PTSD and Bipolar Mental Health

Culture and Health Nursing
Case Study: Jeannette
Treating patients appropriately demands that providers foster an environment in which patients can be candid about their health conditions. It should be viewed as a positive first step that Jeanette and her mother disclosed the fact that they have been using a Haitian voodoo priestess (mambo) coming to the house to treat Jeanette. Unfortunately, many of the herbs used in such traditional practices are not only ineffective, but can be potentially dangerous, particularly if mixed with conventional medical treatments such as antidepressants (Kelak, Cheah, & Safii, 2018). Mental health issues such as posttraumatic stress disorder can be confusing and frightening for a family, and using traditional medicine may be comforting to people like Jeanette’s mother. It may also be less traumatic to think of her daughter as cursed rather than as suffering from a mental illness.
Clinicians must be culturally sensitive. Seeking spiritual comfort is a natural and accepted part of treatment. On the other hand, some spiritual practices (such as the aforementioned herbs) can be counterproductive and delay needed conventional medical treatment. Additionally, posttraumatic stress is a neurobiological issue as well as a mental health issue. Its symptoms can be extremely severe and involve unlearning ingrained fear-based responses. “PTSD was found to be associated with deficits in fear extinction, increased generalization of fear, and a negative bias of viewing threat from neutral stimuli and feeling danger in a safe environment” (Abdallah, et al. 2019, par.3). Unlearning the patterns of behavior that cause the individual to re-experience the trauma she has undergone requires treatment beyond the care Jeanette is currently receiving. Evidence-based medical advice suggests that a combination of talk-based therapy found to work well for PTSD patients such as cognitive behavioral therapy (CBT) and targeted pharmacology to treat anxiety and depression is recommended.
Case Study: Julie
Ideally, bipolar patients should be treated with a combined approach of medication to reduce the severity of their mood cycles and talk-based therapies to address the complications their illness has caused in their life. Bipolar disorder is characterized by alternating periods of depression with mania. The severity is dependent upon the type of bipolarity, with some patients experiencing extreme shifts between mania and depression, while others merely experience more mild depression alternated with periods of hypomania. The most common forms of treatment are mood stabilizers, or in some instances the use of atypical antipsychotics (“Bipolar Disorder,” 2020). But while bipolar disorder is considered a mental health condition which requires some form of chemical intervention, this does not mean patients cannot benefit from talk therapy. In fact, it is usually recommended that the two be used in conjunction, particularly when a patient like Julie is experiencing a transition into new motherhood.
As seen in Julie’s case, a traumatic life event triggered a depressive state and a suicide attempt (Salagre, et al, 2018). Bipolar patients are at particularly high risk for suicide, and are frequently co-morbid for self-harm. Even in women without previous mental health conditions, postpartum depression can be severe due to the biochemical and sociological changes initiated by pregnancy and delivery. In Julie’s case, a refusal to adhere to treatment may be seen as a cry for help. But it may also be that Julie is experiencing side effects from her medication that she finds unpleasant. Regardless, it is vital to speak to the patient and to gain a sense of how to make a treatment program useful and acceptable to her, combining what may need to be an adjusted medication schedule along with a form of therapy that is supported with evidence-based research to suit the needs of a bipolar patient. Involving Julie’s partner, with Julie’s consent, may also be useful to assume more of the burdens of childcare.
References
Abdallah, C. G., Averill, L. A., Akiki, T. J., Raza, M., Averill, C. L., Gomaa, H., Adikey, A., & Krystal, J. H. (2019). The neurobiology and pharmacotherapy of posttraumatic stress disorder. Annual Review of Pharmacology and Toxicology, 59, 171–189. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326888/
Bipolar disorder. (2020). NIH. Retrieved from: https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml
Kelak, J. A., Cheah, W. L., & Safii, R. (2018). Patient’s decision to disclose the use of traditional and complementary medicine to medical doctor: A descriptive phenomenology study. Evidence-Based Complementary and Alternative Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832099/
Salagre, E., Dodd, S., Aedo, A., Rosa, A., Amoretti, S., Pinzon, J., Reinares, M., Berk, M., Kapczinski, F. P., Vieta, E., & Grande, I. (2018). Toward precision psychiatry in bipolar Disorder: Staging 2.0. Frontiers in Psychiatry, 9, 641. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282906/