms was the only criterion for participants. The selected patients were surveyed with their caregivers (two or one family member) in a semi-structured interview with answering questions and observational methods. The method of data analysis in this study was qualitative and phenomenological approach. All raw data collected from family members and the patient were categorized and encrypted through interviews to shape participants' information about behaviors, emotions, thoughts, and issues. In this way, the obvious content of the messages were described in an orderly and meaningful pattern.
Results: Findings showed that parents' adaptive strategies were manifested in five strategies: exploratory, accreditation, security, educational and motivational. In exploratory strategies, parents provided adaptation strategies by creating a space to accept the new situation and using the environment to cope with the situation. Accreditation strategies were divided into two parts: direct and indirect accreditation. Security strategies were divided into emotional stimuli in communicating with the adolescent and reassuring stimuli in responding to the adolescent's needs. Educational strategies were divided into practical experiences (living conditions in crisis) and theoretical training. Motivational strategies were divided into cognitive, emotional, environmental, and endurance motivators.
Around the disease and in the process of parent-child adaptation, parents are taught skills such as identifying and exploring environmental and communication strategies, accreditation as an adaptive strategy, identifying safe situations and benefiting from practical experiences and theoretical training in improving critical situations. In relation to children, they teach their adolescents to recognize the communication needs of their children in relation to parents and learn strategies for maintaining relationships for a long time to improve the communication pattern, to pay attention to the needs of discovering adaptive strategies, and in normal and critical situations by talking about emotions. Children and respect for it and recognizing the credentials of the mediators to understand and establish emotional connection with the children to credit their emotions and help them adapt to new situations.
The results of the study showed that among the adaptive pathways of the family system, the paths that harmonize the family with changes are of special importance. One of the ways to coordinate the family with change is to adapt the duties of members to new situations of crisis and adjust behavioral changes to each other, attention and consideration of the environment and community.
Walsh (17) considers these characteristics necessary to create and strengthen resilience. He argues that families need to have a flexible structure to function well in the face of adversity and to adapt to changing environmental and developmental demands. The results of this study are consistent with the research of Azhideh (19) who found that family participatory methods can be effective in interpersonal relationships of family members. Therefore, these three adaptive paths are interrelated and can be explained with each other.
Conclusion: The results and consequences of the adaptation process of families with adolescents with bipolar disorder showed that in normal family life, families return to stability and peace in the family and resume efforts for a better future and individuals return. They came to terms with the normal situation and the normal attitude towards the bipolar experience and the constructive approach to this experience like other experiences. Also, pursuing hobbies and hobbies, accompanying family members together, working hard in difficult situations, avoiding stagnation and laziness, as a factor of construction and hope, comparing one's situation with others like oneself as a factor of mobility, strengthening religious ties, increasing Other experiences were experiences, purposefulness of daily activities, and confidence in rebuilding and restarting the conceptual spectrum of family strategy outcomes. Therefore, this study reported the role of parental strategies in better adaptation to adolescent bipolar disorder. The aim of this study was to better understand the strategies of parents in the process of adaptation to a child with bipolar disorder.
 
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Type of Study: Research | Subject: Clinical Psychiatry

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