BHCS is very lucky to have Kelcy share her work on our blog. Kelcy is seeking her master's in counseling at Montana State University. In this article Kelcy explores the evidence surrounding bipolar disorder. We are excited to share her work with you.
This paper will review and break down six different research articles regarding bipolar disorder. The applicable information to the practice of a clinical counselor will be considered. Considering the level of evidence and how the research was conducted is a crucial factor to weigh in when considering how it influences best practice ethics. The strengths and weaknesses of these articles will be examined. Finally, how this information affects a client will be discussed.
It is critical to consider the age of onset and early signs of bipolar disorder when talking about teenagers so it can be diagnosed and treated giving the client a higher quality of life. It is shown that clinicians must be aware that teenagers at risk for or on the spectrum of bipolar disorder will show signs of hyperactivity and fatigue (Weintraub et al., 2019). Other things to look out for and be aware of early on with adolescents are types of symptoms most present when showing mania: delusions and hallucinations, irritability and anger, and mood liability. The depressive side of the spectrum also has its own most prevalent symptoms: increased appetite and forming isolated communities (Weintraub et al., 2019).
When sleep is considered an essential thing for emotion regulation it becomes a topic of interest when considering its effects on bipolar disorder. During manic episodes, a reduced need for sleep and difficulty falling asleep are prevalent issues. In contrast, a depressive episode shows more signs of hypersomnia, insomnia, or subjective daytime sleepiness (Morton & Murray, 2020). Understanding these sleep patterns can help a clinician tune into what kinds of episodes the client could be experiencing and when. Noticing that people with bipolar disorder usually go to bed late and wake late and tend to have unstable 24-hour routines highlight important factors of client lives that can give clues pointing toward their mental health experience (Morton & Murray, 2020).
Interestingly, it has been found that those with bipolar disorder I are more likely to have a comorbidity of substance use disorder. The most used substances are alcohol and cannabis. Those with bipolar disorder and substance use disorder typically have an early age of onset and are more familiar with psychiatric disorders (Crowe et al., 2020; Menculini et al., 2021). Substance use disorders with bipolar disorder are related to sleep disturbances after substance use has stopped and cause impairment to emotional regulation (Crowe et al., 2020). This could be useful when watching for signs of substance use disorders or understanding the why behind a client's substance use disorder could lead you to the underlying issue of bipolar disorder.
Along with a high comorbidity rate of substance use disorders with bipolar disorders come other disorders that are important to mention and specific to gender. While substance use disorder was more highly associated with males that have bipolar disorders, anxiety and eating disorders are most prominent for females (Loftus et al., 2019). It seems there is a more significant influence on bipolar comorbidities from sex rather than from the subtype of the disorder. Increasing awareness of early signs of panic disorder and alcohol abuse will be necessary for clinicians to implement into their practice when working with clients that have a bipolar disorder (Loftus et al., 2019).
Examining the neuroscience of disorders can give deeper insight into how brains function when working under a certain disorder. It has been shown that those with major depressive disorder have higher levels of alpha waves in the frontal regions and those with bipolar disorder have higher levels of beta waves in the frontal regions (Kim et al., 2019). Alpha waves are congruent with attention deficit hyperactive disorder when present with major depressive disorder and are separate from affective symptoms. Yet, attention deficit hyperactive disorder has a more significant association with relative powers with the gamma power and other mood symptoms (Kim et al., 2019).
When considering the levels of evidence of each article, it is important to consider the type of study it is and how the data is collected and analyzed. The research paper, Network analysis of mood symptoms in adolescents with or at high risk for bipolar disorder, is a level three non-experiential study (Weintraub et al., 2019). The paper, an update on sleep in bipolar disorders: presentation, comorbidities, temporal relationships, and treatment, is a level five study because it is a literature review (Morton and Murray, 2020). The level one study used, Effects of psychotherapy on comorbid bipolar disorder and substance use disorder, is a systematic review (Crowe et al., 2020).
The article, Substance use disorders in bipolar disorders: Clinical correlates and treatment response to mood stabilizers, is a level one due to its cross-sectional design which is quantitative research (Menculini et al., 2021). The study, Resting-state alpha and gamma activity in affective disorder with ADHD symptoms: Comparison between bipolar disorder and major depressive disorder, is a level two quasi-experimental design (Kim et al., 2019). Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype, is a level three qualitative study (Loftus et al., 2019).
Network analysis of mood symptoms in adolescents with or at high risk for bipolar disorder, is a strong study due to its high participant number of 272 people, using formal assessments as measurements, and using common statistical tools to evaluate the data like network centrality analysis and bootstrapping centrality network parameters. (Weintraub et al., 2019). An update on sleep in bipolar disorders: presentation, comorbidities, temporal relationships, and treatment, is a good review of the knowledge out there about sleep and bipolar disorders making the point that more information needs to be shared. It plays the role of being informative and not necessarily giving information that is recent enough to be fully reliable (Morton and Murray, 2020).
Effects of psychotherapy on comorbid bipolar disorder and substance use disorder: A systematic review, is the highest level of study due to its review of random control trial quantitative studies, and it could have had more reviewers to lessen biases (Crowe et al., 2020). Substance use disorders in bipolar disorders: Clinical correlates and treatment response to mood stabilizers, is a high-level one study due to it being a cross-sectional study, and it could have used current severity at the time of assessment rather than lifetime variables (Menculini et al., 2021).
Resting-state alpha and gamma activity in affective disorder with ADHD symptoms: Comparison between bipolar disorder and major depressive disorder, has a low sample size, however, they did use reliable measurements from qEEG and EEG analyses (Kim et al., 2019). Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype, has a decently high number of participants (739), and used reliable data analysis programs like the IMB SPSS Statistics version 23; however, it did not give clear information on the chronology of comorbidity onset which is within the title of this article (Loftus et al., 2019).
When inquiring into a client's life and mental health history knowing what kinds of signs to anticipate and questions to ask can substantially change how a clinician pieces the clues of their current mental health state together. The current client being discussed has suspected of being bipolar and has current severe substance use issues. The information that fatigues, hyperactivity, increased appetite, and isolated communities are signs of bipolar in adolescents can give insight into the current client's history with his disorder and how he has learned to cope before seeking help (Weintraub et al., 2019).
Understanding the client's sleep patterns could give insight into when and what kind of episodes are occurring for him and in what pattern they tend to unfold (Morton & Murray, 2020). The client currently has a high and severe use of both alcohol and cannabis which are two of the substances that are most abused among bipolar populations. It is highly prevalent that those with bipolar disorder also have a comorbid substance abuse disorder and issues with emotional dysregulation, which is telling of the client's current issues (Crowe et al., 2020; Menculini et al., 2021).
Among the highest rate of comorbidities for males is substance use disorders and at the top is alcohol abuse (Loftus et al., 2019). The current client is struggling with this exact issue and has high anxiety, consideration of panic attacks occurring for this client should be reviewed. The information that a client with bipolar disorder's brain works more prominently in beta waves gives insight into their operations daily (Kim et al., 2019). Helping the client harness his brain's beta wave state could empower the client's skills to problem solve and use his ability to focus his attention (2021).
Overall, clinicians need to inform themselves about the different states, symptoms, and presentations of disorders. Many variants can change the accuracy of diagnosis and through research, clinicians can become more familiar with those specifics. Clients will then receive considerably better care.
Crowe, M., Eggleston, K., Douglas, K., & Porter, R. J. (2020). Effects of psychotherapy on comorbid bipolar disorder and substance use disorder: A systematic review. Bipolar Disorders, 23(2), 141-151. Link
Loftus, J., Scott, J., Vorspan, F., Icick, R., Henry, C., Gard, S., Kahn, J. P., Leboyer, M., Bellivier, F., Etain, B. (2020). Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype. Journal of Affective Disorders, 267, 258–263. Link
Kim, J. S., Oh, S., Jeon, H. J., Hong, K. S., Baek, J. H. (2019). Resting-state alpha and gamma activity in affective disorder with ADHD symptoms: Comparison between bipolar disorder and major depressive disorder. International Journal of Psychophysiology, 143, 57–63. Link
Menculini, G., Steardo, L., Verdolini, N., Cirimbilli, F., Moretti, P., Tortorella, A. (2022). Substance use disorders in bipolar disorders: Clinical correlates and treatment response to mood stabilizers. Journal of Affective Disorders, 300, 326–333. Link
Morton, E., & Murray, G. (2020). An update on sleep in bipolar disorders: Presentation, comorbidities, temporal relationships and treatment. Current Opinion in Psychology, 34, 1–6. Link
Understanding brain waves. Neurofeedback Alliance. (2021, June 9). Retrieved July 2, 2022, from Link
Weintraub, M. J., Schneck, C. D., Miklowitz, D. J. (2020). Network analysis of mood symptoms in adolescents with or at high risk for bipolar disorder. Bipolar Disorders, 22(2), 128–138. Link