The Unipolar Depressive Illnesses - Essay Example

 «The Unipolar Depressive Illnesses» Hirschfeld, et.al., (2003) conducted a study for estimating rates of “positive screens for bipolar 1 and bipolar II disorders” within the US (p. 53). Bipolar is defined as a form of clinical depression with a range of symptoms. Bipolar I and Bipolar II are terms used to express the severity of the illness with Bipolar II representing the more chronic form of the illness (Lewis, et. al. 20003). Hirschfeld, et. al. (2003) conducted the study by distributing the Mood Disorder Questionnaire among a representative sample of the population in the US. The questionnaire was distributed among a population sample of 127, 800 individuals. The sample consisted of adults who were at least 18 years of age and older, representing various demographics in the US. The response rate was 66.8% with 85, 358 respondents completing the questionnaire. Those who did not complete the questionnaire (3404) were identified by reference to the US Census report for the year 2000 and telephone interviews were conducted to identify the reasons for failure to participate in the questionnaire (Hirschfeld, et. al., 2003). The results of the study found that when balanced by reference to the US Census of 2000, 3.4% registered positive screen tests for bipolar I and bipolar II disorders. When the reasons for failing to participated in the questionnaire were taken into account the overall results demonstrated that the rate of positive screen tests for bipolar I and bipolar II disorders among the US’s general population was 3.7% (Hirschfeld, et. al., 2003). In other words, the bipolar I and bipolar II disorders are not that uncommon among the general population of the US. The results also determined that of the individuals presenting positive screen tests for bipolar I and bipolar II disorders, approximately 19.8% indicated that they had been clinically diagnosed with bipolar disorders. Another 31.2% of the respondents testing positive for bipolar I and bipolar II disorders reported that they had been previously diagnosed by a medical doctor with having unipolar depressive illnesses (Hirschfeld, et.al., 2003). In addition, the results of Hirschfeld, et.al.’s (2003) study indicated that another 49% of the respondents testing positive for bipolar I and bipolar II disorders had not received a previous clinical diagnosis of either bipolar I, bipolar II or any other unipolar disorders. The results of the study also revealed that those testing positive for bipolar I and bipolar II disorders were most frequently young with low income. Moreover, those testing positive for bipolar I and bipolar II disorders were found to have higher degrees of asthma, allergies, migraines and substance abuse than those who did not test positive for either of the disorders (Hirschfeld, et. al., 2003). As a result of this study, Hirschfeld et. al. (2003) concluded that: The positive MDQ screen rate of 3.7% suggests that nearly 4% of American adults may suffer from bipolar I and II disorders. Young adults and individuals with lower income are at greater risk for this largely underdiagnosed disorder (p. 59). It would therefore appear that individuals with specific physical ailments such as migraines, asthma and allergies might confuse bipolar symptoms with agitation or irritation brought on by these physical ailments. Likewise individuals who abuse drugs and/or alcohol may confuse bipolar symptoms with the side effects of substance abuse. This might account for the under-diagnosis of bipolar disorders or it might explain why family members and friends of those affected are not alerted to the possibility of bipolar diagnosis. Complicating matters the fact that many of those persons suffering from bipolar have low income, the opportunities for proper diagnosis and treatment are further compromised. Axelrod, Woodard, and Alphs (1994) conducted a study in which it tested the effectiveness of the Negative Symptom Assessment (NSA) for rating the negative symptoms associated with schizophrenia. The study was conducted by using a standard NSA among 223 patients hospitalized with schizophrenia. The NSA scale used rated communication, emotion/affect, motivation, gross cognition, retardation and social involvement (Axelrod, et. al., 1994). The study was justified on the grounds that the positive symptoms of schizophrenia such as delusions and hallucinations are typically identified as the core drivers of schizophrenia. It was only in relatively recent times that the negative symptoms assumed importance in the diagnosis and treatment of schizophrenia. The negative symptoms are typically described as “diminished affect, poverty of speech, avolition, and social withdrawal” (Axelrod, et. al., 1994, p. 173). More than 8 scales have been developed for rating and identifying the negative symptoms associated with schizophrenia, however, their validity is questionable and in some cases “poor” (Axelrod, et. al., 1994, p. 173). The NSA is comprised of 26 items which was expressly designed to identify and describe the nature of the negative symptoms in a way that is “more standardized and comprehensive” (Axelrod, et. al., 1994, p. 173). In particular, the NSA evaluates and identifies a larger scope of negative symptoms and has more detailed and “anchored items” and is used with the inclusion of a standard and “structured interview” (Axelrod, et. al., 1994, p. 173). Essentially, the NSA was constructed around the idea that the negative symptoms of schizophrenia are complex and “multidimensional in nature” (Axelrod, et. al, 1994, p. 174). It therefore follows that since negative symptoms of schizophrenia are multidimensional: ...it would be possible to evaluate differential medication efficacy, treatment outcome, and pathophysociological significance of individual negative dimensions (Axelrod, et. al., 1994, p. 174). The previous scales typically utilized universal rates and scores and did not take account of the potential for a wide range of factors that could inform of and measure the wider range of potential negative symptoms. The NSA cures these deficits by providing for the more accurate identification of the multidimensional aspects of schizophrenia’s negative symptoms (Axelrod, et. al., 1994). The study conducted by Axelrod, et. al. (1994) involved 12 different psychiatric facilities and the patients were all clinically diagnosed with schizophrenia. Each of the respondents were interviewed pursuant to the NSA interview format a weed after they were hospitalized. 27 “clinical rates” conducted the interview and “achieved excellent consistency of ratings” (Axelrod, et. al., 1994, p. 174). The NSA was used on one group of patients (experimental group) and a single model was used on another group of patients (control group). The results of the study indicated that the NSA was far more effective in identifying and rating the nature of the multidimensional negative symptoms of schizophrenia. In particular, the NSA rated and measured communication, emotion/affect, retardation, social involvement, motivation and gross cognition and did not produce generalized results such as those typically associated with previous scales. Given its effectiveness and the fact that previous and existing scales have failed to accomplish the depth of results the NSA has shown it can accomplish, the NSA should be used as the standard scale for measuring and identifying the negative symptoms of schizophrenia (Axelrod, et. al., 1994). Works Cited Axelrod, B. N.; Goldman, R. S.; Woodard, J. L. and Alphs, L. D. “Factor Structure of the Negative Symptom Assessment.” Psychiatry Research, (1994) Vol. 52: 173-179. Hirschfeld, R. M.; Calabrese, J.R.; Weissman, M. M.; Reed, M.; Davies, M.A.; Frye, M.A.; Keck, PE, Jr.; McElroy, S. L.; McNulty, J.P. and Wagner, K. D. “Screening for Bipolar Disorder in the Community”. The Journal of Clinical Psychiatry. (2003) Vol. 64(1): 53-59. Lewis, L. et.al. “A Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder.” Arch. Gen. Psychiatry. (2003) Vol. 60(3): 261-269. Read More