Comorbidity in bipolar disorder is the rule rather than the exception more than 60% of bipolar patients have a comorbid diagnosis and is associated with a mixed affective or dysphoric state; high rates of suicidality; less favourable response to lithium and poorer overall outcome. There is convincing evidence that rates of substance use and anxiety disorders are higher among patients with bipolar disorder compared to their rates in the general population. The interaction between anxiety disorders and substance use goes both ways: patients with bipolar disorder have a higher rate of substance use and anxiety disorder, and vice versa. Bipolar disorder is also associated with borderline personality disorder and ADHD, and to a lesser extent with weight gain. As more than 40% of bipolar patients have anxiety disorder, it is indicated that while diagnosing bipolar patients, systematic enquiry about different anxiety disorders is called for. This also presents a therapeutic challenge, since agents that effectively treat anxiety disorders are associated with the risk of induced mania. Therefore, the treating psychiatrist needs to carefully evaluate the potential benefit of treating the anxiety against the potential cost of inducing a manic episode. A possible solution would be to use, when possible, a non-pharmacological intervention, such as a cognitivebehavioural approach. Alternately, it is suggested that the clinician attempts to ensure that the patient receives adequate treatment with mood stabilizers before slowly and carefully attempting the addition of anti-anxiety compounds with a relatively lower risk of mania induction (e.g. SSRIs compared to TCAs).
This study focused on the active attempts of individuals with severe mental illness to make sense of their disorders and initiate processes of personal growth. The findings are based on bimonthly comprehensive assessments conducted over a 1-year period with 43 persons who were hospitalized for schizophrenia and related disorders. Results reveal that living with severe mental illness may also generate processes of growth and change. Clinical and theoretical implications of these results are discussed.
The current study focuses on the various strategies employed by individuals coping with psychiatric disorders. Data was gathered as part of the Yale Longitudinal Study; participants were 43 males and females--men and women with psychotic symptoms who were diagnosed with either schizophrenia, schizoaffective disorder, or major affective disorder with psychotic features. Participants were first assessed during hospitalization and completed bi-monthly follow-up interviews over the course of a year. Using qualitative research methods, each participant was interviewed using a semistructured interview that assessed the course of the disorder and change processes, focusing on each person's experiences of coping with a mental illness. In employing qualitative research methods the data obtained was distinctive in that it was suggested by the participants themselves, rather than being limited to predetermined categories. Results revealed a number of common coping strategies employed by individuals with a mental illness. These included: regulating activity, involvement and external stimuli; controlling symptoms; determination and hope; and the instigation of a change in attitude. The implications of these results are discussed for further research and for developing more effective treatment interventions for people with psychiatric disorders.
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