Free Literature Review On Bipolar Disorder

Literature Review

A mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning. It is easy to forget that Bipolar Disorder, as we know it, is a recent construct. Bipolar Disorder is now recognized as a potentially treatable psychiatric illness that has substantial mortality and high economic impact. According to Swann (2006), every aspect of its definition, boundaries, mechanism, and treatment, however, is subject to debate. We need to understand Bipolar Disorder well enough that we will no longer wait for a manic episode before we can diagnose.

Bipolar Disorder

Bipolar Disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks. Symptoms of Bipolar Disorder can be severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar Disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But this illness can be treated, and people who are afflicted with it can lead full and productive lives. Bipolar disorder often appears in the late teens or early adult years. At least half of all cases start before age 25.1. Some people have their first symptoms during childhood, while others may develop symptoms later in life. Bipolar Disorder is not easy to spot when it starts. Some people suffer for years before they are properly diagnosed and treated. The National Institute of Mental Health (NIMH) claims that Bipolar Disorder is like diabetes or heart disease as they are long-term illnesses that must be carefully managed throughout the life of the person affected by them.
The NIMH revealed that Bipolar Disorder affects approximately 5.7 million adult Americans or about 2.6% of the U.S. population age 18 and older every year. The median age of onset for Bipolar Disorder is 25 years, although the illness can start in early childhood or as late as the 40's and 50's. An equal number of men and women develop Bipolar Disorder and it is found in all ages, races, ethnic groups and social classes. More than two-thirds of people with Bipolar Disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component (NIMH).

Prevalence Bipolar Disorder

The National Comorbidity Study reported a lifetime prevalence of nearly 4% for Bipolar Disorder. This illness is more common in women than in men, with a ratio of approximately 3:2. Centers for Disease Controls and Prevention (CDC) reveals that Bipolar Disorder has been deemed the most expensive behavioral health care diagnosis, costing more than twice as much as depression per affected individual. The annual insurance payments were greater for medical services for persons with Bipolar Disorder than for patients with other behavioral healthcare diagnoses.
Approximately 200,000 individuals with Bipolar Disorder are homeless, constituting 1/3 of the approximate 600,000 homeless population. It is also noted that 90,000 individuals with Bipolar Disorder are in the hospital. According to Wyatt, Bipolar Disorder affects 1% of the population, which accounts for a fourth of all mental health costs and takes up one in three psychiatric hospital beds. (CDC)

Challenges

People with bipolar disorder can face many challenges — from the illness’s fluctuating feelings to its destructive effects on relationships.
The first challenge is feeling uncontrollable symptoms, such as mood changes that can seem to appear suddenly and without provocation. According to Sheri Van Dijk, MSW, these fluctuating moods can diminish one’s daily functioning and ruin relationships as well.
The second challenge is that Bipolar Disorder can be hard on relationships. Van Dijk also states that the very symptoms of swinging moods and risky behaviors often leave loved ones feeling confused and exhausted, as if they are walking on egg shells.
The third challenge involves its medication. According to Johnson, “There is ‘one size fits all’ medication that helps everyone with Bipolar Disorder.” Lithium is typically the first line of treatment, but for some people the side effects are especially troublesome. Finding the right medication (or combination of medications) can seem like a daunting process.
According to Tartakovsky, about two-thirds of people with Bipolar Disorder also have a diagnosable anxiety disorder. Psychotherapy is tremendously helpful for managing Bipolar Disorder and the above challenges. It is important that anyone who has been prescribed medications should not stop taking them abruptly as it will boost the risk for relapse. Tartakovsky also states that the person should communicate regularly with his/her doctor.

Treatment Approaches

The Mental Health Cooperative (MHC) is a non-profit outpatient facility that treats Bipolar Disorder with a unique service model, intensive community-based case management, individual and family psychotherapy, and psychiatric clinic services. The MHC statement goal is: “Here to help! You are the center of the team, along with your case manager, psychiatric provider, and therapist as we work together to help meet your behavioral health needs.”
A case manager connects the clients with services they may need. A psychiatrist helps clients to understand their symptoms and recommends a plan of care. A therapist assists clients in learning new skills and strategies. The nurse provides health support, educates and assists clients in goal setting.
Bipolar Disorder is very treatable. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended. Medication alone or a combination of psychotherapy and medication is optimal for managing the disorder over time. Medications known as “mood stabilizers” are usually prescribed to help control Bipolar Disorder. In most cases, this illness is much better controlled if treatment is continuous.
Mood changes can still occur even when there are no breaks in treatment. Thus, working closely with a psychiatrist and communicating openly can make a difference in the effectiveness of treatment (American Psychological Association).
Mood stabilizers are most commonly used as preventive treatment for mania and depression states and are also used to improve symptoms during acute manic episode, hypo manic episode, and mixed episodes. Mood stabilizers also function to reduce symptoms of depression. The most commonly used mood stabilizers are lithium, valproate or Depakote, and carbamazepine or Tegretol.
Studies show that one out of three persons who take mood-stabilizing medications for life will be free of the symptoms of Bipolar Disorder. Other than mood stabilizers, other types of medications are also available to help those affected by Bipolar Disorder. Anti-anxiety medications such as lorazepam or Ativan and clonazepam or Klonopin and antipsychotic drugs, such haloperidol or Haldol and perphenazine or Trilafon are used for insomnia and work together with the mood stabilizers.
Antidepressants are prescribed together with mood stabilizers in order to prevent the patient from experiencing extreme episodes. Antidepressants, if used on their own in the treatment of Bipolar Disorder, can push the person’s mood up too high causing hypomania, mania, or rapid cycling. Most experts consider Wellbutrin or Prozac, and Luvox, Paxil or Zoloft as the two types of antidepressants to be the most effective for patients with Bipolar Disorder.
The Center for Mental Health Services (CMHS) estimates that the country's 2,100 consumer-run organizations, those that have mental health consumers as more than 50% of decision-makers, serve more than 500,000 people each year. Many drop-in centers, including the newly developed Brevard Drop-in Center, in Melbourne, Florida, serve needs outside of the traditional mental health care system. According to Jean McPhaden, the Executive Director of the Brevard Center and a mental health consumer, instead of clinical support, the drop-in center simply offers safe environments for people to socialize, communicate and participate in activities that support recovery.
According to McPhaden, at the Brevard Center, the most popular activities include the peer-run support groups, member-led arts-and-crafts projects, and free phone service. But most importantly, members enjoy the center's comfortable, unstructured atmosphere, and the chance to interact with people who understand where what they are going though.
According to Cynkar, some consumers find that their development and recovery are enhanced by their mental health advocacy efforts through their drop-in center. By helping other members obtain housing, transportation and other government services, or by educating the public about mental health issues, consumers recognize that they are also helping themselves.

Benefits of Support Groups

A support group is a group of people with a particular condition, such as depression or Bipolar Disorder, who meet regularly to discuss their problems and their strategies for coping.
Regardless of format, in a support group, people find other people with problems similar to theirs. Members of a support group typically share their personal experiences and offer one another emotional comfort and moral support. They may also offer practical advice and tips to help each other cope with their situation.
According to Mayo Clinic (2015), the benefits of participating in support groups may include: feeling less lonely, isolated or judged; gaining a sense of empowerment and control; improving one’s coping skills and sense of adjustment; talking openly and honestly about one’s feelings; reducing distress, depression or anxiety; developing a clearer understanding of what to expect with their situation; getting practical advice or information about treatment options; and comparing notes about resources, such as doctors and alternative options.

Shortage of Support Groups

Encouraging people with mood disorders to attend a self-help group was difficult. In the study of Hill, Silk, Yeaton (2000), patients (N=226) hospitalized for major depression or Bipolar Disorder randomly assigned a Manic-Depressive and Depressive Association (MDDA) sponsor were compared to those who were not assigned a sponsor. Volunteer sponsors with stabilized illnesses received training on introducing MDDA and accompanying an individual to a meeting. Researchers compared attendance at an MDDA meeting after an individual went with a sponsor. Individuals with sponsors were almost seven times as likely (6.8) to attend subsequent meeting(s) on their own than those without sponsors. The proportion of individuals attending meetings was greater among persons with sponsors (56%) than those without sponsors (15%).
“Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life” (Hill, Silk, Yeaton, 2000).

Methodology

Primary and secondary data collection methods will be used in the study. Primary data collection methods such as interviews, surveys and use of questionnaires will be used in the study. Samples will be used in the course of provide raw data regarding the bipolar disorder. Both qualitative and quantitative methods will be used as primary data collections mechanisms.
The research will use a mixture of both qualitative research methods and quantitative research. Qualitative research will be used as there is need to conduct an in depth analysis of the bipolar disorder. Qualitative techniques of data collection will be used to great extent in the research. Qualitative research methods attempts to answer why something happens and not just what happened. In this regard, it will be an instrumental tool in researching on the bipolar disorder. It is a useful research methodology in health research.
Participatory research techniques will be used in the study. Individuals will be allowed to participate in the research exercise as stakeholders (Dongre A, et al, 2009, pg 11). Victims of bipolar order and other people having knowledge on bipolar order will be allowed to participate in the research. Pair wise ranking, Venn diagram and social mapping will be used in the study.
In-depth analysis techniques such as interviews and discussions will be used in the study (Dongre A, et al, 2009, pg 12). Key informant interviews, in- depth Interviews and focus group discussions will be conducted to ensure that more reliable date is obtained on the bipolar disorder. These methods are useful in health and medical research.
Systematic technique can work with other research methods such as participatory research methods. It will, therefore, be used in the study to come up with credible data.
Sampling techniques will be used as one of the research tools. Samples will used in the study (Michael, A et al. pg 6).
A combination of qualitative and quantitative research methods is ensures that the benefits of all the approaches are tapped during the study. Both qualitative and quantitative research methods have their limitations (Gill, P 2008, pg.293). These limitations will be reduced if the two approaches are integrated.
Quantitative data collection methods should be used for less in-depth analysis. It is used in making generalizations about an issue under research. Qualitative research offers the in-depth analysis that quantitative research does not offer (Maclean, L 1998, pg. 16). Quantitative data collection methods are useful short term research methods. It is a quick way of obtaining results in a study.
Secondary date collection methods will be used in the study. Scholarly books, journals reports and articles will be reviewed. This method of study will be useful given the time and financial constraints of the study. Documentary review is a secondary data collection tool that will be utilized in the research.
Qualitative research methods have weaknesses which should be complemented by quantitative data collection methods. Qualitative data lacks objectivity and interviewers are required to be highly qualified (Choy, L 2014, pg.101). Qualitative research method is time consuming due to the long time taken in conducting interviews. These limitations can be addressed by use of other quantitative data collection.
Resource constraints are a major hindrance to quantitative research as it requires huge resources (Choy, L 2014, pg.101). Large sample sizes cannot be dealt with through quantitative data collection methods due to financial implications.

Limitations

The research should be conducted within a short period time. The research should be finished in 3 months. This means that the research will use small sample sizes collected within limited areas. Small sample sizes may affect the credibility of the research. The data may, therefore, not be representative of the whole situation. Since the issue under study is rare, more research coverage is necessary to ensure that the data obtained for analysis is credible.
Time limitation is a hindrance to research. More time would result into more reliable and representative data.
Constraints in terms of the specialists will be a limitation to the study. The research requires more skilled personnel in health matters. The data collection methods that will be used also require the use of skilled and expert interviewers. Quantitative data collection methods will require the use of more qualified experts which is lacking. Lack of specialists given the unique nature of the bipolar condition is a major hindrance to the study. Due to the uniqueness of the health condition, most correspondents may not be aware of the condition. Their participation in the research will require more expert guidance.
Finances are also a limitation to on the study. The study would have been bigger and, therefore, more reliable if the finances were not an issue in the research. The Uniqueness of the health condition requires bigger sample sizes and large geographical and population coverage which is not possible with the financial constraints.
Quantitative data collection methods require more resources. Since it will be used in the study more finances will be needed in the study. Limited finances will therefore impact on the research.

References

Dongre A, et al (2009) “Application of Qualitative Methods in Health Research: An Overview”, Online J Health Allied Scs, 8(4):3 http://www.ojhas.org/issue32/2009-4-3.htm
Michael, A et al “Getting from What to Why: Using Qualitative Methods in Public Health Systems Research”, Retrieved from http://www.academyhealth.org/files/publications/QMforPH.pdf
Maclean, L (1998) “Blending qualitative and quantitative study methods in health services research”, Health Informatics Journal 4, 15-22
Choy, L (2014) “The Strengths and Weaknesses of Research Methodology: Comparison and Complimentary between Qualitative and Quantitative Approaches” OSR Journal of Humanities and Social Science (IOSR-JHSS) 19(4), PP 99-104
Opdenakker, R (2006) “Advantages and Disadvantages of Four Interview Techniques in Qualitative Research” Retrieved from http://www.qualitative-research.net/index.php/fqs/article/view/175/392
“Qualitative Research Methods: A Data Collector’s Field Guide” Retrieved from http://www.ccs.neu.edu/course/is4800sp12/resources/qualmethods.pdf
Gill, P (2008) “Methods of data collection in qualitative research: interviews and focus groups” British Dental Journal 204, 291 – 295.