Medication Reflection: Bipolar Affective Disorder from the Biopsychosocial


This study develops an in-depth understanding of the significant findings concerning the biopsychosocial approach to bipolar affective disorder using a case study of a patient, Christopher (a pseudonym),  with bipolar affective disorder. The paper examines the components of biopsychosocial interventions for bipolar affective disorder. Such include biological/pharmacological, psychological, and socio-environmental factors that influence the causes and progression of bipolar affective disorder and their relationship to the case study patient. The study concludes that over-reliance on pharmacological intervention alone may not be effective for patients with bipolar affective disorders. The pharmacological or biomedical intervention focuses only on the treatment and bipolar affective disorder symptom elimination while ignoring psychological and socio-environmental factors affecting the disease progression. A biopsychosocial intervention ensures holistic therapy and can facilitate the full recovery of patients with bipolar affective disorder. Understanding biopsychosocial intervention for bipolar affective disorder will align my thesis and professional development towards holistic therapy when dealing with mental disorder issues in research and practices. This ensures that my adopted intervention mode addresses the body, mind, and spirit to support the full recovery of patients with mental illness, including bipolar affective disorder.

The Person

Case Presentation: Anonymised Introduction to the Person

This is a case of a 65-year-old male patient, Christopher. He was presented to the emergency room in the acute inpatient mental health ward due to irritation and mental disturbance. The patient is a retired teacher but operates a successful private elementary school with four outlets. They started the school with his late wife, who succumbed to heart complications in 2021. The patient was depressed for months following his wife’s death. The patient has two children who are currently adults with their families. The patient presently lives alone in their home but frequently gets visited by her two sons and their family. The patient had a history of hypertension, which runs in the family. Christopher never reported any case of past psychotic disorder(s) history. However, he reported having engaged in substance abuse and was living in the street during his teenage years after running away from his abusive parents before being adopted. Examinations included thyroid function, liver function analysis, electrolyte tests, lipid profile tests, Vitamins B12 and A tests, and brucella. Computed tomography (CT) and magnetic resonance imaging (MRI) was done on the patient’s brain and spinal cord, all of which their outcomes were within a normal range (Alotaibi, et al., 2020).

The patient was violent, disturbing other patients in the ward and loudly expressing his desire to be taken home as soon as possible. Midazolam 3 mg/IV and haloperidol 5 mg/IM were administered to calm the patient (Alotaibi, et al.). The patient was healthy until two weeks before admission to the emergency room, where he became hyperactive and talked too much. The patient was overspending and had distorted sleep patterns. The patient was also physically and verbally aggressive and even had altercations with the neighbors, who reported him to the police. The patient also developed reckless driving habits. He claimed that someone had installed a secret camera in his car to monitor his actions. He often heard imaginary voices instructing him (Alotaibi, et al., 2020). The symptoms intensified the week before his admission to the emergency department. The patient had been to a different hospital before visiting our facilities. He was also admitted to the emergency department for similar symptoms and discharged later on valproic acid 500 mg and olanzapine 5 mg. The patient was under the prescriptions for three months and experienced some slight improvements in sleep patterns and moods, returning to his baseline (Alotaibi, et al., 2020).

The biopsychosocial approach was considered for the patient this time than overly relying only on the pharmacological system. The pharmacological or biomedical model focuses only on the treatment and bipolar affective disorder symptom elimination. However, the biopsychosocial approach focuses on patient’s insight of key symptoms and how they, alongside their families, respond to them (Haslam, et al., 2018). It incorporates the biological, psychological, and sociological aspects of the disease.

Features and the Wider Context of a Patient with Bipolar Affective Disorder  

It was discovered that bipolar affective disorder had a severe impact on the quality of the patient’s life, and posed an increased risk of death if left unattended. The bipolar affective disorder is a medical diagnosis occasioned by mood shifts, characterised by a period of mania and depression (Tremain, et al., 2019). The patient was experiencing mania and depression exhibited through intense behaviour change and thinking changes, and mood swings. This conforms to the research findings that bipolar affective disorder implies sharing two poles, low and high (Tremain, et al., 2019). The high pole, in most instances, is experienced as mania, while the low pole presents as depression. The diagnostic criteria require that mania take at least seven days or require hospitalization (Tremain, et al., 2019). Some of the symptoms the patient displayed include euphoria or irritability and other symptoms such as decreased sleep, impulsive behaviour, grandiose ideas, flight of ideas, distractibility, increased talkativeness, , and racing thoughts, which also conforms to the study findings on the condition (Tremain, et al., 2019). Research has shown that the mixed episodes are characterized by simultaneous depressive symptoms and manic symptoms lasting for at least seven days—however, not all people with bipolar affective disorder experience depression (Tremain, et al., 2019). The bipolar affective disorder is occasioned by at least a single lifetime hypomanic episode and a single episode of major depression. Hypomania has similar symptoms as mania but lasts for a shorter period, about four days. Even though it is noticeable to other symptoms, it is not linked to functional impairment (Tremain, et al., 2019). Major depressive episodes are defined by intense loss of interest or sadness alongside symptoms such as insomnia, weight gain or loss, feelings of worthlessness, cognitive dysfunction, and suicidal attempts or ideation lasting at least two weeks or more (Rice, et al., 2019).

The contemporary understanding of bipolar affective disorder suggests that many patients experience unfavourable outcomes (Hyman, 2019). Even with advancements in pharmacological treatment, most bipolar affective disorder patients develop chronicity with significant general burden and disability (Hyman, 2019). The burden also extends to their families and society at large. Even symptomatic remission is not identical today and may imply functional recovery (Hyman, 2019). The pharmacological treatment, in many cases, fails to address most of the patients’ needs. As such, there is an increasing need to develop and implement patient-centered effective, affordable interventions (Hyman, 2019). Early successful treatment accompanied by full recovery where possible and management and control of subsyndromal symptoms, poor medication adherence, and psychosocial stress are cited as some of the factors that predict earlier relapse and poor overall health (Hyman, 2019).

The biopsychosocial approach was recommended for the patient in this case, to understand his health and health behaviours. The biopsychosocial approach explores the potential biological, psychological, and social factors that impact overall health and behaviour (Gove, 2019). The selection of the intervention confirms the research findings that the biopsychosocial approach to bipolar affective disorder helps primary caregivers to conceptualize the interactions among the psychosocial and biological components of illness to enhance the dynamic correlation between caregivers and their patients and the multidisciplinary models within the patient’s care (Gove, 2019). Conceptualised in 1977 by George Engel, the biopsychosocial model postulates that understanding an individual’s medical condition must consider biological, psychological, and social factors (Gove, 2019). The bio implies the physiological pathology aspects. The psycho includes the behaviours and thoughts, including psychological distress, attribution, present coping mechanism, and avoidance/fear beliefs (Gove, 2019). The social aspects include the socio-environmental, socio-economical, and cultural factors, including work and family issues. The biopsychosocial is adopted commonly in chronic pain as pain is perceived in psycho-physiological behaviour, which cuts across social, biological, and psychological factors (Adams & Turk, 2018). The biopsychosocial model incorporates the pharmacological/biological, psychological, and socio-environmental factors impacting illness, as discussed in the following section  (Adams & Turk, 2018).

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