Description of Psychosocial Disorder - Essay Example

Introduction It is estimated that 5.7 million (2.6 of North American adults currently experience bipolar disorder in any given year (Kessler,Chiu, Demler, & Walters, 2005). Bipolar disorder is not often recognized by general practitioners as an illness, and many people experiencing the disorder may go undiagnosed for many years (Goodwin, & Jamison, 1990). It is a long-term disorder, and requires careful management by way of lifestyle changes to manage across the lifespan. This paper will review the literature pertaining to bipolar disorder. Firstly a description of the psychosocial disorder will be presented. Secondly, the social, emotional, cognitive and behavioral aspects of bipolar will be described. Next, the interactive effects of class, ethnicity, and gender will be detailed. Following will be an outline of current treatment options and their strengths and weaknesses. Finally a conclusion shall summarize the main points of the paper and provide implications for research into bipolar disorder. Review of the Literature Description of the Psychosocial Disorder Bipolar disorder is also known as manic-depressive illness and is a psychological disorder that induces shifts in a person's mood, energy levels and their ability to function optimally in society. Unlike everyday ups-and-downs, the experiences of mood swings with bipolar disorder are much more severe (Kessler et al., 2005). In general, the disorder develops during late adolescence or early adulthood, although some people will have their first symptoms in childhood, or in later adulthood (DSM-IV, 1994). The consequences of bipolar disorder are dysfunctional interpersonal relationships, poor job and academic performance, isolation and at the extreme, suicide. However, the disorder is able to be treated and many people who experience bipolar disorder lead full and productive lives, contributing to the community and building stable support relationships. Describe the Disorder The manic episodes are diagnosed by the presence of three or more symptoms of elevated mood occurring for most of the day, nearly every day, for a week or more. Depressive episodes are diagnosed when five or more symptoms last for most of the day, nearly every day, for two weeks or longer (DSM-IV, 1994). Social The person experiencing bipolar may blame others for the way that they feel. As such, bipolar disorder may lead a person to isolate themselves from support networks, as their interpersonal relationships cannot be sustained over the erratic behavior. Family and friends may find themselves being shouted at, talked about inappropriately in public or having false accusations made against them. Bipolar disorder may result in the person becoming very egotistical or self-centered and this is not conductive to healthy social relationships, and people may draw away from the person with bipolar (DSM-IV, 1994; Goodwin & Jamison, 1990). Emotional Bipolar disorder is characterized by significant mood swings, a person goes from an extreme "high" (mania) of feeling overly good and euphoric, during which they may or may not also be irritable, to a state of sadness, loneliness and hopelessness (depression). Like a pendulum the person's mood swings back and forth, although there are also experiences of normal mood in between the extreme episodes of mania and depression (DSM-IV, 1994; Kessler et al., 2005). Cognitive During a manic episode the person's thought tend to "race" and "jump" very rapidly, form one idea to the next. The person is easily distracted and has difficulty concentrating, and they tend to have unrealistic believes in their capabilities and "powers". During both the manic and depressive phases their judgment tends to be poor. In general there is denial by the person experiencing the episodes that anything is different or wrong (DSM-IV, 1994; Sachs & Thase, 2000). Behavioral During the manic phase, the person may have increased energy levels and be very active and restlessness, or creative and extremely "chatty". The person may go on a shopping or gambling spree during a manic phase. And little sleep is required during the manic phase of bipolar. The libido and sexual drive may be dramatically enhanced also during the manic phase, with a loss of interest during depression. Drug abuse may occur during the manic or depressive phases. And provocative, intrusive, or aggressive behavior marks erratic changes in behavior that are very different form usual behaviors (DSM-IV, 1994; Henny, 2000). Interactive Effects The interactive effects of socio-economic status (class) ethnicity and gender can be profound. Low socio-economic status can restrict basic nutrition and access to resources, such as doctors and treatment (Goodwin & Jamison, 1990). African Americans, American Indians and Alaskan Natives, Asians and Pacific Islanders, and Hispanic Americans are more likely to live in low socio-economic conditions due to ongoing post-colonial effects. Also, important factors such as mistrust of the system, ethnic stigma, communication difficulties, and stereotyping may constrain equality of access to the health care system and to treatment (McMany, 2002). As many of these ethnic groups maintain a culture of extended family, a person with bipolar may be cared for within the community and not taken for diagnosis. As to gender differences, more women than men appear to experience bipolar and this may be due to the thyroid gland's production of hormones that influence a woman's menstrual and menopausal cycles. However, it may be that gender roles which socialize women to have higher disclosure have led more women to seek diagnosis than men (Goodwin & Jamison, 1990). Treatment Options Mood-stabilizing medications such as antidepressants are one treatment option, alone or in combination. For example Lithium and volproate are common choices to deal with emotional symptoms. However, there is the danger of over-prescribing and "dulling" the cognitive and emotional aspects of the personality, resulting in limited behavior and under-functioning of sociality (Sachs & Thase, 2000). In combination with medication psychosocial intervention has been found helpful, such as psychotherapy. This cognitive-behavioral approach supports, encourages and educates the person about their illness and can lead to self-control over mood swings, as well as cognitive, behavioral and social symptoms. However, the treatment is lengthy, can be expensive, and also requires other social support systems that may not exist for the person (Huxley, Parikh, & Baldessarini, 2000). A third alternative is the use of dietary changes to support mood stabilization, and subsequently other symptoms. The use of St John's Wort, Hypericum perforatum, has been found helpful for mood stabilization but is not yet FDA approved. Omega fatty acids found in fish and grains has also been found to be beneficial for emotional and cognitive stabilization; however research is still limited (Henny, 2000). Conclusion It is clear that the symptoms of bipolar disorder are complex, and inter-related. Social, emotional, cognitive and behavioral changes that are dramatic from usual behaviors may be indicative of manic and depressive mood swings. As such more investigation of bipolar treatments is needed. Especially combination treatments rather than medications alone. It is anticipated that further research will aid those who experience bipolar to more fully contribute to, function within and to be supported by, their communities. References Kessler, R.C., Chiu, W.T., Demler, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617-27. Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV) (1994). Washington, DC: American Psychiatric Press. Goodwin, F.K., Jamison, K.R. (1990). Manic-Depressive Illness. New York: Oxford University Press. Henney, J. E. (2000). Risk of drug interactions with St. John's Wort. From the Food and Drug Administration. Journal of the American Medical Association, 283(13), 1679-1685. Huxley, N. A., Parikh, S. V., & Baldessarini, R. J. (2000). Effectiveness of psychosocial treatments in bipolar disorder: State of the evidence. Harvard Review of Psychiatry, 8(3), 126-40. McMany, J. (2002). Ethnopolar : Ethnicity and depression and bipolar. Retrieved Febuary 5, 2007, from McMan's Depression and Bipolar Web, http://www.mcmanweb.com/article-151.htm Sachs, G.S., & Thase M.E. (2000). Bipolar disorder therapeutics: Maintenance treatment. Biological Psychiatry, 48(6), 573-81. Read More