Sample Issue-Analysis Report
Note to reader: This draft is re-printed here with the author's permission. These student drafts are provided for a couple of reasons: first, to give you a taste of the variety of topics and approaches students have taken, and second, to provide instructors with readings that might be used in class discussions and activities. These samples are not perfect and represent final grades from across the grade scale (A through F), so please be forgiving, understanding, and respectful if you find errors or problems.
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Donna Walter
Professor Peterson
Final draft Issue Analysis
07 November 2014
Consequences of being Labeled Bipolar
The world we live in moves fast and is becoming extremely confusing. The world today seems to have many problems. Does Bipolar (BPD) and drug abuse have any thing to do with this? How does our court systems reflect on these problems? Do they see a problem and how is it addressed? Some of the world’s problems resonate from Bipolar (BPD) and Drug abuse(SUD). This has been big problem in almost all communities. Some people are diagnosed bipolar that have substance abuse problems. Not all that are diagnosed with Bipolar (BPD) are diagnosed properly. Some bipolar (BPD) people have a hard time staying on there medications. Those that don’t stay on their medications are more likely to self medicate themselves. They then turn to drugs off the street, which can get them in trouble with the law.
Among psychiatric patients, those with bipolar disorder (BPD) have the highest prevalence of alcohol or other substance use disorders (SUD) (1-3). Lifetime comorbidity between BPD and SUD ranges between 17% and 61% (4-12). Several studies have reported that substance abuse in patients with BPD is associated with more hospitalizations, a higher incidence of dysphonic mania, earlier onset of mood symptoms, more comorbid Axis I disorders, and suicide risk (13-17). More over, it is associated with poor treatment response and increasing suffering, disability and cost (18-21). Although the frequency of the co-occurrence between BPD and SUD is well documented, the reasons for this to still be going on are alarming.(Bizzarri et.al.,2006).
This not being clear when an individual comes into the court system it is extremely confusing for a while. The person is evaluated and sent out to receive a mental evaluation and this sill is not clear information. The individual is usually brought in for many reasons, drugs, theft, domestic violence or possibly sexual assault.” They first usually come into the justice system and then referred to the district court depending on the nature of the crime and how many offences”. (Judge Bob 2014). Not everyone gets the opportunity to be evaluated, so they go untreated for a long time.” Some do and we consider them the lucky ones that get the help they are in need of”. (Judge Bob 2014)
“Drug Abuse plays a big role with this particular BPD and SUD”. (Dr. Carl). The courts have no way of proving if this is occurring. The courts are then forced to take another look at the case especially if the person keeps having the same pattern of crimes. The courts then order a mental evaluation and due to the results of the test they my have different circumstances to deal with. The criminal is then court ordered to do this evaluation. They are state appointed a psychologist.
“There are many reasons people have trouble with there BPD medications”. (Dr. Carl). “Some do not have insurance or means to get their BPD medications”. (DR. Carl) “Some are not sure how to get insurance or even how to apply for some kind of assistance”. (Dr. Carl) This leads to self-medicating themselves with street drugs or what ever they can get their hands on. Unfortunately this gets them in all kinds of trouble. A Bipolar person is confused often with many different mood swings that keep them off balance with life in general. There are many studies on this type of behavior.
Of the patients with BPD and SUD, 11 used only alcohol, 28 used alcohol and other substances, and 18 used other substances only (13 used one substance and five used many). Of the 35 patients with SUD, 16 used alcohol with other substances and 19 used only other substances (seven used one, 12 used many). Of the BPD patients, 17.2% had panic disorder or agoraphobia, 11.1% had social phobia, 14.9% obsessive-compulsive disorder (OCD), 8.9% generalized anxiety disorder (GAD), 4.4% anorexia nervosa, and 2.2% had other Axis I disorders. (Bizzarri et al.,2006).
Substance abuse in bipolar disorder
The Mean age (SD) doesn’t choose between any Gender male, female, marital status, married, single, divorced, widow, high or low education, employed, unemployed, housewife or student. This disorder BPD and SUD is not absent in any of these areas. Yes there are many studies out there but the most accurate ones are the in patient studies. Since BPD and SUD are so close it’s hard to know with out some history documented. This is how people are more likely to be miss-labeled (Dr. Carl). Although the frequency of the co-occurrence between BPD and SUD is well documented, the reasons for this association are not clear. While BPD patients with or without SUD did not differ on mean age, gender, marital status, education or occupation, there was an imbalance with the other groups on demographic characteristics. Table 2. Prevalence (%) of substance use disorders in patients with BPD + SUD. (Henna et.al.,1993)
Of the BPD patients, 17.2% had panic disorder or agoraphobia, 11.1% had social phobia, 14.9% obsessive-compulsive disorder (OCD), 8.9% gen- eralized anxiety disorder (GAD), 4.4% anorexia nervosa, and 2.2% had other Axis I disorders. Of the BPD + SUD patients, 28.1% had panic dis- order, 12.3% social phobia, 3.5% simple phobia, 14% OCD, 3.5% GAD, 7.0% anorexia nervosa, 10.5% bulimia, 1.8% adjustment disorder, and 3.5% had other Axis I disorders.
Assessments
The diagnostic interview consisted of the adminis- tration of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I/P) (37), and the Structured Clinical Interview for the Spectrum of Substance Use (SCI-SUBS) (36). The diagnostic assessment was conducted by three psychiatrists (JVB, CG and AS), and four residents in psychi- atry (SS, MRD, FR and LR), who were trained to use the SCID-I/P at the University of Pisa and certified if they reached a substantial level of agreement (>0.90) on 10 interviews with the trainer. The SCI-SUBS is a new interview developed and validated at the University of Pisa, (Henna2011).
The sensitivity to drugs and substances’ domain explores increased sensitivity to medications and substances (such as mood changes, anxiety attacks and strong sensations). The self-medication domain explores the use of substances and non-prescribed drugs in order to relieve symptoms related to mood, anxiety, eating disorders, or body dysmorphic disorder; or to increase performance or enhance sensorial perceptions. The “sensation seeking “domain investigates the tendency to seek strong emotions. (Bizzarri et. al., 2006).
The most frequently abused substances were alcohol, marijuana, sedative/hypnotics and cocaine. Only the use of amphetamines and other stimulants was lower than reported in other studies; indeed, the use of these substances may be influenced by their availability or by market forces. Many use more than one substance, but none met DSM-IV criteria for multiple substance use disorder. Most patients with BPD and SUD reported that they frequently used substances in order to alleviate mood/anxiety symptoms, to achieve or maintain a sense of euphoria, and increase energy.
BPD and SUD frequently reported more generic reasons for substance use, such as alleviating boredom, relaxing after work, escaping from reality, and improving performance. Similar motivations have also been found in the general population. This result suggest that a high sensation seeking score may be a common factor in all subjects who develop a SUD, regardless of the presence of other psychiatric diagnoses. It is not possible to establish causality between psychiatric symptoms, high scores for sensation seeking and substance sensitivity and SUD in patients with BPD from a cross-sectional study. Longitudinal studies are needed in order to confirm this finding. (Bizzarri et al., 2006).
“These days prescription drug use it through the roof with the number of people using”. (Dr. Carl 2014). Prescription use legal or illegal we are seeing more of this activity. Most the time people are going to the doctor to just obtain prescriptions for addictive behavior or to sell them. There’s a black market for prescription drugs. Some participants on Medicaid pay nothing for the medications. They use their Medicaid card for the purchase and then sell them for extra money. Since Medicaid cards are only issued to those that are low income or qualifies for state assistance. Some find this an easy way to make money. That also can leads them into trouble if they are caught selling the prescriptions or they find themselves addicted to them. “There are two many pain clinics that make it so easy to get your hands on them”. (Dr. Carl 2014).
These two mood disorders are extremely important to our communities. We should all work together in this matter of BPD and SUD better and help find some long-term results. Regrettably there are two many loop holes and many BPD and SUD slip right through them. For this reason BPD and SUD disorders could use another looked at how we could efficiently make some important and healthy changes. This could not only help the communities but the court systems. Lets all help the most important ones that suffer from BPD and SUD disorder. This could be a positive and great change that could take place. Due to the statistics that show they are close related and work in similar ways together. We as a community could work together and help the courts and doctors. We could all speak up and make some amazing changes in the system. Especially by helping the people that suffer from BSD and SUD. This could be beneficial for everyone.
References
Judge, Bob. Personal interview. October 27 2014.
Dr. Carl. Personal Interview. October 29 2014.
Bizzarri, J.V., Sbrana, A., Rucci, P., Ravani, L., Massel, G.J., Gonnelli, C.,… Cassano, G.B., (2006). Bipolar Disorders. New York, NY: Blackwell Munksgaard.
Henna, E., Hatch, J.P. Nicoletti, M., Swann, A.C., Zunta-Soares, G., Soares, J.C., (2012). Bipolar Disorders. San Antonio, TX, USA: Blackwell Publishing Ltd.