MS_task_01_proposal for activity

26/08/2015 1
Proposal for a health promotion/prevention
activity
Topic: bipolar disorder - the basics
Author: Garth Richards

26/08/2015 2
Proposal for a health promotion/prevention activity
1. The name of the activity
“Bipolar disorder – the basics”.
2. The aim of the activity is:
(i) to increase awareness and
understanding of BD, and
(ii) to educate people around how to
help prevent a relapse.

26/08/2015 3
What is bipolar disorder?
BD “… is a brain disorder that causes
unusual shifts in mood, energy, activity
levels, and the ability to carry out daily
tasks. Intense emotional states occur in
distinct periods called ‘mood episodes’.
Each mood episode represents a drastic
change from a person's usual mood and
behaviour”. (Bipolar Disorder in Adults,
2015).
Four types of BD are described in the
DSM-V. (pp.123-154). Type I and type II
are by far the most commonly diagnosed.
In BD type I, the person exhibits mania,
and psychotic symptoms are present.
In BD type II, the person exhibits
hypomania, and psychotic symptoms
are absent.
In both type I and II, a switch to severe
depression is always present.

26/08/2015 4
More on: What is bipolar disorder?
Relapse
“A relapse in bipolar disorder is when
an episode of mania, hypomania, or
depression occurs after a period of
being in remission. … Sometimes it is
possible to predict a relapse, often it is
not. “ (McInnis, M. 2014).

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3. Supporting evidence and statistics
The lifetime prevalence of bipolar
disorder is estimated at 1–4% of
the general population. (Singh and
Berk, 2008).
BD affects approximately 2.6% of
adult Americans (i.e. 5.7 million
people).
BD reduces life expectancy by 9.2
years. 33% of patients attempt
suicide, and 15% complete suicide.
This represents 12% of all
Australian suicides. The suicide rate
is 50 to 60 times higher than the
general population.
69% of patients with BD are
misdiagnosed, delaying proper
treatment for 5 to 10 years. The most
common mis-diagnosis is major
depressive disorder (“What you need
to know”, 2015).

26/08/2015 6
More on: supporting evidence and
statistics
BD is a chronic disease with periods of
remission and relapse. It was
estimated to be the 7th leading cause
of non-fatal disease burden in the
world in 1990, accounting for 3% of
total YLD [years lived with disability],
around the same percentage as
chronic obstructive lung conditions.
(Ayuso-Mateos, 2006).
"The cost of lost productivity resulting
from this illness in the United States
during the early 1990s was estimated
at $15.5 billion annually." (Mok et al.,
2011).

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Comorbidity of BD with medical and/or
other psychiatric disorders is very
common.
Definition: "When two disorders or
illnesses occur in the same person,
simultaneously or sequentially, they are
described as comorbid. Comorbidity also
implies interactions between the illnesses
that affect the course and prognosis of
both." (Comorbidity: Addiction and Other
Mental Illnesses, 2010).
Psychiatric comorbidity
Nearly 50% of persons with BD will also
develop a comorbid anxiety disorder.
The most commonly-identified forms of
anxiety disorder were: generalized
anxiety disorder (20%), social phobia
(20%), panic disorder (19%), and PTSD
(post-traumatic stress disorder) (17%).
Comorbid anxiety disorders increase the
likelihood and degree of adverse
outcomes, including time spent unwell,
suicidal behaviour, drug or alcohol
misuse, and impaired functioning.
(Sparks, 2015)
Other common comorbid psychiatric
disorders include: substance abuse,
ADHD, eating disorders, and phobias in
general including, for example,
agoraphobia. (“What other mental
disorders are associated”, 2015).

26/08/2015 8
Medical comorbidity
Persons with BD have higher rates of
medical [i.e. non-psychiatric] illness than
those with unipolar depression and the
general population. The most common
medical disorders are: asthma, Type 2
diabetes, elevated lipids, epilepsy, gastric
ulcers, hypertension, kidney disease,
multiple sclerosis, osteoarthritis and
thyroid disease. (Sparks, 2014).
In general, comorbidity is expensive.
"Approximately 75 million people in the
U.S. have two or more chronic conditions,
defined as ‘conditions that last a year or
more and require ongoing medical
attention and/or limit activities of daily
living.’
[Parekh and Barton, 2010]. Some 65% of
health care spending is directed at this
24% of the population." (Thomas, 2013)

26/08/2015 9
4. The target audience
Mental health and AOD workers,
people with BD and their significant
others, and any other interested
people; and …
… the need for the activity
evidence suggests that non-health
professionals are poorly-informed
about this very serious disorder. (“Gaps
Exist In Public‘s“, 2015), (Parkinson, H.,
2104a), (Davey, G., 2013, 20 August),
(Dawkins, K., 2014). Therefore, this
activity targets the need for access to
reliable evidence-based information
which participants can use to:
• promote awareness and understanding
of the disorder, and
• better inform themselves of the facts,
instead of relying on (sometimes) poor-
quality, frequently erroneous and
sensationalist material.

26/08/2015 10
5. stigma
Stigma has been defined as “A mark
of disgrace associated with a particular
circumstance, quality, or person: [for
example] ‘the stigma of
mental disorder’ [and] ‘to be a non-
reader carries a social stigma’”.
(http://www.oxforddictionaries.com/d
efinition/english/stigma).
Mental health stigma consists of:
(i) social stigma (prejudicial attitudes
and discriminating behaviour directed
towards individuals with mental health
problems as a result of
the psychiatric label they have been
given) and
(ii) perceived stigma or self-stigma (the
internalizing by the mental health
sufferer of their perceptions of
discrimination). (Davey, 2013).
What is behind stigma?
“…a toxic concoction of ignorance and
fear, of prejudice and power play.”
(Allan, 2013).

26/08/2015 11
What are the effects of stigma?
stigma isolates people
stigma excludes people from day-to-day
activities
stigma stops people getting and keeping
jobs
stigma prevents people seeking help
stigma has a negative impact on physical
health
stigma delays treatment and impairs
recovery. (Living with stigma and
discrimination, 2008).
Poor understanding of BD among the
general public: a telling example
A 1999 US survey revealed that: only 33%
of respondents know that BD is
characterised by wide swings in emotion
or mood; 44% believe people with BD are
often violent; 25% think people who have
mood disorders are very different to
other people; a majority believe mood
disorders can be prevented by adopting
"self-help" techniques, including positive
thinking; and only 35% would consult a
mental health professional themselves or
for someone else experiencing symptoms
of BD. (“Gaps Exist In Public‘s“, 2015).

26/08/2015 12
Media portrayal of bipolar disorder
Not all media portrayals of bipolar
disorder are inaccurate and stigmatising,
according to one writer with the
disorder (Parkinson, 2104b). The actor
Clare Danes plays the CIA analyst Carrie
Mathison (left) in the series Homeland.
Stephen Fry (right) speaks of his
experiences with bipolar disorder in the
2006 BBC documentary "The Secret Life
of the Manic Depressive“.

26/08/2015 13
6. A rationale for the activity
A great deal of non-evidence-based
material is available on the
Internet. What professionals write
for their peers is highly informative,
but often difficult for the general
public to understand.
Therefore we argue that a need
exists for a brief overview of BD
presented - as far as possible - in
non-technical language. We will
use technical language when
needed. This will help to inform
those who wish to research the
condition in more detail.
7. How the activity meets the needs of
the target audience
As it appears that some people wish to
know more, in a broad sense this
activity informs and empowers
participants through education.
Accurate and appropriate information
helps to break down stigma, which
arises partly through ignorance.
People with a diagnosis, or suspected
diagnosis, of BD will be better able to
discuss their needs with any treating
professional.

26/08/2015 14
8. The expected outcomes of the
activity
Increased audience awareness and
understanding of BD; the ability for
health professionals, family, friends
and carers to better support people
with BD; the ability of any participant
to further research the disorder in an
efficient and effective manner.
9. What feedback methods will be used
Brief entry survey at start of activity,
and brief exit survey at end of activity.
10. Participant consent
Consent form to be returned to trainer
with enrolment form no later than one
week before training session.
11. Overview of how the activity is to be
conducted
Participants complete entry survey and
self-score.
Trainer facilitates discussion based on
results of entry survey and on
participant’s questions and remarks.
Participants complete exit survey to
measure user satisfaction level.

26/08/2015 15
12. Materials and estimate of costs for activity

26/08/2015 16
References
Allen, C. (2013). The most toxic issue facing those with mental health problems is stigma.
http://www.theguardian.com/society/2013/apr/03/mental-health-problems-stigma-employers
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders:
DSM-5. .(5th ed.). Washington, D.C: American Psychiatric Association.
Ayuso-Mateos, J. L. (2006). Global burden of bipolar disorder in the year 2000. Retrieved:
19/08/2015 from: http://www.who.int/healthinfo/statistics/bod_bipolar.pdf
Bipolar Disorder in Adults. (2015). NIH Publication No. 12-3679
Revised 2012. Retrieved 18/08/2015 from:
http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml
Comorbidity: Addiction and Other Mental Illnesses. (2010). Retrieved 18/08/2015 from:
http://www.drugabuse.gov/publications/research-reports/comorbidity-addiction-other-mental-illn

26/08/2015 17
Davey, G. (2013, 20 August). Mental Health & Stigma: Mental health symptoms are still viewed as
threatening and uncomfortable. [blog post]. Retrieved 22/08/2015 from:
https://www.psychologytoday.com/blog/why-we-worry/201308/mental-health-stigma
Dawkins, K. (2014). The Top 5 Most Ignorant Opinions on Bipolar Disorder. Psych Central.
Retrieved 19/08/2015 from: http://blogs.psychcentral.com/bipolar-life/2014/02/opinions
Dunne, A. (2015). Mental health 'labels' can do more harm than good, warn researchers.
Retrieved 16/08/2015 from:
http://medicalxpress.com/news/2015-08-mental-health-good.html
Gaps Exist In Public's Understanding Of Bipolar Disorder: National Survey Validates Need for
Better Education, Improved Diagnosis. (2015). Retrieved 19/08/2015 from:
http://www.planetpsych.com/zPsychology_101/gaps_in_understanding.htm
Living with stigma and discrimination (2008). Retrieved 19/08/2015 from:
http://www.time-to-change.org.uk/what-are-mental-health-problems/stigma-discrimination/impa
McInnis, M. (2014). Dealing with relapse. Retrieved 19/08/2015 from:
http://www.bphope.com/ask-the-doctor-dealing-with-relapse/

26/08/2015 18
Mok Y. M. et al. (2011). Ministry of Health Clinical Practice Guidelines: Bipolar Disorder.
Singapore Med J 2011; 52(12) : 914.
http://www.apamedcentral.org/Synapse/Data/PDFData/0022SMJ/smj-52-914.pdf
Parekh, A. and Barton, M. (2010). The Challenge of Multiple Comorbidity for the US Health Care
System. JAMA. 2010;303(13):1303-1304.
Parkinson, H.J. (2104a). 10 things you should never say to someone with bipolar disorder.
http://www.theguardian.com/commentisfree/2014/sep/23/bipolar-disorder-joy-10-things-you-sh
Parkinson, H.J. (2104b). Does Homeland sensationalise Carrie Mathison's bipolar disorder?
(2014). Retrieved 19/08/2015 from:
http://www.theguardian.com/commentisfree/2014/dec/01/homeland-carrie-mathison-bipolar-di

26/08/2015 19
Singh, A. and Berk, M. (2008). Acute management of bipolar disorders. Retrieved 10/08/2015
from: http://www.australianprescriber.com/magazine/31/3/73/6
Sparks, G. (2015). Comorbid Anxiety Disorders Found in Nearly Half of Bipolar Disorder Patients.
http://www.brookhavenhospital.com/comorbid-anxiety-disorders-found-in-nearly-half-of-bipolar-
Sparks, G. (2014). Bipolar Disorder Linked To Higher Rates of Medical Illness
http://www.brookhavenhospital.com/bipolar-disorder-linked-to-higher-rates-of-medical-
illness/
Thomas, K. (2013). The Comorbidity Crisis. [blog post]. Retrieved 18/08/2015 from:
http://asserttrue.blogspot.com.au/2013/02/the-comorbidity-crisis_24.html#
What is stigma? (2015). Retrieved 16/08/2015 from:
http://www.mentalhealth.wa.gov.au/mental_illness_and_health/mh_stigma.aspx

26/08/2015 20
What other mental disorders are associated with bipolar disorder? (2015). Retrieved
16/08/2015 from: https://www.sharecare.com/health/bipolar-disorder/what-mental-
disorders-associated-bipolar
What you need to know about bipolar disorder. (2011). Retrieved 19/08/2015 from:
http://www.americannursetoday.com/what-you-need-to-know-about-bipolar-disorder
WHO. (2008). The global burden of disease: 2004 update. World Health Organisation. Retrieved
16/08/2015 from:
http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/
Yasgur, B.S. (2015). Stigmatizing Patients with Borderline Personality Disorder. Retrieved
16/08/2015 from: http://www.psychiatryadvisor.com/practice-management/stigmatizing-
patients-with-borderline-personality-disorder/article/407316

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