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PCN 523 Topic 5 Psychological Testing and Clinical Diagnosis (Obj. 5.1 and 5.2)

Selected Disease: Bipolar Disorder.

Over the years, the prevalence of mental and mood disorders is increasingly high. These disorders have been known to encompass a broad range of additive issues specifically because individuals who suffer from these disorders tend to pick up addictive behaviors and personalities. One such disorder is Bipolar Disorder.

Causes of Bipolar Disorder

Bipolar disorder refers to a mental disease that is characterized by There are several causes of the disorder. One of the causes is genetics in that, people born with specific types of genes tend to develop bipolar disorder, (Goodwin, 2007). Family history and genetics easily trigger the development of the disease. Another cause is imbalanced chemicals in the individual`s brain.

Symptoms

A patient suffering from Bipolar disorder has a reduced concentration span. The person experiences sudden shifts in moods and emotions due to imbalanced chemicals in the individual`s brain. The chemicals in the heightened proportion induce mood swings which may affect the brain structure and functioning of the individual. These chemicals include dopamine, noradrenaline, and serotonin. Besides, the patient experiences significant shifts in energy levels, moods, and emotional highs and lows. The disorder is also known as manic depression, particularly because patients suffering from the disease experience depressive and manic episodes, (Strakowski, 2000).

The patient may experience episodes of depression. Bipolar disorder and substance abuse are co- occurring and thus patients may exhibit characteristics such as inappropriate sexual activity and gambling. Also, the individual`s brain is different from that of a healthy person which affect the brain structure and functioning of the individual. There is also a dysfunction of chemical messengers or neurotransmitters in the patient`s brain due to external factors, social circumstances or psychological stress, (Strakowski, 2000). A traumatic experience or environment can also induce the development of bipolar disorder, especially when the person is exposed to genetic disposition.

Prevalence

The patterns of comorbidity, the severity, impact, and prevalence rates of bipolar disorder are seen to be remarkably similar internationally with the treatment of the disorder often unmet in low-income countries. According to reports, 10% of the general world population meet the overall criteria for Bipolar I Disorder, 1.3% Bipolar II Disorder and 1.32% DSM-IV Bipolar Disorder. The aggregate lifetime prevalence is about 0.7% Bipolar I Disorder and 0.5% Bipolar II Disorder within a period of 12 months. The sub- threshold, according to reports was approximately 1.3% Bipolar Disorder, 2.3% Bipolar Spectrum within a period of 12 months. 60% of the patients responded with mania and role impairment while 74% of the respondents exhibited depression.

Course and Development

The disorder develops in early adulthood or later stages of adolescence. The average age of onset is therefore 18 years for Bipolar I Disorder and mid-20s for Bipolar II Disorder for all genders. Some individuals develop the first signs during childhood, (Goodwin, 2007). However, the symptoms do not develop until much later in life, although the disorder is an ongoing condition. 65% of patients experience hypomanic or manic episodes after or before a major depressive episode. Women tend to experience mixed feature and rapid cycling episodes as well as alcohol and eating diseases (co-occurring) than males, (Cohen, 2013). Once the disease has established itself, the episodes of depression and mania recur across the patient`s life span which may lead the patient to commit suicide.

Assessment Tools

The tools used for the diagnosis of Bipolar Disorder are Structured Clinical Interview for DSM-IV (SCID) and the DSM’s crosscutting symptom measure. SCID is a validated tool that assesses Bipolar Disorder based on DSM-IV criteria, (Goodwin, 2007). Here, psychotic symptoms yield a diagnosis of Bipolar Disorder after a maintained presence (symptoms) of at least two weeks. Structured Clinical Interview for DSM-IV involves an interview performed by various modules which allow the interview to remain tailored to diagnose Bipolar Disorder. The module consists probes that cover symptoms for use during clinical judgment of information obtained.

Structured Clinical Interview for DSM-IV is a recommended psychological test and is thus considered reliable and valid. It is done as a routine part of the clinical intake procedure through the utilization of well-structured interviews that cover a variety of diagnoses, (Cohen, 2013). SCID contains a modular design that reflects on the interviewer’s clinical judgment and core symptoms, thus gathering supplemental information or use when probes fail to provide adequate data. The reliability of SCID is well-supported by the American Psychiatric Publishing and at least 10 major trials, (Strakowski, 2000). SCID is administered by a trained mental health professional or a clinician who is familiar with the DSM-5 diagnostic criteria and classification. The pricing of SCID is based on the intended use, such as educational use, not- profit, non-commercial research or commercial research.

The DSM’s crosscutting symptom measure is used across bipolar diagnostic symptoms based on two levels. Level 1 encompasses more concise symptoms while level 2 involves general symptoms such as anxiety, sleep disturbance, anger, somatic symptoms, mania, irritability, inattention, repetitive thoughts, substance abuse, and depression Self- report versions are conducted on adolescents and children while adults utilize level 1 CCSMs. After determining the threshold scores from CCSMs conducted in level 1, level 2 CCSMs are performed to provide more detailed information for use in assessment and diagnosis, (Strakowski, 2000). The assessment is conducted by researchers and clinicians with level 2 tests performed without acquiring costs.

Personality assessments are not suitable for use in the diagnosis of bipolar disorder because they lack a biological marker for the disease. Since the symptoms are reviewed through unstructured mechanisms, a personality test may result in comorbid conditions going undetected. Thus, it is critical to routinely screen the disorder, according to the structured diagnostic tools.

REFERENCES

Cohen, R., Swerdlik, M., & Sturman, E. (2013). Psychological Testing and Assessment. New York: McGraw-Hill.

Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: Recurrent depression, substance use and bipolar disorders (Vol. 1). Psychology Bulletin.

Strakowski, S. M., & DelBello, M. P. (2000). The co-occurrence of substance use and bipolar disorders, 20 (2), 191-206.

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