Table 3 Categories of perspectives of families with type one bipolar disorder concerning the nature of the disease and non-adherence to treatment
Order | Themes | Subthemes | Code examplesa |
|---|---|---|---|
1 | knowledge about the disorder | General knowledge | Not knowing the name of the disorder Knowledge of mania phase Knowledge of depression phase Not mentioning depression phase Lack of knowledge about the outcome of the disorder Misunderstanding recovery and medication effects |
Knowledge about signs and symptoms of mania phase | Aggression Labile mood Irritability Agitation Running away from home Battering Tendency to leave home Insomnia Grandeur delusion Having two personality states and Assuming another person identity | ||
Knowledge about signs and symptoms of depression phase | Anorexia Isolation Suicidal ideation Insomnia Loss of libido Ideation of dying | ||
Knowledge about etiology of disorder | Genetic abnormality Family treatment during childhood Family not being guilty Lack of proper training of parents before parenthood Unusual conditions of parents during sexual intercourse Brain disorder Mother’s lack of understanding the patient during puberty Divorcing the spouse Genetic abnormality in addition to precipitating factors Insufficient etiological knowledge about disorder | ||
Knowledge about the relapse reasons of disorder) | Discontinuation of medications Unemployment and society’s lack of support Financial problems Death of the father | ||
2 | Information about the medications | Knowledge about effects of the administered medications on patient | Reduction in aggression No reduction in aggression Reduction in the patient’s omnipotence Patient’s mood stability Reduction in running away from home Loss of libido Reduced lying Cessation of self-talking No effect on job functioning |
Knowledge about the side effects of prescribed medications | Medication addiction Obesity and increased appetite Increased sleep Reduced activity and energy Gastrointestinal complications Headache Loss of memory Hump Loss of vivacity Loss of fluency Sluggish speaking Difficulty waking up | ||
3 | Information about the treatment | Knowledge about the treatment | The need to take medications These patients’ incomplete and lasting recovery Treatment: the patient being employed Treatment: exercising The patient’s need to be monitored by the doctor The medication advantages outweigh its disadvantages Treatment: The patient participation in educational classes and development of insight about the disease The family’s negative perspective on medication Futility of psychologist and counseling Treatment: childbearing (wrong) Treatment: things progressing according to the patient’s wish |
4 | Information about the role of the family in the treatment |  | Calming the patient and sympathizing and empathizing with him Not stimulating the patient Bearing with the patient Not leaving the patient alone Encouraging the patient to exercise Encouraging the patient to go out Normalization of disorder Generating hope Taking the patient to the doctor Making the house quiet Breaking up the patient’s drug-use implements Informing significant others life of patient’s symptoms Tricking the patient into hospitalization Comforting the patient and creating a sense guilt in them |
5 | Reasons for pharmacologic treatment non-adherence |  | Relatives’ comments Comments of the powerful and knowledgeable people The patient’s worsening symptoms The patient missing their medications The patient’s stubbornness and anger toward the family The family’s non-familiarity with the disorder and the treatment process The patient’s negative ideations about medications Medication side-effects affecting the patient’s appearance Medication side-effects affecting the patient’s functioning Permanent change of the patient’s doctor by the family TV celebrity talks about futility of medications Not visiting the doctor during new year holidays The patient not being annoyed by the symptoms during mania phase Using alcohol Lack of insight about their own disorder Absence of a family member to help the patient with taking medications Family not agreeing to look after the patient The patient not waking to take their medications Relative’s disagreement with the patient and their stubbornness |