"I'm still swimming"

Treatment of bipolar affective disorder is often difficult and lengthy. Enabling participation in a return to work process is equally daunting, primarily due to the dramatic and oftentimes sudden shifts in mood and thought. The following case study attempts to illustrate the complicated process of return to [and stay at] work for an individual who has mixed bipolar affective disorder. Work has always played a significant role in Ray's life and remains a valued goal and accomplishment for Ray. Work has been a means to structure and routine, and it has been from this routine that wellness has become possible for Ray. The metaphor, "I'm still swimming" helps to illustrate the continual treading of water, which both Ray and his occupational therapist [first author] have experienced over the past 6 years. This case study illustrates the strategies employed in maximizing the person-environment-occupation fit for Ray, as well as the importance of collaboration and partnership in the return-to-work process. It is also meant to stimulate thought and discussion about what is important for occupational therapists, and other health professionals to consider, when attempting the task of return-to-work for an individual with mixed bipolar affective disorder.     

Practice guidelines: therapeutic interventions aimed at assisting people with bipolar affective disorder achieve their vocational goals

Based on a thorough review of literature and findings from an earlier study on what are the factors helping individuals with bipolar disorder to find and remain in employment, the practice guidelines are proposed to aim at assisting individuals affected by bipolar disorder or other persistent mental disorder achieve their vocational goals. The proposed guidelines emphasise an integrated approach to the employment problem, incorporating clinical, vocational training and employment services. The guidelines advocate quick job placements as opposed to prolonged pre-vocational assessment and training are preferable for people with bipolar disorder in view of their usual high educational achievements and vocational experiences prior to the onset of illness. When necessary, a graduated approach to immediate placement may be adopted. Interventions proposed in these guidelines involve working with an individual client, mobilising support from family, workmates, managers, advising the employers on provision of support systems within the actual workplace and liaising with government agencies to reinforce client's aspiration to work.     

Bipolar disorder and the college student: A review and implications for universities

Abstract

Objective: This brief report provides a review of the prevalence and expression of bipolar disorder in the college student population. Implications for college teachers and universities working with students with bipolar disorder are presented. Methods: Responses from the National College Health Assessment (2009–2017) reference groups were collated to estimate whether the prevalence of students with bipolar disorder has been increasing over time. Results: Data indicate that although overall prevalence is low, the presence of students with bipolar disorder has increased over the past decade. Conclusions: To help students with serious mental illness, including bipolar disorder, succeed in higher education, practices consistent with the philosophy of supported education should be adopted. Special attention will need to be paid to students’ financial and academic challenges.     

Stress and Safety for Gay Men at Work Within Masculinized Industries

Lesbians and gay men still have concerns related to being openly gay at work and maintaining health and wellness. A gay man working within a masculinized industry (historically male-dominated and higher risk, with an emphasis on authority and masculinity) may have additional concerns that are augmented by the nature of his work and related to maintaining safety and reducing stress experienced on the job. The purpose of this article is to examine some of the safety and stress concerns gay men in these industries may face. Fictional, composite cases—derived from relevant news stories and literature published in academic journals—were analyzed through a guided inquiry process based loosely on Riessman's (1993) narrative evaluation. Discussion and implications focus on policies, practices, and future directions for research that may help to ameliorate some of the issues faced by gay men at work within masculinized industries.     

What helps people with bipolar affective disorder succeed in employment: a grounded theory approach

The present study used a qualitative research design to unfold those contextual factors which influence vocational outcomes amongst people with bipolar disorder (BD). The data for this qualitative study was collated using a grounded theory approach because of its particular relevance to the study's aims i.e., to propose a theory grounded in the data that provided an account of the vocational integration process people with BD go through. The emerging theory consists of two over-arching principles that determine an individual's readiness to join the workforce: i) recovery from an acute phase of BD and ii) goodness of fit between the individual, support, job and wider contextual components. The emerging theory is in general agreement with those issues discussed in the literature. The present study also highlights the importance of maintaining a sense of hope and how self-determination may help individuals achieve their vocational goals. The credibility of these findings was strengthened by the method of triangulation of data interpretation and sources.     

Narrative Therapy,Eating Disorders and Groups: Enhancing Outcomes in Rural NSW

Abstract

The present paper reports on a study conducted with seven women who identified themselves as experiencing depression as well as an eating disorder and who live in a rural region of northern New South Wales. Self-referred, the women participated in a weekly group for 10 weeks, with a mixture of topics, conducted within a narrative therapy framework. A comparison of pre- and post-group tests demonstrated a reduction in depression scores and eating disorder risk. All women reported a change in daily practices, together with less self-criticism. These findings were supported by a post-group evaluation survey that revealed that externalisation of, and disengagement from, the eating disorder strongly assisted the women to make changes in their daily practices. Although preliminary and short term, the outcomes of the present study indicate that group work conducted within a narrative therapy framework may result in positive changes for women entangled with depression and an eating disorder.     

Narrative Methods for Differential Diagnosis in a Case of Autism

Diagnosis is rarely a straightforward process. This is especially so in psychiatry, where diagnoses are not based on organic biomarkers (e.g., blood tests). Diagnosis can be particularly complicated for children, whose symptoms must be disentangled from typical developmental processes. In this paper, we examine how clinicians use narrative as a method for differentiating a child's autism from a possible co‐morbid seizure disorder. Our approach is conversation analysis, and we show that narrative is a pervasive and endogenous practice for producing warrantable diagnostic knowledge about patients and, as such, forms part of what we term “the practical epistemology of clinical work.”     

Pediatric Bipolar Disorder: The Child Psychiatrist Perspective

This study’s objectives were to gain insight into reasons for the considerable rise in pediatric bipolar disorder (PBD) and what impact the new diagnosis of disruptive mood dysregulation disorder (DMDD) may have on child psychiatric treatment. A purposive sample of 10 child psychiatrists was interviewed for this qualitative study. Interviews were transcribed and coded for themes. Participants believe that PBD is often misdiagnosed and overdiagnosed, though their understandings of the reasons behind this vary. The majority attribute it to providers trying to help children who need services but do not fit a diagnostic category, and undertrained professionals diagnosing children. Most see DMDD as positive, though opinions on how it might impact children and treatment vary. All see family as vital in the treatment process. Participants in this exploratory study support a team approach and social workers have a key role as part of this team.     

The relationship between childhood abuse and suicidality in adult bipolar disorder

This study evaluates the effect of childhood sexual and physical abuse on suicidality in adults with bipolar disorder. We conducted a retrospective chart review of adult outpatients (N= 381) with DSM-IV-TR-defined bipolar disorder seeking evaluation and treatment at an academic specialty research program (i.e., Mood Disorders Pharmacology Unit, University Health Network, University of Toronto) between October 2002 and November 2005. Eighteen percent (n = 68) of adult patients with bipolar disorder had a recorded history of childhood abuse (p = 0.009). Sixty-three percent (n = 43) of bipolar patients with a history of childhood abuse reported lifetime suicidality (chi2 = 6.885, df= 1, p = 0.009). Logistic regression analysis indicated that Childhood abuse was a significant predictor of lifetime suicidality in adult bipolar patients (OR = 2.05, CI = 1.19-3.510). Childhood abuse is associated with suicidal ideation and suicide attempts in adults with bipolar disorder. Anamnestic inquiry regarding childhood maltreatment is salient to risk assessment, illness management planning, preventative strategies, and treatment interventions in bipolar disorder.     

Parenting Among Mothers With Bipolar Disorder: Strengths,Challenges, and Service Needs

Bipolar disorder is a severe form of mental illness with a primary disruption in mood. With fluctuating phases of mania and depression, bipolar disorder can have a serious impact on all activities of daily living, including parenting. Ten mothers with bipolar disorder were interviewed to understand their strengths, challenges, and service needs in parenting. Results describe their love for their children, problems in disciplining, and need for more support groups, among other findings. Interestingly, manic and hypomanic phases are reported to provide more energy to parent. Implications of the study for social work practice and research are discussed.     

Collaborative care for individuals with bipolar disorder or schizophrenia and co-occurring physical health conditions: A systematic review

While rates of chronic physical health conditions are increasing for the general population, individuals with severe mental illness are at greater risk. Co-occurring mental and physical health conditions are associated with poor health care utilization, socioeconomic, and patient-reported health status outcomes. This study used systematic review procedures to investigate the effectiveness of collaborative care models for improving the health of adults with bipolar disorder or schizophrenia and co-occurring chronic physical health conditions. Six studies met inclusion criteria, and included outcomes related to quality of life, physical health, and mental health. Collective and study-level results are reported and discussed, including implications for social work practice and research.     

Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans

Schizophrenia is diagnosed more frequently among African Americans while mood disorders are identified more often among whites. Such findings have raised serious questions about the accuracy of clinical judgment. This article analyzes data on 665 African American and white psychiatric inpatients using a semi-structured diagnostic instrument. The paper explores the relationship of patient race to schizophrenia, schizoaffective disorder, major depression, and bipolar disorder. The paper also explores the extent to which patient race is related to the manner in which clinicians link individual symptoms to diagnoses. Results indicate some significant race differences in diagnosis remain even when a semi-structured instrument and DSM criteria are used, whites, were more likely than African Americans to receive a diagnosis of bipolar disorder and less likely to be diagnosed with schizophrenia. There were no race differences in major depression. Some patterns of symptom attribution differed by race. The results are consistent with previous sociological research showing that patient race is related to diagnosis even when standardized diagnostic criteria are used. These findings underscore the importance of clinical judgment within the context of cross-race and cross-ethnic diagnosis. Clinical training programs must reduce ethnocentric bias by teaching the appropriate use of the socio-cultural information necessary to employ DSM-IV's Cultural Formulation.     

Caring for older adults with bipolar disorder

Bipolar disorder is a recurrent, chronic mental illness that has a profound impact on the lives of patients and their families and may require extensive use of mental health services. Although bipolar disorder is often considered an illness of young people, the disorder is being recognized as more common in older adults than previously thought. Much more research needs to be done to understand the impact of aging on the course and treatment of bipolar disorder. Evidence-based interventions for treatment of this disorder in older adults must be developed. Mental health nurses can play a key role in enhancing medication adherence, implementing structured psychosocial interventions, and carrying out research to enhance diagnosis and treatment of older adults with bipolar disorder.     

NARRATIVE'S MOMENT AND SOCIOLOGY'S PHENOMENA: Toward a Narrative Sociology

In its urgency to establish itself as a science, sociology missed the opportunity to nurture its narrative character that the Thomas and Znaniecki research represented. Another moment now exists in an array of contradictions inherent in conventional sociological practices and the increasing acceptance and sophistication of narrative work in the human sciences. These conditions contain the potential for developing a narrative sociology in which sociology's phenomena are seen as significantly constituted by stories and in which sociological work is seen as narrative work. This article examines those conditions for purposes of opening spaces that a narrative sociology might fill.     

Bipolar disorder in children

This article presents an overview of bipolar disorder (BPD) in children, a condition that only recently has been recognized as a legitimate diagnosis. Bipolar disorder in children is underrecognized for many reasons including lack of awareness, diagnostic confusion, and the different clinical picture in children. Available data strongly suggest that prepubertal childhood BPD is a non-episodic, chronic, rapid cycling, mixed manic state. It may be comorbid with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) or it may demonstrate features of ADHD and CD, further complicating recognition and subsequent treatment. Treatment issues are discussed, and some reasons for the urgency of early recognition and treatment are explained.     

Using Psychodynamic, Cognitive-Behavioral, and Solution-Focused Questioning to Co-Construct a New Narrative

The narrative and social construction metaphors are used as the conceptual frame for the clinical work with a client who felt trapped in an emotionally abusive relationship. To help the client deconstruct a problem-saturated narrative, questions were asked which drew from psychodynamic, cognitive-behavioral, and solution-focused models. The rationale for the use and timing of deconstructive questions from the various models is discussed. The problem-saturated story during the time of intake is presented, as is the change process that led to a more solution-focused narrative. An effective short-term treatment was created through the use of interventions drawn from multiple clinical models. Effectiveness was judged by client's improved emotional state, and the ability of the client to imagine and pursue identified solutions.     

Screening for pediatric bipolar disorder in primary care

A child or adolescent with pediatric bipolar disorder (PBD) is at higher risk for suicide, violence, and impaired psychosocial functioning. The prevalence of diagnosed PBD has increased 40-fold in less than 2 decades, leading some to believe that PBD is inaccurately diagnosed. Complicating this issue, disagreements exist among clinicians as to the utility of current screening methods. The assessment picture is further muddied by the high rate of comorbid psychiatric conditions. A literature review was performed to describe the present understanding of PBD and identify current practices of screening for the disorder. Although screening tools are available, the literature suggests they lack validity. Awareness, a thorough interview, and expedient referral may assist clinicians in making a correct diagnosis. Accurate assessment will help ease the psychological and economic burden of PBD.     

Preface

Four children from three families in which the mother had a bipolar disorder were interviewed to understand their perspectives on their mothers' parenting. Children identified strengths in their mother's parenting, such as helping them with homework and moods and providing for their wants. They also identified challenges, such as mothers sleeping well into the day and displaying anger. Two children were worried over the possibility of having a bipolar disorder themselves. Implications of these findings for social work practice include acknowledging and supporting mothers' strengths in parenting, providing appropriate services to manage mothers' sleep and anger, and psychoeducation for children.     

Embracing Risk and Promise for Student Engagement: Incorporating Experiential Teaching Methods in a Community Psychology Course

This article is a narrative from the field about the redesign of a community psychology course to integrate a partnership with a community-based activism program. The narrative highlights risks and promise associated with the experience and aims to contribute to the literature on community-university partnerships as a mechanism for advancing student learning and civic engagement. A general thesis of this narrative is that embracing both the risks and promises of utilizing this pedagogical approach can help to sustain an instructor’s commitment to this approach.     

The importance of volitional narrative in treatment: An ethnographic case study in a work progran

The revised theory of the model of human occupation expands the concept of volition to include volitional narrative. This paper focuses on the application of this theory of volition to a client's experience in a work program. This ethnographic case study describes the volitional narrative and life world of one client who attended the occupational therapy work based program. For fifteen months the client was the subject of narrative interviews, participant observation, videotapes and telephone contacts. The findings will illustrate how knowledge of a client's volitional narrative and life world can shed critical light on understanding treatment conflicts. Finally, the discussion will underscore how important it is for work based programs to be designed to encourage therapists to adapt their treatment approaches to maximize the opportunities to seek out the client's volitional narratives and to create meaningful experiences that are consistent with the client's life world.