Integration of Evidence-Based Practice in APRN Protocols- Societal Implications and Models of Abnormality

Integration of Evidence-Based Practice in APRN Protocols- Societal Implications and Models of Abnormality

Depressive and bipolar disorders affect about 4 percent of the population in America in their varied syndromal as well as subsyndromal forms (Miklowitz & Johnson, 2019). It is an extremely recurrent, pricey, and impairing illness that results in high rates of medical problems, comorbidity, disability, suicide completions, and attempts. These diseases also have wide-ranging impacts on an individual’s functioning between and during episodes, including family distress, impaired work performance, low life satisfaction, and relationship dysfunction (Miklowitz & Johnson, 2019). Social impairments also characterize bipolar youths even during the phases of remission. Functional impairment is likely to result from symptoms, but it is likely for impairments to enhance recurrence speed. Depressive and bipolar disorders lead to stigma, social isolation, and health inequalities, and their causation can be better understood through the cognitive and biological models of abnormality.

Background

Developmental and lifespan psychopathology perspectives can help explain the course of depressive and bipolar disorders. The disease episodes could arise from a complex interaction between stress, genes, neurobiology as well as psychological vulnerabilities at different developmental points. Certain twin studies provide strong evidence of the possibility of genetic transmission at the beginning of these disorders. Childhood adversity such as neglect, physical and sexual abuse, as well as high familial, expressed discord and emotion, and life events tend to evoke or worsen particular preexisting vulnerabilities, leading to more incapacitating courses of the diseases among some patients.

Even though pharmacotherapy tends to be the first line of treatment in stabilizing patients who have depressive and bipolar disorders, psychosocial treatments, which are used alongside pharmacotherapy and deal with stress variables, emotional, interpersonal, and cognitive vulnerabilities, and their linkages can record higher success than pharmacotherapy alone in the prevention of recurrences (Miklowitz & Johnson, 2019). Cognitive behavioral therapy is among the commonly used forms of therapy in the treatment of depressive and bipolar disorders. Other forms of therapy, like family-focused therapy, can also be used. This will help the patient function normally within the family setting as well as in society as a whole. Therapies such as meditation and guided imagery, as well as exercise, provide considerable benefits in the alleviation of these symptoms (Strulovici, 2017).

Societal and Cultural Implications

The clinical management of depressive and bipolar disorder patients is strongly influenced by culture and is also dependent on the healthcare delivery context. Healthcare practitioners need to comprehend how to deliver healthcare in various cultures and systems. According to Oedegaard et al. (2016), cultural, social, and financial factors influence health-seeking behaviors among patients, and this emphasizes the need for knowledge on such factors so as to sufficiently identify and manage patients with depressive and bipolar disorders. There are different ways in which culture can impact individuals’ mental health. Cultural stigma is among the most common ways in which individuals suffering from mental health problems are negatively affected. Each culture has a varying way of looking at issues of mental health. Most cultures have high levels of stigma in relation to mental health, and such challenges are normally considered weaknesses; therefore, there is an emphasis on hiding them. This makes it highly difficult for individuals to speak openly and seek help, and hence the high rates of suicidal completions and attempts, especially among patients with mood disorders. Culture also plays a key role in the understanding of symptoms. Different cultures have different impacts on the manner in which individuals describe and feel about their different symptoms. This is likely to affect whether an individual will choose to recognize and open up about their physical symptoms alone, emotional symptoms alone, or both. Cultural factors also tend to determine the extent to which an individual receives help from the community and family when dealing with issues of mental health (Neighbors et al., 2018). With the already existing stigma, most minorities tend to be left out when it comes to seeking support and treatment for mental health. Lastly, there are very few culturally-sensitive healthcare practitioners who can effectively deal with patients in a culturally sensitive manner. Such things tend to discourage individuals from seeking help.

Depressive and bipolar disorders are complicated to diagnose and treat. Such disorders tend to cause various fluctuations in behavior and mood, influencing the manner in which people function and interact with other people on an everyday basis. People who are diagnosed with bipolar disorder tend to experience symptoms within a framework that is often based on their cultural norms, values, and beliefs (Warren, 2017). Culture is a personal and complex biopsychosocial phenomenon that offers meaning to life for a person, a community, and a group. It is important for psychiatric mental health practitioners to comprehend the role that culture plays and incorporate this knowledge into the biopsychosocial care of the patients. The development and sustenance of the interpersonal therapeutic relationship existing between psychiatric healthcare practitioners and patients necessitate the use of a cultural framework, which is the link between cultural competence and culture.

The patient’s culture is likely to impact various aspects of mental illness, mental health, as well as patterns of utilization of health care. However, it is important to note that a general statement about the cultural traits of a certain group of people is likely to cause stereotyping based on the person’s affiliation or appearance (US Department of Health and Human Services, 2017). In the US, African Americans suffering from bipolar disorder, in comparison with whites, are said to have relatively higher rates of obtaining an initial clinical diagnosis besides bipolar disorder, and this misdiagnosis is likely to prevent treatment strategies that can help in the management of the disease (Neighbors et al., 2018).

Occupational functioning is considered among the most challenging impairments for people with depressive and bipolar disorders due to heightened rates of unemployment as well as vocational impairments (O’Donnell et al., 2017). Individuals who are employed and suffer from these disorders tend to face discrimination in terms of receiving employee benefits like health insurance in comparison to individuals with no disabilities or those with physical disabilities (O’Donnell et al., 2017). Furthermore, poor employment outcomes for individuals with depressive and bipolar disorders are linked with elevated levels of financial disability throughout the world, and about $14.1 billion loss in productivity is usually recorded annually in the US (O’Donnell et al., 2017). Besides the financial loss, unemployed people suffering from depressive and bipolar disorders tend to experience psychopathology, reduced self-esteem rates, as well as poorer quality of life. Individuals in employment usually complain of social stressors in their work environments, such as stigma and conflicts linked with their work impairments. About 81 percent of individuals with mood disorders report bullying at work (that is, severe conflict and exclusion from work) as compared to about 55.7 percent of individuals with anxiety disorders (O’Donnell et al., 2017). Furthermore, employed individuals who suffer from depressive and bipolar disorders often report major difficulties getting along with other employees, exposure to stigma, and exclusion, which impact them socially, physically, and psychologically, thereby lessening their quality of life.

Models of Abnormality

Biological Model

Bipolar disorders have a pathophysiology that is quite complex, multifactorial, and not understood in full (Sigitova et al., 2017). The present knowledge offers the basis for the formulation of various biological hypotheses of bipolar disorder based on the identification of particular biomarkers for disease course and expression as well as vulnerability and treatment reaction. The various biomarkers for bipolar disease are under research, with structural brain changes searched through neuroimaging methods, and various polymorphisms in various susceptibility genes have been found in genetic studies (Sigitova et al., 2017). Neurochemical biomarkers are among the most studied of all. Through structural neuroimaging studies among patients with bipolar disorders, neuropathological and anatomical abnormalities have been found, which have been linked with neuro-progression. Furthermore, mild traumatic brain injury is said to be a risk factor for developing heterogeneous neuropsychiatric illnesses like bipolar disorders. The common and most direct method of describing the symptomatology and pathophysiology of affective symptoms is a disruption to the cortico-striatal-limbic circuits. Additionally, genetic studies suggest that various chromosomal regions, together with candidate genes, are linked to susceptibility to bipolar disorder, with every gene exerting a moderate or mild effect (Sigitova et al., 2017). Such issues are based on the biological model of abnormality.

Cognitive Model

The cognitive model of abnormality suggests that depressed mood states are usually heightened by thinking patterns that intensify mood shifts (Scott, 2013). For instance, as individuals become depressed, they get more negative in the manner in which they view themselves, their future as well as their world (negative cognitive triad). As a result, such individuals tend to jump to negative conclusions, view things in all-or-nothing terms, overgeneralize, and self-blame or personalize to an excessive extent (cognitive distortions). Alterations in their behaviors, such as avoidance of social interaction, are likely to be a consequence or cause of their mood shifts as well as negative thinking. Cognitive susceptibility to depression is believed to arise from dysfunctional underlying beliefs like (I am unlovable) which develop from initial learning experiences and drive behavior and thinking. Such beliefs are usually activated by major life events and the particular meaning for that person. Mania is also considered to be a mirror image of depression, often characterized by a highly positive cognitive triad of future, world, and self and positive cognitive distortions.

Conclusion

Depressive and bipolar disorders are among the most common mood disorders. Bipolar disorders are said to be highly complex and are yet to be fully understood. These disorders, like other mental health problems, have major cultural and societal implications, especially in relation to medical-seeking behaviors. Individuals are often stigmatized, and this prevents them from seeking health care services. Cultural sensitivity is of key importance in the diagnosis and management of such disorders, especially among minority groups who already face various forms of discrimination and inequalities. The cognitive and biological models provide key facts about the genesis of depressive and bipolar disorders.

 References

Miklowitz, D. J., & Johnson, S. L. (2019). Social and familial factors in the course of bipolar disorder: basic processes and relevant interventions. Clinical Psychology: Science and Practice, 16(2), 281.

Neighbors, H. W., Trierweiler, S. J., Ford, B. C., & Muroff, J. R. (2018). Racial differences in DSM diagnosis using a semi-structured instrument: The importance of clinical judgment in the diagnosis of African Americans. Journal of health and social behavior, 237-256.

O’Donnell, L., Himle, J. A., Ryan, K., Grogan-Kaylor, A., McInnis, M. G., Weintraub, J., … & Deldin, P. (2017). Social aspects of the workplace among individuals with bipolar disorder. Journal of the Society for Social Work and Research, 8(3), 379-398.

Oedegaard, C. H., Berk, L., Berk, M., International Society for Bipolar Disorders (ISBD) Transcultural Task Force, Youngstrom, E. A., Dilsaver, S. C., … & Engebretsen, I. M. (2016). An ISBD perspective on the sociocultural challenges of managing bipolar disorder: A content analysis. Australian & New Zealand Journal of Psychiatry, 50(11), 1096-1103.

Scott, J. (2013). Cognitive theory and therapy of bipolar disorders. In CBT for Psychosis (pp. 245-258). Routledge.

Sigitova, E., Fišar, Z., Hroudová, J., Cikánková, T., & Raboch, J. (2017). Biological hypotheses and biomarkers of bipolar disorder. Psychiatry and clinical neurosciences, 71(2), 77-103.

Strulovici, A. (2017). Non-pharmacological therapeutic recommendations in bipolar affective disorder. Psihiatru.Ro, 1(48). https://doi.org/10.26416/psih.48.1.2017.1006

US Department of Health and Human Services. (2017). Chapter 2: Culture counts: The influence of culture and society on mental health. Mental health: Culture, race, and ethnicity—A supplement to mental health: A report of the surgeon general. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Warren, B. J. (2017). Cultural aspects of bipolar disorder: Interpersonal meaning for clients & psychiatric nurses. Journal of psychosocial nursing and mental health services, 45(7), 32-37.

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Integration of Evidence-Based Practice in APRN Protocols- Societal Implications and Models of Abnormality

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