CLINICAL PERSPECTIVES OF BIPOLAR DISORDER

Outubro de 2021 – Vol. 26 – Nº 10

Yuana Ivia Ponte Viana¹, Guilherme Pinho Cardoso¹, Modesto Leite Rolim Neto¹.

¹School of Medicine, Federal University of Cariri – UFCA, Barbalha, Ceará, Brazil.

Corresponding Author

Modesto Leite Rolim Neto, PhD

¹School of Medicine, Federal University of Cariri – UFCA, Barbalha, Ceará, Brazil.

Phone: (+55 88 99042979)

Email: [email protected]

Abstract

Background: Bipolar Disorder is a mental illness that affects up to 1% of the world’s population. This condition causes a significant drop in the life expectancy of these individuals, who goes through life to trying to control the symptoms. This implies in hospitalizations, medical monitoring and psychosocial accompaniment, which is not enough to accomplish their well-being and quality of life.

Objective: To analyze how the clinical follow-up of these patients occurs, the difficulties that come with this diagnosis, why they live 10 to 15 years less than the rest of the population and what is being done to improve this situation.

Results: according to the sources used for the research, we observed that the diagnosis of bipolar disorder is accompanied by several stigmas, including the clinical aspect. The deaths of these patients do not occur only by suicide, but most of them die at early ages for relatively common problems such as heart attack, diabetes or stroke. This happens because the symptoms of these problems are covered up by the diagnosis of mental illness.

Conclusion: Patients with bipolar disorder require special attention. Careful analysis of each clinical picture may help these patients to have a longer life expectancy. In addition, more alternative treatments, such as psychosocial assistance, are needed to observe more carefully the evolution of these and help them deal with their illness.

Keywords: Bipolar Disorder; Mental Illness; Clinical Aspect; Suicide.

1.Introduction

Bipolar disorder (BD) is a serious mental condition with intense mood swings where the individual can quickly change from a state of happiness or maniac to sadness and depression (American Psychiatric Association-APA, 2000). That illness is present in 2-3% of population independent of ethnic, race, nationality or culture (Bauer et al.,2018). This individual’s life expectancy can be reduced in at least 10 years and only walking to a worst-case scenario (G1, 2018a). Here we show that this situation occurs by many reasons, like the delay in diagnostic, the difficulty in adapt to the treatment and the low attention health professionals give to other symptoms besides the mental illness (New York Times, 2018a, New York Times, 2017a).

To recognize a BD the psychiatric uses a series of questionnaires and count with their experience to diagnostic the specific disease (G1, 2018a). In many cases, patients only find out their BD after years of treatment for other conditions, usually depression (New York Times, 2018a). This mistake is related with the depressions or maniac episodes, that happens in almost 40% of people with bipolar disorder within 2 years after recovering from the first episode. The primer difference between them is that in depression the low energy state is persistent, while in BD it comes with mania or hypomania episodes (G1, 2018a).

In the future, many advance can be done in this parameter. In Brazil, researches have been made about diagnostic BD based in the individual dream (G1, 2018b). Beyond that, studies try to relate some mental health problems with brains MRI and other imaging methods, while genetics’ developments searches genes carry BD characteristic (Bauer et al., 2018). Despite that, academic study and the public attention still marginalizes this subject (New York Times, 2018a).

The analyses clinic of the BD patient is important to the comprehension of the low life expectancy, which can be explained by many factors. suicide rates among these people are 15% higher than in the rest of the population (PubMed 2018a). some factors related are early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities and treatment. Another problem is the health systems failures in patient management, professionals are not always prepared to deal with episodes of depression and dementia, which in the worst case can lead to suicide, as with an NHS user in London, in which the patient had already tried the act on the same day with an object and this was not withdrawn by the team responsible (The Guardian, 2018a). Besides that, the BD diagnostic influence in how the Clinicians treat the person, attributing all their symptoms to the mental illness leading to misdiagnosis (New York Times, 2018a).

Even with an accurate diagnostic, the management of all the treatment is a challenge, starting with how to optimize the treatment, because it should be personalized to every patient according to their clinical progress, and aligned with their predominant polarity, and how to balance risk and benefits of the polypharmacy (Bauer et al., 2018, Vieta et al., 2018). This difficult have been affecting the relation between health professional and patient. The clinicians have been treating the BD patients, and individual with others serious mental problems, as their case wore hopelessly. This gloom point of view is taking way some possibilities from those individuals since not all treatment possibilities or tests have been offered. (New York Times, 2018a).

Recent studies show the importance to start a medicament in earlier stages, that improves the probability of the efficacy of treatment while a delay in treatment can increase re risk of suicidal attempts and increase the duration of the illness (Vieta et al.,2018), because the BD is a neurodegenerative illness, inducing a progressive loss of cognitive function. Usually the patients took several years of experimentation to find the rightful medication and adapt to the treatment, while not finding the correct medication they report a miss of his creativity and productivity and losing their ability to manage one’s thoughts, emotions, behaviors and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support(Bauer et al., 2018, WHO, 2012a).

Today the medicaments treatment of BD is based on lithium or valproate or the second generation of antipsychotics (aripiprazole, olanzapine, paliperidone extended-release, quetiapine, and risperidone long-acting injection release). If one of this is not feasible, the first-generation antipsychotics or carbamazepine may be used (WHO, 2015). All these treatments need to be supervised by a specialist. (Plans et al, 2018). On the other hand, the same drugs that treat can cause tremor, muscular weakness, diabetes insipidus, cardiac arrhythmias, lethargy (WHO, 2009a). These side effects are the reason why sometimes individuals have difficulties to adhere to drug treatment (WHO, 2015a/ New York Times, 2017a).

Despite the enormous importance of the drug treatment, that is not the only possibility. Some patients that have problems with most drugs have to use alternative ways to control his emotions, like meditation, dream therapy, exercise and nutrition (New York Times, 2017a). This can happen because BD is not only a result of a genetic inherence but also environmental conditions (Vieta et al., 2018). (Table 1)

Adapted from: PEBMED 2018a

The Psychoeducation should be routinely offered because it can decrease the risk of relapse, improve treatment adherence, and reduce the number and length of hospitalization (Vieta et al.,2018). In addition, it can help to enhance independent living skills, vocational and economic inclusion, and develop cognitive and social abilities. That can be reached by a series of cognitive-behavioral therapy and family interventions. However, trained professionals, whom can evaluate the situations of the patient and the people that are related to, can only practice this activity. (WHO, 2012a/ WHO, 2015b).

A study showed patients with BD had significantly worse family functioning in all domains, like problem-solving, communication, roles, affective responsiveness, affective involvement, behavior control, general functioning, compared with Families with no member with mental conditions (Altamura et al, 2018).  This condition is damaging to the sick individual and all the people around him, and make the skill development harder than the usual, what evidence the great importance of the interventions made by professionals (Altamura et al, 2018/ WHO 2012a).

The social environment is also important to the wellbeing of BD patient. Activities aimed at improving community attitudes towards people with mental conditions may be considered for implementation. These activities should be planned and implemented with the involvement of the service users, careers and the wider community (WHO, 2012b). An example of that in many universities have wellbeing advisers or mental health advisers are able to co-ordinate support for individuals and help make sure you receive any adjustments they need. besides that, some universities rely on Nightline, a night-time telephone support service staffed by student volunteers, for those who need human contact in times of crises (THEGUARDIAN, 2018a).

The situation of patients with bipolar disorder is far from the recommended one. Although there are many researches and patients’ reports, all clinical management is still deficient. From diagnosis to treatment, all stages have difficulties that require the attention of health professionals, family members, and society, with the aim of improving a better quality of life to individuals with BD. (New York Times, 2018a)

2.References

Altamura, A. C. et. Al., 2018. The impact of psychosis on brain anatomy in bipolar disorder: A structural MRI study. Journal of Affective Disorders, 233, 100-109

Bauer, M. et al. Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives. Lancet Psychiatry, August 23, 2018

G1 2018(a): Transtorno bipolar reduz a expectativa de vida em pelo menos 10 anos. August, 2018

G1 2018 (b): Cientistas brasileiros criam programa para diagnosticar esquizofrenia e transtorno bipolar através do relato de sonhos. August, 2018

Kazdin, Alan e. Encyclopedia of Psychology: 8 Volume Set. 1. ed. [S.l.]: American Psychological Association, 2000. 4128 p. v. 1.

New York Times 2017 (a): Patient Voices: Bipolar Disorder. March 21, 2017

New York Times 2018 (a): The Largest Health Disparity We Don’t Talk About: Americans with serious mental illnesses die 15 to 30 years earlier than those without. May 30, 2018

Plans, L. et. Al. 2018. Association between completed suicide and bipolar disorder: A systematic review of the literature. Journal of Affective Disorders. S0165-0327(18)30514-7

PubMed 2018 (a): Transtorno bipolar: você sabe fechar esse diagnóstico? April, 2018.

The Guardian 2018(a): Woman killed herself after series of NHS trust errors, jury finds

The Guardian 2018 (b): Mental health at university: know where to find support 14 Aug 2018.

World Health Organization 2009(a): Pharmacological treatment of mental disorders in primary health care

Word Health Organization 2012(a): Psychoeducation, family interventions and cognitive-behavioral therapy

World Health Organization 2012(b): Strategies aimed at improving community attitudes

World Health Organization 2015(a): Antipsychotics and mood stabilizers (lithium, valproate, or carbamazepine) for maintenance treatment of bipolar disorder

World Health Organization 2015(b): Recovery-oriented psychosocial strategies enhancing independent living and social skills (such as life skills and social skills training).

Vieta, E. et al. Bipolar disorders. Nat. Rev. Dis. Primers 4,