This paper examines Bipolar Disorder Type I from both theoretical and empirical perspectives. It begins by defining the disorder using DSM-IV diagnostic criteria and reviewing its prevalence, including the significant challenge of misdiagnosis. Two major theoretical frameworks are then applied: Peplau's Theory of Interpersonal Relations in Nursing, which emphasizes a collaborative nurse-patient relationship, and Cognitive Behavioral Therapy (CBT), which supports self-management and symptom recognition as adjuncts to medication. The paper concludes by evaluating the Mood Disorder Questionnaire (MDQ) as a reliable, clinically validated screening instrument for Bipolar I diagnosis.
Bipolar disorder, which was at one time called manic depressive disorder, is a mental illness defined by alternations between manic moods and clinical depression. It is now common to differentiate between Bipolar I and Bipolar II disorders. In a general sense, Bipolar I disorder most closely corresponds to the previously used terminology of manic depression. Bipolar I generates mood swings that are extremely severe and significantly impair functioning and quality of life. It can also entail psychotic episodes in some cases. Because of the severity of the disorder, many people suffering from Bipolar I are institutionalized. The length of each mood swing can range from days to months to years. Some people with this disorder remain in a certain state for so long that they no longer consider themselves to be bipolar. Then, unexpectedly, their mood will shift drastically in the opposite direction, causing extreme distress for both the sufferer and their loved ones (Joyce & Mitchell, 2005).
The DSM-IV provides the following criteria for Bipolar I Disorder:
"The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified" (p. 350).
According to Doran (2007), the lifetime prevalence of Bipolar Disorder Type I is approximately 1 percent of the U.S. population. However, when less strict criteria are used than those applied by the DSM-IV, Doran reports that studies estimate the actual prevalence to be five times higher.
Incidents of misdiagnosis also make it difficult to estimate the true number of bipolar sufferers. According to Hirschfeld (2002), "Results from the National Depressive and Manic Depressive Association (NDMDA) survey indicate that 73% of patients with bipolar disorder were misdiagnosed on initial presentation to a healthcare professional" (p. 9).
The essence of Peplau's model is to create a "shared experience" in which the nurse and the client experience the treatment process together on an equal plane, as opposed to the client merely being the passive receiver of the nurse's treatment. This theory therefore seems highly applicable to bipolar disorder because it is ultimately about finding a balance.
Peplau emphasized six methods of achieving this goal: observation, description, formulation, interpretation, validation, and intervention. She also identified six different roles that nurses play in the treatment process: the Stranger Role, the Resource Role, the Teaching Role, the Counseling Role, the Surrogate Role, and the Active Leadership Role (Meleis, 1991).
The ultimate goal of interpersonal nursing theory is to maximize each of these roles by focusing on the communication process. "For Peplau, the focus is on the nurse-patient relationship and its phases: orientation, identification, exploitation, and resolution; harnessing energy from anxiety and tension to positively defining, understanding, and meeting productively the problem at hand" (Meleis, 1991, p. 256).
The concepts of Peplau's model can be applied to the treatment of bipolar clients through a focus on compassion, understanding, and education. The nurse can assist patients by moving past the stranger role as quickly as possible, functioning simultaneously as teacher and counselor — in other words, becoming the patient's mentor and confidant. This requires excellent communication and listening skills on the part of the nurse.
"CBT as adjunct treatment for symptom self-management"
"MDQ validity, reliability, and clinical screening use"
"Cited sources and bibliography"
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