First developed by George Engel, a cardiologist, biopsychosocial approach to bipolar mental disorder suggests that a number of factors are interlinked in respect to the cause, progress and promotion of the condition. According to the model, biological, social and psychological factors contribute to the disease.
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In simple terms, the model argues that the mind and body systems are interlinked ad interdependent, with similar factors affecting each of these aspects of human (Miklowitz, Richards, George, Frank, et al., 2010). The approach is a straightforward technique that attempts to provide intervention protocols from more than one perspective.
In general, the approach includes pharmacotherapy, psychological and social intervention perspectives. In this context, a pharmacotherapy is enhanced with active collaboration with the patient to determine the type of medications needed.
It is also coupled with an adjunctive psychotherapy for enhancing illness adaptations, medical adherence, interpersonal relationships as well as job functioning. However, biopsychosocial approach involves recognition of the roles of stress within the course of outcomes. In addition, the psychosocial interventions have the potential to influence these processes in a positive manner.
The purpose of this paper is to develop an in-depth review of literature in determining important findings about biopsychosocial approach to the condition.
Pharmacotherapy: current and frequently prescribed medications
In biopsychosocial, a number of biological aspects are linked to the cause and progression of the disease. Thus, biological approach to the disease involves application of pharmacological agents that target biological factors involved in the disease cause and progression. For example, risperidone and olanzapine are chemical drugs used to treat patients whose conditions are “atypical antipsychotic” in nature.
These drugs are administered in doses of 2-4mg/day and 15-20mg/day respectively. They tend to manage such symptoms as aggression, suicidal attempts and devastating consequences of impulsivity. Benzodiazepines are effective in calming manic problems, soothing anxiety as well as reducing insomnia.
According to the American Psychiatric Association (2012), mood disability is one of the most common conditions in patients with bipolar mental disorder. Therefore, a pharmacological agent must be used to stabilize the patient’s moods. According to the American Psychiatric Association (2012), lithium is one of the most effective agents of mood stabilization. However, lithium has some side effects.
Anticonvulsants such as carbamazepine, sodium valproate, lamotrigine and topiramate have been used to treat the condition since 1970s. According to Post, Ketter, Uhde and Ballenger (2007), Carbamazepine is important in managing manic episodes because there are some evidences that it effectively manages rapid-cycling disorder. However, it is less effective than lithium. In addition, it may lead to dependency.
Sodium valproate is also effective in treating manic episodes, but it has side effects equal to those of carbamazepine. According to Geddes, Calabrese and Goodwin (2008), lamotrigine has some efficacy in managing depression, but other studies have shown that it has no benefit in patients with rapid cycling disorder.
Possible side effects
Despite their effectiveness, these pharmacological agents have a number of side effects, which limits their use in treating bipolar mental disorder. For example, benzodiazepines and other anticonvulsants work through sedating and muscle-relaxation actions. Thus, they cause dizziness, drowsiness and decline in the levels of alertness and brain concentration (Geddes, Calabrese & Goodwin, 2008).
Cognitive impairments may result from long-term use of these agents. Carbamazepine (Tegretol) has similar side effects. Lithium has a number of side effects such as hair loss, weakness of muscles, hand tremor, acne, reduced thyroid action, impaired memory, diarrhea and increased rate of urination.
Biopsychosocial approach emphasizes on psychotherapy to manage the condition. In simple terms, it involves a talk therapy in which patients work closely with therapists to discuss the condition and problems with an aim of learning new skills (Scott, Paykel, Morriss, Bentall et al., 2006). Patients are given an opportunity to talk about their experiences and gain insight into thinking processes that cause or contribute to depression and mood swings (Miklowitz, Richards, George, Frank, et al., 2010).
In addition, they explore their previous experiences and their contributions to the condition. It also gives patients an opportunity to learn new skills in practically coping with the condition, which decreases the probability of developing depressive episodes in future (Moltz, 2003). Although psychotherapy is an effective intervention protocol in managing bipolar disorder, it is not a unified field because there are different methods involved (Miklowitz, Richards, George, Frank, et al., 2010).
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Psychotherapists apply several approaches and techniques. However, some major schools of thought dominate the field. According to Moltz (2003), family systems, psychodynamic and cognitive-behavioral methods are common in the field. In addition, humanistic schools are sometimes effective, but to a lesser extent. Each of these methods has a perspective on the factors that cause bipolar disorder and the best way to solve these problems (Scott, Paykel, Morriss, Bentall et al., 2006).
Nevertheless, all types of psychotherapy seek to provide patients with information about depression and help them understand, express as well as control moods and feelings in an effective manner (Moltz, 2003). In addition, they help them transform their negative perspectives and thoughts, behaviors, attitudes as well as relationships with other individuals (Moltz, 2003).
Psychological and developmental issues related to origins of the disorder
In biopsychosocial approach to bipolar mental disorder, biology, psychology and sociology are important fields in determining psychological and developmental issues that cause the condition (Moltz, 2003). From a psychological perspective, a number of theories have been developed to explain the cause and origins of the problem (Miklowitz, Richards, George, Frank, et al., 2010). In these theories, personality, interpersonal relationships and history of experiences are important factors.
Psychodynamic models were developed in the early part of the 20th century. They ocused on interrelationships of the mind with mental, motivational forces and emotions (Moltz, 2003). These theories were based on the notion that the conscious and unconscious parts of the human mind may be in conflict with each other, which causes repression (Miklowitz, Richards, George, Frank, et al., 2010).
An individual must resolve early developmental conflicts in order to cope with repression and achieve a stable mental condition. Inability to resolve these problems results into mental failure such as bipolar disorder.
According to Moltz (2003), behavioral theory argues that dysfunctional behavior such as depression comes from human contact with the environment (through learning). This means that it can also be resolved through unlearning.
Finally, the sociology of depression involves cultural context in which the patients reside, grow or work (Miklowitz, Richards, George, Frank, et al., 2010). It also examines the social stressors that individuals experience in their lives. A branch of medicine known as ethnomedicine attempts to determine the causes of illnesses based on cultures and ethnicities (Moltz, 2003).
It suggests that cultural and ethnic differences in people’s focus on themselves and individual place within the social and cultural hierarchy are linked to the cause, rate and progress of depression (Scott, Paykel, Morriss, Bentall et al., 2006). Both individualistic and collectivistic orientations of an individual to a given culture are important causes of depressions in humans (Scott, Paykel, Morriss, Bentall et al., 2006).
This review of literature indicates that biopsychosocial model is an effective technique of managing bipolar disorder because it approaches the condition from multiple directions. It includes pharmacotherapy, psychological and sociological dimensions. This implies that it attempts to treat the symptoms while also addressing the social, environmental and mental causes of the disease.
American Psychiatric Association. (2012). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Geddes, J. R., Calabrese, J. R., & Goodwin, G. M. (2008). Lamotrigine for treatment of bipolar depression: Independent meta-analysis and meta-regression of individual patient data from five randomised trials. The British Journal of Psychiatry 194(1), 4–9
Miklowitz, D. J., Richards, J. A., George, E. L., Frank, E., et al. (2010). Integrated family and individual therapy for bipolar disorder: results of a treatment development study. J Clin Psychiatry, 64(2), 182-91.
Moltz, D. A. (2003). Bipolar disorder and the family: An integrative model. Family process, 32(4), 409-423.
Post, R. M., Ketter, T. A., Uhde, T., & Ballenger, J. C. (2007). Thirty years of clinical experience with carbamazepine in the treatment of bipolar illness: Principles and practice. CNS Drugs 21(1), 47–71.
Scott, J. A. N., Paykel, E., Morriss, R., Bentall, R., et al. (2006). Cognitive–behavioural therapy for severe and recurrent bipolar disorders Randomised controlled trial. The British Journal of Psychiatry, 188(4), 313-320.