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A Combination of Self-management Practices, Therapy, and Medication can be Effective in Managing Bipolar Disorder
Asia Elmi
Metropolitan State University

Author’s Note
The Methods and Findings research argument segment was prepared for WRIT 331 Instructor Kris Frykman on March 30, 202.

A combination of self-management practices, therapy, and medication can be effective in managing bipolar disorder

Over 10 million people in the United States and 46 million people globally have been diagnosed with bipolar disorder, previously known as manic depression. Bipolar disease is presented in the patient as episodes of extreme highs where the patient has high energy and extreme lows where the patient may have feelings of despair and suicidal thoughts. According to Gordovez and McMahon (2020), there are different types of bipolar disorders. As a result, episodes of bipolar disorder vary among people who live with this disease and are often dependent on how well a patient can manage their symptoms. Bipolar disorder requires lifetime treatment because although its symptoms come and go, the condition itself lasts a lifetime. Current treatment measures for bipolar have included the use of prescription drugs, sometimes coupled with psychotherapy. According to Vieta et al. (2018), medication alone has proven ineffective in managing the symptoms of bipolar. Therefore, in support of research, I advocate that in addition to receiving any necessary medication, patients should receive ongoing therapy to learn self-management skills.
Methods
Toniolo, R. A., Fernandes, F. D., Silva, M., Dias, R. D., &Lafer, B. (2017). Cognitive effects of creatine monohydrate adjunctive therapy in patients with bipolar depression: Results from a randomized, double-blind, placebo-controlled trial. Journal of Affective Disorders, 224, 69-75. https://doi.org/10.1016/j.jad.2016.11.029
This research used eighteen (N=18) Bipolar depression patients (Toniolo et al., 2017). According to DSM-IV criteria, the patients were registered in a six-week, randomized, placebo-controlled test. Researchers collected 6g daily of creatine monohydrate as adjunctive therapy from theeighteen patients and submitted them to neuropsychological assessments at baseline and week six. The assessments included the Stroop color-word test, FAS verbal fluency test, Wisconsin Card Sorting Test, and Digit Span subtest of the Wechsler Adult Intelligence Scale–Third Edition.
Chiang, K., Tsai, J., Liu, D., Lin, C., Chiu, H., & Chou, K. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PLOS ONE, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849
The methodology used in this source included electronic searches using Medicine OVID, EMBASE, PubMed, and Cochrane Library from inception to July 2016. The study involved 1384 patients (Chiang et al., 2017). Apart from the electronic literature search, researchers also transformed keywords like “bipolar depression,” “manic-depressive psychosis,” “cognitive therapy,” “bipolar disorder,” and “cognitive-behavioral therapy” into MeSH terms and included only the randomized controlled trials (RCTs). The researchers then calculated the ratios of relapse or worsening rates together with 95% confidence levels for the average differences in thepsychological functioning, mania, and depression levels. Finally, the researchers conducted a subgroup analysis according to the features of CBT approaches, therapists, and patients.
Kessing, L. V., Munkholm, K., Faurholt-Jepsen, M., Miskowiak, K. W., Nielsen, L. B., Frikke-Schmidt, R., Ekstrøm, C., Winther, O., Pedersen, B. K., Poulsen, H. E., McIntyre, R. S., Kapczinski, F., Gattaz, W. F., Bardram, J., Frost, M., Mayora, O., Knudsen, G. M., Phillips, M., &Vinberg, M. (2017). The bipolar illness onset study: Research protocol for the BIO cohort study. BMJ Open, 7(6), e015462. https://doi.org/10.1136/bmjopen-2016-015462
In this source, 300 patients with first-episode bipolar disorder were involved alongside 200 of their healthy offsprings or siblings and 100 people without any family history of bipolar illness or affective bipolar (Kessing et al., 2017). The researchers monitored the 600 participants longitudinally with recurrent blood samples and other considerable biological tissues. The research also used automatically generated and self-monitored smartphone data, a smaller group of the lot with neuroimaging during a 5-10 years period, and also conducted neuropsychological tests.
Plans, L., Nieto, E., Benabarre, A., & Vieta, E. (2019). Completed suicide in bipolar disorder patients: A cohort study after the first hospitalization. Journal of Affective Disorders, 257, 340-344. https://doi.org/10.1016/j.jad.2019.07.048
In this source, researchers monitored 313 bipolar patients with bipolar disorder. The researchers studied a retrospective group consisting of all Bipolar Disorders type 1 and Bipolar Disorders type 2 according to DSM-IV criteria, which had been admitted to the psychiatry unit for the first time in their entire lives (Plans et al., 2019). The hospitals considered included 21 general hospitals from a region in Catalonia, between 1996 and 2016. All the respective patients were reexamined in a community center for medical health on monthly basis until the end of 2017. Researchers collected Multiple variables during the first clinical admission and analyzed between those patients who had Complete suicide and those without.
Findings and results
Toniolo, R. A., Fernandes, F. D., Silva, M., Dias, R. D., &Lafer, B. (2017). Cognitive effects of creatine monohydrate adjunctive therapy in patients with bipolar depression: Results from a randomized, double-blind, placebo-controlled trial. Journal of Affective Disorders, 224, 69-75. https://doi.org/10.1016/j.jad.2016.11.029
The researchers in this source found that in the verbal fluency test, there was a statistically considerablevariancein treatment groups due to varying total scores after six weeks, with improvement in the lot receiving additional treatment with creatine (Toniolo et al., 2017). In other neuropsychological tests, the researcher found no large differences between the sub-groups of the changes. The researchers concluded that creatine monohydrate effectively improves verbal fluency tests in bipolar patients if the doctors used it within six weeks.
Chiang, K., Tsai, J., Liu, D., Lin, C., Chiu, H., & Chou, K. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PLOS ONE, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849
In this source, a total of 19 RCTs comprising of 1384 type 1 and type two Bipolar Disorders patients were enrolled for meta-analysis and systematic review. The researchers found out from the main review that CBT can lower the lapse rate. And improve depressive symptoms (CI = -0.963—0.026. g = 0.494), psychological functioning (95% CI =0.106-0.809, G=0.457) and mania severity (95% CI = -1.127 to -0.035, g = 0.581) (Chiang et al., 2017). The researchers concluded that CBT is effective in reducing the relapse rate and improving psychological functioning, mania severity, and depressive symptoms with a mild to moderate effect size. The subgroup analysis showed that improvements in mania and depression are more significant with a CBT treatment duration of more than 90 minutes per session. Also, the researchers concluded that the worsening rate is significantly lower among patients with type 1 Bipolar Disorder.
Kessing, L. V., Munkholm, K., Faurholt-Jepsen, M., Miskowiak, K. W., Nielsen, L. B., Frikke-Schmidt, R., Ekstrøm, C., Winther, O., Pedersen, B. K., Poulsen, H. E., McIntyre, R. S., Kapczinski, F., Gattaz, W. F., Bardram, J., Frost, M., Mayora, O., Knudsen, G. M., Phillips, M., &Vinberg, M. (2017). The bipolar illness onset study: Research protocol for the BIO cohort study. BMJ Open, 7(6), e015462. https://doi.org/10.1136/bmjopen-2016-015462
The researchers in this source found that 115 of the 300 patients… with first-episode bipolar disorder had improved over the years when put under psychotherapy, while only 90 patients responded positively to medical treatment (Kessing et al., 2017). However, the patients put under medical treatment with drugs responded quickly than patients put under psychotherapy treatment. Another result indicates that 25% of the 200 family members showed some high lapse of mania and depression through some distant episodes. The scientists concluded that an accurate diagnosis of Bipolar Disorder in its onset periods could help overcome the disorder’s life-threatening effects.
Plans, L., Nieto, E., Benabarre, A., & Vieta, E. (2019). Completed suicide in bipolar disorder patients: A cohort study after the first hospitalization. Journal of Affective Disorders, 257, 340-344. https://doi.org/10.1016/j.jad.2019.07.048
In this source, the researchers found out that 14 of 313 patients included completed suicide in the 11 years follow-up. They also found out that 93% of the patients used violent methods (Plans et al., 2019). The researchers further analyzed that treating Bipolar Disorder using antidepressants and lamotrigine was associated with a high risk of complete suicide. However, treatment with valproate and antipsychotics showed a lower risk of complete suicide. After conducting a logistic regression multivariant analysis, the researchers found that only immediate previous violent suicide and close family history were relevant factors of Complete suicide. They concluded that bipolar patients were 58 times more likely to have complete violent suicide than the general population.

References
Chiang, K., Tsai, J., Liu, D., Lin, C., Chiu, H., & Chou, K. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PLOS ONE, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849
Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of bipolar disorder. Molecular psychiatry, 25(3), 544-559. Retrieved from https://www.nature.com/articles/s41380-019-0634-7
Kessing, L. V., Munkholm, K., Faurholt-Jepsen, M., Miskowiak, K. W., Nielsen, L. B., Frikke-Schmidt, R., Ekstrøm, C., Winther, O., Pedersen, B. K., Poulsen, H. E., McIntyre, R. S., Kapczinski, F., Gattaz, W. F., Bardram, J., Frost, M., Mayora, O., Knudsen, G. M., Phillips, M., &Vinberg, M. (2017). The bipolar illness onset study: Research protocol for the BIO cohort study. BMJ Open, 7(6), e015462. https://doi.org/10.1136/bmjopen-2016-015462
Plans, L., Nieto, E., Benabarre, A., & Vieta, E. (2019). Completed suicide in bipolar disorder patients: A cohort study after the first hospitalization. Journal of Affective Disorders, 257, 340-344. https://doi.org/10.1016/j.jad.2019.07.048
Toniolo, R. A., Fernandes, F. D., Silva, M., Dias, R. D., &Lafer, B. (2017). Cognitive effects of creatine monohydrate adjunctive therapy in patients with bipolar depression: Results from a randomized, double-blind, placebo-controlled trial. Journal of Affective Disorders, 224, 69-75. https://doi.org/10.1016/j.jad.2016.11.029
Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., … & Grande, I. (2018). Bipolar disorders. Nature reviews Disease primers, 4(1), 1-16. Retrieved from https://www.nature.com/articles/nrdp20188¬¬¬¬

Edits in addition to Methods and Findings: 17/25
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• APA paper format; APA in-text citations with page or paragraph reference; APA references in alphabetical order and in proper format; zero plagiarism: 0/5 Due to plagiarism oversights, rather than assigning you a zero on this assignment per page 7 of the course syllabus, I am choosing to only give you a zero on this segment of the assignment rubric.

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