Bipolar Disorder A Life-Long Illness
Unfortunately for all the medical advancements and discoveries the world has gone through and achieved in the last few years we have still been unable to find a cure for bipolar disorder. Therefore bipolar disorder is a serious issue which affects up to approximately 5.7 million people in the US alone every year. That amounts to 2.6 of the American population aged 18years or older being affected by the disorder every year. (Bipolar Disorder Statistics, 2006). One of the leading causes of disability, Bipolar disorder makes the patients unable to function and carry out and maintain long term relationships or remain employed for a long period of time. Patients who live on benefits and social security provided with the government put additional burden on the government for providing and covering substantial costs for the treatment of the disorder. These costs when accumulated can amount to a significant value for an individual person let alone a number of patients. Additionally this disorder causes emotional and physical trauma on both the patients and any other members of friends or family. The affects of this can be further complicated and intensified if the patient affected is young. This is often translated into reality as the median ages of the patients who first manifest the symptoms of the disease are 25. Patients suffering from intense physical and emotional trauma also often commit suicide. Taking all these elements into consideration bipolar disorder is a serious cause of concern for any nation let alone the US and therefore the whole system and its subsystems should come together and devise ways to battle this disorder and introduce measures and initiatives that support the patients and make their lives more manageable.
Background
Bipolar disorder belongs to a category of mood disorders that consist of abnormal spikes and depressions in moods of the patient. These abnormal moods are commonly referred as mania. Patients experiencing this disorder also suffer from episodes of depression as well. Other times they experience mixed episodes which consist of elements of both mania and depression at the same time (Monica Ramirez, 2006). However under normal circumstances these periods are separated by a time period of normality, with regards to moods. Unfortunately there have been cases where a patient experiences rapid cycling. Rapid cycling occurs when depression and mania rapidly alternate. Extreme manic episodes have been known to result in delusions, hallucinations and other psychotic symptoms. After considerable study and research health experts have been able to identify bipolar disorder that lie over a spectrum, known as the bipolar spectrum. This spectrum includes Bipolar I, Bipolar II, Cyclothymia and other types based on the severity of the symptoms.
A person is said to have Bipolar I disorder when heshe experiences manic or mixed episodes for at least seven days. These episodes are so severe in their nature and intensity that the patient needs immediate hospital care. The patient may also experience depression. Mania and depression are considered to be symptoms of the bipolar disorder when they depict a significant change from the person normal behavioral and mood pattern. Bipolar II disorder consists of episodes of depressions and episodes of hypomania (not the high intensity manic episodes) being faced by the patient alternatively. Cyclothymia is a form of Bipolar disorder that is lesser in intensity and milder than Bipolar I and Bipolar II disorders. Patients with Cyclothymia experience mild forms of depressions and hypomania for a period of two years. A patient is diagnosed to have Bipolar Disorder Not Otherwise Specified, when the symptoms heshe is displaying are clearly different from the individuals normal behavioral patterns and the symptoms being displayed do not meet the diagnostic requirements for either Bipolar I or Bipolar II Disorder (National Institute of Mental Health, 2009)
Variation in the human behavior regarding moods, energy levels and emotional states has always been a part of the human condition since the beginning. Some of the critical terms used in describing, recording and diagnosing the bipolar disorder, such as melancholia and mania originate Ancient Greek language. However the term Bipolar Disorder is fairly recent and points to the high and low ends of mood spectrum change (poles). Emil Kraepelin, a German psychiatrist is credited with the creation of the term manic-depressive illness which he used to describe all kinds of mood disorders in the late nineteenth century. However another German psychiatrist, Karl Leonhard was responsible for creating a distinction and coining the terms unipolar disorder and bipolar disorder in 1957.
Bipolar disorder is a serious medical concern for people all over the world. In the US alone it affects 5.7 million people each year (Bipolar Disorder Statistics, 2006). Whats even more worrying about this is the fact that more and more people are experiencing this disorder. In a study conducted by Blader and Carlson (2007) to analyze and asses the trend in hospitalization of patients having the disorder. Basing their study on primary psychiatric diagnosis which they collected from the annual National Hospital Discharge Survey (NHDS) for data from 1996 through 2004, Blader and Carlson were alarmed at finding out significant increase in children and adolescents discharge rates with regards to bipolar disorder. The results of such findings meant that for children who had a primary diagnosis of bipolar disorder, the population adjusted rate of hospital discharges from 1.3 per 10,000 US children in 1996 to 7.3 per 10,000 US children in 2006. In adolescents however this rate increased by four times (Current Understanding in the Development of Bipolar Disorder in Pediatric Patients, 2008). This is further graphically described in the figure below
A study based on the data from the National Epidemiological Catchment Area in the US, yielded a 0.8 lifetime prevalence rate for bipolar disorder I and 0.5 lifetime prevalence rate of bipolar disorder II and Cyclothymia. One or more than one symptoms were also included in this study as sub threshold diagnostic criteria. This study finally concluded that a total tally of 6.4 people have a disorder lying in the bipolar spectrum (Judd Akiskal, 2003). However a more recent analysis and study based on the US National Comorbidity Survey resulted in the conclusion that 1.1 met the lifetime prevalence for bipolar II, 1 for bipolar I and 2.4 for sub threshold symptoms. However there are limitation and variations in these finding s as most often than not prevalence studies are carried out by lay persons who have limited knowledge about the subject and who follow preplanned and structured interview patterns. Additionally the results are also influenced whether a categorical or spectrum approach is used. Therefore concern regarding both over and under diagnosis have surfaced recently (Phelps, 2006). The figure below graphically depicts the disability adjusted life year for patients of bipolar disorder.
As doctors and psychiatrist became more aware of this disorder and the medication and treatments methodologies that are most effective, they have started increasing the use of psychotropic medications for the treatment of this disorder. Madaan and Chang developed an algorithm that shows the flow of treatment of bipolar patients. This work was based on the previous study conducted by Kowatch and his colleagues.
In their study Maadan and Chang proposed that a patient must continue therapy for at least 6-8 weeks with the optimal dosage of the current medication heshe is using, before shifting to a new treatment and medication methodology or employing a combination of a host of different treatment options. However in clinical practice it is very common to treat bipolar disorder with a combination of medications and treatment options. This is applicable to the treatment of adults, children and adolescents. According to a study a mean of 3.4 medications for patients for the treatment of bipolar disorder was found out (Current Understanding in the Development of Bipolar Disorder in Pediatric Patients, 2008).
Due to such complicated and varied treatments and medications involved in addition to the intensive psychological care and hospitalization, bipolar disease puts an increasing monetary burden on the patients, their family and friends and the government itself as well. In the US alone it costs 7.6 Billion USD in direct healthcare costs each year for the treatment and medication of Bipolar disorder. If we look at it from the patients perspective then lifetime consumer costs amount to 12000USD for patients who experience a single manic episode, for people who undergo a multitude of manic episodes it costs up to 600,000USD in lifetime costs (Bipolar Disorder Fact Sheet, 2003). Diagnosis of the disorder due to its complexity and multitude of symptoms is based on observed behaviour and self reported incidents by the patients. Unfortunately the disorder tends to get worse if not treated. Over time if a person is not treated for the disorder heshe may experience more intense symptoms appearing more frequently as compared to the symptoms which came at the beginning of the disorder. Such delays in diagnosis and treatment cause the patient to suffer from personal, emotional, social and work related problems. This is due to the sudden and unexpected alteration in behaviour which causes disruption and distress. According to a study almost 50 of people who receive a delayed diagnosis or are misdiagnosis of bipolar disorder, abuse drugs and alcohol (Bipolar Disorder Fact Sheet, 2003). When a person experiences a depressive episode it increases the chances of suicide as well. This is corroborated by a study carried out by the National institute of Mental Health which concludes that Bipolar disorder results in 9.2 years in life reduction as one in five people having the disorder commit suicide (Bipolar Disorder Statistics, 2006).
Plan of Action
Awareness and lack of knowledge are the two main issues that need to be addressed in order to increase the societys knowledge, tolerance and understanding of bipolar disorder and to make lives more manageable and comfortable for the patients of the disorder. People who are the closest to the patients need to be educated and need to be aware of the tragedies and the emotional and physical stress the patients of the disorder are going through. They should be made to understand as to how to deal with such problems and become more tolerant to the condition of the patient. They should act a pillar of support, because effective support for bipolar disorder starts at home. Patients need people who are tolerant and understand their condition so that they can get some support and love and understanding. If a patient is not surrounded by a close circle of loving friends and family, then isolation and loneliness can set in which can cause depression. Therefore regular contact in itself is therapeutic for bipolar disorder patients. Additionally friends and family and society as a whole should pay greater attention to stop the disorder from passing on the next generation. Careful and comprehensive physical and psychological assessment of your spouse before getting married can also lead to children being born that have a reduced risk of experiencing this disorder. If we look at it from the patients perspective then heshe should understand and grasp some key elements that will go a long way in the treatment of this disorder. First of all hope and the belief that you can manage your symptoms and the disorder as a whole is essential for recovery. Good symptom management often leads to long periods of normality and wellness therefore patients should never lose hope. Personal responsibility is another key element. The patient should actively participate in his or her treatment. It is up to the patient to take action towards the stability of his or her moods. This includes activities like taking your prescribed medication, asking and taking medical help from professionals and keeping appointments with the health care providers. The patient needs to become a self advocate so that he or she can demand the treatment and medication that is needed to make the patients life more manageable and better. Education is another key element. The patient should be knowledgeable about his disorder, its symptoms and his or her condition. If a patient has sufficient knowledge about the bipolar disorder he or she will be better placed to make more accurate and informed decisions about all the aspects of his life and hisher treatment. As discussed earlier, effective recovery and wellness for patients of bipolar disorder require more than just a solo effort, support from close friends and family members is essential for increasing stability, quality and manageability of the life of the patient.
All of these efforts need initiatives to increase knowledge and understanding of the disorder. As the disorder manifest itself in children quite often, we could design a nationwide bipolar disorder awareness campaign, in which a few selected professional carry out certain informative sessions with children, providing them of information regarding the disorder and how to manage the symptoms. For each diagnosed and recognized patient of bipolar disorder, whether they be children or adult, a group of people must be assigned to them as community service so that they can provide support and love to the patient. The patient while benefitting from the care could take advantage s of cultivating new social relationships. Education programs through infomercials, pamphlets or in some cases house visits could also be provided to women who are pregnant so they fully understand how to deal with such a disorder if it manifests itself in their child. The government by mandate should also assign special days off for people with this disorder so that they can carry on with their professional lives while being able to manage their symptoms by relieving their stress in rougher periods of manic or depressive episodes. The government also needs to take a central role in our fight with this order more grants should be given to researchers that are carrying out promising studies on this disorder, more specialized facilities should be created for the treatment and medications of this disorder. Doctors and psychiatrist should also be given education and access to use a central database consisting of records and family history of all bipolar disorder patients so that they can easily draw upon the data to correctly diagnose the disorder in children of the people who are affected by this disorder.
Measure Success
In order to measure our success of our plan of action the two elements necessary are the life prevalence rate of the bipolar disorder and the reduction in the life time amount of money spent in the treatment and medication of the disorder. If our plan of action can bring about a 10 improvement in both our measures of success over a period of five years, we would consider the plan of action a success. Further improvement could be brought by learning and drawing upon the knowledge gathered by the help of the activities conducted in our plan of action. The best way to find information regarding both the elements that we have considered as our measures off success is to conduct detail surveys based on authentic and well organized and up to date databases and authentic information gathering institutes such as the national institute of mental health. When we have collected the data for over a period of five years we could present our research findings and the effectiveness of our plan of action to a proper and concerned audience by way of publishing a detailed article in a credible journal, so that after its peer reviewed it can gain further credibility and possibly adapted in other areas of the world if proved successful. Special presentation could also be designed and developed to be given to special audience s like the ministry of health so that they can grasp the essential of the plan of action and its effectiveness in reducing the life prevalence rate and the money spent throughout the life of a patient of the disorder.
Monitor
After we have identified our measures of success and developed our plan of action it is essential that we continue to measure the patients of the disorder and their symptoms in order to measure and analyze the effectiveness of our plan of action. In this case we could carry out periodic surveys consisting of both the psychiatrist and the patients themselves in order to collect relevant data that can be monitor regarding both the measures of our success. This could consist of medical records, financial details of the patients regarding monetary expenditure on treatment and medication of the bipolar disorder.
Conclusion
If the plan of action that I have developed is implemented effectively and properly it would go a long way in reducing the number of people that are undergoing the disorder. It would reduce the monetary pressure on both the patient and the government, freeing up essential funds that could be used to carry out further study the disorder or develop medication or treatment methods that make the lives of the patients more manageable and comfortable. Victims will have more support and understanding from their loved ones as well as the society as a whole reducing the number of suicides in such patients and the social and emotional trauma they face. Quality of life of such patients will improve significantly and they could enjoy a more productive life. Having a mentally and physically population is an asset for any country in the world let alone the US. The youth and children are the leaders of the world of tomorrow, having a healthy youth is positive for both the culture and economy of the US of A. if the plan of action yields success, we would be able to reduce the number of people who are affected by this disorder and this would do our part in helping the world to be a better place for everyone.
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