الفهرس 
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Abstract
Interpersonal and Social Rhythm Therapy (IPSRT) is a kind of biopsychosocial intervention that relies on ideas from various disciplines to regulate social rhythm, maximize functional outcomes, and help regulate the mood of patients with BD. This is done to improve overall well-being. It was assumed that IPSRT might be helpful for people with BD because it tackles a patient’s interpersonal problem and helps him resolve it. It also plays an essential role in regulating disruptions in social rhythm, improving patients‟ functioning.
The present study aimed to examine the efficacy of Interpersonal and Social Rhythm Therapy among patients with bipolar disorder.
The study followed a quasi-experimental repeated measures research design. It was conducted at the psychiatric outpatient clinics of the Main University Hospital, which is affiliated with the Faculty of Medicine, Alexandria University, and one other private clinic to complete the study sample. The study subjects consisted of 27 out patients diagnosed with bipolar disorder according to DSM-5.
Tools for data collection included:
- Tool I: A Socio-Demographic and Clinical Data Structured Interview Schedule for Patients with BD.
- Tool II: Multnomah Community Ability Scale (MCAS):
MCAS is a standardized scale created by Barker et al. (1994b) to assess the degree of functioning of clients with mental illness living in the community.
- Tool III: Interpersonal Problem Areas Rating Scale (IPARS-M):
It is a structured interview guide created by Klerman et al. (1984) to evaluate four major interpersonal problem areas in a patient‟s life: unresolved grief, interpersonal role conflicts, role transitions, and interpersonal deficiencies in the past or present. Andrade et al. (2008) then modified it, adding a fifth problem, ”loss of healthy self.”
- Tool IV: Social Rhythm Metric Scale (SRM-II-5):
SRM-II-5 is a tool for quantifying an individual’s daily social rhythms. Frank (1990) developed it as a set of 17 daily activities, which were then shortened to SRM-II-5 and included only five daily activities considered to constitute an individual’s social rhythm.
Administrative steps:
- Approval was obtained from the Research Ethics Committee, Faculty of Nursing, Alexandria University.
- Official written permissions for conducting the study were obtained from the director of day clinics at the Main University Hospital
Training steps: The researcher completed a training as follows: -
- An online training program on Interpersonal and Social Rhythm Therapy (IPSRT) for bipolar disorders under the supervision of Frank E, Swartz H, and Frankel D (https://www.ipsrt.org/ ).
Pilot study and internal consistency steps:
- A pilot study was carried out on 3 patients diagnosed with BD to ensure the clarity of the tools (MCAS and IPARS-M). The pilot study subjects were excluded from the actual study.
- Tool II (MCAS) and tool III (IPARS-M) proved to be internally consistent by using Cronbach‟s alpha test method on 3 patients who met the inclusion criteria of the study subjects (Cronbach‟s alpha 0.898 and 0.878 respectively).
Planning steps:
- IPSRT sessions were translated into Arabic language, the content of each session was revised and approved by the supervisors, and necessary required modifications were made.
Actual study:
The following steps were used to conduct the descriptive part of the study:
- The researcher visited the Main University Hospital 3 times/week for a month to select the available patients.
- Patients‟ medical charts were reviewed to determine patients’ diagnoses and ensure that the patients fulfilled the inclusion criteria.
- 27 patients with BD, males and females, were recruited after screening the patients’ charts.
- One to two patients were interviewed daily to explain the purpose of the study, establish rapport, and complete the required questionnaires.
The following steps were used to conduct the experimental part of the study:
- Written informed consent was obtained from each participant for continuity and adherence to training.
- A written plan for every session (time, meetings, and setting) was scheduled according to the patient and researcher’s time.
- Between sessions, telephone guidance was conducted twice weekly with each patient.
- Patients‟ responses, feedback about the most used skills, estimated time, and any obstacles during the intervention were documented.
- Corrective feedback was given to the patients by the researcher to make the sessions more efficient.
Evaluative step:
After 3 months of training intervention, each patient was interviewed at the outpatient clinics using tools II and IV to determine the effectiveness of IPSRT.
The following is a list of the most significant findings:
Fifty-one percent of the patients were between the ages of twenty and thirty. There was a ratio of 66.7% of single persons.
Patients with a bachelor’s degree consisted of 88.3% of the sample, whereas 63% of them were unemployed.
88.9% of the patients did not know about their illness, and 51.9% of them were previously admitted to the hospital, with the top reasons being multiple social stressors.
It was found that 55.6% of the patients had interpersonal deficiencies in the past or present, 40.7% had interpersonal role conflicts, and 22.2% had role transitions. Those who had unresolved grief and loss of healthy self, consisted 25.9% of the sample respectively.
The social rhythm of the studied subjects improved from 2.91 ±1.32 to 4.89± .23 immediately post-intervention and further to 5.04 ±1.21 one-month post-intervention. This difference was statistically significant (P=0.001 for both), with a large effect size of 83.2%.
The Multnomah community ability score of the studied subjects significantly improved from 55.52 ±7.42 to 68.67 ±7.13 immediately post-intervention and slightly further to 68.74 ±7.24 one-month post-intervention. This indicates a substantial improvement in the functional outcomes of the patients. The effect size was large at 90.2%. Statistical analysis revealed significant differences between the pre-intervention and immediate post-intervention scores and the one-month post-intervention scores (P=0.001 for both). However, there was no significant difference between the scores immediately post-intervention and one-month post-intervention (P=1.000).
The following are the most important recommendations:
I- Recommendations geared toward psychiatric hospital staff:
Psychiatric out patients‟ clinics may consider the application of IPSRT intervention as an essential constituent in the care of patients with Bipolar disorder. This should be associated with essential pharmacotherapy provided for those patients.
The IPSRT intervention program can be incorporated in the psychiatric hospitals protocol of care, including appropriate tools needed for communication analysis and role - play application.
To maximize the benefits of IPSRT, participants should be involved in employment – focused rehabilitation.
II- Recommendations geared toward families of patients with Bipolar disorder:
Families‟ psychoeducational interventions should be developed to increase families’ awareness about illness and their triggering factors, to involve them in strategies of the therapy, and consequently affect future response and behavior of the individual.