Bakgrund: Bipolär sjukdom innebär perioder av mani och depressioner vilket kan medföra svårigheter för personer som drabbats. För att kunna förstå och hjälpa dessa personer behöver sjukvårdspersonal kunskap om hur sjukdomen upplevs och hanteras. Syfte: att belysa hur personer med bipolär sjukdom upplever och hanterar sin sjukdom. Metod: En allmän litteraturstudie genomfördes med kvalitativa artiklar. Resultat: Personernas inställning till diagnosen och behandling varierade och relationen till sjukvårdspersonalen var betydelsefull. Svårigheterna att hantera och bemöta sjukdomen orsakade känslor av osäkerhet, okontrollerbarhet och instabilitet. Sjukdomen påverkade självförtroendet och självkänslan och orsakade upplevd stigmatisering och problem i relationer. För att kunna hantera bipolär sjukdom krävdes egen acceptans, kunskap och insikt, struktur i vardagen samt stöd från närstående. Diskussion: Resultaten diskuteras utifrån Antonovskys teori om känsla av sammanhang, KASAM. Problematiken kring acceptans av sjukdomen och motivation till fortsatt behandling är viktig kunskap för sjukvårdspersonal, liksom att sjukvårdspersonal har personernas försämrade självkänsla och upplevda stigmatisering i åtanke. Detta för att hjälpa personerna att känna KASAM och få ett mer salutogent perspektiv. Patientutbildning bör anpassas efter varje individs behov. Slutsats: Lyhördhet för hur varje individ upplever och hanterar sitt liv med bipolär sjukdom krävs, samt att vården anpassas därefter. Därvid kan patienternas KASAM ökas. / Background: Bipolar disorder involves periods of mania and depression, which may cause difficulties for those affected. In order to understand and help those affected, health care providers need to be aware of the subjective experience and coping skills of their clients. Purpose: To examine how people with bipolar disorder experience and handle their illness. Method: A literature review of relevant qualitative articles was conducted. Results: subjects' attitudes towards the diagnosis and treatment varied and the relationship with healthcare professionals was relevant. The disorder was accompanied with feelings of uncertainty, uncontrollability and instability. It also affected self confidence, self-esteem, caused an experience of stigma and relationship difficulties. Coping strategies included acceptance, information, structure of everyday life and family support. Discussion: Antonovskys theory about sense of coherence, SOC, was used for the discussion Acceptance and motivation to treatment are key- topics for health care professionals. Clients lower self- esteem and the issue of stigma needs to be addressed. This might increase the clients SOC and facilitate the move towards a salutogenic perspective. Patient information should be adapted to individual needs. Conclusion: Awareness of individual experiences and skills is necessary. The clients care and treatment needs to be adapted accordingly.

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De psykiatriska diagnoserna har ökat i antal det senaste decenniet. Hur påverkas en individ av att få en psykiatrisk diagnos? Bipolär sjukdom tillhör gruppen psykiska sjukdomar och kännetecknas av växlingar mellan förhöjda stämningslägen såsom mani eller hypomani samt perioder av depressioner. Sjukdomen delas in i bipolär I och II, där bipolär I är den allvarligare varianten. Syftet med föreliggande studie är att undersöka vilken betydelse diagnosen haft för individer med bipolär sjukdom. Åtta personer, sex kvinnor och två män mellan 39-65 år (medelålder 51.6) diagnosticerade med bipolär sjukdom I eller II intervjuades. Svaren bearbetades med hjälp av induktiv tematisk analys. Resultatet visar att diagnosen haft en klart övervägande positiv betydelse. De huvudteman som framkom var förklaring, förståelse och acceptans, samt adekvat behandling. De samstämmiga uppfattningarna om att diagnosen haft en stor positiv betydelse förklaras bland annat av att majoriteten av deltagarna levt i många år utan rätt diagnos, vilket i sin tur inneburit många år inom den psykiatriska vården utan att få rätt hjälp. Rätt diagnos har inneburit rätt behandling, i synnerhet medicinskt, men även via psykoedukativa och psykoterapeutiska insatser. Rätt typ av behandling har därmed medfört en balans i livet, där funktionsförmågan förbättrats avsevärt, och livskvalitén ökat. Ett fåtal negativa konsekvenser av diagnosen framkom i två teman; initiala effekter av diagnosen samt diagnosens begränsande effekt.

The proposed study has one central purpose, to determine if the Comprehensive System (CS), an empirically valid system for scoring and interpreting the Rorschach Inkblot Test, can effectively discriminate between individuals diagnosed with borderline personality disorder (BPD) and those diagnosed with bipolar disorder. Previously conducted, peer-reviewed studies since 1985 have uncovered CS variables that were statistically significant in BPD and in bipolar groups when examined separately. However, there have been relatively few such investigations, making the body of research with CS variables small in this area. It would be valuable to know whether or not the CS is a useful tool in distinguishing between these two disorders. A second goal of the current study is to uncover variables that help diagnose both bipolar disorder and BPD as separate entities. Some CS variables have not been previously studied with regard bipolar disorder or BPD. Additional research with variables known to be useful in identifying these disorders will cross-validate findings that already exist. Moreover, if the Rorschach could help classify individuals with these disorders and uncover distinct differences between them in their test results, these data would also lend support for the idea that these are indeed two different disorders, a tertiary goal of the current study. / text

Introduction: Bipolar Disorder (BD) is a chronic mental illness associated with functional decline, mortality, and significant health care costs; furthermore, specific general medical conditions have been found to occur disproportionately within BD patient populations, among them, migraine is one of the most studied. Migraine has a global prevalence of 10%, and it is a disorder with elevated direct and indirect costs, the later mostly derived from its association with mood and anxiety disorders. Specifically, the reported prevalence of migraine in the BD population ranges from 24.8% to 39.8%, rates that are considerable higher than those found in the general population. / Objective: To explore the prevalence and clinical characteristics of BD patients with and without migraine (Study 1), and to examine the psychiatric comorbidity in patients suffering from migraine (Study 2). / Methods: 323 BD patients were studied, using SADS-L and SCID as diagnostic interviews, and ill-Migraine questionnaire to assess the presence of migraine. Statistical analyses were conducted using parametric analysis and the development of log-linear models. Additionally, 102 migraine patients were interviewed using SADS-L, and the descriptive characteristics of the sample were analyzed. / Results: For Study 1, we found that 24.5% of BD patients suffer from migraine, and it is significantly associated with BD 2, suicidal behaviour, and a variety of anxiety disorders. As well, over 70% of migraine patients showed a lifetime psychiatric diagnosis, mainly within the spheres of mood and anxiety disorders; specifically, the prevalence of BD among migraine patients was 12.7%. / Conclusions: Our study highlights the high prevalence of migraine among BD patients, and the elevated prevalence of psychiatric comorbidity among migraine sufferers. The study of this comorbidity will deepen our understanding of the mechanisms that underlie both disorders and provide a better framework for the developing of molecular techniques to further analyze the molecular physiopathology of Bipolar Disorder.

Correlation between 8-hydroxy-2-deoxyguanosine (8-OHdG) and/or redox imbalance and 5-methylcytosine (5mc) levels was studied in patients with bipolar disorder (BD) and an excellent response to lithium treatment, their affected and unaffected relatives (AR and UR, respectively) and controls. We demonstrated that global methylation was decreased in BD subjects and their relatives compared to controls and remained so after lithium treatment in BD subjects, while UR and AR were no longer different than controls. 8-OHdG levels and Complex I activity did not differ between groups before and after lithium treatment. Finally, glutathione peroxidase activity was higher in relatives of patients before and after lithium treatment and negatively correlated with 5mc levels. The methylation pattern in BD subjects may be specific for BD and that lithium may be involved in regulating global methylation. This study supports the antioxidant properties of lithium through regulation of glutathione system.

Correlation between 8-hydroxy-2-deoxyguanosine (8-OHdG) and/or redox imbalance and 5-methylcytosine (5mc) levels was studied in patients with bipolar disorder (BD) and an excellent response to lithium treatment, their affected and unaffected relatives (AR and UR, respectively) and controls. We demonstrated that global methylation was decreased in BD subjects and their relatives compared to controls and remained so after lithium treatment in BD subjects, while UR and AR were no longer different than controls. 8-OHdG levels and Complex I activity did not differ between groups before and after lithium treatment. Finally, glutathione peroxidase activity was higher in relatives of patients before and after lithium treatment and negatively correlated with 5mc levels. The methylation pattern in BD subjects may be specific for BD and that lithium may be involved in regulating global methylation. This study supports the antioxidant properties of lithium through regulation of glutathione system.

Bakgrunden till studien är att bipolär sjukdom är en av de tjugo vanligaste orsaker till funktionsnedsättning i världen. Det finns få studier gjorda på hur patienter upplever att vårdas för sjukdomen. Vårdpersonal kommer möta patienter med diagnosen inom all form av sjukvård. Syftet är att belysa behov av vård och stöd såsom det upplevs av patienter med bipolär sjukdom. Metoden som användes var en litteraturstudie där sju självbiografiska böcker analyserades med hjälp av en kvalitativ metod. Resultatet sammanfattas i fem teman: livsrytm och balans, hinder för att söka vård när behovet finns, olika behov av stöd, behov av trygga punkter och olika sätt att bli värdigt bemött och lyssnad till. I diskussionen påvisas det utmärkande i resultatet, att patienter upplevde det svårt att ta in information när de var både i maniska- och depressiva episoder. Det är viktigt att sjuksköterskor har en förståelse för hur människor med bipolär sjukdom upplever sina liv för att kunna ge individuellt anpassad information och stöd. / The background to this study was that bipolar disorder is one of the twenty most common reasons of disability in the world. There are few studies made on the subject of patients with bipolar disorder owns experience of the given healthcare. Caregivers will meet these patients in all kind of healthcare. The purpose of this study is to describe how patients with bipolar disorder experience their need of support and care. A qualitative literature method was used, where seven autobiographies where analyzed. The result summarized in five main themes: life rhythm and balance, barriers to seek care when the need exist, the need of support, need to comfortable points and different ways to be treated with dignity and listened to. The discussion demonstrated the significant of the result, patients with bipolar disorder finds it difficult to take in information when they have both a manic and a depressive episode. It is important that nurses have patience and understanding for the patient's life and his or her illness. The nurses have to understand the meaning of giving individual information and support to the patient.

There has recently been an intense debate about the increased rate of bipolar disorders (BPD) in children and adolescents observed in clinical settings. Thus, there is great interest in child and adolescent symptoms of hypomania and whether these symptoms subsequently will develop into BPD. More knowledge about early signs could give insight into the development of the disorder. There are also concerns that hypomanic symptoms in adolescence indicate excess risk of other health conditions. It has been reported that patients with mood disorders have a high consumption of prescription drugs in different ATC classes. The primary objective of this thesis was to better understand the mental health outcome of adolescents with hypomania spectrum symptoms and to identify early risk factors for adult bipolar disorder among adolescents with mood disorders. In order to widen the scope and investigate health outcome of mood disorder in general psychopharmacological outcomes were included. A community sample of adolescents (N=2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes, while another 197 fulfilled the criteria for major depressive disorder (MDD) without a history of a hypomania spectrum episode. A follow-up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed. Univariate and multivariate analyses were used. The results indicate that the phenomenology of the hypomania spectrum episodes during childhood and adolescence per se does not predict adult bipolar disorder. However, having both affective symptoms during adolescence and a family history of bipolar disorder increases the risk of developing bipolar disorders in adulthood. Disruptive disorder in childhood or adolescence as well as family histories of BPD emerged as significant risk factors that differentiated between the future development of BPD and MDD. Adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes in adulthood. Both groups are at increased risk for subsequent mental health problems, high consumption of prescription drugs, and high health care use, compared with the control group. The high rates of prescription drugs in many ATC classes found among the former depressed females seem to indicate a series of co-morbid somatic illnesses. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course. Characteristics such as disruptive disorders and family history warrant particular attention.

This dissertation examines how bipolar disorder, a common and disabling psychiatric condition, is made relevant as a participants’ concern in a site of massively consequential psychological business – the psychotherapy session. As its central thesis is the claim that the practices by which bipolar disorder gets done as bipolar disorder are invariably absent in most formal accounts of the disorder. In this regard, the dissertation provides an empirically grounded description of a range of discursive practices associated with the doing of bipolar disorder in psychotherapy. This is undertaken from a discursive psychological orientation that draws extensively from ethnomethodology, conversation analysis, and Wittgensteinian philosophy. Following a review of bipolar disorder as a diagnostic psychiatric category, consideration is given to alternate conceptualisations which suggest the category is constructed in-and-through complex socio-historical practices which are often occluded and considered irrelevant to the category’s situated deployment. This notion is used to provide a more sustained examination of how one might ‘get at’ such practices in situ by way of conducting ethnomethodological and conversation analytically informed investigations. In consideration of how one might approach psychological categorisation practices in talk-in-interaction, a discursive psychological orientation is developed which stresses the social, public nature of psychological categories in use. The empirical materials examined in the dissertation are drawn from a corpus of audio recordings of seven ‘naturally occurring’ psychotherapy sessions involving a clinical psychologist and five clients for whom the category ‘bipolar disorder’ has demonstrable relevance. Practices examined include those relating to the production and recognition of what might count as a bipolar disorder ‘symptom’, the manner in which ‘moods’ operate as account production devices, and the methods by which psychological terms (such as ‘thought’ and ‘feel’) operate in-and-as situated practices involved in psychotherapeutic business.