Maimonides's primer for treating bipolar illness.

A recent article by Ellen Frank and her colleagues reports on the efficacy of Interpersonal and Social Rhythm Therapy (IPSRT), a therapy that attempts to limit the number and extent of clinical regressions of individuals with bipolar illness by regularizing their daily routines.1 Derived largely from interpersonal psychotherapy,2 IPSRT “focuses on the links between mood symptoms and quality of social relationships and social roles, the importance of maintaining regularity in daily routines, and the identification and management of potential precipitants of rhythm disruption.” 1p998 It also emphasizes attention to “grief for the lost healthy self,” 1p998 a mourning for the compromised healthy functioning caused by the illness. The therapy educates patients about the manifestations of bipolar illness, suggests behavioral interventions to alleviate specific symptoms (e.g., sleep hygiene to minimize insomnia), and provides help in addressing adverse events caused by the disease. It is administered both acutely and as a maintenance treatment. IPSRT is based on the “social zeitgeber hypotheses.” Zeitgebers are environmental cues (e.g., light) that help regulate the biological clock of an organism; zeitgeber events (e.g., the light-dark cycle of a twenty-four-hour day) keep circadian rhythms normalized. Cindy Ehlers, Ellen Frank and David Kupfer suggest that loss of social zeitgebers, such as one’s routine responsibilities and contacts, can distort biological rhythms and, in turn, promote affective instability in vulnerable individuals.3 Studies of rhythmdisrupting life events support this theory,4,5 suggesting that the zeitgeber hypothesis may represent a crucial link between psychosocial and biological events. In conjunction with pharmacologic management, adjunctive treatments such as cognitive therapy and psychoeducational programs have long proven beneficial to patients suffering from bipolar illness (e.g., by increasing medication compliance, decreasing the incidence of clinical episodes and hospital admissions, and enhancing psychosocial functioning).6 Frank and her colleagues suggest that their randomized study of IPSRT also qualifies it as a useful treatment for bipoMaimonides’s primer for treating bipolar illness