Introdução: Pacientes com Transtorno Bipolar (TB) e seus familiares apresentam níveis de estresse significativamente mais elevados que a população geral. Coping, utilizado para gerenciar situações estressantes, tem sido alvo de investigação e intervenções psicossociais em pacientes bipolares, auxiliando-os no manejo destes fatores e melhorando desfechos clínicos no tratamento. Objetivos: O presente estudo tem por objetivo primário comparar pacientes com TB, seus familiares de primeiro grau e um grupo de controles saudáveis quanto ao uso de estratégias de coping adaptativas e desadaptativas. Como objetivos secundários, serão feitas análises explorando diferenças de tipos específicos de coping utilizados pelos indivíduos dos diferentes grupos (pacientes, familiares e controles), através da escala Brief COPE. Outras correlações com variáveis clínicas serão exploradas, como fatores sociodemográficos e clínicos, buscando encontrar relações com as estratégias de coping na amostra de pacientes com TB. Método: Trata-se de um estudo transversal com amostragem por conveniência. O estudo incluiu 36 pacientes eutímicos com TB, 39 familiares de primeiro grau destes pacientes e 44 controles. As estratégias de coping foram avaliadas através da Escala Brief COPE. Resultados: Diferenças significativas foram encontradas quanto ao uso de estratégias adaptativas e desadaptativas entre pacientes, familiares e controles. Pacientes utilizam em menor grau estratégias adaptativas, quando comparados aos controles. Por outro lado, os familiares demonstram maior uso de estratégias desadaptativas, semelhante ao que é observado nos pacientes, diferindo do grupo controle. Limitações: O tamanho amostral é um importante limitador para as conclusões do estudo. Ainda, as conclusões foram baseadas em dados transversais. A utilização de avaliações psicológicas e clínicas em estudos longitudinais permitiriam um melhor mapeamento das mudanças ou manutenção nos padrões psicológicos dos participantes. Conclusões: O grupo de familiares encontra-se em um nível intermediário entre pacientes e controles, ou seja, familiares fazem uso de estratégias desadaptativas em níveis semelhantes ao grupo de pacientes, mas apresentam maior uso de estratégias adaptativas, assim como o grupo controle. Intervenções psicossociais com este grupo são justificadas, favorecendo o uso das estratégias adaptativas em detrimento das estratégias desadaptativas. / Background: Patients with Bipolar disorder (BD) and their relatives exhibit significantly higher stress levels than the general population. Coping strategies, used to manage stressful situations, have been the subject of research and have also been used in psychosocial interventions with bipolar patients in order to help them manage stress factors and improve the clinical outcome of treatment. Objectives: This study has the objective to compare BD patients, their first-degree relatives and a group of healthy controls on the use of adaptive strategies and maladaptive coping. The specific objectives, analyzes will be made by exploiting differences in specific types of coping used by individuals from different groups (patients, relatives and controls) through the Brief COPE scale. Other correlations with clinical variables will be explored, such as demographic and clinical factors, trying to find relations with coping strategies in the sample of patients with BD. Method: This was a cross-sectional study with sampling by convenience, enrolling 36 patients with BD, 39 of their first-degree relatives and 44 controls. Coping strategies were assessed using the Brief COPE scale. Results: Significant differences were detected between use of adaptive and maladaptive strategies by patients, patients' relatives and controls. Patients used adaptive strategies less often than the patients' relatives and controls. In contrast, the patients' relatives reported greater use of maladaptive strategies than the controls and were similar to the patients in this respect. Limitations: The sample size is an important factor limiting the conclusions that can be drawn from this study. Furthermore, these conclusions are based on cross-sectional data. Conclusions: The group of patients' relatives were at an intermediate level between the patients and the healthy controls, i.e. family make use of maladaptive strategies at similar levels to the group of patients, but greater use of adaptive strategies, as well as the control group. This group merits psychosocial interventions to encourage use of adaptive strategies rather than maladaptive strategies.

Objetivo: Esta dissertação tem por objetivo avaliar as relações entre marcadores inflamatórios e o transtorno bipolar (TB), avaliando de forma prospectiva os níveis séricos de diversas citocinas de uma mesma amostra de pacientes com transtorno de humor bipolar em mania e após seu tratamento. Métodos: Para a avaliação dos níveis séricos de citocinas em diferentes fases do TB, foi acompanhado um grupo de vinte e três pacientes antes e após o tratamento de um episódio de mania. O diagnóstico foi definido conforme critérios da Entrevista Clínica Estruturada para DSM-IV, SCID-I. A análise das variáveis foi realizada através do teste de Wilcoxon para amostras pareadas. Resultados: Não foram observadas diferenças nos níveis de citocinas antes e após o tratamento dos pacientes em episódio maníaco. Conclusões: Estes achados devem ser interpretados com cautela. Devido ao pequeno tamanho amostral não é possível controlar possíveis fatores de confusão, como, por exemplo, índice de massa corpórea e fármacos utilizados para o episódio maníaco. Estudos maiores poderiam elucidar se o tratamento do episódio maníaco não está associado a alterações nos níveis de citocinas. / Objectives: This report aims to evaluate the relation between inflammatory markers and bipolar disorder, assessing prospectively cytokines serum levels of a group of bipolar patients in acute mania and after treatment. Methods: In order to assess changes in cytokines serum levels of BD patients during acute mania and after treatment, twenty three bipolar patients were prospectively compared during and after treatment of a manic episode. Diagnoses were made using the Structured Clinical Interview for DSM-IV, SCID-I. Analysis were made using paired samples Wilcoxon signed rank test. Results: No differences were found in cytokine serum levels before and after treatment for acute mania Conclusion: These findings should be interpreted with caution. Due to small sample size, it was not possible to control possible bias, such as body mass index and prescribed medications.

Orientadores: Marco Aurelio Zezzi Arruda, Claudio Eduardo Muller Banzato / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Quimica / Made available in DSpace on 2018-08-15T06:35:00Z (GMT). No. of bitstreams: 1 Sussulini_Alessandra_D.pdf: 1708235 bytes, checksum: 9eb972af4e73014944c3fe61c3ed86d5 (MD5) Previous issue date: 2010 / Resumo: O transtorno afetivo bipolar é uma doença psiquiátrica caracterizada por alterações de humor marcantes, oscilando entre episódios de mania e depressão, que afeta entre 1 a 3% da população mundial. Os mecanismos em nível molecular deste transtorno, assim como de seu tratamento com lítio, que é o medicamento mais utilizado, ainda não são estabelecidos. Assim sendo, o objetivo deste trabalho de Tese consistiu em explorar biomarcadores potenciais (metabólitos, proteínas e íons metálicos livres ou ligados a proteínas) para o transtorno afetivo bipolar e seu tratamento com lítio. Para isso, foi realizada a comparação dos perfis metabonômicos (utilizando espectroscopia de ressonância magnética nuclear de hidrogênio e análise quimiométrica), proteômicos (utilizando eletroforese bidimensional em gel de poliacrilamida e diferentes técnicas de espectrometria de massas molecular) e metalômicos (utilizando espectrometria de massas com fonte de plasma indutivamente acoplado) de amostras de soro sangüíneo de pacientes com transtorno afetivo bipolar utilizando o lítio (n = 15) ou outras drogas excluindo o lítio (n = 10) e de indivíduos saudáveis (n = 25). A análise metabonômica indicou os lipídeos como sendo os metabólitos mais afetados na presença do transtorno afetivo bipolar e do tratamento com lítio, o que corroborou com os resultados da análise proteômica, onde a apolipoproteína A-I foi uma das proteínas que sofreu maior alteração em seus níveis, sendo subexpressa em pacientes bipolares, independentemente do tratamento, porém apresentando uma restauração ao nível do grupo controle após o tratamento com lítio. As análises ionômicas apontaram As, B, Cl, Cr, Fe, K, Li, Mg, P, S, Se, Si, Sr e Zn como os íons livres diferenciais e as análises metaloproteômicas apontaram, principalmente, Ca, Co, Fe, K, Mg, Mn, Na, Ti e Zn ligados a proteínas como sendo os metais que sofreram as maiores alterações na presença do transtorno afetivo bipolar e de seu tratamento com lítio. Dentre as proteínas ligadas a metais que apresentaram diferenças entre os grupos estudados em termos de metais ligados, destacam-se a apolipoproteína A-I, a transtiretina e a vitronectina, que haviam sido identificadas previamente nas análises proteômicas por apresentarem alterações em suas expressões. A partir destes estudos, foi possível identificar, de maneira exploratória, moléculas diferenciais que podem orientar futuros estudos envolvendo os mecanismos patofisiológicos do transtorno afetivo bipolar e de ação terapêutica de drogas como o lítio, bem como na descoberta de biomarcadores para a doença e/ou seu tratamento com lítio / Abstract: Bipolar disorder is a psychiatric illness characterized by marked mood changes, oscillating between mania and depression episodes, which affects 1-3% of the worldwide population. Molecular level mechanisms of this disorder, as well as of its treatment with lithium, which is the most widely used medication, are not yet known. Thus, the aim of this work consisted in explore potential biomarkers (metabolites, proteins, metal ions free or bounded to proteins) for bipolar disorder and its treatment with lithium. For this purpose, it was performed the comparison of metabonomic (using hydrogen nuclear magnetic resonance spectroscopy and chemometric analysis), proteomic (using 2-D gel electrophoresis and different molecular mass spectrometry techniques), and metallomic (using inductively coupled plasma mass spectrometry) profiles for blood serum samples of bipolar disorder patients treated with lithium (n = 15) or other drugs than lithium (n = 10) and healthy individuals (n = 25). Metabonomic analyses indicated lipids as the most affected metabolites in the presence of bipolar disorder and of lithium treatment, which corroborated with the results of proteomic analyses, where apolipoprotein A-I was one of the proteins that showed highest alterations in its levels. It was downregulated in bipolar disorder patients, independently of the treatment, but showed a level restored to that of the control group after lithium treatment. Ionomic analyses detected As, B, Cl, Cr, Fe, K, Li, Mg, P, S, Se, Si, Sr e Zn as differential free ions, and metalloproteomic analyses detected mainly Ca, Co, Fe, K, Mg, Mn, Na, Ti and Zn bound to proteins as being the metals that presented highest alterations in the presence of bipolar disorder and lithium treatment. Among the metal-binding proteins that indicated differences between the studied groups, apolipoprotein A-I, transthyretin and vitronectin, which were previously identified in the proteomic analyses, are highlighted. With the studies described in this research work, it was possible to identify, in an exploratory way, differential molecules that can guide future studies on the patophysiological mechanisms of bipolar disorder or terapeutic action pathways of drugs like lithium, as well as on the discovery of biomarkers for the illness and/or its treatment with lithium / Doutorado / Quimica Analitica / Doutor em Ciências

Alteração da fosfolipase A2 tem sido descrita em diversas doenças neuropsiquiátricas. Esta enzima é responsável pelo metabolismo dos fosfolípides de membrana e parece estar envolvida na fisiopatologia do transtorno bipolar. Neste estudo, foram analisados os três principais subtipos da PLA2 (sPLA2, cPLA2 e iPLA2) em plaquetas de pacientes e indivíduos controles. A atividade de subtipos de PLA2 foi determinada em 20 pacientes TB sem tratamento com estabilizadores de humor e após seis semanas de tratamento com lítio; 72 pacientes medicados e 65 controles (16 pareados com os pacientes sem tratamento e 49 com os pacientes previamente medicados), pelo método radioenzimático. Os pacientes foram diagnosticados e classificados de acordo com os critérios estabelecidos no DSM-IV-TR. Foi verificado que Os pacientes no estágio inicial da doença apresentaram menor atividade de iPLA2, sPLA2 e cPLA2 quando comparadas ao grupo controle. Seis semanas de tratamento com o lítio não foram suficientes para observar alterações nos resultados obtidos. No entanto, o lítio diminuiu a sintomatologia maníaca e a depressiva, avaliadas pelas escalas de Hamilton e Young, respectivamente (p < 0,01 para as duas comparações). Os pacientes medicados não diferiram do grupo controle para os três subtipos de PLA2 avaliados. Estes resultados sugerem que no estágio inicial do TB há uma diminuição da atividade das PLA2, e que a ação de um ou mais medicamentos que são incluídos na terapêutica para este transtorno podem reverter essa diminuição. Sugere-se ainda que a diminuição da atividade da iPLA2 no estágio inicial do transtorno bipolar, além de alterar o remodelamento da membrana, possa ser um fator de risco para o desenvolvimento de demência nestes pacientes. / Changes in phospholipase A2 have been reported in several psychiatric disorders. This enzyme is responsible for the metabolism of membrane phospholipids and has been suggested to play a role in bipolar disorder physiopathology. In this study, the activity of the three main subtypes of phospholipase A2 (PLA2) were analyzed (sPLA2, cPLA2 and iPLA2) in platelets of BD patients and health subjects. Subjects enrolled were: 20 drug-naïve and drug free BD patients, who were treated with lithium for six weeks; 72 BD long-term treatment patients and 65 controls (16 for the drug-naïve and drug free and 49 for the long term group). PLA2 subtype activities were determined by the radio enzymatic method. Patients\' diagnostic and classification were made according to DSM-IV-TR criteria. Patients at the early stage of the disease presented lower iPLA2, sPLA2 and cPLA2 activity than the control group. Six weeks treatment with lithium did not change these activities. However, lithium reduced the maniac and depressive symptoms, evaluated with Hamilton and Young scales, respectively (p < 0.01, for both comparisons). Long-term treated patients presented similar PLA2 activities to control group. The results suggest that at the early stage of BD iPLA2 activity is decreased and that the adequate treatment of BD could reverse this reduction. We suggest that a reduction of iPLA2 activity at the early stage of BD can modify the membrane metabolism, and could be a risk for the development of dementia in BD patients.

Background: Informal caregivers provide unpaid support to a family member, which has been shown to more positively affect their relatives’ health outcomes than equivalent paid caregivers. The provision of this support, however, comes at a cost to the carers’ health and wellbeing through meeting the demands of the caring role. Efforts have been made to alleviate these consequences through various forms of interventions aimed to enable the carers to meet these demands. The reported success of these interventions is varied in regards to their effectiveness; an argument supported by literature review papers on the subject that questions the methodologies and evaluations of these interventions. Rationale: There is a need to explore the ways to enhance the health and wellbeing of informal carers by means of a robust design and evaluation. This thesis reports a study, the aim of which is to provide information about how to reduce the negative effects of the carer role whilst enhancing the positive effects using an intervention developed using lived experience. Method: The self-care intervention was developed and piloted with those caring for a relative with bipolar disorder. This was achieved in three stages: (i) qualitative interviews with carers to explore and understand the role, (ii) developing the intervention informed by qualitative findings, and finally by (iii) piloting the intervention. Effectiveness of the intervention was determined using health and wellbeing outcomes, the results of which were compared to a control group who did not take part in the intervention. Results: A positive potential for psychoeducational, cognitive behavioural and mindfulness techniques in enhancing the health and wellbeing of those caring for a relative diagnosed with bipolar disorder was found. From the exploration of lived experience, “Being Bound” was elicited from the data representing the conflict between the detrimental effects of providing care and being unable to take respite or reprieve through guilt and anxiety. Conclusion: Professionals who work with family members, individually or as part of a family unit, should consider the benefits of targeted information for carers. Provision of information is not enough to engage the carer in the process of understanding their relative’s behaviours, but requires a process of interaction and personalisation. In contributing to existing research, the use of hermeneutic phenomenology provided new insight in to the experiences of those providing care. The outcome of the intervention pilot shows positive potential for the use of interventions beyond psychoeducation alone and the use of a self-care approach.

The study aimed to test how progress on achievement and power goals, and perceptions of power, fluctuate with mania symptoms in Bipolar Disorder (BD), testing the Dominance Behavioural System (DBS) model. The DBS includes biological, psychological, and behavioural components that serve the goal of control over social and material resources needed for survival and reproduction (Johnson, Leedom, & Muhtadie, 2012c). Daily diary methodology was employed, with 29 individuals meeting the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV) criteria for BD I or II as verified by the Structured Clinical Interview [SCID-I-RV] (First, Spitzer, Gibbon & Williams, 2002). Baseline measures of dominance motivation and ambitious goal setting were taken. Over fourteen days, participants reported daily on their goal progress, symptoms of mania, power, and anger. It was hypothesised there would be a positive relationship between symptoms of mania and dominance motivation. It was also hypothesised that for power but not achievement goals, ii) goal progress would be associated with perceptions of power, iii) symptoms of mania, and iv) that goal frustration would be associated with anger. Pearson’s correlations and multilevel modelling analyses found largely null results with the exception of a positive relationship between progress towards power goals and perceptions of power. Thus, the results did not provide support for the DBS model predictions for relationships between power goals and manic symptoms. Future studies could utilise further measures of dominance motivation and power, and study goal pursuit over a more protracted duration, including comparisons between BD, depressed groups, and healthy controls.

This dissertation is a contribution to the contemporary field of phenomenological psychopathology, or the phenomenological study of psychiatric disorders. The work proceeds with two major aims. The first is to show how a phenomenological approach can clarify and illuminate the nature of psychopathology—specifically those conditions typically labeled as major depressive disorder and bipolar disorder. The second is to show how engaging with psychopathological conditions can challenge and undermine many phenomenological presuppositions, especially phenomenology’s status as a transcendental philosophy and its corresponding anti-naturalistic outlook. In the opening chapter, I articulate the three layers of the subject matter of phenomenological research—what I refer to as “existentials,” “modes,” and “prejudices.” As I argue, while each layer contributes to what we might call the “structure” of human existence, they do not do so in the same way, or to the same degree. Because phenomenological psychopathology—and applied phenomenology in general—aims to characterize how the structure of human existence can change and alter, it is paramount that these layers be adequately delineated and defined before investigating these changes. In chapters two through five, I conduct hermeneutic and phenomenological investigations of psychopathological phenomena typically labeled as major depressive disorder or bipolar disorder. These investigations address the affective aspects of depression and mania, and the embodied aspects of depression. In addition to clearly articulating the nature of these phenomena, I show how certain psychopathological conditions involve changes in the deepest or most fundamental layer of human existence—what I refer to as existentials. As I argue, many of the classical phenomenologists (including Husserl and Heidegger) believed that these structural features were necessary, unchanging, and universal. However, this presupposition is challenged through the examination of psychopathological and neuropathological conditions, undermining the status of phenomenology as a transcendental philosophy. While this challenge to classical phenomenology is only sketched in the early chapters, in chapters six and seven I develop it in more detail in order to achieve two distinct ends. In chapter six I argue that psychopathology and neuropathology not only challenge phenomenology’s status as a transcendental philosophy, but also supply a key to developing a phenomenological naturalism (which I contrast with a naturalized phenomenology). Phenomenological naturalism, as I articulate it, is a position in which phenomenology is not subsumed by the metaphysical and methodological framework of the natural sciences, but nonetheless maintains the capacity to investigate how the natural world stands independent of human subjectivity (and how events in the natural world can bring about changes in the most fundamental structures of human existence). In the seventh chapter I argue that a phenomenology in which existentials are contingent and variable rather than necessary and unchanging allows phenomenologists to contribute to new dimensional approaches to psychiatric classification. Rather than begin from distinct categories of disorder, these approaches begin from distinct core features of human existence. These features, referred to as either dimensions or constructs, can vary in degree and are studied in both normal and pathological forms.

Magister Artium (Social Work) - MA(SW) / Caregivers of people with psychiatric illnesses experience challenges, which contribute significantly to their burden of care and can result in health and mental health problems. The researcher was interested in the lived experiences of caregivers, which resulted in the following research questions: What are the lived experiences of caregivers caring for a co-morbid bi-polar and substance-abuse patient, and what context and situations contribute to the problems? The goal of this research was to explore the experiences of family members caring for relatives admitted in a psychiatric hospital, and the contexts in which these occurred. The objectives were to explore and describe the lived experiences of family members caring for a relative with a co-morbid diagnosis of bi-polar and substance abuse, as well as the situations or contexts in which these experiences occur. These objectives were followed by the last objective of the research, which was to make recommendations to the multi-disciplinary teams (MDTs) on services for family members caring for such a relative. A qualitative, phenomenological research approach was used for this study with explorative and descriptive research designs. The population for the study comprised families in the Western Cape caring for female relatives admitted to a psychiatric hospital with co-morbid bipolar and substance use disorder. The researcher purposively selected relatives of female in-patients admitted in a female admission ward. Families were chosen whose members were admitted for more than three months. In-depth phenomenological interviews were done with six participants until data saturation was reached. Phenomenological data analysis, focusing on the textural (lived experience) and structural (context in which it was experienced), were followed after data collection. Findings comprised a composite description of the phenomena of both textural and structural description. The findings of this research resulted in conclusions and recommendations for MDTs and social work on interventions for family members caring for a family member with this mental condition. Findings from this study conclude what was found in the literature regarding challenges in the system leads to caregivers feeling burdened with their mentally ill relative, and that resources and support are lacking in communities. This led to recommendations aiming at MDTs, government and social workers working in institutions, to align with community social workers in order to strengthen working relationships with the aim of providing the necessary support services to families caring for mentally ill relatives. Future research suggestions are also aimed at supporting families caring for patients with a mental illness for which reasons for re-admissions will be assessed and evaluated.

Bipolar disorder (BPD) is associated with negative health outcomes and high relapse rates and group psychoeducation (PE) is recognised as an effective intervention when used in conjunction with pharmacological treatment. Unhealthy beliefs and attitudes have not been measured or related to outcomes in group PE and the mechanism for how PE exerts its effect are unidentified. Aims: (a). An adapted group psychoeducation intervention will change (improve) unhealthy personal beliefs about illness and attitudes towards medication when compared to a treatment as usual group. (b). Changes in unhealthy personal beliefs and attitudes will be maintained overtime (a 12 month follow up period). (c). People who subsequently relapse compared to those who do not relapse, will have less improvement in their unhealthy personal beliefs about illness and attitudes towards medication from PE. (d). An evaluation of the efficacy of psychoeducation in a systematic review for bipolar disorder in preventing relapse and other outcomes will identify factors that relate to clinical outcomes. Methods: A 10 session PE intervention was adapted and 38 participants with bipolar disorder I or II (using DSM-IV criteria) were recruited from a Specialist Affective Disorders Service. A waiting list assessment time was used as a parallel group control and a longitudinal study took place over a 12 month follow up period in all participants once they had received the intervention. A mirror image study reviewed case notes to identify relapse 12 month pre versus post intervention. Assessments measuring, beliefs and attitudes, mood symptoms and satisfaction where carried out, 8 weeks prior to intervention (waiting list), pre intervention, and 6 and 12 months post intervention. Results Summary: The waiting list control comparison showed significant improvement in attitudes measured by the Personal Beliefs about Illness Questionnaire (PBIQ) and Drug attitude Inventory (DAI) and symptoms and functioning. Beliefs on all domains of the PBIQ improved significantly (p<0.001) as did attitudes toward medication (p<0.001) there were also small but significant improvements in mood symptoms. In all participants (n=38) improvements were maintained over the 12 month follow up period. Nine people relapsed in the 12 months after the intervention compared with 22 before (p<0.002) and relapsers improved significantly less than non-relapsers following PE on the PBIQ (p=0.012) and the DAI (p=0.046). Conclusions: A group PE intervention reduced unhealthy personal beliefs and attitudes, both manic and depressive relapse and improved functioning. Improvements are maintained over time except adherence which remained unchanged. The amount of improvement in the PBIQ and DAI is related to relapse with non relapsers improving more than relapsers. The systematic review provides reasonable evidence that psychoeducation is at least modestly effective in preventing relapse in bipolar disorder, with the strongest evidence for reducing overall and manic relapse.

This thesis explores the experience of parenting with severe mental illness, using qualitative methodologies. It is presented in three parts: a literature review, a report of the empirical research, and a critical reflection of the process undertaken. The literature review provides both a systematic review of qualitative studies exploring the experience of parenting with a severe mental illness (SMI), and a meta-synthesis of the findings from the included studies. The findings demonstrated six overarching themes that were central to the parents' experience. The themes were interlinked and often conflictual in nature and a model of the relationship between the themes is provided. The synthesis revealed how the additional and conflicting pressures faced by parents with SMI can interact with their symptoms to affect parenting behaviours and decisions about engagement with services. The model of themes elicited by the synthesis provides a broad conceptual framework in which parenting with SMI can be considered across the age range of children, parental symptoms and parenting roles. The empirical research provides a specific focus on the views and experiences of parents with Bipolar Disorder (BD). Interpretative Phenomenological Analysis was used to explore the lived experience of parenting with BD, to provide insight into the parents' perspective and the influence that this may have on outcomes for parents as well as their children. The analysis resulted in six overarching themes, each of which consisted of a number of sub-themes. There were important interactions between the themes and these are illustrated for the reader. It was found that the parents identified a number of challenges in being a parent with BD and experienced feelings of inadequacy, guilt and worry relating to the impact that their illness had on their children and family. Strategies for managing these feelings and limiting the impact of BD could have an inadvertent negative effect on their own well-being, and that of their child. Learning to accept their diagnosis and developing strategies for managing their symptoms were crucial for positive parenting, although the changing needs of their children often presented new challenges. Contextual factors, including the stigma associated with mental illness, could also either mediate or exacerbate the challenge of parenting with BD. The clinical implications of these findings are discussed. The critical reflection provides a consideration of qualitative methodologies and a personal reflection on the qualitative process in relation to the empirical research. It details the critical debates around qualitative methodology, the application of qualitative methodologies, and the challenges this presented for the researcher. The report was written on completion of the investigation and reflects the process by which, as a novice, the author was able to develop an understanding of qualitative methodology and carry out an insightful piece of research.