Physical health of patients with bipolardisorder

Bipolar disorder patient has mood swings in which the mood alternates between extreme poles. You could go from being vey manic which is being excited to being depressed. This has affected around 3% of the population and has an alarming connection with suicide rates. The purpose of this article is reviewing the characteristics of Bipolar Disorder and approaches to minimize health risks to this mental disorder. They use research from a clinic and help you understand how the bipolar disorder is usually underrated because it is like major depressive episodes. The substance of this report is based on the November 2011 proceedings of a 1-day independent symposium and is augmented with the related literature. The symposium was organized to provide an outline of the historical history of bipolar disorder, the importance of tracking patients’ physical wellbeing on pharmacotherapy, the importance of psychoeducation as part of routine bipolar disorder care, and an example of a presently functioning bipolar clinic.
The workshop and the conference aimed to inform UK-based healthcare professionals (HCPs) about the benefits, obstacles and aspirations involved with developing a bipolar clinic and the services available in their own clinical practices.
As a psychiatric condition, bipolar disorder also involves regular pharmacotherapy and supervision, and the modification of health care services to the patient’s needs. In addition, patient awareness is required to avoid fast progression from manic to depressive symptoms as a result of drug non-adherence or inappropriate administration. Therefore, patients should be trained about how to cope with destabilizing influences that may contribute to symptoms of depressive or depression. Bipolar disorder care can control symptoms and episodes, but it is unlikely to result in complete recovery. The original treatment in fact poses an obstacle. Most patients seek treatment during depressive periods and are then misdiagnosed with unipolar MDD
or schizoaffective disorder. Concurrent comorbidities also add to the severity of the condition leading to misdiagnosis, undetected effects, drug coadministration and subsequent elevated risk of adverse events related to the care. Implementing interventions to identify bipolar disorder- specific signs, in addition to tools currently used to assess the mental state of a patient, may minimize the risk of misdiagnosis and increase clinical performance. Mental health and physical health are closely linked to risk factors such as weight gain, metabolic syndrome, smoking and diabetes which lead to cardiovascular disease, early death or potential suicide. Patients commonly use self-medication and drug abuse to alleviate symptoms of comorbidity or depression which put them at an increased health risk. Daily health tests are also necessary to ensure the patient gets the best treatment available. There is, however, a difference between the NICE recommendations and the amount and duration of safety tests that are carried out. Mental health and physical health are closely linked to risk factors such as weight gain, metabolic syndrome, smoking and diabetes which lead to cardiovascular disease, early death or potential suicide. Patients commonly use self-medication and drug abuse to alleviate symptoms of comorbidity or depression which put them at an increased health risk. Daily health tests are also necessary to ensure the patient gets the best treatment available. There is, however, a difference between the NICE recommendations and the amount and duration of safety tests that are carried out.
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A persistent mental illness with an early onset, bipolar disorder is characterized by a constant danger of switching between remission and relapse. Recurrent depressive episodes characterize it and a pathologically high mood with increased vigor and activity, during which patients may lose sleep, become overconfident, have trouble focusing, talk excessively, and act irresponsibly. As a result, it is frequently difficult to carry out routine tasks and preserve interpersonal connections [1]. With lifetime prevalence rates of 0.6% for bipolar I disorder and 0.4% for bipolar II disorder, and a lifetime prevalence of 1.4% for subthreshold bipolar disorder, it is estimated that 2.4% of the world’s population suffers from some kind of bipolar disorder [2]. The bipolar disorder must be viewed in the context of the 450 million people worldwide who suffer from neuropsychiatric disorders, which are all linked to a higher risk of dying. However, because many suicides are classified as deliberate injuries rather than suicides linked to a mental disease, the number of deaths from mental disorders may be significantly undercounted [3]. Due to a poor understanding of the strong connections between mental disease and other health conditions, the burden of mental disorders is also likely to be understated [3]. The most prevalent neuropsychiatric disorders that raise the risk of concomitant physical diseases include schizophrenia, dementia, alcohol, and substance use disorders, unipolar and bipolar affective disorders, and unipolar and bipolar mood disorders. The development and progression of physical and social handicaps have been found to be predicted by depression, which is itself a potent potential risk factor for depression in young people [4].

High rates of general mortality and suicide among psychiatric patients are caused by disease burden and mental instability. The risk of suicide may rise at times of fast changes in the depressive state and would, therefore, mostly occur at the beginning and end of episodes, which helps to explain why a significant percentage of suicides happen in the first 6–12 months following hospital discharge. In comparison to the general population, men with bipolar disorder have suicide rates that are 13.5 times greater than those of women, which are 21.9 times higher [5].

Although the idea behind it extends back to antiquity, bipolar disorder was first referred to as “circular madness” in the nineteenth century, signifying recurrent symptoms of mania and depression with a “desperate, awful, and incurable” outlook [6]. Although rigorous antidepressant, antimanic, and mood-stabilizing therapy have been developed, the long-term prognosis has not changed noticeably over time. Recurrence of episodes with incomplete remission is common, chronicity development and suicide are still common, and total recovery without additional episodes is uncommon. Bipolar patients have historically had a 20% lifetime hospitalization rate, 50% of their episodes lasting 2–7 months, and a lifetime recurrence risk of 0.4 episodes per year. Each patient’s disease progresses differently, and each patient’s episodes’ lengths and cycle rhythm are unique [6]. A subset of features is used to describe the patient’s mental state both during and after a manic or depressive episode. Episodes are classified as either depressed, manic, or mixed. The degree of reaction, remission, and recovery a patient experiences determines the stages of the disease. The nature of the current episode is typically used to describe deviations from an expected treatment outcome, and the subsequent episode is described as a relapse, recurrence, or switch (Fig. [NaN]) [8]. These deviations can be measured using recognized rating scales like the Montgomery-Sberg Depression Rating Scale or the Young Mania Rating Scale. Guidelines for the evaluation and diagnosis of people with mental diseases can be found in diagnostic manuals like the Diagnostic and Statistical Manual of Mental Disorders (DSM). Yet, less formal diagnostic techniques are frequently employed and result in the misdiagnosis of bipolar illnesses in 45% of patients.

When manic symptoms are present, 31% of people have unipolar depressive illnesses, and when depressive symptoms are present, 31% have psychotic disorders [9, 10].

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Major depressive disorders (MDDs) and bipolar disorders are the two primary categories of mood disorders. Each condition has its own collection of symptoms, and a diagnosis considers the persistence, character, and severity of the symptoms [11].

Depending on the patient’s medical history, bipolar disorders are divided into bipolar I and bipolar II disorders. Bipolar I disorder patients typically experience following episodes that can be either manic or depressive and have experienced at least one episode of mania. In rare situations, patients have also experienced previous experiences of sadness. Only major depressive episodes (MDEs) and hypomanic episodes are present in patients who fit the criteria for bipolar II illness [11]. In both bipolar disorders, there is significant subthreshold mood symptomatology between episodes. A patient who exhibits signs of mood instability, hypomania, and depressive symptoms but does not meet the length or severity criteria for bipolar II disorder is diagnosed with bipolar disorder not otherwise specified (BPNOS).

The cyclothymic disorder can be identified in people who have never had a manic, mixed, or depressed episode but who have had many episodes of depressive and hypomanic symptoms for at least two years with no longer than two months without any symptomatic periods [11].

The BRIDGE research

Recurrent MDEs are a hallmark of unipolar MDD but are also a significant component of bipolar disorder. Bipolar disorder patients typically seek therapy for depression because depressed episodes are typically more common and stressful than hypomanic episodes. Patients with hypomanic episodes or subthreshold bipolar characteristics are thus misdiagnosed as having unipolar MDD or remain unrecognized [10]. Patients with bipolar disorder may experience an increased risk of suicidal thoughts, mood swings, cycling, mixed states, medication resistance, or non-adherence due to misdiagnosis and ineffective treatment. The BRIDGE (Bipolar Disorder: Improving Diagnosis, Guidance, and Education) study examined the prevalence of bipolar symptoms in patients with MDD using the DSM, fourth edition, text revision (DSMIVTR) criteria and the bipolarity specifier criteria in order to address misdiagnoses of bipolar disorder. Based on indicators like a family history of the disorder, co-occurring substance use disorder, or borderline personality disorder, the diagnostic specifier for bipolar disorder identified significantly more patients with MDEs (47%) as having well-established bipolar features compared to DSM-IV-TR criteria (16%) [10]. This study also found a connection between antidepressant use and the onset of hypomania or manic episodes specific to bipolar disorder, which is not a DSM-IV-TR diagnostic requirement. Due to the high rate of patients receiving the incorrect diagnosis of bipolar disorder, it is important to consider family history, illness trajectory, and clinical condition in addition to DSM-IV TR criteria when evaluating individuals with MDD for bipolarity.

The EPIDEP research on bipolar -2 disorder

The Epidemiologic Study in Bipolar Depression (EPIDEP) set out to prove that bipolar II disorder can be classified as an MDE that is accompanied by hypomania and/or cyclothymic disorder. Cyclothymic temperamental (CT) dysregulation has become a reliable indicator of bipolar II disorder and may be used to make a quantitative diagnosis of the condition. Instead of an MDE, which is thought to be a fundamental aspect of bipolar II disorder, patients with this condition exhibit a more complicated baseline of temperamental dysregulation (cyclothymic, depressive, hyperthymic, and irritable). According to research that was done using the CT rating (CTR) scale, persistent mood instability (cyclothymia) was found to be a significant vulnerability factor for mood switching [12]. As a result, mood swings are a clinical indicator of bipolar II disorder. In actuality, mood lability, energetic hyperactivity, and daydreaming were the three temperamental traits that best predicted the transition from unipolar to bipolar II diseases.

The EPIDEP trial also showed that untrained psychiatrists could correctly diagnose bipolarity in all of its forms, including psychotic, mixed manic, and bipolar II disorder types, by combining a patient- and clinician-rated CTR scale with structured interviews. The following are the results of a survey conducted by the American Psychological Association (APA) on the subject of the use of the term “psychological assessment” in the workplace.

Bipolar disorder patients’ quality of life

Patients with bipolar disorder often have a low quality of life (QoL), which is strongly influenced by two factors: the nature of the mental illness itself and treatment-related comorbidity. Patients with bipolar disorder face many challenges in leading a normal lifestyle, even with the help of family, friends, and caregivers. A significant portion of patients may not fully match the syndromal criteria for the manic-depressive disorder, but they still frequently exhibit moody, irritable, erratic, and explosive behavior, which adds to their isolation and misunderstanding. I’m sure you’ve heard of it, but there are a lot of people out there who haven’t heard of it, and you’re probably one of them. Patients with bipolar disorder may demonstrate characteristics of social impairment, such as difficulty making and keeping friends and having close interactions with a spouse. A normal lifestyle is also hampered by the incapacity to manage finances, household chores, and emergencies [13].

Self-medication with alcohol, drugs, and smoking often occurs in this patient population [14]—possibly as a result of their low quality of life. This raises their chance of developing comorbid disorders, which further lowers their quality of life. Long-term diseases, including cardiovascular disease, obesity, metabolic syndrome, and diabetes, are often brought on by a combination of this, a sedentary lifestyle [15], treatment-related comorbidities such as weight gain, and changes in blood glucose and lipid levels [16]. Severe health issues, further polypharmacy, and lifestyle impairment may result in the patient taking more self-medication and developing depression. Long spells of depression are common in bipolar II patients, with the ratio of depression to mania/hypomania being 37:1 and 3:1, respectively.

Respectively for bipolar II disorder and bipolar I disorder [17]. The high risk of suicides among people with mental illness is influenced by disease burden and mental instability. Early medication, psychoeducational programs, cognitive behavioral therapy, and family-focused treatment may enhance patient quality of life. By reducing the likelihood of comorbidities and easing bipolar disorder symptoms with medication and psychoeducation, patients are better able to reintegrate into society and lead normal lives.

health in people with bipolar disorder

Several risk factors for cardiovascular diseases, such as obesity, smoking, hypertension, hyperglycemia, dyslipidemia, and type 2 diabetes, are more likely present in bipolar disorder patients. Moreover, antipsychotics, which are a common form of treatment for bipolar illness, have been associated with an increased risk of alterations in metabolic parameters, which could raise the total risk of comorbidity [16]. Patients with bipolar disorder have twice as many comorbid physical health issues as the general population. Patients with bipolar illness have incidences of ischemic heart disease, stroke, hypertension, and diabetes of 5.1%, 1.5%, 14.7%, and 4.1%, respectively [18]. Compared to the general population, bipolar illness has been linked to these comorbid disorders developing earlier [19].

goals of the research

This page discusses the symptoms of bipolar disorder, methods for reducing hazards to physical health, available treatments, and how each of these factors may affect patient quality of life.

Materials and procedures

This article’s information was derived from the proceedings of a one-day standalone symposium in November 2011 and augmented with material from related academic works. The symposium’s objectives were to provide an overview of the natural history of bipolar disorder, emphasize the value of keeping track of patients’ physical health while they are receiving medication, discuss the role of psychoeducation in the course of standard care for bipolar disorder, and provide an illustration of an active bipolar clinic. The meeting’s and workshop’s goal was to inform UK-based healthcare professionals (HCPs) on the possibilities, difficulties, and expectations of creating a bipolar clinic using the available resources in their clinical settings.

Results

reducing risk factors associated with health A cardiovascular condition

For epidemiological general health studies, serious mental illness (SMI), which includes schizophrenia and bipolar disorder, is referred to as the leading cause of mortality. The most crucial target comorbidities to reduce to improve general patient health are diabetes, metabolic syndrome, and smoking. Due to time constraints that prevent a mental health specialist from offering preventative services and a lack of familiarity with medical risk factors like obesity and cardiovascular disease [15], growing evidence suggests that patients with mental illness may receive low-intensity care for a number of medical conditions.

Obesity

Patients with bipolar disorder who report poor diet, medical comorbidities, and a sedentary lifestyle may make it more difficult to lower their risk of obesity [15]. In fact, metabolic syndrome, which causes diabetes, is present in 21–63% of people with bipolar disorder [21] and is 2-3 times more common in people with SMI [22] than it is in the general population. Psychotropic medication use may play a significant role in metabolic syndrome by increasing brain appetite receptors and encouraging abdominal obesity [22]. Moreover, patients

Bipolar disorder patients are more likely than those with schizophrenia or no SMI to have poor exercise habits, and they are also more likely to report considerable exercise intolerance due to smoking, being overweight, and taking medications [15, 23]. Moreover, a sedentary lifestyle, weight gain, and medical comorbidities may make a patient more susceptible to subsequent depressive relapses. Thus, therapeutic strategies targeted at enhancing dietary and exercise habits ought to be customized to the particular challenges experienced by patients with bipolar illness [15] and ought to be based on gradual lifestyle adjustments rather than radical shifts in patient behavior. Educational efforts are required to encourage a healthy lifestyle, such as modifications in food alternatives, motivational interviews, and routine health screenings [24]. In order to help patients control their weight, the National Institute for Health and Clinical Excellence (NICE) advises HCPs to guide diet, exercise, and weight loss, as well as monitor blood pressure and blood glucose levels [25]. Patients may also be referred to a dietician or specialized services [26].

abusing drugs

Individuals (24%) with mood disorders frequently self-medicate to reduce affective symptoms using alcohol, illegal substances, or misusing prescription medicine; rates of self-medication are higher for alcohol than for drugs. Nonetheless, individuals with bipolar I disorder had the highest rates of self-medication, with 38-41% of patients using alcohol or medications to treat their symptoms, primarily during the depressed period. However, 32% of bipolar II illness patients in the depressed phase and 8% in the hypomanic phase self-medicate, respectively. The increased prevalence of alcoholism in patients with bipolar I disorder (41%) compared to bipolar II illness (25%) is consistent with these findings. These patients frequently report mood enhancement, stress relief, euphoric maintenance, and energy boost as reasons for substance misuse [14]. Women with bipolar disorder are more susceptible to drinking than other females, despite men being more than twice as likely to utilize drugs to treat troubling mood symptoms that eventually lead to lifetime alcoholism [27]. The patients who self-medicate are more likely to be young, divorced, or widowed. Self-medication is a tactic connected with high mental disease comorbidity, even though these persons may use it with the purpose of elevating their mood. As a comparison to bipolar illness existing by itself, alternative psychiatric problems like eating, anxiety, or substance abuse disorders are twice as likely to be present. Consequently, thorough initial assessments of patients with bipolar disorder are necessary to identify any potential future drug use inclinations and counteract them with the necessary education.

Smoking is another kind of self-medication, despite not being acknowledged as such. Between 75 and 85 percent of patients with SMI are smokers, and many of them have higher rates of morbidity and mortality due to conditions connected to tobacco use. Compared to non-smokers with SMI, smokers with SMI report more mental symptoms, hospitalizations, and the requirement for greater prescription dosages. In addition, compared to non-smokers and light smokers, heavy smokers in this patient population experience more positive symptoms (hallucinations and delusions) and negative symptoms (anhedonia, alogia, low motivation, and poor social skills), as well as an elevated risk of cardiovascular disorders. According to research, the natural bipolar cycle may be enhanced in a third of bipolar disorder patients who smoke on a regular basis by intensified episodic symptoms, more frequent bouts of both affective poles, and quicker cycling. The bipolar cycle’s destabilization may also impact individual episodic lengths and the stability of mood between episodes. Smoking also seems linked to worse treatment results in bipolar mania and a higher risk of treatment abandonment. As a result, smoking should not be seen as a habit that patients with mental illness frequently engage in but rather as a comorbid disorder that needs active treatment. Adequate smoking cessation programs backed by mental health physicians trained in quitting procedures may be introduced as a strategy to minimize smoking and smoking-related harms, as could focused educational campaigns to discourage smoking initiation.

A key element in preventing or effectively managing comorbidities associated with bipolar disorder is routine physical health assessments. Regular screening is necessary for cardiovascular and obesity-related risk factors in particular. NICE [26] advises primary care doctors to check the following things on all patients over the age of 40 once a year: lipid levels, including cholesterol, plasma glucose levels, weight, blood pressure, smoking status, and alcohol usage. According to NICE guidelines, every patient starting long-term pharmaceutical treatment for bipolar illness should have their weight, height, plasma glucose, and lipids checked. Those at risk for cardiovascular disease should also have an ECG scheduled. Additionally, guidelines advise that patients using antipsychotics have their weight examined every three months for the first year of treatment (more frequently if weight is gained quickly), as well as their plasma glucose and lipid levels three months after starting medication (more often at elevated levels). The majority of patients do not obtain the ongoing physical health monitoring they need in addition to medicine, despite these guidelines. The individual rates of screening are much lower (weight check, 56%; glucose blood test, 36%; cholesterol blood test, 29%) [32], and only 64% of patients receiving mood stabilizers receive an annual physical review [33] despite evidence that 87% of patients with SMI receive one or more screening tests for cardiovascular disease. Only a tiny percentage of patients (good eating, 16%; gym referral, 20%; weight loss, 15%; and smoking cessation, 38%) [32] received health promotion counseling.

Discussion

As a chronic condition, bipolar disorder frequently necessitates ongoing medication management, patient monitoring, and customization of healthcare services to meet the patient’s needs. Moreover, patient education is required to prevent the abrupt transition from manic to depressive episodes that might occur as a result of non-adherence or improper medication delivery. Patients should therefore be taught coping mechanisms for destabilizing events that might trigger manic or depressive episodes.

Bipolar disorder treatment can control symptoms and episodes, but it is unlikely to result in complete recovery [6]. The initial diagnosis is difficult enough. Many people who seek treatment during depressive episodes receive incorrect unipolar MDD or schizoaffective disorder diagnoses. Concurrent comorbidities frequently enhance the complexity of a condition, increasing the likelihood of misdiagnosis, missed symptoms, concurrent medication administration, and adverse treatment events. Combining existing techniques for assessing a patient’s mental state with measures that recognize bipolar disorder-specific symptoms should lower the likelihood of misdiagnosis and enhance treatment outcomes.

In individuals with MDEs, bipolar disorder is a prevalent and serious mental illness that physicians frequently fail to recognize. People with bipolar disease frequently rely on family and caregivers to lead a regular lifestyle and struggle to keep up friendships and romantic connections.

Physical and mental health are intertwined, and risk factors like obesity, metabolic syndrome, smoking, and diabetes can cause cardiovascular disease, early death, or even suicidal thoughts. Patients frequently self-medicate or abuse drugs to treat comorbidity or depression symptoms, putting their health at risk. In order to ensure that the patient receives the best care possible, routine health checks are necessary. However, NICE recommendations and the quantity and frequency of health checks carried out differ.

Early pharmacotherapeutic and psychoeducational interventions are crucial to improve treatment outcomes and the patient’s knowledge of how to reduce health risks. Atypical antipsychotics are a successful and popular treatment for bipolar illness, but they may severely influence physical health and, as a result, lower patients’ quality of life. Bipolar clinics may help patients understand their condition better and ultimately enhance the standard of therapy by providing psychoeducation.

Acknowledgments

Bristol-Myers Squibb, Uxbridge, UK, provided funding for the meeting that served as the basis for this addendum. Ogilvy Healthworld Medical Education, London, UK, provided editorial assistance for the creation of this publication; Bristol-Myers Squibb contributed money.

References

Young, A. H., & Grunze, H. (2013). Physical health of patients with bipolar disorder. Acta Psychiatrica

Scandinavica, 127, 3–10. https://doi-org.ctcproxy.mnpals.net/10.1111/acps.12117

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To Prepare:

• Review the information presented in the Learning Resources for using the Walden Library, searching the databases, and evaluating online resources.
  

  Physical health of patients with bipolardisorder

• Begin searching for a peer-reviewed article that pertains to your practice area and interests you.

Post the following:

Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.

Heres the peer review article i selected:  Physical and mental health status of former smokers and non‐smokers patients with bipolar disorder.

Citation:

Nobile, B., Godin, O., Gard, S., Samalin, L., Brousse, G., Loftus, J., Aubin, V., Belzeaux, R., Dubertret, C., Le Strat, Y., Mazer, N., Prémorel, A., Roux, P., Polosan, M., Schwintzer, T., Llorca, P., Biseul, I., Etain, B., Moirand, R., … Icick, R. (2023). Physical and mental health status of former smokers and non‐smokers patients with bipolar disorder. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13535

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