[Illness perception and coping with illness of bipolar manic-depressive patients]

Subjective concepts and experience of illness and coping behaviour are important factors for the course of bipolar disorder. 81 remitted and discharged patients (bipolar manic-depressive and bipolar schizoaffective) were interviewed on these topics. The last manic episode was usually reported as pleasant, but the recollection of acute symptoms was often affected by shame. Patients with few episodes preferred social and interactional explanations for their disordered states. The medical concept of illness was accepted with advancing episodes, it correlated with resignation and feelings of powerlessness. Initially active and conflict-orientated forms of coping predominated. But after further manic episodes family members often declared themselves responsible for the prevention of relapse (without success); the patients now showed an increase of denial and externalization. The data are condensed to a concept of a gradual change of attitudes of bipolar patients (with therapeutical implications).