bipolar disorder research essay

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Understanding Bipolar Disorder: An In-Depth Essay

From euphoric highs to crushing lows, the human mind can orchestrate a symphony of emotions that leaves both sufferers and observers in awe of its raw, uncontrollable power. This emotional rollercoaster is a hallmark of bipolar disorder, a complex mental health condition that affects millions of people worldwide. As we delve into the intricacies of this disorder, we’ll explore its various facets, from its definition and types to its impact on individuals and society at large.

What is Bipolar Disorder?

Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood episodes can last for days, weeks, or even months, significantly impacting a person’s energy levels, activity, behavior, and ability to function in daily life.

The concept of bipolar disorder has evolved over time, with researchers and mental health professionals gaining a deeper Understanding the Concept of Mundo Bipolar – a term that encapsulates the unique world experienced by those living with this condition. This perspective acknowledges the multifaceted nature of bipolar disorder and its profound impact on an individual’s perception of reality.

Types of Bipolar Disorder

Bipolar disorder is not a one-size-fits-all condition. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes several types of bipolar and related disorders:

1. Bipolar I Disorder: Characterized by at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes.

2. Bipolar II Disorder: Defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic episodes.

3. Cyclothymic Disorder: A milder form of bipolar disorder, involving numerous periods of hypomanic and depressive symptoms lasting for at least two years.

4. Other Specified and Unspecified Bipolar and Related Disorders: These categories include bipolar-like disorders that don’t meet the criteria for the aforementioned diagnoses.

Understanding these distinctions is crucial for accurate diagnosis and effective treatment planning.

Causes and Risk Factors

The exact cause of bipolar disorder remains unknown, but research suggests that a combination of factors contributes to its development:

1. Genetics: Bipolar disorder tends to run in families, indicating a strong genetic component. However, having a family history doesn’t guarantee that an individual will develop the condition.

2. Brain Structure and Function: Studies have shown differences in brain structure and function between people with bipolar disorder and those without. These differences may contribute to the disorder’s symptoms.

3. Environmental Factors: Stressful life events, trauma, or significant life changes may trigger the onset of bipolar disorder in susceptible individuals.

4. Neurotransmitter Imbalances: Abnormalities in neurotransmitter systems, particularly those involving serotonin, norepinephrine, and dopamine, may play a role in bipolar disorder.

5. Circadian Rhythm Disruptions: Disturbances in the body’s natural daily rhythms, such as sleep-wake cycles, have been linked to bipolar disorder.

Common Symptoms of Bipolar Disorder

The symptoms of bipolar disorder can vary widely between individuals and even within the same person over time. However, the core features involve distinct episodes of mania (or hypomania) and depression.

Manic Episode Symptoms: – Elevated mood or euphoria – Increased energy and activity – Decreased need for sleep – Racing thoughts and rapid speech – Impulsivity and risk-taking behavior – Grandiose beliefs or inflated self-esteem – Distractibility and difficulty concentrating

Depressive Episode Symptoms: – Persistent sadness or emptiness – Loss of interest in previously enjoyed activities – Fatigue and decreased energy – Changes in appetite and weight – Sleep disturbances (insomnia or excessive sleeping) – Difficulty concentrating and making decisions – Feelings of worthlessness or guilt – Thoughts of death or suicide

It’s important to note that some individuals may experience mixed episodes, where symptoms of both mania and depression occur simultaneously.

Diagnostic Criteria for Bipolar Disorder

Diagnosing bipolar disorder can be challenging, as its symptoms can overlap with other mental health conditions. Mental health professionals use the criteria outlined in the DSM-5 to make an accurate diagnosis. These criteria include:

1. The presence of at least one manic or hypomanic episode (for Bipolar I and II, respectively) 2. The occurrence of at least one major depressive episode (for Bipolar II) 3. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning 4. The symptoms are not better explained by another mental disorder or medical condition

A comprehensive evaluation typically involves a detailed medical history, physical examination, and sometimes laboratory tests to rule out other potential causes of symptoms.

Distinguishing Bipolar Disorder from other Mental Health Conditions

Bipolar disorder shares symptoms with several other mental health conditions, which can complicate diagnosis. Some conditions that may be mistaken for bipolar disorder include:

1. Major Depressive Disorder: While both conditions involve depressive episodes, bipolar disorder is distinguished by the presence of manic or hypomanic episodes.

2. Borderline Personality Disorder: This condition can involve rapid mood swings, but they are typically triggered by interpersonal events and last for shorter periods than bipolar mood episodes.

3. Attention-Deficit/Hyperactivity Disorder (ADHD): The hyperactivity and impulsivity seen in ADHD can resemble manic symptoms, but ADHD symptoms are typically chronic rather than episodic.

4. Schizophrenia: While both conditions can involve psychotic symptoms, schizophrenia is characterized by persistent delusions and hallucinations rather than mood episodes.

Accurate differentiation is crucial for appropriate treatment, as the management strategies for these conditions can differ significantly.

Effects of Bipolar Disorder on Personal Relationships

Bipolar disorder can have profound effects on personal relationships. The unpredictable nature of mood swings can strain even the strongest bonds between partners, family members, and friends. During manic episodes, individuals may engage in risky or hurtful behaviors that damage trust. Conversely, depressive episodes can lead to withdrawal and emotional unavailability, leaving loved ones feeling helpless and frustrated.

Communication often becomes a significant challenge, as the person with bipolar disorder may struggle to express their needs or understand the impact of their behavior on others. Moreover, the caregiver burden on partners or family members can be substantial, leading to stress, burnout, and sometimes resentment.

However, with proper treatment, education, and support, many individuals with bipolar disorder maintain healthy, fulfilling relationships. Open communication, boundary-setting, and mutual understanding are key components of navigating relationships affected by bipolar disorder.

Challenges Faced by Individuals with Bipolar Disorder

Living with bipolar disorder presents numerous challenges that extend beyond managing mood symptoms. Some of the most common difficulties include:

1. Employment Issues: The episodic nature of bipolar disorder can lead to inconsistent job performance, difficulties maintaining employment, and career setbacks.

2. Financial Instability: Impulsive spending during manic episodes and inability to work during severe depressive episodes can result in significant financial problems.

3. Academic Struggles: For students, bipolar disorder can interfere with concentration, attendance, and overall academic performance.

4. Substance Abuse: Many individuals with bipolar disorder turn to drugs or alcohol as a form of self-medication, leading to co-occurring substance use disorders.

5. Physical Health Complications: Bipolar disorder is associated with an increased risk of various physical health problems, including cardiovascular disease, diabetes, and obesity.

6. Legal Issues: Manic episodes can sometimes lead to legal troubles due to reckless behavior or poor judgment.

7. Self-Esteem and Identity Concerns: The cyclical nature of bipolar disorder can leave individuals questioning their sense of self and struggling with self-esteem.

Societal Stigma and Misunderstandings

Despite increased awareness of mental health issues in recent years, bipolar disorder continues to be surrounded by stigma and misconceptions. Common misunderstandings include:

1. Bipolar disorder is just mood swings: This trivializes the severity and impact of the condition.

2. People with bipolar disorder are always either manic or depressed: In reality, many individuals experience periods of stable mood between episodes.

3. Bipolar disorder makes people violent or dangerous: While manic episodes can lead to agitation, most individuals with bipolar disorder are not violent.

4. Bipolar disorder is a character flaw or weakness: It’s a legitimate medical condition, not a personal failing.

These misconceptions can lead to discrimination in various aspects of life, including employment, housing, and social interactions. They can also prevent individuals from seeking help due to fear of judgment or rejection.

Combating stigma requires ongoing education, open dialogue, and representation of accurate portrayals of bipolar disorder in media and public discourse.

Medication Options for Bipolar Disorder

Medication is a cornerstone of bipolar disorder treatment. The primary goals of pharmacological interventions are to stabilize mood, prevent relapses, and manage acute episodes. Common medications used in bipolar disorder treatment include:

1. Mood Stabilizers: These are the foundation of bipolar disorder treatment. Examples include: – Lithium: One of the oldest and most effective treatments for bipolar disorder – Valproic acid (Depakene) and divalproex sodium (Depakote) – Carbamazepine (Tegretol, Carbatrol) – Lamotrigine (Lamictal)

2. Antipsychotics: These can help manage manic or mixed episodes. Some commonly prescribed antipsychotics include: – Olanzapine (Zyprexa) – Risperidone (Risperdal) – Quetiapine (Seroquel) – Aripiprazole (Abilify)

3. Antidepressants: These may be prescribed cautiously to manage depressive episodes, always in combination with a mood stabilizer to prevent triggering mania. Examples include: – Fluoxetine (Prozac) – Sertraline (Zoloft) – Bupropion (Wellbutrin)

4. Anti-anxiety Medications: These may be used short-term to help with anxiety symptoms or sleep disturbances.

It’s crucial to note that medication regimens are highly individualized. What works for one person may not work for another, and it often takes time and patience to find the right combination and dosage.

Therapeutic Approaches for Bipolar Disorder

While medication is essential, psychotherapy plays a vital role in the comprehensive treatment of bipolar disorder. Several evidence-based therapeutic approaches have shown effectiveness:

1. Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and change negative thought patterns and behaviors associated with mood episodes. It can improve coping skills, reduce symptoms, and prevent relapse.

2. Interpersonal and Social Rhythm Therapy (IPSRT): This therapy focuses on stabilizing daily routines and improving interpersonal relationships. It’s particularly effective in managing the disruptions to circadian rhythms often seen in bipolar disorder.

3. Family-Focused Therapy: This approach involves family members in treatment, educating them about the disorder and improving family communication and problem-solving skills.

4. Psychoeducation: Education about bipolar disorder, its symptoms, and management strategies can empower individuals to take an active role in their treatment.

5. Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder, DBT can be helpful for individuals with bipolar disorder in managing emotions and improving interpersonal effectiveness.

6. Mindfulness-Based Cognitive Therapy: This combines elements of CBT with mindfulness techniques to help prevent depressive relapse.

These therapies can be delivered individually, in groups, or even online, providing flexibility to meet diverse needs and preferences.

Lifestyle Changes to Support Mental Health

In addition to medication and therapy, certain lifestyle modifications can significantly support the management of bipolar disorder:

1. Establishing a Consistent Sleep Schedule: Regular sleep patterns can help stabilize mood and prevent episodes.

2. Stress Management: Techniques such as meditation, deep breathing exercises, or yoga can help manage stress, a common trigger for mood episodes.

3. Regular Exercise: Physical activity has been shown to have mood-stabilizing effects and can improve overall well-being.

4. Healthy Diet: A balanced diet can support overall health and may help stabilize mood.

5. Avoiding Alcohol and Drugs: Substance use can interfere with medication effectiveness and trigger mood episodes.

6. Maintaining a Mood Chart: Tracking daily moods, sleep patterns, and life events can help identify triggers and early warning signs of episodes.

7. Building a Support Network: Having a strong support system of friends, family, or support groups can provide crucial emotional support.

8. Developing a Crisis Plan: Creating a plan for what to do during severe mood episodes can provide a sense of control and ensure quick access to help when needed.

Choosing a Focus for the Essay

When writing an essay on bipolar disorder, it’s important to choose a specific focus or angle. Some potential topics could include:

1. The historical evolution of bipolar disorder diagnosis and treatment 2. The impact of bipolar disorder on creativity and artistic expression 3. Challenges in diagnosing bipolar disorder in children and adolescents 4. The role of genetics in bipolar disorder 5. Bipolar disorder and its relationship to other mental health conditions 6. The economic impact of bipolar disorder on individuals and society 7. Cultural variations in the presentation and treatment of bipolar disorder 8. Emerging treatments and future directions in bipolar disorder research

Choosing a focused topic allows for a more in-depth exploration and can make the essay more engaging and informative.

Structuring the Essay

A well-structured essay on bipolar disorder should include:

1. Introduction: Provide a brief overview of bipolar disorder and state the essay’s main focus or thesis.

2. Background Information: Offer essential context about bipolar disorder, including its definition, types, and prevalence.

3. Main Body: Divide the main content into logical sections, each addressing a specific aspect of the chosen topic. Use subheadings to improve readability.

4. Discussion: Analyze the information presented, discussing implications, controversies, or areas for further research.

5. Conclusion: Summarize the main points and restate the thesis in light of the evidence presented. Consider ending with thoughts on future directions or a call to action.

Remember to use transitions between sections to ensure a smooth flow of ideas.

Addressing Controversial Topics

When writing about bipolar disorder, you may encounter controversial or sensitive topics. These might include:

1. The overdiagnosis or underdiagnosis of bipolar disorder 2. The role of pharmaceutical companies in shaping bipolar disorder treatment 3. The use of electroconvulsive therapy (ECT) in treatment-resistant cases 4. The potential link between creativity and bipolar disorder 5. The ethics of genetic testing for bipolar disorder susceptibility

When addressing these topics:

– Present balanced viewpoints, acknowledging different perspectives – Rely on credible, peer-reviewed sources rather than anecdotal evidence – Avoid sensationalism or stigmatizing language – Clearly distinguish between established facts and areas of ongoing debate or uncertainty

Providing Reliable Sources

Using reliable sources is crucial when writing about a complex medical condition like bipolar disorder. Some reputable sources include:

1. Peer-reviewed academic journals (e.g., Journal of Affective Disorders, Bipolar Disorders) 2. Professional organizations (e.g., American Psychiatric Association, National Institute of Mental Health) 3. Reputable mental health websites (e.g., National Alliance on Mental Illness, Mental Health America) 4. Government health agencies (e.g., Centers for Disease Control and Prevention, World Health Organization)

When citing sources:

– Use the most recent information available, as understanding of bipolar disorder is continually evolving – Properly attribute all information to its original source – Consider including a mix of primary research articles and review papers for a comprehensive perspective

Bipolar disorder is a complex and challenging mental health condition that affects millions of individuals worldwide. Its impact extends far beyond mood swings, touching every aspect of a person’s life from relationships and career to physical health and self-identity. While the road to managing bipolar disorder can be difficult, advances in understanding and treatment offer hope for improved outcomes.

As our knowledge of bipolar disorder continues to grow, so does our ability to provide effective support and treatment. By combining medication, psychotherapy, lifestyle modifications, and a strong support system, many individuals with bipolar disorder lead fulfilling, productive lives. However, challenges remain, particularly in areas of early diagnosis

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Bipolar disorders

Affiliations.

1 Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada. Electronic address: [email protected].
2 Institute for Mental and Physical Health and Clinical Translation Strategic Research Centre, School of Medicine, Deakin University, Melbourne, VIC, Australia; Mental Health Drug and Alcohol Services, Barwon Health, Geelong, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
3 Department of Psychiatry, Adult Division, Kingston General Hospital, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
4 Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
5 Department of Psychiatry, Faculty of Medicine, University of Antioquia, Medellín, Colombia; Mood Disorders Program, Hospital Universitario San Vicente Fundación, Medellín, Colombia.
6 Copenhagen Affective Disorders Research Centre, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
7 Discipline of Psychiatry, Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Academic Psychiatry, Northern Sydney Local Health District, Sydney, Australia.
8 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
9 Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
10 Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
11 Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
12 Department of Psychiatry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark.
13 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, London, UK.
14 Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
PMID: 33278937
DOI: 10.1016/S0140-6736(20)31544-0

Bipolar disorders are a complex group of severe and chronic disorders that includes bipolar I disorder, defined by the presence of a syndromal, manic episode, and bipolar II disorder, defined by the presence of a syndromal, hypomanic episode and a major depressive episode. Bipolar disorders substantially reduce psychosocial functioning and are associated with a loss of approximately 10-20 potential years of life. The mortality gap between populations with bipolar disorders and the general population is principally a result of excess deaths from cardiovascular disease and suicide. Bipolar disorder has a high heritability (approximately 70%). Bipolar disorders share genetic risk alleles with other mental and medical disorders. Bipolar I has a closer genetic association with schizophrenia relative to bipolar II, which has a closer genetic association with major depressive disorder. Although the pathogenesis of bipolar disorders is unknown, implicated processes include disturbances in neuronal-glial plasticity, monoaminergic signalling, inflammatory homoeostasis, cellular metabolic pathways, and mitochondrial function. The high prevalence of childhood maltreatment in people with bipolar disorders and the association between childhood maltreatment and a more complex presentation of bipolar disorder (eg, one including suicidality) highlight the role of adverse environmental exposures on the presentation of bipolar disorders. Although mania defines bipolar I disorder, depressive episodes and symptoms dominate the longitudinal course of, and disproportionately account for morbidity and mortality in, bipolar disorders. Lithium is the gold standard mood-stabilising agent for the treatment of people with bipolar disorders, and has antimanic, antidepressant, and anti-suicide effects. Although antipsychotics are effective in treating mania, few antipsychotics have proven to be effective in bipolar depression. Divalproex and carbamazepine are effective in the treatment of acute mania and lamotrigine is effective at treating and preventing bipolar depression. Antidepressants are widely prescribed for bipolar disorders despite a paucity of compelling evidence for their short-term or long-term efficacy. Moreover, antidepressant prescription in bipolar disorder is associated, in many cases, with mood destabilisation, especially during maintenance treatment. Unfortunately, effective pharmacological treatments for bipolar disorders are not universally available, particularly in low-income and middle-income countries. Targeting medical and psychiatric comorbidity, integrating adjunctive psychosocial treatments, and involving caregivers have been shown to improve health outcomes for people with bipolar disorders. The aim of this Seminar, which is intended mainly for primary care physicians, is to provide an overview of diagnostic, pathogenetic, and treatment considerations in bipolar disorders. Towards the foregoing aim, we review and synthesise evidence on the epidemiology, mechanisms, screening, and treatment of bipolar disorders.

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128 Bipolar Disorder Essay Topic Ideas & Examples

🏆 best topics for a research paper on bipolar disorder, 💡 most interesting bipolar disorder research topics, 📌 simple & easy research questions about mood disorders, 👍 good research questions about bipolar disorder, ❓ research questions about bipolar disorder.

Bipolar Disorder in the Muslim and Discrimination of People With This Mental Illness However, the largest proportion of Muslims believes that there is a significant association of mental illnesses like bipolar disorder and evil spirits.
Bipolar Mental Disorder: A Bio-Psychosocial Approach First developed by George Engel, a cardiologist, biopsychosocial approach to bipolar mental disorder suggests that a number of factors are interlinked in respect to the cause, progress and promotion of the condition. Effectiveness In biopsychosocial, […]
Treatment, Symptoms, and Prevention of Bipolar Disorder The disorder is a leading cause of disability in the world. Studies have revealed that the incidence of bipolar disorder among men and women is the same.
Mental Status Examination in Case of Bipolar I Disorder The primary diagnosis differs from bipolar II disorder due to the evidence of a manic episode instead of hypomanic episodes. The diagnosis also differs from cyclothymia due to the highly irregular patient’s behavior and lack […]
Avoidant Personality Disorder and Bipolar Disorder Personal disorders can develop out of a sudden and become the cause of numerous unpleasant issues for a person and his/her family. Therefore, it is crucial to identify the disease and provide a main diagnosis […]
Untreated Bipolar Disorder’s Impact on Relationships The ratio of men and women undergoing disorder is almost the same. Bipolar disorder is a mental disability marked by the two extreme sides of mood swings; the highs and the lows.
Jimi Hendrix: Bipolar Disorder However, even though he was writing about his mood disorder which he described as maniac depression, it is clear that there are some differences between his description of the disorder and the DSM-IV-TR description of […]
Bipolar Disorder in Clinical Practice Therefore, for proper treatment, a professional therapist must follow the psychiatric diagnostic criteria for the disorder. Depression and mania, or a combination of the two, are hallmarks of bipolar disorder, a serious, long-term psychiatric condition.
Bipolar Disorder: A Major Psychological Issue in America The medication of bipolar disorder under the trimodal entity enshrines an apt intersection of the metaparadigm of nursing based on the age of the victims.
Bipolar 1 Disorder and Cyclothymia There are close relations between some disorders, like Bipolar 1 and Cyclothymia, and clinicians must be kept to make a proper diagnosis to ensure treatment of the correct disease.
Bipolar Disorder and Its Clinical Characteristics The disease began gradually with the development of a depressive state after a failed pregnancy. The period lasted for two months, after which the patient had an increase in strength, appetite, and unhealthy agitation.
Bipolar Disorder Info on the National Health Service Website The proposals are sent to the Department of Health of the NHS for review. The NHS advises a specialized examination for the diagnosis of bipolar disorder, in which the psychiatrist should present questions to determine […]
Bipolar Disorder: Diagnostic Evaluation It would be reasonable to claim that in Vee’s case, the diagnosis is bipolar disorder. Vee is likely to be affected by Bipolar I Disorder, given that the following criteria are met for the manic […]
Schizophrenia and Bipolar Disorder Portrayal in Mass Media Thus, the portrayal of the disorder in the media is the mix of symptoms that belong to bipolar I and II disorders in the textbook.
Bipolar Disorder and Depressive Episodes On a scale from 1 to 5, the importance of the question can be assessed by 4 due to a fairly clear description of the depression symptoms.
Bipolar Disorder and Its Diagnostics According to Grunze et al, in severe episodes of mania, it is advisable to prescribe oral forms of dopamine antagonists, among which haloperidol, olanzapine, risperidone, and quetiapine are especially effective.
Bipolar Disorder in Asian American Woman According to Soreff, it is common and important to adjust the dosage of medication in the treatment of the bipolar disorder.
Treating a Patient With Bipolar Disorder Symptoms of manic and depressive episodes may coexist in a dissociative fugue as the disease progresses. Bipolar disorder is usually identified in late teens or early adulthood as is in the case of Cheryl R.
Bipolar Disorder and Current Treatment Options With BAD, there is no formation of a defect, as well as any other pronounced personality changes, even in the case of a long course of the disease and frequent occurrence and phase change. These […]
Pharmacogenetic Testing of Bipolar Disorder As such, the healthcare provider will apply the findings of the genetic test to alter the treatment plan. Therefore, it will be possible to learn and clarify the particular characteristics of the group under study […]
Discussing of Bipolar Disorder Sometimes the causes are also physical, such as a difference in the composition of the brain. The death of a loved one or an instance of abuse can serve as a trigger for the condition.
Implications of Diagnosing and Treating Patients With Bipolar Disorder The purpose of this essay is to examine a variety of legal, ethical, and cultural implications in treating patients with bipolar disorder.
Bipolar Disorder: Biopsychopharmacosocial Approach Steven is divorced, and his condition was among the causes of the split with his wife. During the first years after the initial diagnosis of bipolar disorder, Steven has been prescribed an antidepressant to manage […]
Bipolar Disorder Therapy in a 26-Year-Old Female Patient It becomes evident that she was compliant with the prescription, and now she appears to be less sedated and lethargic, which is the result of lowering the levels of Risperdal in her blood.
Lithium Versus Lamotrigine in Long Term Treatment for Bipolar Affective Disorder 5 But lithium was described to be efficacious in the reduction of manic relapses, and is not efficacious in the reduction of relapses that lead to depression.
Types of Accommodations and Bipolar Disorder Concerning interaction with coworkers as an accommodation measure, the employers should inform all workers of their right to accommodations, and offer sensitivity education to employees and supervisors.
Bipolar Disorder Racial Statistics in the UK It is also important to mention the leading causes of the development of bipolar disorder according to official data of the National Health Service.
Bipolar Disorder and Its Impact on Humans One minute a bipolar patient could be smiling and laughing with you and in the next they get very offended and suddenly they are not in the mood to talk anymore.
Psychological Disorder Analysis: A Case of Bipolar Disorder Do you have interest in a hobby and look forward to enjoyable activities? Are you able to have fun or joy?
Suicide and Bipolar Disorder: Medical Treatment Still, the possibility to reduce the risks of suicides among people is the achieved outcome that makes physicians and psychiatrists choose this medication. This drug helps to reduce the frequency and severity of mood changes […]
Bipolar Disorder: Reoccurring Hypomania & Depression Admission Date: 9/10/2018 Name J.D. DOB: 4/5/1990 Sex: Female Allergies: None Language: English VS: BP 130/98, HR 74, Respirations 19, Pulse Ox 98% Chief Complaint: The patient is concerned with reoccurring hypomania episodes and […]
Bipolar Disorder and St. Augustine Florida This disorder is very serious and in the most severe cases may lead to the death of the patients. This paper explores the complex issue of bipolar disorder and the organizations specialized in providing professional […]
Schizophrenia and Bipolar Disorder in Children and Adolescents It is acknowledged by the researchers that the symptoms indicate the possibility of bipolar disease and not schizophrenia. Psychiatric and physiological factors, among others, contribute to the prevalence of self-harm in children and young people.
Bipolar Disorder Patient Examination and Therapy The patient admits that he becomes angry and aggressive, which he regrets afterward. He suggests that he has depression and claims to feel worthlessness and critically increased fatigue, which occurred 2 months ago.
Bipolar Disorder Treatment Features This is substantiated by Aldinger and Schulze because the authors state that the environment and genetics of an individual with bipolar determine the development of this condition.
Bipolar Disorder: Drug Treatment Modalities The course of BD consists of the periods of the excited and passive states that are called mania and depression respectively.
Bipolar Disorder Main Causes This means that it is the presence of the bipolar disorder that alters the functioning of the brain circuits as opposed to the brain circuits leading to the presence of the disease.
Cognitive-Behavioral Therapy for Bipolar Disorder Cognitive-behavioral therapy for bipolar disorder has unique features that distinguish the treatment of depression from that of bipolar disorder by the same therapy.
The Bipolar Disorder and Its Management The functions of the brain rely upon the intermittent moods of depression and mania that characterize the disorder. Bipolar disorder is a neurological and psychological disorder that affects the normal functioning of the brain.
Mental Health: Bipolar Disorder Problem The first limitation that made the study difficult was lack of accurate records for patients who had been diagnosed with bipolar disorder.
Bipolar Disorder: Symptoms, Effects, Diagnosis and Treatment It is important to note that bipolar is a condition that keeps on recurring and hence the patient has to be on medication for the rest of his/her life.
The Psychosocial Context of Bipolar Disorder In their study, Lauren Alloy and the group of the researchers focus on the psychosocial context for the development of bipolar disorder as one of the most influential factors.
Bipolar Disorder and Schizophrenia Genetically, an alteration in the serotonin, dopamine and glutamate genes may be the cause of the disease. Therefore, the close interactions of genetic, psychological and environmental factors lead to severe cases of bipolar disorder.
The Psychopathology of Bipolar Disorder In addition to the depressive and manic episodes, patients may experience mixed episodes of the bipolar disorder, which severely distort neuropsychological coordination thus impairing cognitive functions. The two period episodes of bipolar disorder, mania and […]
Treatment of Bipolar Disorder Also referred to as Manic Depression or Bipolar Affective Disorder, Bipolar disorder is categorized as one of the serious mood disorders.
Bipolar Disorder and Its Main Phases The mixed episode phase entails a mixture of depression, mania, and hypomania feelings. Hypomania is the transition point between mania and depression while mixed episode phase entails conditions of all other phases.
Managing Bipolar Disorder Bipolar spectrum, that is, the range of this disorder lies within three broad categories: bipolar II, cyclothymia, and bipolar I.this spectrum depends mainly on nature and asperity of the mood episodes that one goes through.
Bipolar Disorder: Causes, Symptoms and Facts The third myth related to bipolar disorder is that the only thing that is affected by the disorder is the mood.
Bipolar Disorder Symptoms and Treatments This helps one understand more about the symptoms associated with the disorder and alongside various medical treatments, therapy and support from loved ones, this disorder is very manageable. Bipolar II is the more common type […]
Bipolar II Disorder: Causes, Symptoms, Treatment This paper will discuss the difficulties of identifying the symptoms of bipolar II disorder which is recognized as the most frequent one, the stages of assessment required for the adequate diagnosis of condition and the […]
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Macbeth Suffered From Schizophrenia and Bipolar Disorder
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Open access
Published: 06 November 2018

The challenges of living with bipolar disorder: a qualitative study of the implications for health care and research

Eva F. Maassen ORCID: orcid.org/0000-0003-0211-0994 1 , 2 ,
Barbara J. Regeer 1 ,
Eline J. Regeer 2 ,
Joske F. G. Bunders 1 &
Ralph W. Kupka 2 , 3

International Journal of Bipolar Disorders volume 6 , Article number: 23 ( 2018 ) Cite this article

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In mental health care, clinical practice is often based on the best available research evidence. However, research findings are difficult to apply to clinical practice, resulting in an implementation gap. To bridge the gap between research and clinical practice, patients’ perspectives should be used in health care and research. This study aimed to understand the challenges people with bipolar disorder (BD) experience and examine what these challenges imply for health care and research needs.

Two qualitative studies were used, one to formulate research needs and another to formulate healthcare needs. In both studies focus group discussions were conducted with patients to explore their challenges in living with BD and associated needs, focusing on the themes diagnosis, treatment and recovery.

Patients’ needs are clustered in ‘disorder-specific’ and ‘generic’ needs. Specific needs concern preventing late or incorrect diagnosis, support in search for individualized treatment and supporting clinical, functional, social and personal recovery. Generic needs concern health professionals, communication and the healthcare system.

Patients with BD address disorder-specific and generic healthcare and research needs. This indicates that disorder-specific treatment guidelines address only in part the needs of patients in everyday clinical practice.

Bipolar disorder (BD) is a major mood disorder characterized by recurrent episodes of depression and (hypo)mania (Goodwin and Jamison 2007 ). According to the Diagnostic and Statistical Manual 5 (DSM-5), the two main subtypes are BD-I (manic episodes, often combined with depression) and BD-II (hypomanic episodes, combined with depression) (APA 2014 ). The estimated lifetime prevalence of BD is 1.3% in the Dutch adult population (de Graaf et al. 2012 ), and BD is associated with high direct (health expenditure) and indirect (e.g. unemployment) costs (Fajutrao et al. 2009 ; Michalak et al. 2012 ), making it an important public health issue. In addition to the economic impact on society, BD has a tremendous impact on patients and their caregivers (Granek et al. 2016 ; Rusner et al. 2009 ). Even between mood episodes, BD is often associated with functional impairment (Van Der Voort et al. 2015 ; Strejilevich et al. 2013 ), such as occupational or psychosocial impairment (Huxley and Baldessarini 2007 ; MacQueen et al. 2001 ; Yasuyama et al. 2017 ). Apart from symptomatic recovery, treatment can help to overcome these impairments and so improve the person’s quality of life (IsHak et al. 2012 ).

Evidence Based Medicine (EBM), introduced in the early 1990s, is a prominent paradigm in modern (mental) health care. It strives to deliver health care based on the best available research evidence, integrated with individual clinical expertise (Sackett et al. 1996 ). EBM was introduced as a new paradigm to ‘de - emphasize intuition’ and ‘ unsystematic clinical experience’ (Guyatt et al. 1992 ) (p. 2420). Despite its popularity in principle (Barratt 2008 ), EBM has also been criticized. One such criticism is the ignorance of patients’ preferences and healthcare needs (Bensing 2000 ). A second criticism relates to the difficulty of adopting evidence-based treatment options in clinical practice (Bensing 2000 ), due to the fact that research outcomes measured in ‘the gold standard’ randomized-controlled trials (RCTs) seldom correspond to the outcomes clinical practice seeks and are not responsive to patients’ needs (Newnham and Page 2010 ). Moreover, EBM provides an overview on population level instead of individual level (Darlenski et al. 2010 ). Thus, adopting research evidence in clinical practice entails difficulties, resulting in an implementation gap.

To bridge the gap between research and clinical practice, it is argued that patients’ perspectives should be used in both health care and research. Patients have experiential knowledge about their illness, living with it in their personal context and their care needs (Tait 2005 ). This is valuable for both clinical practice and research as their knowledge complements that of health professionals and researchers (Tait 2005 ; Broerse et al. 2010 ; Caron-Flinterman et al. 2005 ). This source of knowledge can be used in the process of translating evidence into clinical practice (Schrevel 2015 ). Moreover, patient participation can enhance the clinical relevance of and support for research and the outcomes in practice (Abma and Broerse 2010 ). Hence, it is argued that these perspectives should be explicated and integrated into clinical guidelines, clinical practice, and research (Misak 2010 ; Rycroft-Malone et al. 2004 ).

Given the advantages of including patients’ perspectives, patients are increasingly involved in healthcare services (Bagchus et al. 2014 ; Larsson et al. 2007 ), healthcare quality (e.g. guideline development) (Pittens et al. 2013 ) and health-related research (e.g. agenda setting, research design) (Broerse et al. 2010 ; Boote et al. 2010 ; Elberse et al. 2012 ; Teunissen et al. 2011 ). However, patients’ perspectives on health care and on research are often studied separately. We argue that to be able to provide care focused on the patients and their needs, care and research must closely interact.

We hypothesize that the challenges BD patients experience and the associated care and research needs are interwoven, and that combining them would provide a more comprehensive understanding. We hypothesize that this more comprehensive understanding would help to close the gap between clinical practice and research. For this reason, this study aims to understand the challenges people with BD experience and examine what these challenges imply for healthcare and research needs.

To understand the challenges and needs of people with BD, we undertook two qualitative studies. The first aimed to formulate a research agenda for BD from a patient’s perspective, by gaining insights into their challenges and research needs. A second study yielded an understanding of the care needs from a patient’s perspective. In this article, the results of these two studies are combined in order to investigate the relationship between research needs and care needs. Challenges are defined as ‘difficulties patients face, due to having BD’. Care needs are defined as that what patients ‘desire to receive from healthcare services to improve overall health’ (Asadi-Lari et al. 2004 ) (p. 2). Research needs are defined as that what patients ‘desire to receive from research to improve overall health’.

Study on research needs

In this study, mixed-methods were used to formulate research needs from a patient’s perspective. First six focus group discussions (FGDs) with 35 patients were conducted to formulate challenges in living with BD and hopes for the future, and to formulate research needs arising from these difficulties and aspirations. These research needs were validated in a larger sample (n = 219) by means of a questionnaire. We have reported this study in detail elsewhere (Maassen et al. 2018 ).

Study on care needs

This study was part of a nationwide Dutch project to generate a practical guideline for BD: a translation of the existing clinical guideline to clinical practice, resulting in a standard of care that patients with BD could expect. The practical guideline (Netwerk Kwaliteitsontwikkeling GGZ 2017 ) was written by a taskforce comprising health professionals, patients. In addition to the involvement of three BD patients in the taskforce, a systematic qualitative study was conducted to gain insight into the needs of a broader group of patients.

Participants and data collection

To formulate the care needs of people with BD, seven FGDs were conducted, with a total of 56 participants, including patients (n = 49) and caregivers (n = 9); some participants were both patient and caregiver. The inclusion criteria for patients were having been diagnosed with BD, aged 18 years or older and euthymic at time of the FGDs. Inclusion criteria for caregivers were caring for someone with BD and aged 18 years or older. To recruit participants, a maximum variation sampling strategy was used to collect a broad range of care needs (Kuper et al. 2008 ). First, all outpatient clinics specialized in BD affiliated with the Dutch Foundation for Bipolar Disorder (Dutch: Kenniscentrum Bipolaire Stoornissen) were contacted by means of an announcement at regular meetings and by email if they were interested to participate. From these outpatient clinics, patients were recruited by means of flyers and posters. Second, patients were recruited at a quarterly meeting of the Dutch patient and caregiver association for bipolar disorder. The FGDs were conducted between March and May 2016.

The FGDs were designed to address challenges experienced in BD health care and areas of improvement for health care for people with BD. The FGDs were structured by means of a guide and each session was facilitated by two moderators. The leading moderator was either BJR or EFM, having both extensive experience with FGD’s from previous studies. The first FGD explored a broad range of needs. The subsequent six FGDs aimed to gain a deeper understanding of these care needs, and were structured according to the outline of the practical guideline (Netwerk Kwaliteitsontwikkeling GGZ 2017 ). Three chapters were of particular interest: diagnosis, treatment and recovery. These themes were discussed in the FGDs, two in each session, all themes three times in total. Moreover, questions on specific aspects of care formulated by the members of the workgroup were posed. The sessions took 90–120 min. The FGDs were audiotaped and transcribed verbatim. A summary of the FGDs was sent to the participants for a member check.

Data analysis

To analyze the data on challenges and needs, a framework for thematic analysis to identify, analyze and report patterns (themes) in qualitative data sets by Braun and Clarke ( 2006 ) was used. First, we familiarized ourselves with the data by carefully reading the transcripts. Second, open coding was used to derive initial codes from the data. These codes were provided to quotes that reflected a certain challenge or care need. Third, we searched for patterns within the codes reflecting challenges and within those reflecting needs. For both challenges and needs, similar or overlapping codes were clustered into themes. Subsequently, all needs were categorized as ‘specific’ or ‘generic’. The former are specific to BD and the latter are relevant for a broad range of psychiatric illnesses. Finally, a causal analysis provided a clear understanding of how challenges related to each other and how they related to the described needs.

To analyze the data on needs regarding recovery, four domains were distinguished, namely clinical, functional, social and personal recovery (Lloyd et al. 2008 ; van der Stel 2015 ). Clinical recovery refers to symptomatic remission; functional recovery concerns recovery of functioning that is impaired due to the disorder, particularly in the domain of executive functions; social recovery concerns the improvement of the patient’s position in society; personal recovery concerns the ability of the patient to give meaning to what had happened and to get a grip on their own life. The analyses were discussed between BR and EM. The qualitative software program MAX QDA 11.1.2 was used (MaxQDA).

Ethical considerations

According to the Medical Ethical Committee of VU University Medical Center, the Medical Research Involving Human Subjects Act does not apply to the current study. All participants gave written or verbal informed consent regarding the aim of the study and for audiotaping and its use for analysis and scientific publications. Participation was voluntary and participants could withdraw from the study at any time. Anonymity was ensured.

This section is in three parts. The first presents the participants’ characteristics. The second presents the challenges BD patients face, derived from both studies, and the disorder-specific care and research needs associated with these challenges. The third part describes the generic care needs that patients formulated.

Characteristics of the participants

In the study on care needs, 56 patients and caregivers participated. The mean age of the participants was 52 years (24–75), of whom 67.8% were women. The groups varied from four to sixteen participants, and all groups included men and women. Of all participants 87.5% was diagnosed with BD, of whom 48.9% was diagnosed with BD I. 3.5% was both caregivers and diagnosed with BD. Of 4 patients the age was missing, and from 6 patients the bipolar subtype.

Despite the fact that participants acknowledge the inevitable diagnostic difficulties of a complex disorder like BD, in both studies they describe a range of challenges in different phases of the diagnostic process (Fig. 1 ). Patients explained that the general practitioner (GP) and society in general did not recognize early-warning signs and mood swings were not well interpreted, resulting in late or incorrect diagnosis. Patients formulated a need for more research on what early-warning signs could be and on how to improve GPs’ knowledge about BD. Formulated care needs were associated with GPs using this knowledge to recognize early-warning signs in individual patients. One participant explained that certain symptoms must be noticed and placed in the right context:

Challenges with diagnosis (squares) including relating research needs (white circles) and care needs (grey circles). (1): mentioned in study on research needs; (2): mentioned in study on care needs. Dotted lines: division of challenges into sub challenges. Arrows: causal relation between challenges

I call it, ‘testing overflow of ideas’. [….] When it happens for the first time you yourself do not recognize it. Someone else close to you or the health professional, who is often not involved yet, must signal it. (FG6)

Moreover, these challenges are associated with the need to pay attention to family history and to use a multidisciplinary approach to diagnosis to benefit from multiple perspectives. The untimely recognition of early symptoms also results in another challenge: inadequate referral to the right specialized health professional. After referral, people often face a waiting list, again causing delay in the diagnostic process. These challenges result in the need for research on optimal referral systems and the care need for timely referral. One participant described her process after the GP decided to refer her:

But, yes, at that moment the communication wasn’t good at all. Because the general practitioner said: ‘she urgently has to be seen by someone’. Subsequently, three weeks went by, until I finally arrived at depression [department]. And at that department they said: ‘well, you are in the wrong place, you need to go to bipolar [department ]’. (FG1)

The challenge of being misdiagnosed is associated with the need to be able to ask for a second opinion and to have a timely and thorough diagnosis. On the one hand, it is important for patients that health professionals quickly understand what is going on, on the other hand that health professionals take the time to thoroughly investigate the symptoms by making several appointments.

From both studies, two main challenges related to the treatment of BD were derived (Fig. 2 ). The first is finding appropriate and satisfactory treatment. Participants explained that it is difficult to find the right medication and dosage that is effective and has acceptable side-effects. One participant illustrates:

Challenges with treatment (squares) including relating research needs (white circles) and care needs (grey circles). (1): mentioned in study on research needs; (2): mentioned in study on care needs. Dotted lines: division of challenges into sub challenges. Arrows: causal relation between challenges

I think, at one point, we have to choose, either overweight or depressed. (FG1)

Some participants said that they struggle with having to use medication indefinitely, including the associated medical checks. The difficult search for the right pharmacological treatment results in the need for research on long-term side-effects, on the mechanism of action of medicine and on the development of better targeted medication with fewer adverse side-effects. In care, patients would appreciate all the known information on the side-effects and intended effects. One participant explained the importance of being properly informed about medication:

I don’t read anything [about medication], because then I wouldn’t dare taking it. But I do think, when you explain it well, the advantages, the disadvantages, the treatment, the idea behind it, that would help a lot in compliance. (FG1)

A second aspect is the challenge of finding non-pharmacological therapies that fit patients’ needs. They said they and the health professionals often do not know which non-pharmacological therapies are available and effective:

But we found the carefarm ourselves Footnote 1 [….]. You have to search for yourself completely. Yes, I actually hoped that that would be presented to you, like: ‘this would be something for you’. (FG3)

Participants mentioned a variety of non-pharmacological therapies they found useful, namely cognitive behavior therapy (CBT), EMDR, running therapy, social-rhythm training, light therapy, mindfulness, psychotherapy, psychoeducation, and training in living with mood swings. They formulated the care need to receive an overview of all available treatment options in order to find a treatment best suited to their needs. They would appreciate research on the effectiveness of non-pharmacological treatments.

A third aspect within this challenge is finding the right balance between non-pharmacological and pharmacological treatment. Participants differed in their opinion about the need for medication. Whereas some participants stated that they need medication to function, others pointed out that they found non-pharmacological treatments effective, resulting in less or no medication use. They explained that the preferred balance can also change over time, depending on their mood. However, they experience a dominant focus on pharmacological treatment by the health professionals. To address this challenge, patients need support in searching for an appropriate balance.

Next to the challenge of finding appropriate and satisfactory treatment, a second treatment-related challenge is hospitalization. Participants often had a traumatic experience, due to seclusion, the authoritarian attitudes of clinical staff, and not involving their family. Patients therefore found it important to try preventing being hospitalized, for example by means of home treatment, which some participants experienced positively. Despite the challenges relating to hospitalization, participants did acknowledge that in some cases it cannot be avoided, in which case they urged for close family involvement, open communication and being treated by their own psychiatrist. Still, in the study on research needs, hospitalization did not emerge as an important research theme.

In both studies, participants described challenges in all four domains of recovery: clinical, functional, social and personal (Fig. 3 ). In relation to clinical recovery, participants struggled with the symptoms of mood episodes, the psychosis and the fear of a future episode. In contrast, some participants mentioned that they sometimes miss the hypomanic state they had experienced previously due to effective medical treatment. In the domain of functional recovery, participants contended with having to function below their educational level due to residual symptoms, such as cognitive problems, due to the importance of preventing stress in order to reduce the risk of a new episode, and because of low energy levels. This leads to the care need that health professionals should pay attention to the level of functioning of their patients.

Challenges with recovery (squares) including relating research needs (white circles) and care needs (grey circles). (1): mentioned in study on research needs; (2): mentioned in study on care needs. Dotted lines: division of challenges into sub challenges. Arrows: causal relation between challenges

In the domain of social recovery, participants described challenges with maintaining friendships, due to stigma, being unpredictable and with deciding when to disclose the disorder. The latter resulted in the care need for tips on disclosure. Moreover, patients experienced challenges with reintegration to work, due to colleagues’ lack of understanding, problems with functioning during an episode, the complicating policy of the (Dutch) Employee Insurance Agency Footnote 2 in relation to the fluctuating course of BD and the negative impact of stress. These challenges are associated with the care need that health professionals should pay attention to work and the need for research on how to improve the Social Security Agency’s policy.

For their personal recovery, participants struggled with acceptance of the disorder, due to shame, stigma, having to live by structured rules and disciplines, and the chronic nature of BD. This results in care needs for grief counselling and attention to acceptance and the need for research on the impact of being diagnosed with BD. Limited understanding within society also causes problems with acceptance, corresponding with the care need for education for caregivers and for research on how to increase social acceptance. Another challenge in personal recovery was discovering what recovery means and what constitute meaningful daily activities. Patients appreciated the support of health professionals in this area. One participant described the difficult search for the meaning of recovery:

I have been looking to recover towards the situation [before diagnosis] for a long time; that I could do what I always did and what I liked. But then I was confronted with the fact that I shouldn’t expect that to happen, or only with a lot of effort. (…) Then you start thinking, now what? A compromise. I don’t want to call that recovery, but it is a recovered, partly accepted, situation. But it is not recovery as I expected it to be. (FG5)

In general, participants considered frequent contact with a nurse or psychiatrist supportive, to help them monitor their mood and help them find (efficient) self-management strategies. Most participants appreciated the involvement of caregivers in the treatment and contact with peers.

Generic care needs

We have described BD-specific needs, but patients mentioned also mentioned several generic care needs. The latter are clustered into three categories. The first concerns the health professionals . Participants stressed the importance of a good health professional, who carefully listens, takes time, and makes them feel understood, resulting in a sense of connection. Furthermore, a good health professional treats beyond the guideline, and focuses on the needs of the individual patient. When there is no sense of connection, it should be possible to change to another health professional. The second category concerns communication between the patient and the health professional . Health professionals should communicate in an open, honest and clear way both in the early diagnostic phase and during treatment. Open communication facilitates individualized care, in which the patient is involved in decision making. In addition, participants wanted to be treated as a person, not as a patient, and according to a strength-based approach. The third category concerns needs at the level of the healthcare system . Participants struggled with the availability of the health professionals and preferred access to good care 24/7 and being able to contact their health professional quickly when necessary. Currently, according to the participants, the care system is not geared to the mood swings of BD, because patients often faced waiting lists before they could see a health professional.

Is adequate treatment also having a number from a mental health institution you can always call when you are in need, that you can go there? And not that you can go in three weeks, but on a really short notice. So at least a phone call. (FG3)

Participants were often frustrated by the limited collaboration between health professionals, within their own team, between departments of the organization, and between different organizations, including complementary health professionals. They would appreciate being able to merge their conventional and complementary treatment, with greater collaboration among the different health professionals. Furthermore, they would like continuity of health professionals as this improves both the diagnostic phase and treatment, and because that health professional gets to know the patient.

We hypothesized that research and care needs of patients are closely intertwined and that understanding these, by explicating patients’ perspectives, could contribute to closing the gap between research and care. Therefore, this study aimed to understand the challenges patients with BD face and examine what these imply for both healthcare and research. In the study on needs for research and in the study on care needs, patients formulated challenges relating to receiving the correct diagnosis, finding the right treatment, including the proper balance between non-pharmacological and pharmacological treatment, and to their individual search for clinical, functional, social and personal recovery. The formulated needs in both studies clearly reflected these challenges, leading to closely corresponding needs. Another important finding of our study is that patients not only formulate disorder-specific needs, but also many generic needs.

The needs found in our study are in line with the current literature on the needs of patients with BD, namely for more non-pharmacological treatment (Malmström et al. 2016 ; Nestsiarovich et al. 2017 ), timely recognition of early-warning signs and self-management strategies to prevent a new episode (Goossens et al. 2014 ), better information on treatment and treatment alternatives (Malmström et al. 2016 ; Neogi et al. 2016 ) and coping with grief (Goossens et al. 2014 ). Moreover, the need for frequent contact with health professionals, being listened to, receiving enough time, shared decision-making on pharmacological treatment, involving caregivers (Malmström et al. 2016 ; Fisher et al. 2017 ; Skelly et al. 2013 ), and the urge for better access to health care and continuity of health professionals (Nestsiarovich et al. 2017 ; Skelly et al. 2013 ) are confirmed by the literature. Our study added to this set of literature by providing insights in patients’ needs in the diagnostic process and illustrating the interrelation between research needs and care needs from a patient’s perspective.

The generic healthcare needs patients addressed in this study are clustered into three categories: the health professional , communication between the patient and the health professional and the health system. These categories all fit in a model of patient-centered care (PCC) by Maassen et al. ( 2016 ) In their review, patients’ perspectives on good care are compared with academic perspectives of PCC and a model of PCC is created comprising four dimensions: patient, health professional, patient – professional interaction and healthcare organization. All the generic needs formulated in this study fit into these four dimensions. The need to be treated as a person with strengths fits the dimension ‘patient’, and the need for a good health professional who carefully listens, takes time and makes them feel understood, resulting in a good connection with the professional, fits the dimension ‘health professional’ of this model. Furthermore, patients in this study stressed the importance of open communication in order to provide individualized care, which fits the dimension of ‘patient–professional interaction’. The urge for better access to health care, geared to patients’ mood swings and the need for better collaboration between health professionals and continuity of health professionals fits the dimension of ‘health care organization’ of the model. This study confirms the findings from the review and contributes to the literature stressing the importance of a patient-centered care approach (Mills et al. 2014 ; Scholl et al. 2014 ).

In the prevailing healthcare paradigm, EBM, the best available evidence should guide treatment of patients (Sackett et al. 1996 ; Darlenski et al. 2010 ). This evidence is translated into clinical and practical guidelines, which thus facilitate EBM and could be used as a decision-making tool in clinical practice (Skelly et al. 2013 ). For many psychiatric disorders, treatment is based on such disorder - specific clinical and practical guidelines. However, this disease-focused healthcare system has contributed to its fragmented nature Stange ( 2009 ) argues that this fragmented care system has expanded without the corresponding ability to integrate and personalize accordingly. We argue that acknowledging that disorder - specific clinical and practical guidelines address only parts of the care needs is of major importance, since otherwise important aspects of the patients’ needs will be ignored. Because there is an increasing acknowledgement that health care should be responsive to the needs of patients and should change from being disease-focused towards being patient-focused (Mead and Bower 2000 ; Sidani and Fox 2014 ), currently in the Netherlands generic practical guidelines are written on specific care themes (e.g. co-morbidity, side-effects, daily activity and participation). These generic practical guidelines address some of the generic needs formulated by the patients in our study. We argue that in addition to disorder-specific guidelines, these generic practical guidelines should increasingly be integrated into clinical practice, while health professionals should continuously be sensitive to other emerging needs. We believe that an integration of a disorder-centered and a patient-centered focus is essential to address all needs a patient.

Strengths, limitations and future research

This study has several strengths. First, it contributes to the literature on the challenges and needs of patients with BD. Second, the study is conducted from a patient’s perspective. Moreover, addressing this aim by conducting two separate studies enabled us to triangulate the data.

This study also has several limitations. First, this study reflects the challenges, care needs and research needs of Dutch patient with BD and caregivers. Despite the fact that a maximum variation sampling strategy was used to derive a broad range of challenges and needs throughout the Netherlands, the Dutch setting of the study may limit the transferability to other countries. To understand the overlap and differences between countries, similar research should be conducted in other contexts. Second, given the design of the study, we could not differentiate between patients and caregivers since they participated together in the FGDs. More patients than caregivers participated in the study. For a more in-depth understanding of the challenges and needs faced by caregivers, in future research separate FGDs should be conducted. Third, due to the fixed outline of the practical guideline used to conduct the FGDs, only the healthcare needs for diagnosis, treatment and recovery of BD are studied. Despite the fact that these themes might cover a broad range of health care, it could have resulted in overlooking certain needs in related areas of well-being. Therefore, future research should focus on needs outside of these themes in order to provide a complete set of healthcare needs.

Patients and their caregivers face many challenges in living with BD. Our study contributes to the literature on care and research needs from a patient perspective. Needs specific for BD are preventing late or incorrect diagnosis, support in search for individualized treatment, and supporting clinical, functional, social and personal recovery. Generic healthcare needs concern health professionals, communication and the healthcare system. This explication of both disorder-specific and generic needs indicates that clinical practice guidelines should address and integrate both in order to be responsive to the needs of patients and their caregivers.

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EFM designed the study, contributed to the data collection, managed the analysis and wrote the first draft of the manuscript. BJR designed the study and contributed to the data collection, data analysis, and writing of the manuscript. JFGB contributed to the study design and critical revision of the manuscript. EJR contributed to the study conception and critical revision of the manuscript. RWK contributed to the study design, acquisition of data, and critical revision of the manuscript. All authors contributed to the final manuscript. All authors read and approved the final manuscript.

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Maassen, E.F., Regeer, B.J., Regeer, E.J. et al. The challenges of living with bipolar disorder: a qualitative study of the implications for health care and research. Int J Bipolar Disord 6 , 23 (2018). https://doi.org/10.1186/s40345-018-0131-y

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How To Write An Essay On Bipolar Disorder

Introduction to understanding bipolar disorder.

When writing an essay on bipolar disorder, it's crucial to begin with a clear definition and understanding of the condition. Bipolar disorder is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Your introduction should provide insight into the complexity and seriousness of this disorder, its impact on individuals' lives, and why it's an important topic for discussion. Offer a brief overview of the various aspects of bipolar disorder you intend to explore, whether it's the clinical aspects, treatment options, societal perceptions, or personal accounts.

Examining the Clinical Aspects of Bipolar Disorder

The main body of your essay should delve into the clinical aspects of bipolar disorder. Discuss the symptoms associated with both the manic and depressive phases, and how these can affect a person's behavior, thoughts, and ability to function. Explore the different types of bipolar disorder, such as Bipolar I, Bipolar II, and Cyclothymic Disorder, each having unique patterns of mood swings. It's important to use medically accurate and sensitive language to describe these symptoms and types, relying on reputable sources like psychiatric journals or medical texts. This section should paint a clear clinical picture of bipolar disorder, contributing to a deeper understanding of the condition.

Addressing Treatment and Management

Another critical aspect of your essay should focus on the treatment and management of bipolar disorder. Discuss the various treatment options available, such as medication, psychotherapy, and lifestyle changes, and how these can help manage the symptoms and improve quality of life. Explore the challenges of treating bipolar disorder, including the need for personalized treatment plans, potential side effects of medication, and the importance of long-term management. This part of your essay should also touch upon the support systems, like family, friends, and support groups, which play a crucial role in the lives of those with bipolar disorder.

Concluding with Implications and Personal Reflections

Conclude your essay by summarizing the key points of your analysis and offering a perspective on the broader implications of understanding bipolar disorder. Reflect on the importance of awareness and destigmatization of mental health issues, and how society can better support individuals with bipolar disorder. Consider how advancements in medical research and changes in public perception can impact the treatment and management of the disorder. Your conclusion should not only provide closure to your essay but also encourage further thought and empathy regarding the challenges faced by individuals with bipolar disorder, highlighting the need for ongoing research, support, and understanding.

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Continuing Education Activity

Bipolar disorder, also known as bipolar affective disorder, is one of the top 10 leading causes of disability worldwide. Bipolar disorder is characterized by chronically occurring episodes of mania or hypomania alternating with depression and is often misdiagnosed initially. Treatment involves pharmacotherapy and psychosocial interventions, but mood relapse and incomplete response occur, particularly with depression. Continual reevaluation and treatment modification are commonly required during the long-term care of patients with bipolar disorder. Management of comorbid psychiatric and chronic medical conditions may also be necessary. This activity reviews the etiology, classification, evaluation, management, and prognosis of bipolar affective disorder, and it also highlights the role of the interprofessional team in managing and improving care for patients with this condition.

Recognize patterns of symptoms suggestive of bipolar disorder, its various subtypes, and related disorders.
Implement evidence-based management of bipolar disorder based on current published guidelines.
Select individualized pharmacotherapy plans and adjunct therapies for bipolar disorder and comorbidities.
Describe the necessity of an interprofessional holistic team approach that integrates psychiatric and medical healthcare in caring for patients with bipolar disorder to help achieve the best possible outcomes.
Introduction

Bipolar disorder (BD) is characterized by chronically occurring episodes of mania or hypomania alternating with depression and is often misdiagnosed initially.

Bipolar and related disorders include bipolar I disorder (BD-I), bipolar II disorder (BD-II), cyclothymic disorder, other specified bipolar and related disorders, and bipolar or related disorders, unspecified. The diagnostic label of "bipolar affective disorders" in the International Classification of Diseases 10th Revision (ICD-10) was changed to "bipolar disorders" in the ICD-11. The section on bipolar disorders in the ICD-11 is labeled "bipolar and related disorders," which is consistent with the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). [1]

A World Health Organization study showed "remarkably similar" international prevalence rates, severity, impact, and comorbidities of bipolar spectrum disorder, defined as BD-I, BD-II, and subthreshold bipolar. The aggregate lifetime prevalence of the bipolar spectrum was 2.4%. [2]

BD is often difficult to recognize because symptoms overlap with other psychiatric disorders, psychiatric and somatic comorbidity is common, and patients may lack insight into their conditions, particularly hypomania. Treatment involves pharmacotherapy and psychosocial interventions, but mood relapse and incomplete response occur, particularly with depression. Continual reevaluation and treatment modification are commonly required during the long-term care of these patients. Management of comorbid psychiatric and chronic medical conditions may also be necessary. This activity provides an overview of the etiology, classification, evaluation, and management of bipolar affective disorder.

Currently, the etiology of BD is unknown but appears to be due to an interaction of genetic, epigenetic, neurochemical, and environmental factors. Heritability is well established. [3] [4] [5] Numerous genetic loci have been implicated as increasing the risk of BD; the first was noted in 1987 with "DNA markers" on the short arm of chromosome 11. Since then, an association has been made between at least 30 genes and an increased risk of the condition. [6]

Although it is difficult to establish causation between life events and the development of BD, childhood maltreatment, particularly emotional abuse or neglect, has been linked to the later development of the condition. Other stressful life events associated with developing BD include childbirth, divorce, unemployment, disability, and early parental loss. [7] In adulthood, more than 60% of patients with BD report at least one "stressful life event" before a manic or depressive episode in the preceding 6 months. [6]

The etiology of BD is thought to involve imbalances in systems associated with monoaminergic neurotransmitters, particularly dopamine and serotonin, and intracellular signaling systems that regulate mood. However, no singular dysfunction of these neurotransmitter systems has been identified. [8]

In a recent neuroimaging review article, the ENIGMA Bipolar Disorder Working Group stated, "Overall, these studies point to a diffuse pattern of brain alterations including smaller subcortical volumes, lower cortical thickness and altered white matter integrity in groups of individuals with bipolar disorder compared to healthy controls." [9] Neuroimaging studies have also shown evidence of changes in functional connectivity. [10] [11]

Epidemiology

In the World Mental Health Survey Initiative, the use of mental health services for the bipolar spectrum (BD-I, BD-II, and subthreshold BD) concluded, “Despite cross-site variation in the prevalence rates of bipolar spectrum disorder, the severity, impact, and patterns of comorbidity were remarkably similar internationally.” The aggregate lifetime prevalence of BD-I was 0.6%, BD-II 0.4%, subthreshold BD 1.4%, and bipolar spectrum 2.4%. [2]

There are two peaks in the age of onset: 15-24 years and 45-54 years, with more than 70% of individuals manifesting clinical characteristics of the condition before 25 years of age. [12] [13] Bipolar disorder shows a relatively equal distribution across sex, ethnicity, and urban compared to rural areas. [7] [14]

Cyclothymia is associated with a lifetime prevalence of approximately 0.4-1% and a male-to-female ratio of 1:1. [15]

Pathophysiology

As with the etiology, the pathophysiology of BD is unknown and is thought to involve interactions between multiple genetic, neurochemical, and environmental factors. A recent neurobiology review article discusses in detail the “genetic components, signaling pathways, biochemical changes, and neuroimaging findings” in BD. [10]

Evidence supports a strong genetic component and an epigenetic contribution. Human studies have shown changes in brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4) in patients with BD, indicating neurotrophic signaling is a molecular mechanism associated with decreased neuroplasticity. Other proposed mechanisms include mitochondrial dysfunction, oxidative stress, immune-inflammatory imbalance, and compromised hypothalamic-pituitary-adrenal axis. Additionally, neuroimaging studies have shown “evidence of change in regional activity, functional connectivity, neuronal activity, and bioenergetics associated with BD,” and anatomic studies have revealed dendritic spine loss in the dorsolateral prefrontal cortex in the post-mortem brain tissue of patients with BD. [10] [16]

As mentioned, imbalances in systems associated with monoaminergic neurotransmitters, particularly dopamine and serotonin, and intracellular signaling systems that regulate mood are thought to be involved. However, no singular dysfunction of these neurotransmitter systems has been identified. [8]

History and Physical

Because bipolar disorder is a clinical diagnosis, making the correct diagnosis requires a comprehensive clinical assessment, including the directed patient interview, preferably supplemented by interviews of their relatives and the longitudinal course of their condition. Currently, there is no biomarker or neuroimaging study to aid in making the diagnosis.

Most patients with bipolar disorder are not correctly diagnosed until approximately 6 to 10 years after first contact with a healthcare provider, despite the presence of clinical characteristics of the condition. [17] Notably, misdiagnosing BD after first contact differs from not recognizing the transition from major depressive disorder (MDD), the most common index presentation, to BD. Estimates of patients transitioning to BD within three years of an MDD diagnosis range from 20-30%; therefore, clinicians must maintain an awareness of the potential for this transition when caring for patients with MDD who initially screened negative for BD. [18] Also, subthreshold hypomanic symptoms can occur in as many as 40% of patients with MDD. [19]

Although not highly sensitive and specific, self-report screening tools for BD may aid clinicians in making an accurate diagnosis. The most studied screening tools are the Mood Disorders Questionnaire (sensitivity 80%, specificity 70%) and the Hypomania Checklist 32 (sensitivity 82%, specificity 57%). [20] Positive results should motivate the clinician to conduct a thorough clinical assessment for bipolar disorder.

A significant diagnostic challenge is distinguishing between unipolar and bipolar depression because episodes of unipolar major depression and bipolar depression have the same general diagnostic criteria. Clinicians must inquire about past manic, hypomanic, and depressive episodes in patients presenting with symptoms of a depressive episode. Inquiry into past hypomanic or manic episodes is particularly important for patients with early onset of their first depressive episode (ie, in patients younger than 25 years), a high number of lifetime depressive episodes (5 or more episodes), and a family history of bipolar disorder. These findings in the patient’s history have been shown to increase the likelihood of a bipolar rather than a unipolar diagnosis. [21]

Other factors increasing the likelihood of a diagnostic change from MDD to BD include the presence of psychosis, unresponsiveness to antidepressants, the induction of manic or hypomanic symptoms by antidepressant drug treatment, and polymorbidity, defined as 3 or more comorbid conditions. [18] [22]

General DSM-5 Diagnostic Criteria for Bipolar and Related Disorders (American Psychiatric Association. Diagnostic and StatisticalManual of Mental Disorders 5th edition (DSM-5). Arlington, VA: American Psychiatric Publishing; 2013)

BD-I : Criteria met for at least one manic episode, which might have been preceded or followed by a hypomanic episode or major depressive episode (hypomanic or major depressive episodes are not required for the diagnosis).

BD-II : Criteria met for at least one current or past hypomanic episode and a major depressive episode; no manic episodes.

Cyclothymic disorder : Hypomanic symptoms that do not meet the criteria for hypomanic episodes and depressive symptoms that do not meet the criteria for major depressive episodes in numerousperiods (at least half the time) for at least 2 years (1 year in those aged ≤18 years); criteria for major depressive, manic, or hypomanic episodes have never been met.

Specified bipolar and related disorders : Bipolar-like phenomena that do not meet the criteria for BD-I, BD-II, or cyclothymic disorder due to insufficient duration or severity, ie, 1) short-duration hypomanic episodes and major depressive disorder, 2) hypomanic episodes with insufficient symptoms and major depressive episode, 3) hypomanic episode without a prior major depressive episode, and 4) short-duration cyclothymia.

Unspecified bipolar and related disorders : Characteristic symptoms of bipolar and related disorders that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any category previously mentioned.

The symptoms and episodes used to diagnose these disorders must not be related to the physiological effects of a substance or general medical condition.

BD-I and BD-II can be further specified as rapid cycling or seasonal patterns and whether the episodes have psychotic features, catatonia, anxious distress, melancholic features, or peripartum onset. Rapid cycling refers to 4 or more distinct mood episodes during a 12-month period.

Mood-congruent delusions may be present in either a depressive or manic episode, including delusions of guilt or grandiose delusions of power and wealth. Psychotic features, by definition, are absent in hypomanic episodes.

To better account for "mixed features," the current diagnostic criteria implements specifiers. Manic or hypomanic episodes with mixed features meet the full criteria for mania or hypomania and have at least 3 of the following signs or symptoms: depressed mood, anhedonia, psychomotor retardation, fatigue, excessive guilt, or recurrent thoughts of death. Major depressive episodes with mixed features meet the full criteria for a major depressive episode and have at least 3 of the following signs or symptoms: expansive mood, grandiosity, increased talkativeness, flight of ideas, increased goal-directed activity, indulgence in activities with a high potential for "painful consequences," and decreased need for sleep. The mixed features must be present during "most days."

DSM-5 Diagnostic Criteria for Bipolar I Disorder

For a diagnosis of BD-I, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes (hypomanic or major depressive episodes are not required for the diagnosis).

A manic episode is defined as a distinct period of persistently elevated or irritable mood with increased activity or energy lasting for at least 7 consecutive days or requiring hospitalization. The presence of 3 or more of the following is required to qualify as a manic episode. If the mood is irritable, at least 4 of the following must be present:

Inflated self-esteem or grandiosity
Decreased need for sleep
A compulsion to keep talking or being more talkative than usual
Flight of ideas or racing thoughts
High distractibility
Increased goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation (non-goal-directed activity)
Excessive involvement in activities that have a high potential for painful consequences, such as engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments

The episode is not attributable to the physiological effects of a substance or general medical condition.

The symptoms of a manic episode are markedly more severe than those of a hypomanic episode and result in impaired social or occupational functioning or require hospitalization.

DSM-5 Diagnostic Criteria for Bipolar II Disorder

For a diagnosis of BD-II, it is necessary to have met the criteria for at least one current or past hypomanic episode and a major depressive episode without a manic episode (see below for major depressive episode criteria).

A hypomanic episode is defined as a distinct period of persistently elevated or irritable mood with increased activity or energy lasting for at least 4 consecutive days. The presence of 3 or more of the following is required to qualify as a hypomanic episode. If the mood is irritable, at least 4 of the following must be present:

The episode is an unequivocal change in functioning, uncharacteristic of the person and observable by others. Also, the episode is not severe enough to cause marked impairment, is not due to the physiological effects of a substance or general medical condition, and there is no psychosis (if present, this is mania by definition).

DSM-5 Diagnostic Criteria for a Major Depressive Episode

The presence of 5 or more of the following symptoms daily or nearly every day for a consecutive 2-week period that is a change from baseline or previous functioning:

Subjective report of depressed mood most of the day (or depressed mood observed by others)
Anhedonia most of the day
Significant weight loss when not dieting or weight gain or decrease or increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Decreased concentration or indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan

To meet the criteria, at least one of the symptoms must be depressed mood or anhedonia, the symptoms must not be attributable to a substance or general medical condition, and it causes functional impairment (eg, social or occupational).

Possible Secondary Cause of Bipolar Disorder

The following characteristics may heighten the clinical suspicion for a possible secondary cause in patients with signs and symptoms associated with bipolar disorder: older than 50 at the first onset of symptoms, abnormal vital signs or neurological examination, a recent change in health status or medications temporally associated with symptom onset, unusual response or unresponsiveness to appropriate treatments, and no personal or family history of a psychiatric disorder.

Recommended initial evaluation for a possible secondary cause includes a urine drug screen, complete blood count with blood smear, comprehensive metabolic panel, thyroid function tests, and vitamin B and folate levels.

Treatment / Management

Although numerous clinical practice guidelines exist for the treatment and management of bipolar disorder, there is not enough consistency to generate a ‘meta-consensus’ model. [23] Authors of a recent systematic review concluded, “The absence of a uniform language and recommendations in current guidelines may be an additional complicating factor in the implementation of evidence-based treatments in BD.” [24] The following is an abbreviated synthesis of guidelines published by the National Institute for Health and Care Excellence (NICE), British Association for Psychopharmacology, International College of Neuro-Psychopharmacology (CINP), Canadian Network for Mood and Anxiety Treatments (CANMAT), International Society for Bipolar Disorders (ISBD), and Indian Psychiatric Society (IPS). [25] [26] [27] [28] [29]

Manic Episode

Mania is considered a medical emergency and often requires psychiatric hospitalization. Initial treatment is aimed at stabilization of the potentially or acutely agitated patient to help de-escalate distress, mitigate potentially dangerous behavior, and facilitate the patient assessment and evaluation. When possible, a calming environment with minimal stimuli should be provided. Adjunctive benzodiazepines may be used concomitantly with mood stabilizers and antipsychotic drugs to reduce agitation and promote sleep.

The patient’s current medications must be considered. For example, a second drug is recommended if the patient presents while the condition is already managed with lithium monotherapy. Also, antidepressants are usually tapered and discontinued in a manic phase. First-line monotherapy includes a mood stabilizer, such as lithium or valproate, or an antipsychotic, such as aripiprazole, asenapine, cariprazine, quetiapine, or risperidone.

Add another medication if symptoms are inadequately controlled, or the mania is very severe. Combination treatments include lithium or valproate with either aripiprazole, asenapine, olanzapine, quetiapine, or risperidone. Electroconvulsive therapy (ECT) may be considered as monotherapy or as part of combination therapy in patients whose mania is particularly severe or treatment-resistant and in women with severe mania who are pregnant.

Valproate should not be used for women of childbearing potential due to the unacceptable risk to the fetus of teratogenesis and impaired intellectual development.

Hypomanic Episodes

By definition, hypomanic episodes are not severe enough to cause marked impairment, and there is no psychosis; therefore, these episodes can be managed in an ambulatory setting. Pharmacotherapy is similar to that for mania, but higher doses may be required for the latter.

Acute Bipolar Depression

Suicidal and self-harm risk has priority in managing patients with bipolar disorder who present with an acute depressive episode because most suicide deaths in patients with BD occur during this phase. Patients may or may not require hospitalization.

For patients not already taking long-term medication for BD, first-line monotherapy includes quetiapine, olanzapine, or lurasidone (has not been studied in acute bipolar mania). Combination treatment with olanzapine-fluoxetine, lithium plus lamotrigine, and lurasidone plus lithium or valproate may also be considered.

Consider cognitive behavioral therapy (CBT) as an add-on to pharmacotherapy. However, never consider CBT as monotherapy because there is minimal evidence to support psychological treatments without pharmacotherapy in treating acute bipolar depression.

Also, consider adding ECT for refractory bipolar depression or as a first-line treatment in the presence of psychotic features and a high risk of suicide.

For patients presenting with a depressive episode while taking long-term medication (breakthrough episode), make sure their current treatments are likely to protect them from a manic relapse (eg, mood stabilizer or antipsychotic). When applicable, check the medication dose, patient adherence, drug-drug interactions, and serum concentrations. Also, inquire about current stressors, alcohol or substance use, and psychosocial intervention adherence.

Generally, treatment options for BD-II depression are similar to those for BD-I depression.

Antidepressant medications should not be used as monotherapy in most patients with bipolar disorder, as available evidence does not support their efficacy, and there is a risk of a switch to mania or mood instability during an episode of bipolar depression. Antidepressants can be administered adjunctively to mood stabilizers (eg, lithium and lamotrigine) and second-generation antipsychotics.

Maintenance Treatment

Most patients with bipolar disorder will require maintenance treatment for many years, possibly lifelong, to prevent recurrent episodes and restore their pre-illness functioning. The current recommendation is for continuous rather than intermittent treatment, with treatments that were effective during the acute phase often continued initially to prevent early relapse. Mood stabilizers and atypical antipsychotics alone or in combination are the mainstays of maintenance pharmacotherapy.

There is substantial evidence showing lithium monotherapy’s effectiveness against manic, depressive, and mixed relapse. Additionally, lithium is associated with a decreased risk of suicide in patients with BD. Monitoring during treatment, including serum lithium concentrations, is a standard of care.

In addition to the individualized pharmacotherapy plan, essential components of maintenance treatment include medication adherence, primary prevention and treatment for psychiatric and medical comorbidities, and psychotherapy when appropriate. Suicidality surveillance is critical throughout the maintenance phase.

Differential Diagnosis

The differential diagnosis of bipolar disorder includes other conditions characterized by depression, impulsivity, mood lability, anxiety, cognitive dysfunction, and psychosis. The most common differential diagnoses are MDD, schizophrenia, anxiety disorders, substance use disorders, borderline personality disorder, and in the pediatric age group, attention-deficit/hyperactivity disorder and oppositional defiant disorder. [18] [30]

Bipolar disorder is one of the top 10 leading causes of disability worldwide. [31] A recent meta-analysis showed that patients with BD “experienced reduced life expectancy relative to the general population, with approximately 13 years of potential life lost.” Additionally, patients with bipolar disorder showed a greater reduction in lifespan relative to the general population than patients with common mental health disorders, including anxiety and depressive disorders, and life expectancy was significantly lower in men with BD than in women with BD. [32] A different meta-analysis showed that all-cause mortality in patients with BD is double that expected in the general population. Natural deaths occurred over 1.5 times greater in BD, comprised of an “almost double risk of deaths from circulatory illnesses (heart attacks, strokes, etc) and 3 times the risk of deaths from respiratory illness (COPD, asthma, etc).” Unnatural deaths occurred approximately 7 times more often than in the general population, with an increased suicide risk of approximately 14 times and an increased risk of other violent deaths of almost 4 times. Deaths by all causes studied were similarly increased in men and women. [33] A more recent systematic review of the association between completed suicide and bipolar disorder showed an approximately 20- to 30-fold greater suicide rate in bipolar disorder than in the general population. [34]

Complications

Individuals with bipolar disorder show a markedly increased risk of premature death due to the increased risk of suicide and medical comorbidities, including cardiovascular, respiratory, and endocrine causes. [35] More than half of patients are overweight or obese, which appears to be independent of treatment with weight-promoting psychotropic medications. [36] One-third of patients with bipolar disorder also meet the criteria for metabolic syndrome, which increases the risks of heart disease and stroke. [37] Additionally, attempted suicides are more common among patients with concurrent metabolic syndrome. [37] Comorbid overweight and obesity are associated with a more severe course, an increased lifetime number of depressive and manic episodes, poorer response to pharmacotherapy, and heightened suicide risk. [22] [38] Migraine is also associated with bipolar disorder. [39]

Psychiatric comorbidity is present in 50 to 70% of patients with BD. Of those diagnosed with the condition, 70% to 90% meet the criteria for generalized anxiety disorder, social anxiety disorder, or panic disorder, and 30 to 50% for alcohol and other substance use disorders. [40] [41] [42] Psychiatric comorbidities in patients with bipolar disorder are associated with a more severe course, more frequent depressive and manic episodes, and reduced quality of life. [22] Up to half of patients with BD have a comorbid personality disorder, particularly borderline personality disorder, and 10 to 20% have a binge eating disorder, leading to more frequent mood episodes and higher rates of suicidality and alcohol and substance use disorders. [43] [44]

Deterrence and Patient Education

Psychoeducation delivered individually or in a group setting is recommended for patients and family members and may include teaching to detect and manage prodromes of depression and mania, enhance medication adherence, and improve lifestyle choices. Patients are encouraged to avoid stimulants like caffeine, minimize alcohol consumption, exercise regularly, and practice appropriate sleep hygiene. [28] Providers are encouraged to maximize the therapeutic alliance, convey empathy, allow patients to participate in treatment decisions, and consistently monitor symptoms, which have been shown to reduce suicidal ideation, improve treatment outcomes, and increase patient satisfaction with care. [28] [45] Patients may also benefit from case management or care coordination services to help connect them to community-based resources, such as support groups, mental health centers, and substance use treatment programs.

Enhancing Healthcare Team Outcomes

The goal of treatment for patients with bipolar disorder is a full functional recovery (a return to pre-illness baseline functioning). This goal can best be achieved by integrating psychiatric and medical healthcare using an interprofessional team approach to manage BD and comorbid psychiatric and medical conditions. [46] Interprofessional healthcare teams may consist of any combination of the following: case manager, primary care clinician, psychiatrist, psychiatric nurse practitioner, psychiatric physician assistant, psychiatric nurse specialist, social worker, psychologist, and pharmacist.

Ideally, a consistent long-term alliance will form between the patient, their family, and healthcare team members to provide pharmacotherapy management, psychoeducation, ongoing monitoring, and psychosocial support. [26] Also, patients with bipolar disorder and co-occurring alcohol or substance use disorders may benefit from the involvement of an addiction specialist, as there is evidence that effective treatment can improve outcomes. [47] Pharmacists must perform medication reconciliation to ensure there are no drug-drug interactions that could inhibit effective care and report any concerns they have to the prescriber or their nursing staff. Furthermore, collaborative care models have shown efficacy in improving outcomes when used to treat patients with BD. Key elements include patient psychoeducation, using evidence-based treatment guidelines; collaborative decision-making by patients and their healthcare provider(s); and supportive technology to support monitoring and patient follow-up. [46] [48] [49]

An interprofessional approach is a mainstay in treating patients with bipolar disorder. An interprofessional team that provides a holistic and integrated approach to patient care can help achieve the best possible outcomes with the fewest adverse events. [Level 5]

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Disclosure: Ankit Jain declares no relevant financial relationships with ineligible companies.

Disclosure: Paroma Mitra declares no relevant financial relationships with ineligible companies.

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Research article
Open access
Published: 08 February 2021

Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence

Nasim Mousavi 1 ,
Marzieh Norozpour ORCID: orcid.org/0000-0002-8894-9178 1 ,
Zahra Taherifar 2 ,
Morteza Naserbakht 3 &
Amir Shabani 3

BMC Psychiatry volume 21 , Article number: 83 ( 2021 ) Cite this article

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Bipolar disorder is a common psychiatric disorder with a massive psychological and social burden. Research indicates that treatment adherence is not good in these patients. The families’ knowledge about the disorder is fundamental for managing their patients’ disorder. The purpose of the present study was to investigate the knowledge of the family members of a sample of Iranian patients with bipolar I disorder (BD-I) and to explore the potential reasons for treatment non-adherence.

This study was conducted by qualitative content analysis. In-depth interviews were held and open-coding inductive analysis was performed. A thematic content analysis was used for the qualitative data analysis.

The viewpoints of the family members of the patients were categorized in five themes, including knowledge about the disorder, information about the medications, information about the treatment and the respective role of the family, reasons for pharmacological treatment non-adherence, and strategies applied by families to enhance treatment adherence in the patients. The research findings showed that the family members did not have enough information about the nature of BD-I, which they attributed to their lack of training on the disorder. The families did not know what caused the recurrence of the disorder and did not have sufficient knowledge about its prescribed medications and treatments. Also, most families did not know about the etiology of the disorder.

The lack of knowledge among the family members of patients with BD-I can have a significant impact on relapse and treatment non-adherence. These issues need to be further emphasized in the training of patients’ families. The present findings can be used to re-design the guidelines and protocols in a way to improve treatment adherence and avoid the relapse of BD-I symptoms.

Peer Review reports

Bipolar I disorder (BD-I) is a chronic and recurrent psychiatric disorder in which a person has a manic episode for 1 week, which may present before or after hypomanic or major depressive episodes [ 1 ].

BD-I is accompanied by chronic stress, disability, increased risk of sudden mood swings, higher rates of comorbid disorders and moral, financial, and legal problems. The disorder is ranked the sixth debilitating disease according to the World Health Organization (WHO). BD-I is considered the most expensive mental disorder in terms of the health and behavioral care required by the patients and the burden on governmental institutions and insurance companies [ 2 , 3 , 4 ]. According to a report by the Central Bank of the Islamic Republic of Iran, the average annual income of an Iranian household in 2012 was 209,050,000 Rials. The direct annual cost of one BD-I patient consists of 10% of this average family income [ 5 ].

BD-I affects the patient’s life and has long-term consequences that are visible in the patient’s social performance and quality of life [ 6 , 7 ]. Severe impairment in job performance is observed in about 30% of the patients with BD-I. In such cases, functional improvement falls substantially behind symptom improvement [ 1 ].

Pharmacological treatment is the first-line treatment for BD-I. Evidence shows that about 40% of patients with BD-I do not have good medication adherence, which translates into a higher probability of symptom relapse, hospitalization, and increased suicide risk [ 8 ]. In a study in Tehran, Iran, poor treatment adherence was noticed in about 30% of BD-I patients [ 9 ]. Another study from Iran [ 10 ] also reported the prevalence of poor compliance in BD-I patients after the first episode of mania as 38.1% during a 17-month follow-up period. Therefore, it is of great importance to better understand and investigate the underlying reasons for treatment non-adherence in BD-I patients.

Given the changes implemented in health care systems over the last two decades and the resultant focus on community-based services, the role of families in caring for BD-I patients has become more prominent [ 6 ]. The insufficient knowledge of families about the disorder, its symptoms, and medications has made the management of BD-I more difficult and eventually imposes additional costs on them [ 6 ]. The higher is the cost imposed on the family, the more likely is it for the family members to show adverse reactions to the BD-I patients, which itself leads to a higher chance of disorder relapse [ 3 ].

In Iran, the general public is acquainted with various types of psychiatric illnesses through mass media and public educational websites such as the website of the Iranian Psychiatric Association ( https://iranmentalhealth.com ) and other Persian public written sources. Patients with BD-I and their families become familiar with the treatment process after consulting a general practitioner, a psychiatrist, or a psychologist, and, if necessary, the patients are admitted to the hospital through a psychiatrist. In addition to medical treatment, they receive the necessary training and information about their treatment process in the hospital. Furthermore, an association called ABR (Association of Mental Health Promotion), with an active website ( http://abrcharity.ir ), independently monitors patients, including those with bipolar disorder, after discharge.

Many studies have examined the views and roles of patients with BD-I and their caregivers and also the importance of family awareness and its impact on medication adherence. Tacchi & Scott [ 11 ] and Veligan et al. [ 12 ] suggest that the family members’ beliefs about the nature of BD-I and the information they have about the disorder affect the patient’s medication adherence. The review of literature showed no precise studies conducted to explore the knowledge, information, and opinions of family members of BD-I patients about the disorder and the causes of their medication non-adherence.

In a previous study in Iran [ 13 ], the authors held qualitative interviews with the family members of patients with BD-I and reported that treatment non-adherence is a major problem in these patients. They also reported that the patients and their families did not have sufficient knowledge about the nature of this disorder. Considering these findings about the insufficient knowledge of the family members of BD-I patients and the high rate of treatment non-adherence, it is necessary to conduct more studies to investigate the possible causes of treatment non-adherence and families’ knowledge and beliefs about this disorder in Iran. This study was thus carried out to explore the viewpoints of the family members of BD-I patients about the nature of this disorder and the potential causes of treatment non-adherence. The results can be used for revising the psychoeducation guidelines for BD-I patients, as clinical guidelines mandate the inclusion of psychoeducation in the treatment plan adopted for these patients. The results can also be used to design a protocol to address the disorder relapse, which can have substantial consequences in terms of reducing healthcare costs.

The findings of this study are reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [ 14 ].

Study samples’ characteristics

The participants were the family members of patients diagnosed with BD-I. The patients had been admitted to Iran Psychiatry Hospital in Tehran, Iran, and were receiving pharmacological treatments.

This study used purposive sampling to select the participants. From November 2017 to April 2018, 12 patients were interviewed by two psychiatrists based on the DSM-5 criteria [ 1 ] and received the diagnosis of BD-I. Then these diagnoses were confirmed by A.SH. and their families were invited to participate in the study.

None of the family members refused to participate in the study and they all completed the entire course of the study. The mean age of the participants was 50.83 years. There were three male (25%) and nine female (75%) participants (Table 1 ). Table 2 shows further details on patients’ characteristics.

Data collection

After diagnosing patients with BD-I, and obtaining the written consent of the family members of patients to participate in this study, data were collected by in-depth interviews from family members of patients, conducted at the hospital’s conference hall. No one else was present at the time of the interviews except for the interviewer and the participant. Each interview lasted approximately 20 min and was digitally recorded for subsequent analyses. Two female PhD candidates (N. M. and M. N.) in clinical psychology at the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, who had already received training on the implementation of qualitative studies, held the interviews. They did not know any of the participants. The interviewers introduced themselves to the participants before the beginning of each interview. The interview questions were provided by the authors. The interviews were held only once and were not repeated. Data saturation was reached with 12 participants, and no further participants were interviewed after reaching this number. Data saturation occurs when no new information is obtained by conducting further interviews [ 15 ].

Data analysis

Thematic analysis was used for the qualitative data analysis [ 16 , 17 ]. To this end, the six steps proposed by Clark and Brown [ 17 ] were used.

The raw data derived from the interviews were used for the analysis. The content of the interviews were transcribed verbatim immediately after each interview. Field notes were made during the interviews and were reviewed in this stage. Three authors (M. N., N. M., and Z. T.) read the interviews several times for immersing in the data and getting familiar with it. Line-by-line coding was then applied to generate the initial codes. These steps were performed manually by the three authors without using any computer programs. One author encoded each interview and the interview was then read by another author and encoded again. The individually-extracted codes were then integrated and modified, if necessary.

In the next step, by linking the codes together, their common patterns and concepts were extracted and potential themes and subthemes were identified, keeping the research questions in mind. The data related to the themes were then collected and examined to verify the accuracy of the themes and subthemes, which resulted in five final themes.

Several statements were selected from the interviews as examples and are reported in the results section. To preserve participants’ anonymity, their names and ages are not mentioned in the results; instead, they are represented by random numbers.

Taking into account comprehensiveness, homogeneity, and overlap, the components of the family members’ viewpoints on the nature of the disorder and the reasons for pharmacological treatment non-adherence were categorized into five themes, including knowledge about the disorder, information about the medications, information about the treatment and the respective role of the family, reasons for pharmacological treatment non-adherence, and strategies applied by families to enhance treatment adherence in the patients.

Each of the themes contained several subthemes, which were themselves made up of some open codes. These subthemes contained recurrent codes and concepts that shared a common meaning.

Table 3 presents the themes, subthemes and examples of some of the codes.

Theme one: knowledge about the disorder

Most interviewees did not have sufficient or accurate knowledge about the nature of BD-I, the signs and symptoms of depression and mania cycles, and the outcome of the disorder. They mentioned the lack of training or inadequate training (especially by healthcare providers) as the main cause of insufficient knowledge about BD-I. Additionally, most families did not have a good understanding of the etiology of BD-I.

Some of them considered BD-I as a genetic abnormality, while others considered factors such as adolescent maltreatment, parents’ unusual conditions during sexual intercourse, and the lack of proper training before parenthood as potential causes of BD-I.

Participant No. 5 (a patient’s wife): “I was told that he has a nervous problem.” Participant No. 3 (a patient‘s mother): "I have a theory about having babies. I think that not everyone should have children. The husband and wife should be screened and monitored for two years to see if they understand the matter clearly. Do you see these anomalies now? ... These shameful movies they watch … The person is not feeling well when raising their kid … From an Islamic point of view, from a human’s point of view, both the husband and wife need to be monitored. Their food and other things should also be monitored to see if they can have a healthy baby.”

Participant No. 7 (a patient’s mother): "Because this boy is always impressed by me, sometimes I tell myself, maybe I didn’t fully understand him during his puberty. Sometimes I blame myself, as he has said this many times. I always blame myself … . Sometimes he says, ‘You did this to me, that’s why I’m sick now and take drugs’. For example, when hitting puberty, in the first or second year of high school, he used to get up late and so he got to school very late. Then the school’s principal complained to me, ‘Why is he late again?’ And he says, ‘Why did you wake me up early in the morning? You did this to me.” Participant No. 10 (a patient’s mother), referring to her son's divorce: "That's why he's so broken.” Participant No. 11 (a patient’s sister): "Bipolar disorder has a genetic background. I think there would be no one out there who suffered from the disorder unless they got the genes. It is a genetic disorder, but it emerges when a patient experiences a series of shocking events. Well, some have higher potentials, such as those who get very angry. I mean, the anger itself is not part of the disorder, but in angry people, shocking events affect the patient more rapidly.”

Theme two: information about the medications

Many family members had a misconception about the treatment of the disorder and the effects of psychotropic medications on the patients. In other words, they were unable to accurately identify the therapeutic effects of the administered medications and the time it took for the patients to show signs of improvement. Also, some participants were unaware of the side-effects of the prescribed medications. Some mentioned side-effects like memory loss and drug addiction; however, almost all the participants believed that pharmacological treatment is necessary for the patients despite the side-effects.

Participant No. 1 (a patient’s mother): "The problem of her running away from home with her boyfriend was a big burden for us, but as the prescribed meds began to show their effectiveness, this problem was gradually solved and we finally managed to put up with her aggressiveness and other problems. That is, we were saying to ourselves, ‘This is a period of angriness; we had better not said this, not done that’... We thought the medication was working. But now they’ve told me, ‘No, your patient has not recovered at all, has not been cured.”

Participant No. 1 (a patient's mother): "Her first psychiatrist, who has been visiting her for eight years, was frequently asking if she studies, watches TV or goes to work at all. ‘Whenever she goes back to these routines, then she has recovered,’ the therapist would say. Recently, she’s always been saying, ‘I would love to go to work’ and so on. Once, her employer told her to do some cleaning, and she had responded, ‘I’m not your servant.’ She suddenly broke it off and said, ‘I won’t go to work anymore.’ She didn’t sleep at all, saying, ‘I work so much, but I don’t feel exhausted at all.’ We were also excited and thought ‘Yeah, so this doctor's meds have been good; she’s getting back to normal, she’s working,’ She was frequently organizing her closet, like an obsession.”

Participant No. 3 (a patient’s mother): “I can’t remember the side-effects but I’ve heard about them in classes. My daughter is taking lithium now but she gets these chills. Her stomach is not well. Its side-effects are such that they affect her memory. However, when we compare the pros and cons, we have to take it. "

Theme three: information about the treatment

The regular intake of medications, stress control, work, exercise, regular visits to a psychiatrist or psychologist, and the need to provide insight into the patient’s illness through education were noted by the families in this part. Some participants believed that psychotherapy sessions cannot help treat this disorder while some had completely false or superstitious beliefs about treatment of the disorder.

Participant No. 4 (a patient's son): "Our patient doesn’t accept justifications. When you bring them to classes and convince them that ‘You are sick, and you have to take this medication because of this and that, and we have evidence that you have this disorder,’ and then we show it to them, prove it like in the movies, say that this disorder is serious because of so and so reasons, I think, it would be much easier.”

Participant No. 1 (a patient’s mother): "They sent us to get counseling. Of course, my daughter did not cooperate and didn’t come with. So, I got an appointment under my name to get information and find out how to deal with this disorder. Then the psychologist said, 'No, your daughter is diagnosed with bipolar disorder; this is an acute illness. Counseling does not work for her. She should take medications –a lot of them. And since the doc said those words, we withdrew from counseling altogether.”

Participant No. 5 (a patient’s wife): "My mother-in-law says, ‘If God gives him a baby, he’ll be fine.’ Because his ex-wife also failed to bear a child for him.”

Theme four: information about the role of the family in the treatment

Most families defined their role as helping the patient recover and adhere to their treatment, reminding them to take the medications, encouraging them to go to the doctor, not leaving them alone, and doing whatever they wanted to do so that things went as the patient wished. The patients also appeared to feel guilty when their families tried to comfort them, and this pattern was observed in several of the participants in this study.

Participant No. 6 (a patient’s husband): "We should put up with her, love her, not argue about what she says, listen to her, get her to do exercise to keep busy. I'm here now and I brought her with me too instead of leaving her alone to think about stuff.”

Participant No. 2 (a patient’s mother): "You should be good to them, listen to them, make home a peaceful environment, and not argue.”

Participant No. 8 (a patient’s wife): “I don't know. If he just thinks that everything is okay, all will be okay; but such feelings don’t last forever.”

Participant No. 2 (a patient’s mother): "I tell him to take his meds on time … Say, ‘Let's go to the park to take a look around ... Don't stay at home too much. God is merciful; it won’t be that bad’ … I talk to him, I comfort him sometimes, tell him that I’m ill too because I feel your pain.’ I really do. I’ve been crying alone at home many times. God, what will happen at the end?"(She cries).

Theme five: reasons for pharmacological treatment non-adherence

As for this theme, the participants noted issues that were mostly about the comments made by other people, including relatives or care-providers, such as doctors or specialists in other disciplines. An interesting observation was made by a participant who mentioned a celebrity talking on TV about the inefficiency of medications; following these comments, the patient had stopped taking his medications. Another issue was that the families’ constant changing of the patient’s physician contributed to their medication non-adherence. Another reason noted for non-adherence was that the patients did not suffer from mania symptoms and found that it was not so crucial for them to take the medications. Additionally, some patients reported the physical discomfort and weakness (e.g., impotence) experienced as side-effects of the prescribed medications a reason for their medication non-adherence.

Participant No. 2 (a patient’s mother): "She didn't take the meds for seven to eight months. Her friend had told her ‘Your eyes look different. When you take the medicine, your eyes turn into a strange shape. Get rid of them.’ After seven months, her disease relapsed.”

Participant No. 6 (a patient’s husband): "If we go to a party somewhere and someone asks her, ‘Oh, you take drugs?’ … But that person is not aware of the matter, cause she might look all well, and that person doesn’t know what’s actually happening in my wife’s mind, who then has to admit that she is alright."

Participant No. 7 (a patient’s mother): "At one point at work, some colleagues told him, ‘You will become addicted to the medicines, you will get sick.’ Then, he put the medicines aside and became pessimistic about his work. ‘This job has made me sick,’ so he said and left his job all of a sudden. He had a great job, not a difficult one. He could manage it by himself very easily.”

Participant No. 3 (a patient’s mother): “My son had gone to a doctor to remove the corn on his feet. The doctor had checked his medicine prescriptions and asked, ‘What are these you’re taking? You won’t be able to conceive a baby in the future. It’ll affect you poorly’ and so on. My son keeps repeating what the doctor told him.”

Participant No. 1 (a patient’s mother): "That emergency nurse who came to our house told us to change her doctor. Since then, she has kept repeating this sentence. She threw out all her medicines.”

Participant No. 3 (a patient’s mother): “Since the beginning of the new year, he’s began to no longer take his medications. In Khandevaneh, Footnote 1 Mr. Mehran Ghafourian (a famous Iranian actor) said, ‘I was in a bad mood ... I had depression. I put the medications aside and started exercising.’ My son stopped taking his medicines on hearing those words. I asked him many times to go see a doctor but he said no. He continued to not take his medicines and then his disorder worsened. He was frequently beating us up until we took him to the hospital with the help of the police.”

Participant No. 3 (a patient’s mother): “There was a child psychiatrist on a TV talk. We took our son to her office. We used to visit a counselor as well. The psychiatrist prescribed him some medications. We didn’t know what the medications were. He was taking his medicines. In the middle of therapy, we stopped it. Then, my son-in-law, who is a doctor, said ‘Dr. A -his professor- is a very good doctor.’ My son used to go to Dr. A. earlier when he was a college student. He was taking medicines and he believed in him so much. Then again, my eldest daughter, who is a physician, said ‘Dr. B. is a very helpful therapist. All the doctors, engineers, and educated people go to visit him.’ Then he went there ... And two years ago, I took him to Dr. S. too, to help him get rid of his substance abuse." (This participant named seven different doctors).

Participant No. 4 (a patient’s son) discussed the reasons for the patient’s refusal to take the medications and said: "Well, he doesn't actually believe in the disorder being a real one (in the manic episode). Maybe now he takes the pill in front of you, but you know that it is not something that bothers him. You take pills more easily if you have actual pain, but when you don’t, you ask yourself ‘Why do I have to take all these pills?”

Participant No. 11 (a patient’s sister): “We can note the poor behaviors of those around him. He considers any weaknesses he experiences (e.g., sexual problems) a side-effect of the medicines he’s taking. And he’s linking everything to the medicines and thinking they’re going to make him different from the others.”

The findings of this study regarding the viewpoints of the family members of patients with BD-I were categorized into five themes. Although qualitative studies do not allow for the identification of the extent and relative importance of every condition, recurrent themes and concepts stated by the participants at different individual and social levels were extracted.

Research suggests that there is a relationship between families’ knowledge and beliefs about the disorder and the patients’ medication adherence [ 12 ]. The attitudes and knowledge of the family members have a significant influence on the patient’s own beliefs and attitudes and affect the patient’s decision about treatment compliance [ 18 ]. In agreement with previous studies [ 19 , 20 ], the family caretakers in this study were shown to lack sufficient information and knowledge about the nature of BD-I. In addition, many participants had inaccurate or false information and insisted on these false beliefs. A review study on treatment acceptance found that brief interventions focused on relapse prevention and psychoeducation-based interventions have the greatest impact on relapse prevention [ 21 ]. Maintaining the patients’ circadian rhythms (especially sleep rhythm), controlling activity levels, verifying and controlling initial symptoms of mania and depressive episodes, and not using narcotics or stimulants have been recommended in approved psychotherapy protocols for bipolar patients [ 22 ]. Nonetheless, the participants in this study did not discuss any of these important factors. The lack of knowledge about these important issues among families can have a significant impact on relapse and treatment non-adherence in the patients. These points need to be further emphasized in training patients’ families.

In a qualitative study on bipolar patients and their families, Peters, Pontin, Lobban, and Morriss [ 23 ] found that the viewpoints of patients and their families play an important role in managing the disorder; however, the families usually get despondent about participating in this process, and their perception was that some mental health workers believe that family involvement makes their work more complicated. Meanwhile, the present study showed that, in Iran, families do not have enough information about their role in preventing disorder relapse and attribute their patient’s relapse only to factors such as medication withdrawal, unemployment, lack of community support, and financial problems. Most of them believed that if everything goes as the patient wishes, the disorder will not relapse.

Furthermore, the participants did not have adequate information about the non-pharmacological treatment options available for this disorder and the role that psychologists can play in helping the patients enhance their medication adherence and prevent the symptoms of relapse. A variety of behavioral, cognitive, and emotion-focused interventions are used in the management of bipolar disorders [ 22 ]. Nevertheless, the participants did not have sufficient knowledge about these treatments. The observation that many psychologists in Iran appear unwilling to participate in the treatment of bipolar disorder patients seems to play a role in this lack of knowledge. According to Farhoudian et al. [ 24 ], only about 1.5% of all the studies on psychiatric disorders conducted in Iran between 1973 and 2003 involved bipolar and cyclothymic patients. In a qualitative study on bipolar-II patients and their families, Fisher et al. [ 25 ] found that the number of resources available to patients for deciding about their treatment has increased and their priorities have been given increasing attention; yet, the patients’ and their families’ preferences are not fully considered.

Similar to the studies carried out by Jönsson, Wijk, Skärsäter & Danielson [ 26 ] and Shamsaei, Mohamad Khan Kermanshahi, and Vanaki [ 27 ], in the present study, the patients and their families were struggling with the acceptance, understanding, and management of the disorder. According to the participants, the families’ lack of insight into the patients’ disorder contributed significantly to their medication non-adherence. This finding is in line with Scott and Pope’s [ 28 ] research, but Delmas, Proudfoot, Parker, and Manicavasagar [ 29 ] stated that the rejection of treatment is a complex issue that depends on various factors.

Some of the results of this study are consistent with the findings reported by Clatworthy, Bowskill, Rank, Parham, and Horne [ 8 ], who noted that deliberate treatment non-adherence is associated with factors such as patients’ concerns about the prescribed medications and their side-effects in the case of continuous consumption. Proudfoot et al. [ 30 ] stated that the side-effects of medications, coping with unpleasant symptoms, the extent of awareness about the nature of the disorder, and the reactions to it as well as the stigma associated with the disorder affect the patient’s life path. Besides, these symptoms have a permanent impact on the disorder relapse [ 31 ]. The findings showed that the interaction of the disorder, patient, medications, psychiatric attitude, and cultural attitude with non-compliance is very complex [ 32 ].

In addition to the themes mentioned, there were some interesting results concerning the response process in all the interviews. For example, the majority of the participants only reported symptoms of the manic episode, while two major studies [ 33 , 34 ] have shown that people with bipolar I and II (especially type II) disorders spend most of their symptomatic days with depression. Patients suffer greatly during the depressive episodes but have elevated or irritable moods during the manic episode; in contrast, families find the mania symptoms more annoying and disruptive to themselves. This duality can negatively impact reaching a common understanding with the patient about visiting the doctor and taking medications. Moreover, the fact that some families do not have enough information about the depressive episode can eventuate in neglecting the patient’s need to take medications during this phase, which can then adversely affect medication adherence. These results are somewhat contradictory to the results of a previous study [ 29 ], which reported that both patients and their family members report symptoms of mania and hypomania to their physicians less often, as some of them enjoy the manic symptoms. Family members feel relieved when they see that their patient is happy and shows mania symptoms. A major cause of this discrepancy in findings may be the differences in the study populations. While Delmas et al. [ 29 ] studied patients with bipolar I and II, the present study examined only patients with BD-I. The discrepancy may also partially originate from cultural differences. It seems that when there is a pattern of greater attention to objective and apparent symptoms, very important mental symptoms such as suicidal thoughts, whether during the mania or depressive episode, are neglected by families.

This study showed that families with a higher educational and socioeconomic status tend to seek psychiatric care from different psychiatrists. Frequently changing the treating psychiatrist can cause treatment non-adherence in the patients. Furthermore, as the family members of such patients falsely think that they have greater medical information, they are more likely to encourage the patient to stop taking their prescribed medications.

A major limitation of this study was that most participants were the mothers of the patients, as it was hard to find other family members of the patients to participate in the study. For example, only one child of a patient and one sister were among the participants. Also, all the participants were from Tehran and were selected from one hospital; therefore, the generalization of the results to other cities in Iran should be pursued with caution.

The authors suggest using the findings of this qualitative study regarding the knowledge of the family members of patients with bipolar I disorder (BD-I) as well as the dominating cultural beliefs to design further quantitative studies. The quantitative assessment of individual, familial, and social reasons for treatment non-adherence is also a recommendation for future research. Conducting similar studies on the family members of patients with other types of bipolar disorder with an attention to the different processes and outcomes involved is also recommended. Since there are different ethnicities and subcultures in Iran, the results obtained by examining the residents of the country’s capital city cannot be generalized to the population of other cities and towns, and it is necessary to repeat the study in other populations in order to get familiar with other viewpoints in Iran.

Overall, the results of this study contribute to the emerging qualitative research on bipolar disorder and provide the readers with an insight into the viewpoints of the family members of patients with BD-I. Some inaccurate information might have been observed in participants’ statements due to some deeply-rooted cultural attitudes and beliefs and their correction may require extensive interventions.

The results of this study can be used to compile educational content for patients with bipolar disorder and their families as well as for psychologists, psychiatrists, psychiatry assistants, and hospital health workers.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors express their gratitude to all the staff of Iran Psychiatry Hospital for their generous cooperation in the study.

This research is funded by the Mental Health Research Center of Iran University of Medical Sciences (grant number 95–01–121-27963).

The views expressed are those of the authors and not necessarily those of the Mental Health Research Center of Iran University of Medical Sciences. The funders had no role in the study design, data collection and analysis, interpretation, decision to publish or the writing and preparation of the manuscript.

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NM, MN and ASH conceived the study idea and design. NM, and MN conducted the interviews. NM, MN and ZT conducted transcription and data analysis. NM, MNA and ZT interpreted and presented the results, and contributed to the manuscript. ASH supervised the research activities and contributed to the interpretation of results. NM, MN and ZT wrote the manuscript. All authors have read, edited and approved the final manuscript for submission.

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Mousavi, N., Norozpour, M., Taherifar, Z. et al. Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence. BMC Psychiatry 21 , 83 (2021). https://doi.org/10.1186/s12888-020-03008-x

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Home — Essay Samples — Nursing & Health — Psychiatry & Mental Health — Bipolar Disorder

Essays About Bipolar Disorder

When it comes to choosing a topic for an essay on Bipolar Disorder, there are a plethora of options to consider. Bipolar Disorder is a complex and multifaceted mental illness that affects millions of people worldwide. From the causes and symptoms to treatment and management, there are numerous aspects of Bipolar Disorder that can be explored in an essay. In this article, we will discuss the importance of choosing the right Bipolar Disorder essay topic and provide a list of potential topics to consider.

The first step in choosing a Bipolar Disorder essay topic is to consider your audience and the purpose of your essay. Are you writing for a general audience, mental health professionals, or individuals who have been diagnosed with Bipolar Disorder? Understanding your audience will help you narrow down your topic and tailor your essay to meet their needs and interests.

Another important consideration when choosing a topic for a Bipolar Disorder essay is to ensure that it is relevant and up-to-date. Bipolar Disorder is a rapidly evolving field, with new research and developments emerging regularly. Therefore, it is essential to choose a topic that is current and reflects the latest advancements in the field.

Additionally, it is crucial to select a topic that is of personal interest to you. Writing an essay on Bipolar Disorder can be a challenging and emotionally taxing experience, so choosing a topic that resonates with you can make the process more enjoyable and rewarding.

Now that we have discussed the importance of choosing the right Bipolar Disorder essay topic, let's explore some potential topics to consider:

The Causes of Bipolar Disorder: This topic delves into the various genetic, environmental, and neurobiological factors that contribute to the development of Bipolar Disorder.
The Symptoms and Diagnosis of Bipolar Disorder: This topic explores the different types of Bipolar Disorder, as well as the signs and symptoms that characterize the illness. It also discusses the process of diagnosing Bipolar Disorder and the challenges associated with accurately identifying the condition.
The Impact of Bipolar Disorder on Daily Life: This topic examines the ways in which Bipolar Disorder can affect an individual's personal, professional, and social life. It also discusses the challenges of managing the illness and maintaining a sense of normalcy.
Treatment Options for Bipolar Disorder: This topic explores the various pharmacological and non-pharmacological treatments available for Bipolar Disorder, as well as the benefits and drawbacks of each approach.
The Role of Therapy in Managing Bipolar Disorder: This topic delves into the different types of therapy that can be beneficial for individuals with Bipolar Disorder, such as cognitive-behavioral therapy, interpersonal therapy, and family-focused therapy.
The Stigma of Bipolar Disorder: This topic examines the negative stereotypes and misconceptions surrounding Bipolar Disorder and the impact of stigma on individuals living with the illness.
Bipolar Disorder in Children and Adolescents: This topic explores the unique challenges and considerations associated with diagnosing and treating Bipolar Disorder in young people.
The Link Between Bipolar Disorder and Substance Abuse: This topic discusses the high prevalence of co-occurring substance use disorders among individuals with Bipolar Disorder and the implications for treatment.
The Role of Genetics in Bipolar Disorder: This topic examines the genetic factors that increase the risk of developing Bipolar Disorder and the implications for early intervention and prevention.
Coping Strategies for Individuals with Bipolar Disorder: This topic explores the different self-care techniques and coping strategies that can help individuals manage the symptoms of Bipolar Disorder and improve their quality of life.

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Frontiers in Nutrition
Nutrition, Psychology and Brain Health
Research Topics

Nutrition and Mood Disorders

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The intricate relationship between nutrition and mental health has garnered significant attention in recent years. Emerging research suggests that dietary patterns and specific nutrients can profoundly impact mood disorders such as depression, anxiety, and bipolar disorder. This special issue aims to explore the multifaceted role of nutrition in the prevention, management, and treatment of mood disorders. The primary objective of this special issue is to consolidate current research findings and present novel insights into how various dietary factors influence mood disorders. By bringing together contributions from leading experts in nutrition, psychiatry, and neurobiology, we aim to provide a comprehensive overview of the current state of knowledge and identify potential avenues for future research. We invite original research articles, review papers, clinical trials, meta-analyses, and case studies that address, but are not limited to, the following topics: 1. Nutritional Epidemiology: o Associations between dietary patterns (e.g., Mediterranean diet, Western diet) and mood disorders. o The impact of micronutrients (e.g., vitamins, minerals) on mental health. 2. Biological Mechanisms: o The role of gut microbiota in the gut-brain axis and its impact on mood. o Inflammation, oxidative stress, and their modulation by dietary factors. o Neurotransmitter synthesis and function influenced by diet. 3. Clinical Interventions: o Efficacy of dietary interventions (e.g., omega-3 fatty acids, probiotics) in the treatment of mood disorders. o Nutritional strategies for the prevention and management of depression and anxiety. o The role of diet in the management of bipolar disorder. 4. Public Health and Policy: o The implications of nutritional guidelines for mental health. o Strategies for promoting mental health through dietary recommendations. o The role of socioeconomic factors in diet quality and mental health outcomes. 5. Special Populations: o Nutritional considerations in mood disorders across different age groups (children, adolescents, adults, and elderly). o Gender differences in dietary impact on mood disorders. o The role of nutrition in mood disorders among individuals with comorbid conditions (e.g., obesity, diabetes). 6. Vegan/vegetarian diet and effect on aging.

Keywords : Nutrition, Anxiety, Depression, Oxidative Tress, Nervous system, Neurodegeneration

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Bipolar Disorder
Conclusion. Bipolar disorder is a mental disorder that is characterized by extreme mood changes that range from mania to depression. Risk factors include lifestyle, genetics, environment, drug and alcohol abuse, and major life changes such as death or abuse. Symptoms depend on the type of mod.
Diagnosis and management of bipolar disorders
This review covers the clinical features, subtypes, prevalence, comorbidity, course, genetics, and treatments of bipolar disorders, a recurrent and chronic mood disorder. It does not provide the strongest evidence for the cause of bipolar disorders, but highlights the need for more research and precision medicine.
The challenges of living with bipolar disorder: a qualitative study of
Background. Bipolar disorder (BD) is a major mood disorder characterized by recurrent episodes of depression and (hypo)mania (Goodwin and Jamison 2007).According to the Diagnostic and Statistical Manual 5 (DSM-5), the two main subtypes are BD-I (manic episodes, often combined with depression) and BD-II (hypomanic episodes, combined with depression) (APA 2014).
Understanding Bipolar Disorder: An In-Depth Essay
A well-structured essay on bipolar disorder should include: 1. Introduction: Provide a brief overview of bipolar disorder and state the essay's main focus or thesis. 2. Background Information: Offer essential context about bipolar disorder, including its definition, types, and prevalence.
Bipolar disorders
This article provides an overview of bipolar disorders, a group of severe and chronic mental disorders that include bipolar I and bipolar II. It covers epidemiology, pathogenesis, screening, and treatment of bipolar disorders, but does not mention psychoactive substances or their effects.
Bipolar Disorder
This article provides an overview of bipolar disorder, including its classification, epidemiology, burden of illness, and treatment. It also discusses the role of genetics, neuroimaging, and ...
Bipolar disorders
Bipolar disorders are a complex group of severe and chronic disorders that includes bipolar I disorder, defined by the presence of a syndromal, manic episode, and bipolar II disorder, defined by the presence of a syndromal, hypomanic episode and a major depressive episode. Bipolar disorders substantially reduce psychosocial functioning and are ...
Mapping the scientific research on bipolar disorder: A scientometric
Bipolar disorder (BD) is a severe psychiatric illness with an increasing prevalence worldwide. Although the pathological mechanism of and pharmacological interventions for BD have been extensively investigated in preclinical and clinical studies, a scientometric analysis of the developmental trends, interdisciplinary frontiers, and research hotspots in this field has not yet been conducted.
A Review of Bipolar Disorder in Adults
Epidemiology. Bipolar I disorder starts on average at 18 years and bipolar II disorder at 22 years. 9,14 A community study using the Mood Disorder Questionnaire (MDQ) revealed a prevalence of 3.7 percent. 15 The National Comorbidity Study showed onset typically between 18 and 44, with higher rates between 18 and 34 than 35 and 54. 1 In a survey of members of the DBSA, more than half of the ...
Full article: Bipolar depression: the clinical characteristics and
Overview of bipolar disorder. Bipolar disorder is a chronic and complex mood disorder that is characterized by an admixture of manic (bipolar mania), hypomanic and depressive (bipolar depression) episodes, with significant subsyndromal symptoms that commonly present between major mood episodes Citation 1.Ranked among the leading causes of worldwide disability Citation 2, bipolar I disorder has ...
The Diagnosis and Management of Bipolar I and II Disorders
Making the Diagnosis. The first step toward the accurate diagnosis of BP-I or BP-II disorder is identifying current or past manic, hypomanic, and depressive epi-sodes. Diagnostic criteria for these types of mood episodes, and clinical probes for identi-fying key symptoms, are provided in Table 1.12 With this information, speci c bipo-fi lar ...
(PDF) Bipolar Disorder
Abstract. Bipolar disorder is a severe, complicated, and often misunderstood disorder that can have serious impacts on a person's quality of life, sense of self-worth, and overall health. This ...
Articles
Browse the latest research articles on bipolar disorders published in this peer-reviewed journal. Find topics such as lithium, genetics, mitochondrial DNA, social support, and more.
Bipolar Breakthrough
A genetic study led by Harvard Medical School and the Broad Institute finds a strong genetic risk factor for bipolar disorder and schizophrenia. The gene, AKAP11, interacts with a molecular pathway modified by lithium, the main treatment for bipolar disorder.
Diagnosis and treatment of patients with bipolar disorder: A review for
Introduction. Bipolar disorder (BD) is a chronic illness associated with severely debilitating symptoms that can have profound effects on both patients and their caregivers (Miller, 2006).BD typically begins in adolescence or early adulthood and can have life‐long adverse effects on the patient's mental and physical health, educational and occupational functioning, and interpersonal ...
128 Bipolar Disorder Research Paper Topics
The death of a loved one or an instance of abuse can serve as a trigger for the condition. Implications of Diagnosing and Treating Patients With Bipolar Disorder. The purpose of this essay is to examine a variety of legal, ethical, and cultural implications in treating patients with bipolar disorder.
Bipolar Disorder Essay Examples
2 Understanding Bipolar Disorder: Symptoms, Impact, and Treatment Approaches. Abstract Bipolar disorder is a chronic mental illness. This is an illness that several Americans have and suffer from each year. Bipolar disorder may be triggered by unfortunate events and stressful experiences. Mood swings usually accompany this disorder.
The challenges of living with bipolar disorder: a qualitative study of
Background In mental health care, clinical practice is often based on the best available research evidence. However, research findings are difficult to apply to clinical practice, resulting in an implementation gap. To bridge the gap between research and clinical practice, patients' perspectives should be used in health care and research. This study aimed to understand the challenges people ...
Bipolar Disorder Free Essay Examples And Topic Ideas
22 essay samples found. Bipolar disorder is a mental health condition characterized by extreme mood swings between emotional highs (mania or hypomania) and lows (depression). Essays on this topic could explore the symptoms, diagnosis, and treatment options for bipolar disorder. Additionally, discussions might extend to the impact of bipolar ...
Bipolar Disorder
Bipolar disorder, also known as bipolar affective disorder, is one of the top 10 leading causes of disability worldwide. Bipolar disorder is characterized by chronically occurring episodes of mania or hypomania alternating with depression and is often misdiagnosed initially. Treatment involves pharmacotherapy and psychosocial interventions, but ...
Bipolar I disorder: a qualitative study of the viewpoints of the family
Background Bipolar disorder is a common psychiatric disorder with a massive psychological and social burden. Research indicates that treatment adherence is not good in these patients. The families' knowledge about the disorder is fundamental for managing their patients' disorder. The purpose of the present study was to investigate the knowledge of the family members of a sample of Iranian ...
≡Essays on Bipolar Disorder. Free Examples of Research Paper Topics
2 pages / 1007 words. Bipolar disorder, also known as manic-depressive disorder, is a mental illness that affects an individual's mood, behavior, thoughts, and perceptions, leading to abnormal shifts in energy, mood, and functioning (Huxley, 2002). The symptoms of bipolar disorder are severe and can result in broken relationships, poor...
PDF Diagnosis and management of bipolar disorders
This article provides an overview of the clinical features, diagnostic subtypes, and major treatment modalities for bipolar disorder, based on the DSM-IV and DSM-5 criteria. It also discusses the challenges and advances in the understanding and treatment of bipolar disorder, such as genetics, neuroimaging, and precision medicine.
Nutrition and Mood Disorders
The intricate relationship between nutrition and mental health has garnered significant attention in recent years. Emerging research suggests that dietary patterns and specific nutrients can profoundly impact mood disorders such as depression, anxiety, and bipolar disorder. This special issue aims to explore the multifaceted role of nutrition in the prevention, management, and treatment of ...

Understanding Bipolar Disorder: An In-Depth Essay

What is Bipolar Disorder?

Types of Bipolar Disorder

Causes and Risk Factors

Common Symptoms of Bipolar Disorder

Diagnostic Criteria for Bipolar Disorder

Distinguishing Bipolar Disorder from other Mental Health Conditions

Effects of Bipolar Disorder on Personal Relationships

Challenges Faced by Individuals with Bipolar Disorder

Societal Stigma and Misunderstandings

Medication Options for Bipolar Disorder

Therapeutic Approaches for Bipolar Disorder

Lifestyle Changes to Support Mental Health

Choosing a Focus for the Essay

Structuring the Essay

Addressing Controversial Topics

Providing Reliable Sources

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128 Bipolar Disorder Essay Topic Ideas & Examples

Bipolar Disorder

2 Understanding Bipolar Disorder: Symptoms, Impact, and Treatment Approaches

3 Exploring Bipolar Disorder: Pathology, Characteristics and Care Strategies

4 Differentiating Bipolar Disorder and Schizophrenia: Unraveling Similarities

5 Exploring Bipolar Disorder through the Lens of Demi Lovato’s Journey

The challenges of living with bipolar disorder: a qualitative study of the implications for health care and research

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