Mental Health Causes Disaster Issues

 Self-destruction Most Normal Reason for Death in Those Treated for Bipolar Confusion

·         Despite the widely held belief that mental treatment can effectively prevent suicide in cases of major mental illnesses, recent research reveals a disheartening reality: suicide remains the leading cause of death among individuals diagnosed with bipolar disorder (BD), even in the presence of treatment. Moreover, challenging the assumption that those who die by suicide are predominantly non-compliant with their prescribed medications, statistics indicate that a significant 48% of those who tragically took their own lives did so through an intentional overdose of their psychiatric medications.

·         The findings of the study indicate that individuals undergoing treatment for bipolar disorder are confronted with a stark reality: they are at a staggering threefold increased risk of succumbing to accidents or suicide (categorized as external causes), and their likelihood of dying due to physical health conditions (categorized as internal causes) is doubled when compared to the general population.

·         The researchers succinctly summarize their observations, "Individuals grappling with BD exhibited a sixfold elevation in mortality rates stemming from external factors, and a twofold increase in mortality attributed to internal factors." The comprehensive study, featured in BMJ Mental Health, was spearheaded by Tapio Paljärvi at Niuvanniemi Hospital in Finland. Collaborators encompassed researchers from the University of Eastern Finland, the Karolinska Institute in Sweden, the University of Southern Denmark, and the University of Oxford, UK.

·         The research encompassed a cohort of 47,018 individuals afflicted by bipolar disorder. This pool of participants was meticulously curated using a comprehensive nationwide database in Finland. This repository compiles data from recent hospitalizations and brief institutional stays, ensuring that the individuals included in the study were those who had received explicit and intensified treatment for bipolar disorder (BD). The timeline for their diagnoses spanned from 1998 to 2018, with their ages ranging from 15 to 65 years between the years 2004 and 2018. The median duration of follow-up was approximately eight years.

·         Over the course of the study, a total of 3,300 individuals (7% of the cohort) passed away. The most prevalent cause of death within this group was suicide, with 740 individuals tragically ending their lives in this manner. Strikingly, a significant subset of these suicides, comprising 353 cases (or 48% of the suicides), resulted from the deliberate overconsumption of psychiatric medications.

·         Furthermore, the dataset recorded 265 fatalities attributed to "accidental poisonings." Remarkably, 123 of these cases (or 46% of the accidental poisonings) were due to excessive ingestion of psychiatric medications. It is noteworthy to mention that there exists ambiguity regarding whether some or all of the deaths classified as "accidental poisonings" should have been categorized as "suicides." This uncertainty stems from the societal stigma surrounding suicide, leading to instances where suicidal deaths are labeled as "accidents" in official records.

·         The second most prevalent category of causes of death aggregated under the term "alcohol-related causes," accounted for 595 fatalities. This classification encompassed a spectrum of alcohol-related conditions, including liver disease, alcohol poisoning, and alcohol dependency.

·         An additional 552 individuals within the study cohort succumbed to cardiovascular disease (CVD). Pertinent research has unveiled a disconcerting statistic: individuals taking antipsychotic medications are confronted with a threefold elevated risk of death due to CVD, even after accounting for intricate contributing factors. Moreover, for those undergoing a combination treatment involving phenothiazine-type antipsychotics coupled with antidepressants, their risk of CVD-related mortality surges by over threefold compared to the general population.

·         The contemporary researchers emphasize the implications of their findings, noting, "Given the substantial number of CVD-related deaths observed, recent investigations into BD-associated mortality underscore the paramount importance of averting CVD-related fatalities. Consequently, the cardiometabolic profile of medications employed in BD treatment has garnered heightened attention among healthcare practitioners."

·         It has been a recurring discovery that individuals diagnosed with severe mental disorders tend to face premature mortality, dying several years earlier than their non-affected counterparts. Despite a substantial increase in treatment rates over time, recent research in the UK has brought to light that this disparity in mortality rates, often termed the "mortality gap," is continuing to widen.

·         The present researchers advocate for a psychiatric focus on mitigating substance abuse and suicide. While these recommendations are presented without explicit detailing of how they diverge from current treatment objectives, the researchers underscore the importance of preventive measures. "Prioritizing preventive interventions targeting substance abuse is likely to narrow the mortality gap, encompassing both external and internal causes of death. While suicide prevention remains imperative, enhancing awareness surrounding the risks of overdose and other poisonings is equally warranted."

Winning the Fight: Impressions of a Specialist Living With BPAD

·         The phrase "being on the other side of the table" is commonly used to describe situations that have been reversed or where roles have changed. In the context of clinical practice, we often hear about the experiences of individuals with bipolar affective disorder (BPAD) from their perspective in everyday language. Simultaneously, professionals worldwide have extensively researched and documented the intricacies of BPAD. However, what if those who typically provide healing become the ones seeking it? Presented here is a brief exchange with a seasoned professional who has occupied both roles, thereby sharing their unique and noteworthy insights. This individual is a senior consultant psychiatrist with over 5 years of successful practice.

 

Q: Drawing from your professional and personal experience, what is the most prevalent reaction to receiving a diagnosis of BPAD?

A: From my viewpoint, the predominant reaction isn't centered around fear, apprehension, or anxiety. Instead, it tends to manifest as confusion. Particularly in a country like India, where resources, healthcare access, and time constraints pose challenges, many professionals find themselves unable to comprehensively elucidate the nature, trajectory, and prognosis of the illness. While psychoeducation stands as a crucial component of management, the imbalance between psychiatrists and patients, along with limited time availability, often leads to its omission. Consequently, a significant number of patients are left with nothing but unreliable information propagated by media or the internet. This misinformation tends to paint BPAD as akin to having multiple personalities, an affliction causing complete dysfunction, something uncontrollable, or even worse, incurable. From my vantage point, once the illness is delineated with sufficient psychoeducation encompassing treatment details, and the merits and drawbacks of medication, a considerable number of patients tend to find solace. This transformation transmutes their initial confusion into a constructive rapport with their psychiatrist.

Q: What was your personal reaction upon receiving your diagnosis? Have you ever faced a misdiagnosis?

A: Personally, reflecting back, during the final year of my clinical training, I had minimal exposure to psychiatry or mental health concerns. Being diagnosed with BPAD was somewhat of a relief for me, as it provided a new perspective on my condition and helped me understand what was happening. Unfortunately, like many patients, I encountered a misdiagnosis in the early stages of my illness, being initially labeled with schizophrenia. I went into a state of denial and refrained from researching my symptoms or condition. I continued with my life as usual. However, I now realize that, in the long run, this lack of awareness could have been detrimental.

 

Q: What are the initial reactions of parents upon diagnosis? What are common pitfalls during BPAD diagnosis?

A: For both patients and parents, receiving a BPAD diagnosis can lead to initial confusion. A common pitfall during BPAD diagnosis is that, as clinicians, we are often so entrenched in labeling and categorizing that we overlook the fact that human minds don't adhere strictly to textbooks. Mania might be misjudged as hypomania, borderline behavioral conditions could be misconstrued as psychosis, and so on. We should adopt a more open-minded approach and focus on understanding rather than just labeling. Additionally, in Western societies, stigma is entrenched, and privacy becomes a challenge when it comes to mental illness. Exploring all the intricacies of these pitfalls is beyond the scope of this narrative.

 

Q: Could you share your experience of the first episode of mania? Were there any distinctions between the first and subsequent episodes?

A: Experiencing mania was not a frightening encounter for me. I fondly recall fragments of it. Reflecting on my most prominent episode, I remember being completely unaware and ignorant about it. I felt as if I possessed various superpowers all at once. It was an amplification of life's basic joys. I experienced a high, but I'm grateful that I didn't remain in ignorance and sought professional help.

Sometime later, while sitting in my room, I pondered my behavior and ultimately made the decision to take medication. Thanks to the awareness and support from my family, I was able to attenuate this episode while it was still in the realm of hypomania. However, even after beginning medication, the predominant source of distress wasn't the symptoms themselves, but rather my excessive thoughts. My mind was plagued with racing thoughts and excessive self-doubt. As the medication gradually took effect, I exhibited repetitive questioning and sought constant reassurance from my family about whether I was behaving "normally." It's distressing to realize that your loved ones see you in such a state, and I later appreciated the challenges they endured. For this reason, I believe ignorance can be bliss, as being aware of the symptoms caused me to differentiate between what's typical and what's unexpected, and this was quite distressing.

It's crucial to grasp that an individual entering a manic state isn't necessarily devoid of insight into their condition or psychopathology. Timely medication and gentle guidance prior to the episode can alleviate the patient's fear and encourage them to engage in treatment.

Q: Could you share more about your most memorable depressive episode experience?

A: My most memorable depressive episode took place in mid to late 2006. It was a challenging period as I withdrew from social interactions. Friends would check up on me, but I actively avoided social gatherings. Throughout 2007, I remained episode-free. The most intense depressive episode occurred in 2008. This episode manifested with almost no discernible trigger, and the weight of it was overwhelming. I had self-deprecating thoughts and a perpetual habit of comparing myself to others. Regardless of the medications I was taking, I experienced constant sleepiness and frequent bouts of crying. I spent a significant portion of approximately four years in this state, lasting until 2012. The pinnacle of my depression hit in 2009 when I ceased eating, as every action, including eating, felt utterly meaningless. I was consumed by absolute negativity and emptiness. I wholeheartedly agree that this was the most debilitating phase of my life. Around that time, I was offered electroconvulsive therapy (ECT), but like many parents, mine declined out of concern. The turning point came with the switch from valproate to lithium in 2012. Since starting on lithium, I haven't had any active episodes. I did experience a reactive episode of depression in 2019, triggered by the end of a significant friendship. Nonetheless, medication has been a significant help for me.

 

Q: How do you differentiate between normal highs and lows and an active episode?

A: With my anankastic personality (characterized by obsessive-compulsive tendencies), it can be a bit challenging, but I tend to observe minute details. Consequently, when I'm experiencing happiness, there's a nagging feeling that I might transition into mania. However, over time, you become attuned to your relapse signature. Over my 17 years of dealing with the illness, I've had one full-blown manic episode and one hypomanic episode. The key distinguishing factor is sleeping disturbance, present in both depressive episodes and mania. I've dealt with depression more frequently than mania. Hence, I'm familiar with my relapse signature: it usually starts with irritability, which my family notices too. Being a professional, I manage my own medication, and so far, it has been a positive experience.

I believe that having personally undergone what many professionals’ studies in textbooks has allowed me to connect empathetically with patients and caregivers alike, irrespective of their diagnosis. In this manner, my own experience of illness has played a pivotal role in fostering my compassion and guiding my ethical approach to clinical practice with individuals grappling with mental health issues. It has contributed to shaping me into the proud clinician I am today.

It's essential that individuals with bipolar affective disorder (BPAD) don't perceive their condition as a sentence. On the contrary, adhering to treatment is a profound advantage, in my opinion. Truthfully, I view my outlook as predominantly optimistic, and that's what I aim to convey to all patients who are confronting this condition. I firmly believe in looking at the glass as more than half full, and that's the message I want to convey to all individuals battling this condition: you can triumph over this struggle. I have faith in your capacity to overcome.