Bipolar Disorder and Mental Health - Article Example

? Bipolar Disorder Table of Contents Bipolar Disorder 0 Introduction Bipolar disorder which is also known as manic depressive disorder is a mental state whereby people experience serious mood disorders. Consequently, this causes radical alterations of their moods, which vary from depressive lows to manic highs. Other common symptoms are irritability, mood swings, anger, suicidal thoughts and a sense of hopelessness (National Institute of Mental Health, 2012). Therefore, this discourse aims at discussing in length about the current mental health among the Americans, bipolar disorder, signs and symptoms, diagnosis, mitigation strategies and treatment. It also seeks to give a relevant case study, as well as the historical and policy issues that have been put in place to handle cases of bipolar disorder. It is absolute that examining the issues surrounding bipolar disorder will help in understanding ways through which it can be mitigated and how people can learn to live with those affected. 1.1 Mental Health According to the World Health Organization (WHO), psychological well being is an imperative aspect in life. In the year 2002, it was estimated that around 450 million people across the globe were suffering from behavioral, as well as mental disorders in which around 150 million of them suffered from severe depression. Mental health has serious profound impacts on families and individuals affected as far as their physical, social and economic life is concerned. Since psychological disorders often tend to affect communities as well as the families of those affected, it is essential for people to understand the major effects of mental illness on both the social systems as well as on individuals. Consequently, this will help in improving the mental care systems and ensure effective development of related mental health programs (World Health Organization, 2013). It is alleged that mental health covers a vast range of compulsions often affecting the elderly (Nash, 2010). The American Nursing association is focused on collaborating with the health policy makers to enhance the restoration of universal access to mental health care among the US families. Although there has been extensive efforts aimed at enhancing the world mental health, the World Health Organization has stressed on the need to have a comprehensive definition of what mental health is, and to ensure that this extends beyond the presence or absence of diagnosed disorder to include autonomy, self efficacy, well being and competence (World Health Organization, 2013). One of the common mental health issues that has been widely debated on, and that I have had a personal interaction with is bipolar disorder. In this case, it is important to give a synopsis on the historical and policy issues that surrounds, it as well as other essential factors such as its treatment. 1.2 What is Bipolar Disorder? Scholars define bipolar disorder as a manic depressive mental health state in which a person exhibits bidirectional fluctuations from a depressive to a euphoric state. Other common symptoms are irritability, a sense of hopelessness, grandiosity, low self esteem, insomnia, racing thoughts, distractibility, agitation and suicidal thoughts (Friedman, 2001, pp.165-166). Research also shows that the sleeping patterns of persons suffering from bipolar disorder often vary with the severity, the clinical state, as well as the stage of the disorder. For instance, when depressed, bipolar patients tend to sleep excessively and when in a manic state, they sleep less or not at all (“The Biology of Mental Disorders,” n.d, p.88). In the US, it is estimated that more than two million people suffer from bipolar disorder. One of the main reasons behind its unprecedented rise is complications that hinder appropriate as well as accurate diagnosis. Research shows that half of all the respondents reported visiting more than three mental health experts before having a correct diagnosis (Calibre, n.d, pp.1-2). According to Torrey and Knable (2002, pp.110-111), bipolar disorder can affect anybody though the most affected persons are the elderly people from the age of sixty. Though the disease cannot be characterized among the most severe mental disorders such as Alzheimer disease and schizophrenia that impairs the cognitive ability of an individual, it is equally risky as it makes it complex for patients to control their moods, and can even cause permanent disability. Scholars contend that patients who are in the manic phase suffer more as it makes it hard for people who are close to them to control them. On the same note, those in the depressive phase often refuse to cooperate with the health experts and contemplate risky behaviors such as suicide mostly when they are alone (Suppes et al., 2012, pp.16-17). For that reason, it is important to understand the main signs and symptoms among the people suffering from bipolar disorder to ensure that sound strategies are implemented to curb such cases, as well as deal with those affected. 2.0 Signs and Symptoms 2.1 Sudden Mood Changes In order to fully understand bipolar disorder, it is imperative to note that there are two major categories which are bipolar 1 and bipolar II. The first category is also known as the manic phase while the second one is commonly known as the depressive state. 2.11 The Manic Phase The manic phase is categorized by high manic cycles, whereby, a patient shows feelings and signs of self importance, impulsiveness, loquaciousness and high socialization rate. On the same note, it has been discovered that those persons suffering from this category often sleep for few hours; hence, fostering depression and aggravating their instincts of irritability as well as anger. Moreover, an individual suffering from mania tends to show a low attention span and is often distracted. Additionally, they easily indulge in anti-depressants and drugs for instance sleeping pills and cocaine. Scholars allege that they also tend to reveal levels of intolerance when dealing with serious matters and have impaired judgment skills. In addition to such signs, patients are often characterized by feelings of dominating pressure, inflated level of self esteem, uncontrolled use of finances, are hypersexual and optimistic (Leonard & Jovinelly, 2012). On the flip side, depressive phase patients are often exemplified by a mild mania, which is referred to as hypomania. This phase provides a complete new list of symptoms and signs that are diverse from that of the mania phase. For example, patients experience symptoms and signs which express aggression, hypersomnia, anxiety, isolation, lack of sexual interest, diminished concentration and indifference. Moreover, they often exhibit low levels of energy, reduction of physical and mental processes, whereby, such individuals often feel fatigued and a need to have excessive sleep, pressured speech and lack of interest in the things they used to enjoy before. Research shows that depressive phase of bipolar is likely to last for weeks; hence, leading to deterioration of life in cases whereby the patients find it difficult to cope (Torrey & Knable, 2002). It is evident that patients suffering from bipolar disorder are at high risk of suffering. This is because those affected often suffer from immense and extreme phases, which alternate between happiness and despair or grief. Studies show that persons affected are at a higher risk of committing suicide as well as suffer permanent disability (National Institute of Mental Health, 2012). In this case, it is important for the health experts to come up with sound interventions aimed at combating the spread of bipolar disorder. 2.2 Diagnosis Medical practitioners have come a long way in fully comprehending the different moods exhibited by persons suffering from bipolar disorder, as well as in making accurate diagnosis. Before, bipolar disorder was ranked together with other common disorders such as schizophrenia. However, with more research on mental disorders, the health experts today can easily identify signs as well as symptoms of hypomania and bipolar depression, making it easy to treat the disorders on time by using bipolar medications. Research shows that doctors diagnose bipolar disorder by taking serious and closer look at the symptoms including the frequency, severity and length of the mood swings. In making a diagnosis, mental health experts often pose questions to the patients on their family or personal history in relation to mental illness or bipolar disorder. Additionally, doctors often ask detailed questions on bipolar symptoms and questions focused on memory, ability to express oneself, as well as the aptitude to maintain solid relationships. Moreover, in case a health expert suspects that a patient is suffering from bipolar disorder, they do a number of exams and tests such as physical exams, which include checking vital signs such as blood pressure and heart rate. On the same note, they can do laboratory tests, which can include urine and blood tests to check for physical problems that might trigger the symptoms. Other tests include mood charting, where a doctor keeps a daily record of the patient’s mood, and psychological evaluation which involves a doctor talking to a patient about their thoughts, behavior patterns and feelings (Ketter, 2009, pp.11-12; ANA, 2010). For one to be diagnosed with bipolar disorder, they ought to meet a criterion that has been clearly spelled out by the Diagnostic and Statistical Manual (DSM) of Mental Disorders. For instance, for one to be diagnosed with bipolar I, one has to have mixed or one manic episodes. Additionally, to be considered a manic phase, the mood disturbance has to be severe enough to an extent of causing noticeable difficulties at school, relationships and work. On the other hand, for one to be considered a depressive or a hypomanic phase, the mood disturbance ought to cause a change in one’s functioning and should not be triggered by the use of medication, alcohol or drugs (Mayo Clinic, 2013). According to the DSM guidelines, it is essential for mental health experts to access the patient’s reasoning ability as well as the aptitude to keep up with routines in the workplace as well as in the family (Fast & Preston, 2012). 2.3 An Example Paul a 28 year old gentleman was diagnosed with bipolar disorder in a clinic I was working at. His was a characteristic case of depression characterized by self doubt, incoherent fast speech, uneasiness, irritation at those around him, and even refused to be examined despite his awareness of the problem. Additionally, as I questioned him, I realized that he was always contemplating suicide and his mood swings had caused his ineffectiveness in the workplace to an extent the boss had issued him with a suspension letter because of missing work continuously; hence, poor productivity. 3.0 Mitigation Various policies help in the diagnosing, treatment, as well as care of persons suffering from bipolar disorder. In that case, the stakeholders as well as the government should collaborate in coming up with essential mitigation strategies and policies aimed at combating bipolar disorder and educating the public on ways to prevent it. 3.1 Government Policies According to National Institute of Mental Health (2002), more than two million adults in the US are suffering from bipolar disorder. The number has continued to heighten since by the year 2005, the number of those affected had increased to around 5.8 million (Kessler et al., 2005, pp. 617-619). Consequently, this has had a profound negative effect on the economic sector as most of these people are adults who are supposed to be at the forefront in ensuring economic growth. Following the increase in bipolar cases, various government policies and strategies focused towards helping the community as well as persons affected have been put in place. For instance, the 1995 Disability Discrimination Act was formulated by the government to prevent workers who might be discriminated against on the basis of their mental breakdown or disability, often caused by conditions such as bipolar disorder. Moreover, the Act aimed at ensuring that employers offer proper working conditions, which accommodates for the needs of those disabled, and guarantees that they continue holding employment. Bipolar disorder is seen to cause disability; hence, the Act helps in reducing financial as well as work oriented stress. According to this Act, a person is classified as disabled in case he or she has a physical or mental impairment, which prevents him from engaging in normal daily activities (EEOC, 2000; Caponigro, 2012). According to the Equal Employment Opportunity Commission (EEOC) (2000), the discrimination of a worker on the basis of his or her color, disability, class, or race is illegal. For that reason, through government policies such as the ADA and the EEOC, bipolar patients are fully protected from layoffs as well as unfair dismissal because of their illness. Therefore, these policies are imperative in helping people maintain their financial status and ensure that employers collaborate with other stakeholders in fighting cases of bipolar and coming up with helpful related strategies. 3.2 Stakeholders The main stakeholders who are relevant in this case and that can help in reducing related cases are health professionals, for instance, mental health experts, psychiatrists, and doctors. Others are Nongovernmental and governmental organizations, for instance, the National Alliance on Mental Illness, the National Institute of health and the Americans with the Disabilities Act. Additionally, the Equal Employment Opportunity Commission, Mental Health America, the National Institute of Mental Health, and the Depression and Bipolar Support Alliance play a major role in the treatment, prevention, and protection of the right of persons suffering from bipolar disorder. Finally, the employers of the affected persons such as Paul and their families act as stakeholders. 3.3 The Benefits The policies put in place by the government make it possible for persons suffering from bipolar disorder such as Paul to comfortably go through medication without worrying about job security. On the same note, patients suffering from mental disorders are fully protected by the ADA; hence, have a right to sue their employers in case of discrimination and unfair layoff and treatment. Therefore, such policies help in minimizing stress, which is often related to lack of finances and job, helping patients get the necessary help with ease, and return to their normal routines. Moreover, the ability to hold onto a job in cases of a mental breakdown helps patients to feel accepted; thus, increasing their chances of recovery, and reducing feelings of self pity, isolation, and sadness. Finally, since employers know that such employees are protected by the law, they easily collaborate with other stakeholders in ensuring that such workers get the right healthcare, as well as coming up with more and better policies to ensure that workers feel comfortable in the workplace. 4.0 Treatment The treatment mode applied in the cure of bipolar disease is often achieved through the prescription of the right medications. Such medications often constitute those that prove beneficial in stabilizing as well as controlling mood swings such as antipsychotics, antidepressants and anticonvulsants. 4.1Mood Stabilizers With the pharmaceutical advancements, several medications are now available for the treatment and management of bipolar disorder as approved by the FDA (AACN, 2012). There are various regimens for the treatment of bipolar disorder such as Lithium Carbonate, Valproic Acid, Divalproex, Lamotrigine, and Carbamazepine. Research shows that the most common ones are Lithium and Valproic Acid. However, these medicines work in the same manner in treating bipolar disorder and help in balancing particular brain chemicals that control one’s behavior as well as the emotional state. Lithium is one of the common medicines that are often prescribed in treating mania and preventing the return of both depressive as well as manic episodes. Similarly, Valproic Acid can be used during a manic episode in the prevention of mood cycling between mania and depression. Lithium as well as valproic can be taken together to help in reducing depressive episodes. It is alleged that Valproic Acid is often used during manic phases to persons who do not respond effectively to Lithium Carbonate. Research findings have revealed that Lithium is highly effective in reducing frequency as well as the symptoms of episodes with a 70 to 80% response rate (Timby & Smith, 2005, pp.239-240). 4.1.1 Advantages Lithium Carbonate offers relief to patients suffering from acute phases of depression or mania, helping them not to reoccur. Research reveals that long term use of Lithium helps in reducing cases related to suicide. In that case, such medicines help in enhancing mood, alertness, as well as ways in which such persons relate with other people. On the same note, patients are able to continue with their normal lifestyle; hence, working towards financial fulfillment and economic growth (Nonacs, 2006). 4.1.2 Disadvantages Nevertheless, there a number of side effects, which are accompanied with continuous use of Lithium medications such as tremors, nausea, increase in weight, hyperthyroidism, drowsiness, abnormalities of the kidney and the thyroid, and diarrhea. Other serious side effects include slurred speech, blacking out, heart block, and changes in the heart rhythm. Scholars also allege that Valproic Acid can cause stomach upset, low energy, and changes in platelets and liver functioning. It is also alleged that in case of a lapse, personnel are not available to help the patient; thus, might aggravate the situation. Finally, in case the drugs are not well adhered to, the conditions of the patients might end up worsening (Chew, Hales & Yudofsky, 2009, pp.188-189). 4.2 Antipsychotics According to Gentile (2007) antipsychotics are often used for the treatment of bipolar disorder because of their enhanced neurological tolerability. Moreover, research shows that health outcomes have been enhanced among patients using atypical antipsychotics such as Olanzapine and Risperidone (Gentile, 2007; Ketter, 2009). Antipsychotic drugs are used as a short term treatment in the control of psychotic symptoms for instance delusions and hallucinations, which often occur during severe depression or acute mania. Among people suffering from bipolar disorder, antipsychotic medications are also used as sedatives in treating cases of anxiety, agitation, and insomnia. They are often taken with mood stabilizing regimens to help lessen depression and stabilize one’s mood. Research shows that modern antipsychotics have been quite effective in stabilizing moods; hence, they can be taken along without stabilizers and can be used as a long term treatment to those persons who hardly respond to anticonvulsants and Lithium Carbonate. Various antipsychotics are used in treating bipolar disorder such as Olanzapine, Risperidone, Abilify, Geodon, Saphris, Zyprexia, among others (Fink & Kraynak, 2011). 4.2.1 Pros Antipsychotic drugs help a lot in balancing brain chemicals, commonly known as neurotransmitters. Research also shows that they help in enhancing manic phases effectively and quickly. Moreover, they help in avoiding reckless as well as impulsive behaviors and enhance one’s reasoning ability. Consequently, one is able to engage in their normal activities as they continue their medication (Fink & Kraynak, 2011, pp.122-123). 4.2.2 Cons It has been reported that some of the antipsychotic drugs cause heart failure, high levels of cholesterol, and weight gain. In that case, such people are advised to first get screened for their risks in stroke, diabetes, and heart diseases. Other common side effects are dry mouth, blurred vision, tremor, drowsiness, among others. Additionally, patients using such drugs need constant observation which is often expensive as far as the use of resources, paying of professionals, and time wastage is concerned (Fink & Kraynak, 2011, pp.121-122). 4.3 Antidepressants Various antidepressants are used in controlling depression among people suffering from bipolar disorder such as Lexapro, Prozac, Cymbalta, Paxil, and Rameron (Leonard & Jovinelly, 2012). Other medications include Bupropion, Lamotrigine, Mirtazapine, and Tricylic antidepressants. 4.3.1 Advantages Since patients taking antidepressants are often at close quarters with their health professionals it is easy for them to get well as they are under the watch of the experts. On the same note, adherence to drugs in this case is often ensured and one can easily monitor their progress (Leonard & Jovinelly, 2012). 4.3.2 Disadvantages Research shows that antidepressants do not prevent suicides or reduce the rate of mortality. Additionally, scholars allege that antidepressants are less effective than mood stabilizers in controlling depression. Additionally, antidepressant medications are expensive and patients cannot participate in economic activities since they are often hospitalized. Consequently, isolation from their normal life may end up worsening their situation and cause loss of employment as well as business prospects (Ghaemi, et al, 2003). 5.0 Conclusion Bipolar disorder is a common condition that has continued to affect millions of the American citizens. It is argued that once a diagnosis has been made, the first reaction by the patients is self pity, sadness, and rejection. There is a need for information and more research on bipolar disorder to help patients and families affected directly or indirect. Scholars allege that if all the stakeholders collaborate in coming up with effective strategies and policies, patients suffering from bipolar disorders will be easily reached. Various regimens are used to treat bipolar disorder, though they have grave side effects. Therefore, future researchers should focus on coming up with medications that have less complications in order to help the people affected. Luckily for a patient like Paul, he can use mood stabilizers because his condition is not severe or likely to cause violence or complications. References AACN. (2012). AACN Scope and Standards for Acute Care Nurse Practitioner Practice. Aliso Viejo, CA: American Association of Colleges of Nursing. American Nurses Association, ANA. (2010). Nursing: Scope and standards of practice. Silver Spring: American Nurses Association. Calibre (n.d). The Ultimate Collection of Tips for Figuring out Bipolar Disorder. Washington, D.C: KMS Publishing. Caponigro, J. M., Lee, E. H., Johnson, S. L. & Kring, A. M. (2012). Bipolar Disorder: A Guide for the Newly Diagnosed. Oakland, CA: New Harbinger Publications. Chew, R., Hales, R & Yudofsky, S. (2009). 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