Mental Health Problem: Bipolar Disorder - Essay Example

Mental Health Problem: Bipolar Disorder Introduction Mental health problems are fast becoming common health problems all over the world today. These mental health problems range from the mildest form of anxiety to the most severe form of paranoid schizophrenia. This paper shall discuss bipolar disorder or manic depression. It shall describe the mental health problem and outline how psychological theories would explain this disorder and the clinical interventions which can then be used in order to treat of manage its symptoms. Bipolar Disorder Description Bipolar disorder is a mental disorder or problem which affects moods; these moods may swing from one extreme (mania) to another (depression) (National Health Services, 2009). In this disorder, the patient may at one point, feel very low or depressed; in another instant, he may feel very high and elated. The depressed mood usually manifests in the patient first; so a patient may be diagnosed first as clinically depressed then later, when manic episodes manifest, he may be diagnosed with bipolar disorder (National Health Services, 2009). Because of the erratic manifestations of this disease, it is often misdiagnosed as either clinical depression or schizophrenia. Most often, for many years, patients are treated for the wrong illness and manifestations seem to indicate that applied interventions are not effective for the patients. Consequently, this disease has become an important concern among mental health professionals and among sufferers. Latest figures from the World Health Organization (as cited by the Australia Bipolar Schizoaffective Support Network, 2008) reveal that bipolar disorder is the 6th leading cause of disability in the world, with women 3 times more likely than men to experience rapid cycling. Women are also more likely to experience depressive and mixed moods as compared to men; and women are more likely to be misdiagnosed as depressed and men would most likely be diagnosed as schizophrenic (Australia Bipolar Schizoaffective Support Network, 2008). As was previously mentioned, instances of misdiagnosis is prevalent in bipolar disorders and the World Health Organization (as cited by Australia Bipolar Schizoaffective Support Network, 2008) affirms this fact as they reveal that only 1 person in 4 is likely to receive an accurate diagnosis for this disease. This disease has also been known to cause 9.2 years reduction in the expected life span of bipolar patients (Australia Bipolar Schizoaffective Support Network, 2008). Based on statistics from the Department of Health in the United Kingdom, they reveal that bipolar disorder affects about 1% of the adult population in Britain (Hall, 2006). These patients are also 28 times likely to commit suicide as compared to the rest of the population. About 0.4% of those diagnosed with this disorder have been known to kill themselves every year because of their inability to cope with their erratic emotions (Hall, 2006). Figures also reveal that 90% of hospital consultations for bipolar disorder often end up requiring hospital admission in England from 2002-2003 with about 61% of these admission being women, and 39% being men (Wrong Diagnosis, 2009). The mean age for admissions registered at 48 years, with the youngest sufferer registering at 15 years of age. These figures present alarming rates on bipolar disorder. The top-most concern in the above figures relate to instances of misdiagnosis of this disease. Considering the high rate of suicide for bipolar patients, attention needs to be focused on accurately diagnosing this disorder. The facts below can help this student understand and accurately recognize the manifestations of this disorder. Symptoms/Manifestations of Bipolar Disorder Bipolar disorder, as was previously mentioned, is characterised by mood swings (National Health Services, 2009). Episodes of depression or of mania can last for several weeks or even more, depending on the management of the disorder in the patient. When the patient is depressed, symptoms of the disease include sadness; decreased energy; decreased concentration and faulty memory; feelings of worthlessness; feelings of guilt and despair; feelings of pessimism, self doubt, and suicidal thoughts; delusions, hallucinations, and illogical thoughts (National Health Service, 2009). The manic episodes manifest in extreme contrast to the depressed mood explained above. During manic episodes, the patient feels happy and euphoric; talks very quickly and feels self-important; he is full of new ideas and important plans; he gets easily distracted, easily agitated, or irritated; he does not eat or sleep; and he often also experiences delusions, hallucinations, and illogical thoughts (National Health Service, 2009). This disorder more often manifests with depressive moods; however, some patients do manifest with more episodes of mania than depressive moods. These episodes are sometimes interspersed with normal behaviour; however, many patients do swing from one extreme mood to another with hardly any normal intervals at all. This condition is known as ‘rapid cycling’ (National Health Service, 2009). Some bipolar patients may not always be aware of their behaviour during their manic phase and they often end up being surprised and shocked about their behaviour later. Patients who manifest with extreme episodes are often the ones who can hardly keep their jobs because of their erratic behaviour. Their relationships with other people end up being strained; consequently, thoughts and subsequent attempts at suicide are increased. They also suffer psychotic episodes where they become delusional and they hear, smell, or see things that are not truly there (National Health Services, 2009). This disorder is also a fairly common disorder as it is often seen in one person in 100; it occurs at any age and often develops first in people between 18 to 24 years of age (National Health Service, 2009). The patterns of manifestation of this disease vary in patients; some patients experience swings from depression to manic disorder frequently, while others may experience swings in behaviour at prolonged intervals. Their behaviour may manifest as controlled, while others may manifest extremely erratic behaviour. Psychological Theories There are three theories which are being mainly explored in order to explain bipolar disorders. Based on the cognitive theory, most people have unrealistic negative beliefs about themselves and about the world in general (Bauer, et.al., 2008, p. 23). Because they cannot realize their dreams, people often end up being disappointed and depressed about how their life is turning out. In applying this theory to bipolar disorder, it may only serve to explain the depressive side of this disorder – not the manic side. Another theory which can be used to explain bipolar disorder is the behaviour theory. This theory basically “views depression as a mental giving up when goals cannot be reached” (Lewinsohn, 1974, as quoted by Bauer, et.al., 2008, p. 24). Again, this theory only explains the depressive side of this disorder. The explanation used by this theory also revolves around the similar assumptions laid out by the cognitive theory. In a way, it continues the cognitive theory – when goals cannot be reached, the individual ‘gives up’. In the interpersonal theory, depression is seen in the context of adverse events like personal loss or conflicts in relationships (Frank, 2007, as quoted by Bauer, et.al., 2008, p. 24). This theory still focuses on the depressive side of this order. However, it presents an important factor in the analysis of mental disorders that– more often than not, they are triggered by traumatic experiences, personal conflicts or problems which eventually affect coping skills. These theories only explain one side of the disorder; other authors cite other theories which help explain the incidence of this disorder. To a certain extent, they serve as jumping off points in explaining this disorder and in understanding the process which leads to depression. The chronobiologic theory is also being tapped as one of the theories which explain bipolar disorder. In this theory, sleep patterns and sleep disturbances are being considered as one of its most important aspects. Sleep patterns are normally regulated by the hypothalamus; in some instances and in some patients, lack of sleep or disruption in the normal sleep patterns trigger the manic phase of this disease (Boyd, 2008, p. 370). Some neurotransmitters are also known to follow the circadian patterns which control and regulate sleep; therefore, with disturbances in the circadian rhythm and the sleep patterns, the patterns of behaviour may also be affected in some individuals (Boyd, 2008, p. 370). In applying this theory to bipolar disorders, it is important to note when manic phases of the disorder are triggered. If indeed, a strong correlation between manic behaviour and sleep patterns is established, this chronobiologic theory may be explored further in order to better understand this disorder. The sensitization and kindling theory is being developed as a possible theory in explaining and understanding bipolar disorders. However, this theory has not been fully tested in humans; animal subjects have been used primarily in order to explore the merits of this theory. In this theory, sensitization refers to increased response of the brain due to the repeated use of the same drug; kindling, refers to the subthreshold stimulation that a neuron generates and the subsequent action potential (Boyd, 2008, p. 370). In this instance, as repeated stimulation of the brain is seen, there would now be stereotypical reactions or seizures which would be seen in the patient. With repeated stimulation, there is also an eventual increase in the neurochemicals which would be needed in order to produce the same response; hence, there is a possibility that if adjustments in stimulants are not made, the response would be decreased or diminished (Boyd, 2008, p. 370). This theory may help explain why, in some patients, the interval in transitions from an extreme behaviour to another often become shorter and shorter. And as there are more episodes of mania and depression, the patient would most likely reach a threshold in future episodes which would increase the likelihood of even more incidents of mania or depression (Boyd, 2008, p. 370). Psychological and social theories are often made to relate with each other in explaining and assessing mental health disorders. These theories focus on the impact of loss which can cause depression, especially to individuals who are already genetically vulnerable to depression (Boyd, 2008, p. 370). In assessing mania from a psychological perspective, “it is regarded as a condition that arises from an attempt to overcompensate for depressed feelings, rather than a disorder in its own right” (Boyd, 2008, p. 370). As a person initially manifests depression, the manic behaviour may soon follow as an attempt to conceal or to compensate for his previous behaviour. In this regard, depression may actually be viewed as the main disorder or the main problem. More often than not, the depressive phase would drive the patients to dangerous and self-harming behaviour, and the manic phase would manifest in short bursts of energy and impulsivity. Psychologist Brown, along with some other colleagues, was able to establish in the course of their studies the impact of a hostile family environment in the development of psychological and mental health disorders (as quoted by Frank, 2005, p. 21). This theory measured expressed emotion when hostility, criticism, or emotional over-involvement was present and how these would affect the patient and the manifestations of his disorder. Such theory also echoed similar tones in studies by Miklowitz, et.al. when they were able to demonstrate the “relevance of such a negative family environment to the course of bipolar illness” (as quoted by Frank, 2005, p. 21). In these instances, the development of the disorder is assessed based on a parent’s expressed negativity of their child’s behaviour. Relapse was often seen within 9 months from the incident of parental disapproval. However, their study revealed that relapse seldom manifested in instances when the reaction of parents or family members was benign (Frank, 2005, p. 21). Clinical Interventions Many psychologists and mental health professionals emphasize the need for a multidisciplinary type of treatment for the bipolar patient. The expertise of psychologists, nurses, physicians, pharmacists, and such other health care professionals are needed in order to accomplish a well-rounded approach to treatment. This health care team’s goal is to ensure and prevent manic and depressive episodes in the patient. With lesser episodes of either depression or mania, the patient will have a better chance to live a normal life (Boyd, 2008, p. 370). And when a normal life is a greater possibility for the patient, there are lesser triggers for either manic or depressive episodes. Stress, traumatic events, or family turmoil can often trigger depression, which the patient would later overcompensate with manic behaviour. It is therefore also important to teach the family how to manage the patient’s behaviour in order to avoid triggers and to ensure a normal life for the patient (Boyd, 2008, p. 370). Boyd (2008, pp. 370-371) points out that in the manic phase, it is important to protect the patient against impulsive behaviour, where he would most likely exercise poor judgment and would manifest high-risk behaviour. There are some patients who have been known to jump off buildings or to gamble away their life savings at the height of their mania. When their mania later subsides, they are horrified by their behaviour and this would then trigger their depression. Their depression puts them at an even greater risk of suicide as they contemplate their manic behaviour and their life in general (Boyd, 2008, p. 371). The National Health Services (2009) also recommend a combination of treatments for bipolar patients. Mood stabilizers (lithium carbonate) are one of the primary interventions for this disorder. These mood stabilizers act by preventing episodes of mania and depression; they are given to the patient every day and on a long-term basis (National Health Services, 2009). In some instances psychiatric drugs like anti-depressants and anti-psychotic/anti-convulsant drugs are also given to the patient as and when the symptoms of the mania or depression manifest. The National Health Services (2009) also recommends that a patient’s particular ‘triggers’ should be recognized and identified in order to ensure that the caregivers and the family members can avoid the patient’s exposure to such triggers. Along with triggers, signs of an upcoming manic or depressive episode must also be recognized by the caregivers and family members in order to allow precautionary measures to be set in place (National Health Services, 2009). By learning when a manic or depressive episode is to be expected, the dire or fatal consequences of such episode can now be prevented. In instances of possible self-harm or harm to others, the Mental Health Act imposes compulsory hospital treatment for these patients (National Health Services, 2009). In extreme cases of bipolar disorder, this act is a necessary imposition. Hospitalized patients would have a lesser chance for a normal life, however, hospitalization may be the best way to prevent self-harm and harm to others. The National Health Services (2009) also recommends psychological treatment, regular exercise, planning enjoyable activities, and dietary advice for bipolar patients. Psychological treatments assist patients in coping with depression and with their other symptoms; they also advice patients on how to improve on their relationships. Regular exercise has been known to prevent depressive episodes; and planning activities that the patient enjoys can give the patient a sense of achievement and accomplishment in his daily activities. Effective weight management can also help in the management of this disorder by ensuring that the patient has access to essential nutrients which can, in turn, promote improved body function, prevent illness, and improve a patient’s body image (National Health Services, 2009). Geddes, et.al., (2004, pp. 217-222) sought to assess the applicability and acceptability of lithium in preventing relapse in bipolar disorders. In their research, they undertook a systematic review of randomized controlled trials by comparing the effectiveness of using either lithium or placebo in treating bipolar disorders. The data search was undertaken by combing through materials and researches from the Cochrane database for journals, reference lists, and abstract lists (Geddes, 2004, p. 217). Their research was able to establish that most of the studies revealed that lithium is an effective drug in preventing relapses in the manic stage of bipolar patients. It was however less effective in preventing relapses in the depressive stage of bipolar patients. They concluded that lithium is an effective drug in preventing relapses in bipolar patients. Its effectiveness is clearly seen in manic episodes and less equivocal in depressive episodes (Geddes, 2004, p. 217). In a paper by Frank, et.al., (2008, pp. 1559-1565) they sought to evaluate the effect of acute treatment with interpersonal and social rhythm therapy in bipolar patients over a period of approximately 2.5 years. In their study, they randomly assigned bipolar patients to receive treatment ranging from acute maintenance interpersonal and social rhythm therapy to acute maintenance intensive clinical management. The occupational functioning of these patients was later measured. The study revealed no statistical significance in the treatment effect of intensive clinical management. However, those assigned to interpersonal and social rhythm therapy exhibited improvement in their occupational functioning. Nevertheless, at the end of the two year treatment, there were no differences seen between these two groups. The authors concluded that “interpersonal and social rhythm therapy, with its emphasis on amelioration of interpersonal and role functioning, improved occupational functioning significantly more rapidly than did a psychoeducational and supportive approach with no emphasis on functioning capacities” (Frank, et.al., 2008, p. 1559). This study points out important aspects of treatment in bipolar patients. The social rhythm therapy is an important innovation in treating bipolar patients as it helps them enjoy a normal life. In a paper by Culver (2006), she outlines four main categories of treatment in bipolar disorders. These are: psychoeducation, family-focused therapy, interpersonal and social rhythm therapy, and cognitive-behavioural therapy. She points out that psychoeducation is about providing information about the disorder to the patient and the members of the family. Through psychoeducation, the patients, caregivers, and members of the family will be aware of the triggers and the early signs of manic or depressive attacks. The individual, group or family formats may be applied in these instances (Culver, 2006). Family therapy for bipolar patients first involves an assessment of the family or the couple, and then followed by a psychoeducation about the disorder including its symptoms, early recognition, and management. Communications skills training (speaking and listening) and problem skills training are also adjuncts to family therapy because they help the patient and his family communicate and understand each other; it also helps them manage and cope with the problems that come their way (Culver, 2006). The interpersonal social rhythm therapy integrates psychoeducation, social rhythm therapy (regulated and monitors social activities), and interpersonal psychotherapy (improve quality of interpersonal relationships and satisfaction of social roles) (Culver, 2006). Lastly, cognitive-behavioural therapy includes psychoeducation, enhancing medical compliance, monitoring mood and early warning signs, monitoring and preventing mood escalation, challenging thoughts and beliefs contributing to mood disturbance, and dealing with long-term vulnerability issues (Culver, 2006). These forms of treatment work best in the hands of a mental health care team which can adequately assess and integrate these forms of treatment in the life of the bipolar patient while still allowing him to live a healthy and normal life. Works Cited Bauer, M., Kilbourne, A., Ludman, E., Green, D., 2008, Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms and Achieving Your Life Goals, California: New Harbinger Publications Bipolar disorder, 18 September 2009, National Health Services, viewed 03 November 2009 from http://www.nhs.uk/conditions/Bipolar-disorder/Pages/Introduction.aspx Bipolar statistics, 06 January 2008, Australian Bipolar Schizoaffective Support Network, viewed 03 November 2009 from http://www.abssn.org/site/index.php?option=com_content&view=article&id=84:bipolar-statistics&catid=39:Bipolar&Itemid=88 Boyd, M., 2008, Psychiatric nursing: contemporary practice, Pennsylvania: Lippincott Williams & Wilkins Culver, J., 1 October 2006, Psychosocial Interventions for Bipolar Disorder, Stanford University, viewed 03 November 2009 from http://bipolar.stanford.edu/documents/Culver-EducationDay10-1-06.pdf Frank, E., 2005, Treating bipolar disorder: a clinicians guide to interpersonal and social rhythm therapy, New York: Guilford Press Frank, E., Soreca, I., Swartz, H., Fagiolini, A., Mallinger, A., Thase, M., Grochocinski, V., Houck, P., Kupfer, D., 2008, The Role of Interpersonal and Social Rhythm Therapy in Improving Occupational Functioning in Patients with Bipolar I Disorder, American Journal of Psychiatry, volume 165, pp. 1559-1565 Geddes, J., Burgess, S., Hawton, K., Jamison, K., Goodwin, G., Phil, D., February 2004, Long-Term Lithium Therapy for Bipolar Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials, American Journal of Psychiatry, volume 161, pp. 217-222 Hall, S., 26 July 2006, Doctors failing to identify bipolar disorder, says medicine watchdog, Guardian.uk., viewed 03 November 2009 from http://www.guardian.co.uk/science/2006/jul/26/socialcare.medicineandhealth Statistics about Bipolar Disorder, 2009, Wrong Diagnosis.com, viewed 03 November 2009 from http://www.wrongdiagnosis.com/b/bipolar/stats.htm Symptoms of bipolar disorder, 2009, National Health Services, viewed 03 November 2009 from http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Symptoms.aspx Treating bipolar disorder, 2009, National Health Services, viewed 03 November 2009 from http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Treatment.aspx Read More