Impairment and Psychosocial Functioning in Bipolar Disorder

Researchers have been investigating whether cognitive impairments in bipolar disorder are the result of psychotropic medication or the illness itself. Results indicated deficits involving memory, processing rewards, and sensitivity to negative feedback. All of these limitations present difficulties for bipolar patients in making decisions and adapting to situations which contribute to high-risk behaviors. The data indicated that these deficits represent an effect of the illness itself and are not due to mood-stabilizing medication. This clarification should reassure patients to continue utilizing the benefits of mood-stabilizing medication without concern over harmful cognitive side effects. Optimal treatment involves monitoring and managing symptoms by a psychologist who is trained in the treatment of bipolar disorder and clinical psychopharmacology. One type of specialized psychological treatment of Bipolar disorder is Interpersonal Social Rhythm Therapy (IPSRT). IPSRT is an intervention designed specifically for bipolar patients which involves teaching them how to prevent manic and depressive episodes by stabilizing their sleep/wake cycles and daily routines. Current interpersonal problem areas are also identified in IPSRT and addressed to provide additional stability. In addition to IPSRT, neuropsychological assessment and cognitive retraining also can assist in reducing the effects of neurocognitive impairments on overall functioning.

Some patients with bipolar disorder also have demonstrated poor psychosocial adjustment, for example unemployment and a lack of reliable friends and quality leisure activities. Poor psychosocial adjustment is associated with low quality of life and increased risk of suicide. Psychologists continue examine this crucial area of psychological functioning to improve patient care.

Insight on Psychosocial Functioning in Bipolar Disorder

Executive functioning involves abilities to generate strategic approaches to problems, monitor and planning behaviors, and revise strategies to behaviors that are no longer appropriate. Executive functioning and insight are strongly related to psychosocial adjustment and are often impaired in patients with bipolar disorder.

Insight involves awareness of current psychiatric symptoms, awareness of the presence of psychiatric disorders, and awareness of the achieved effect of treatment. In bipolar disorder, the relationship between poor insight and poorer psychosocial adjustment is likely accounted for by neurocognitive deficits. These deficits are exacerbated by multiple manic and depressive episodes. Thus, managing episodes through medication and psychotherapy is critical in preventing future neurocognitive deterioration.

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Posttraumatic Stress Differences in Men and Women

Although males experience more traumatic events on average than females, females are more likely to meet diagnostic criteria for posttraumatic stress disorder (PTSD). PTSD is defined as an anxiety disorder triggered by a traumatic event and characterized by symptoms of re-experiencing the trauma, avoidance and numbing, and hyperarousal. Females are more likely to have experienced sexual assault and child sexual abuse, but less likely to have experienced accidents, nonsexual assaults, witness death or injury, disaster, fire, combat, or war. Thus, sexual trauma appears to cause more emotional suffering and is more likely to contribute to PTSD than other types of trauma. Female PTSD is also higher when compared to males for the same type of trauma. Males may not have the same emotional responses to traumatic events. For both men and women, multiple traumas increase risk of PTSD symptoms when confronted with a new trauma; even though the current event may not have caused all of the symptoms. Male symptoms of PTSD may manifest differently. Men are less likely to report anxiety or depression; but more likely to report behavioral (i.e., irritable, angry, and violent) and drug problems.

Internet Addiction

The first residential treatment center for Internet addiction in the United States opened its doors in Seattle. Internet addiction has already been taken seriously in China, South Korea, and Taiwan. Pathological computer use can include obsessive use of video games, texting, Facebook, eBay, Twitter and any other obsessive use of technology. The effects of internet addiction have led to loss of a job or marriage, car accidents while texting, and death, generally stemming from a blood clot associated with being sedentary. Warning signs include preoccupation with thoughts of the Internet; using it longer than intended, and for increasing amounts of time; repeated unsuccessful efforts to control use; jeopardizing relationships, school or work; lying to cover Internet use; using the Internet to escape problems or feelings of depression; and physical changes to weight, headaches or carpal tunnel syndrome. In addition, many of these people have difficulty controlling their impulses to chat online, play games, or watch porn. Internet addicts miss out on real interactions and human development. Their hygiene, home, eating, sleeping, and relationships deteriorate and they do not get enough exercise. It remains a newly researched disorder, compulsive and addictive behaviors have been found to share commonalities that respond to traditional methods used to treat alcohol or drug addictions. Early intervention may prevent serious consequences including other disorders from developing.

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