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. 2017 Sep 13;19(8):676–688. doi: 10.1111/bdi.12547

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© 2017 The Authors. Bipolar Disorders Published by John Wiley & Sons Ltd.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Seeking vs avoiding pharmacotherapy. A communication current reality tree (CCRT) reflecting bipolar disorder (BD) management challenges experienced by patients with BD and their family members is shown. Undesirable effects (UDEs) are framed in red rounded rectangles, and additional entities in black rounded rectangles. The red rounded rectangle with dashed lines represents a cluster of UDEs that are further expanded in Figure 3. Arrows signify direct causal relationships; arrows directed to “AND” operators imply that the combination of causes is needed to produce the resulting effect. The lightning sign reflects a conflict between mutually exclusive alternatives [Colour figure can be viewed at wileyonlinelibrary.com]