Benzodiazepines and other anticonvulsants operate through muscle relaxation and sedating actions, causing drowsiness, dizziness, and a decline in brain concentration and alertness. Long-term use of these agents may cause cognitive impairment. Carbamazepine also causes impaired brain concentration (López-Muñoz, et al., 2018). Lithium has several side effects, including muscle weakness, hair loss, acne, hand tremor, impaired memory, impaired thyroid action, increased urination rate, and diarrhea (López-Muñoz, et al., 2018). The case patient complained of muscle weakness and frequent urination. Experts consider limiting the usage of pharmacological agents for bipolar mental disorder due to these side effects (López-Muñoz, et al., 2018). Instead, a combination of pharmacotherapy and psychotherapy is advised for effective outcomes.
Psychotherapy Approach to a Patient with Bipolar Affective Disorder
The psychotherapy was used for the case patient to alleviate psychological suffering. The biopsychosocial model advocates for psychotherapy to complement pharmacotherapy in managing bipolar disorder (Koenders, et al., 2020). Psychotherapy entails a close working relationship with the therapists to discuss conditions and challenges and learn new coping skills (Koenders, et al., 2020). The approach entailed collaboration among the physicians, psychiatrists, and the patient to ensure holistic recovery. The patient was encouraged to express himself freely, discussing their experiences with the disease and the thinking process contributing to mood swings and depression (Koenders, et al., 2020). Using the Cognitive Behavioral Therapy, Christopher was also taught on the relationship between his thoughts, feelings and behaviors. The patient was also assisted to explore his previous experiences and whether they contributed to the illness and its progressions. This approach allows patients with bipolar affective disorder to learn new practical skills to help them cope with the disease, lowering the chances of developing depressive symptoms or episodes in the future (Koenders, et al., 2020). In addition, the practical skills helps prevent relapse. However, despite psychotherapy being an effective method of managing bipolar affective disorder, it has a limitation in that it is not a unified area since it has various treatment approaches involved (Koenders, et al., 2020).
Currently, the concept that the challenge of regulating affective state is an underlying bipolar affective disorder mechanism under two well-known psychological theories (Koenders, et al., 2020). The first one is the behavioural activation system (BAS) dysregulation theory and the second one is the Integrative Cognitive Model (ICM) (Koenders, et al., 2020). The BAS theory emphasizes manic episodes (hypo) in bipolar affective disorder patients. The theory asserts that bipolar affective disorder patients are overly reactive and sensitive to reward and goal-oriented stimuli, leading to reward-motivation and approach-related, consequently precipitating manic symptoms (Koenders, et al., 2020). Research has shown that such mechanisms contribute significantly to manic symptoms for at least for subgroups of bipolar affective disorder patients (Gove, 2019). However, the BAS theory explains the emergence of recurrent depressive episodes. The recurrent depressive episodes in bipolar affective disorder patients can be defined by the behavioural inhibition system (BIS) (Koenders, et al., 2020). BIS is the reverse of BAS. It drives the avoidance and inhibitory behaviours and is linked to avoidance, depression, and over-sensitivity to non-reward when it comes to the population of people with the bipolar affective disorder (Koenders et al. 2020).
The approach and avoidance behaviour operate at some differing levels. When it comes to goal-setting cognitive task, it is considered at a higher level (Kurtz, et al., 2021). Studies have shown that individuals with the bipolar affective disorder exhibit stronger goal-attainment and achievement attitudes and endorse higher ambitions than unaffected controls (Kurtz, et al., 2021). However, bipolar affective disorder patients exhibiting higher purposes or are more goal-driven also have higher chances of developing manic episodes. Besides, people with the bipolar affective disorder also have a higher goal-attainment drive and are likelier to engage in activating and stimulating behaviour that possibly provokes manic episodes (Kurtz, et al., 2021). They report more BAS-relevant occasions, including the opportunity to obtain rewards or goals, goal-striving, and overcoming difficulties, and are at risk of engaging in substance abuse behaviours (Iacobucci, 2022).
The ICM psychological model, on the other hand, states that the underlying mechanism of manic mood fluctuations and depressive episodes can be explained by highly positive and negative appraisals of internal affective variations (Koenders, et al., 2020). For example, a patient diagnose with bipolar affective disorder may experience excessive positive appraisal concerning activated states, such as feeling in their best version when they feel energetic (Carvalho, et al., 2020). The patient can also experience extreme negative appraisal, including losing control when feeling more energetic. Accordingly, the behaviour is controlled by appraisal content (Carvalho, et al., 2020). For example, patients risk developing a manic or hypo state when they engage in stimulating actions to up-regulate the energetic level (ascent behaviours) (Koenders, et al., 2020). On the one hand, social withdrawal to down-regulate the state or descent behaviour increases depressive moods. The appraisal approaches can also apply to negative affective states (Iacobucci, 2022).
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