Bipolar Disorder on the Routine Life of the Individual
Statement of Thesis: Bipolar disorder is an intricate physiological and psychological disorder that can control, tamper, and falsify a person's thoughts and actions in their daily life.
The work of Merikangas, et al. entitled "Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication" reports a growing acknowledgement that bipolar disorder has a "spectrum of expression that is substantially more common than the 1% BP-I prevalence traditionally found in population surveys." (2007) Merikangas, et al. report a study with the objective of estimating "the prevalence, correlates, and treatment patterns of bipolar spectrum disorder in the U.S. population." (2007)
The study was conducted via direct interviews in household settings in the United States. Participants are stated to have been a "nationally representative sample of 9282 English-speaking adults (aged >or=18 years)." (Merikangas, et al., 2007) Main outcome measures are stated as Version 3.0 of the World Health Organization's Composite International Diagnostic Interview, a fully structured lay-administered diagnostic interview, was used to assess DSM-IV lifetime and 12-month Axis I disorders. Subthreshold BPD was defined as recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania. Indicators of clinical severity included age at onset, chronicity, symptom severity, role impairment, co morbidity, and treatment." (Merikangas, et al., 2007)
The study results state "lifetime and 12-month prevalence estimates are 1.0% (0.6%) for BP-I, 1.1% (0.8%) for BP-II, and 2.4% (1.4%) for subthreshold BPD. Most respondents with threshold and subthreshold BPD had lifetime comorbidity with other Axis I disorders, particularly anxiety disorders. Clinical severity and role impairment are greater for threshold than for subthreshold BPD and for BP-II than for BP-I episodes of major depression, but subthreshold cases still have moderate to severe clinical severity and role impairment. Although most people with BPD receive lifetime professional treatment for emotional problems, use of antimanic medication is uncommon, especially in general medical settings." (2009) The study concludes by stating that subthreshhold BPD "is common, clinically significant, and underdetected in treatment settings. Inappropriate treatment of BPD is a serious problem in the U.S. population. Explicit criteria are needed to define subthreshold BPD for future clinical and research purposes." (Merikangas, et al., 2007)
The work of Lichenstein, et al. (2009) report in the work entitled "Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study" that they linked the "multi-generation register which contains information about all children and their parents in Sweden, and the hospital discharge register, which includes all public psychiatric inpatient admissions in Sweden. We identified 9,009,202 unique individuals in more than 2 million nuclear families between 1973 and 2004." (Lichenstein, et al., 2009)
Those who were at risk for schizophrenia, bipolar disorder and comorbidity were assessed for biological and adoptive parents, offspring, full-siblings and half-siblings of probands with one of the diseases." (Lichenstein, et al., 2009) This was accomplished through a multivariate generalised linear mixed model for analysis of genetic and environmental contributions to liability for schizophrenia, bipolar disorder, and the comorbidity." (Lichenstein, et al., 2009) Reported findings include those as follows: "First-degree relatives of probands with either schizophrenia (n=35-985) or bipolar disorder (n=40-487) were at increased risk of these disorders. Half-siblings had a significantly increased risk (schizophrenia: relative risk [RR] 3-6, 95% CI 2-3 -- 5-5 for maternal half-siblings, and 2-7, 1-9 -- 3-8 for paternal half-siblings; bipolar disorder: 4-5, 2-7 -- 7-4 for maternal half-siblings, and 2-4, 1-4 -- 4-1 for paternal half-siblings), but substantially lower than that of the full-siblings (schizophrenia: 9-0, 8-5 -- 11 6; bipolar disorder: 7-9, 7-1 -- 8-8). When relatives of probands with bipolar disorder were analyzed, increased risks for schizophrenia existed for all relationships, including adopted children to biological parents with bipolar disorder. Heritability for schizophrenia and bipolar disorder was 64% and 59%, respectively. Shared environmental effects were small but substantial (schizophrenia: 4-5%, 4-4% -- 7-4%; bipolar disorder: 3-4%, 2-3% -- 6-2%) for both disorders. The comorbidity between disorders was mainly (63%) due to additive genetic effects common to both disorders." (Lichenstein, et al., 2009) It is concluded that evidence was shown that is similar to findings in molecular genetic studies that a common genetic cause is shared and these findings are stated to present a challenge to the current "nosological dichotomy between schizophrenia and bipolar disorder, and are consistent with a reappraisal of these disorders as distinct diagnostic entities." (Lichenstein, et al., 2009)
The work of Strawkowski, et al. (2007) entitled "Effects of Co-occurring Cannabis Use Disorders on the Course of Bipolar Disorder After a First Hospitalization for Mania" states that Cannabis use disorders are known to co-occur commonly in dipolar disorder" and these authors report a study that sought to identify how the sequence of the onsets of a cannabis use disorder and bipolar disorder is associated with the subsequent course of each condition." Patients studied were those meeting the criteria for bipolar I disorder (manic or mixed) and are stated to have been between the ages of 12 and 25 years of age with no previous hospitalizations and only minimal treatment prior to the study. Follow-up of patients is stated at five years and to include 33 "in whom the onset of a cannabis use disorder preceded the onset of bipolar disorder (cannabis first), 36 in whom bipolar disorder onset preceded the onset of cannabis abuse (bipolar first), and 75 with bipolar disorder only." (Strawkowski, et al., 2007) Primary outcome measures were stated to be as follows: (1) Symptomatic recovery and recurrence of both conditions; (2) percentage of follow-up time with affective and cannabis use disorder symptoms. (Strawkowski, et al., 2009) The study states findings that the cannabis group recovered better than other groups however when potential mediator variables were adjusted for the results are stated to have failed to persist. Affective episodes and rapid cycling was linked to cannabis use disorders immediately following hospitalization followed by rapid rates of recurrence." (Strawkowski, et al., 2009) Conclusions stated include that the sequences of onsets of bipolar onset and cannabis use were not as pronounced as that observed in co-occuring alcohol and bipolar disorders.
The work of Post and Liverish (2007) entitled "The Role of Psychosocial Stress in the Onset and Progression of Bipolar Disorder and its Comorbidities: The Need for Earlier and Alternative Modes of Therapeutic Intervention" reports that psychosocial stress plays a role that is prominent "at multiple junctures in the onset and course of bipolar disorder." (Post and Leverich ) Additionally reported is that experiential to recurrence and progression onset of affective episodes and the great prevalence of substance abuse comorbidity as well. It is reported in "a substantial group of controlled studies " that indicated is: "various cognitive behavioral psychotherapies and psycho-educational approaches may yield better outcomes in bipolar disorder than treatment as usual. Yet these approaches do not appear to be frequently or systematically employed in clinical practice, and this may contribute to the considerable residual morbidity and mortality associated with conventional treatment." (2011, ) Earlier treatment resulting in more effective treatment through provision of supportive interventions are all important factors in the consideration of the long-term care of individuals with comorbid conditions of bipolar and drug or alcohol abuse. Possible practical approaches to reducing this deficit (in an illness that is already underdiagnosed and undertreated even with routine medications) are offered. Without the mobilization of new clinical and public health approaches to earlier and more effective treatment and supportive interventions, bipolar illness will continue to have grave implications for many patients' long-term well being. (Post and Leverich, 2009)
The 2007 work of Morena, et al. states that bipolar order while believed to onset many times during childhood remains a mystery to a great extent in terms of the national trending in diagnosing and managing dipolar disorder in young individuals. Morena et al. reports a study that examined the national trends in outpatient visits with diagnosis of bipolar disorder and compares the treatment provided to youth vs. The treatment provided to adults during those type visits. The design involved the comparison of the "…rates of growth between 1994-1995 and 2002-2003 in visits with a bipolar disorder diagnosis by individuals aged 0 to 19 years vs. those aged 20 years or older. For the period of 1999 to 2003, we also compare demographic, clinical, and treatment characteristics of youth and adult bipolar disorder visits."(Morena, et al., 2010)
The study setting was outpatient visits to physicians in office-based practice and participants were chosen through a process of identifying those who visited from the National Ambulatory Medical Care Survey (1999-2003) with a bipolar diagnosis. Primary outcome measures are stated to be "Visits with a diagnosis of bipolar disorder by youth (aged 0-19 years) and by adults (aged 20 years)." (Morena, et al., 2010)
The study reports findings that the estimated "annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994-1995) to 1003 (2002-2003) visits per 100-000 population, and adult visits with a diagnosis of bipolar disorder…