Social functioning in bipolar patients: the perception and perspective of patients, relatives and advocacy organizations - a review

Objective: Recent evidence suggests that bipolar disorder (BD) may alter social functioning in stabilized bipolar patients. We reviewed the available published material on the 'perception and perspective' of bipolar patients, relatives and advocacy organizations concerning the impact of BD on their lifestyle and social functioning. This review seeks to highlight some of the key issues from the patient's perspective. Methods: A systematic, computer-assisted, literature search (MEDLINE, Medscape, Cochrane Library, PubMed) was performed. Seventeen relevant reports were found providing examples of how BD patients and their relatives perceive the impact of the disorder on social functioning and previous and current lifestyles. The data reported were analysed and discussed. Results: The negative impact of BD on a patient's life is high. The relationship with the family appears to be severely and adversely affected in most cases. Stigmatization and rejection within the family appear as important problems. The family's hostile attitude is often due to misinformation and a lack of understanding about the condition. Well-informed relatives, openly supportive, may play a significant role in the recovery process. The presence of stigma, delay in correct diagnosis and high levels of unemployment or frequent problems in retaining employment are reported by a large majority of respondents. Conclusions: There is a real need for an enhanced education, information and awareness program aimed at BD patients, physicians, family members and the public. This will aid diagnosis, reduce current levels of stigmatization and prejudice surrounding the condition while assisting the reintegration of former and present patients back into the community.