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Mental State Deterioration in Bipolar Disorder Patients

Bipolar Disorder (BD) is considered as one of the major causes of morbidity in the western world, particularly due to the frequent episode recurrence as well as the persistence of functional impairment and deterioration of mental state immediately after clinical remission (Mazza et al., 2011). These authors acknowledge that although the depressive phase of BD resulting from the deterioration of mental state has proven to have the greatest burden on normal functioning and quality of life of patients, it is only recently that particular treatment guidelines and updates for BD depression have been developed.

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Extant literature demonstrates that deterioration of mental state among BD patients can be caused by varied factors, including leading a physically inactive lifestyle, poor eating and dietary habits, lack of adequate rest, and engaging in stressful situations or relationships (Mazza et al., 2011). These authors further argue that the presence of sub-threshold manic symptoms in a patient that do not meet DSM-IV criteria for BD, such as chronic irritability, sadness, aggression, defiance and inattention, act to facilitate the deterioration of mental state by enhancing propensity toward mood destabilization, syndromal relapse, and suicidal ideation.

In their case study on a 14 year old boy with a diagnosis of bipolar affective disorder, Samuel et al (2013) noted that the switching of drugs from recommended brand-names to generic preparations is associated with breakthrough seizures and deterioration of the mental state of the patient, often due to adverse neurological interactions. Consequently, it can be argued that particular types of drugs can and do trigger a deterioration of mental state among BD patients, hence the need for careful administration and monitoring of drugs in the treatment of BD.

‘Crohn’s Disease and Ulcerative Colitis’

Available literature demonstrates that “Crohn’s disease (CD) and Ulcerative Colitis (UC) are the two main forms of inflammatory bowel diseases (IBD), characterized by intestinal inflammation and ulceration of unknown etiology” (Soletti et al., 2013 p. 1). These authors further acknowledge that although the two diseases share comparable pathophysiological mechanisms, including immune activation, leukocyte infiltration and enhanced colonic vascular density, involvement of the anal region and surrounding tissues is predominant in CD, while the anatomical localization of UC is the colon as patients with UC often exhibit inflammation from cecum to rectum. While it is documented that symptoms of UC include abdominal pain, malnutrition, bloody diarrhea and elevated risk for dysplasia and adenocarcinoma of the colon, those of untreated CD include crampy abdominal pain and diarrhea, depression, suicidal ideation, impaired quality of life, intestinal fistulas, intramural abscesses as well as bowel obstruction (Mahadev et al., 2012; Soletti et al., 2013).

The role of diet in the treatment of CD cannot be underestimated, particularly in light of research findings indicating that “specially formulated diets for enteral nutrition have proved to be an effective treatment for Crohn’s disease” (Gassul, 2004 p. 79). Consequently, the outline for the patient education plan for CD focusing on dietary treatment is as follows:

  • Patient to increase uptake of dietary lipids, with the view to modulating the immune response which acts to facilitate healing of bowel lesions, hence improving symptoms and quality of life;
  • Patient to avoid offending foodstuffs that may be related to disease relapse, particularly in terms of triggering the abnormal inflammatory response, and;
  • Administration of dietary components and nutritional management not only aimed at fostering the growth of beneficial bacteria, but also modifying the intestinal environment, obstructing the action of particular inflammatory molecules, and generating shifts in the target cells involved in the immune response (Gassul, 2004).

‘Gastroesophageal Disease’

Gastroesophageal disease (GERD) has been defined in the literature as “a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications” (Patrick, 2011 p. 116). These troublesome symptoms, which include heartburn and regurgitation, are dealt with using histamine-2 receptor antagonists, proton pump inhibitors, and a variety of over-the-counter medications specifically aimed at minimizing or stopping the reflux symptoms associated with GERD (Winter et al., 2011)

A patient education plan for the treatment and management of GERD using conservative measures would include the following:

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  • Maintaining a healthy body weight and wearing well-fitting clothes to avoid putting pressure on the abdomen, hence stopping the acid from going back into the esophagus;
  • Patient should not only eat smaller meals to avoid overeating, but also avoid foods and drinks that have the potential to trigger heartburn, such as fatty foods, alcohol, tomato sauce and onion;
  • Patient should avoid smoking to boost the potential of the lower esophageal sphincter to operate to the optimum, and;
  • Patient should avoid lying down after a meal to minimize the reflux symptoms, and should also elevate the head of the bed to avoid experiencing heartburn at night (Winter et al., 2011).

To avoid the recurrence of symptoms, particularly during the night, the patient should avoid tobacco, chocolate and citrus juice, and also exercise other dietary and lifestyle changes including weight loss, adequate timing of meals, elevation of bed during sleep, and avoidance of any foods and drinks that aggravate the reflux symptoms. The patient can also use over-the-counter antacids, histamine H2-receptor antagonists, proton pump inhibitors, prokinetics, spearmint or peppermint, as well as low-carbohydrate diet (Patrick, 2011).

References

Gassul, M.A. (2004). The role of nutrition in the treatment of inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 20(4), 79-83.

Mahadev, S., Young, J.M., Selby, W., & Solomon, M.J (2012). Self-reported depressive symptoms and suicidal feelings in perianal Crohn’s disease. Colorectal Disease, 14(3), 331-335.

Mazza, M., Mandelli, L., Zaninotto, L., Di Nicola, M., Martinotti, G., Harnic, D…Janiri, L. (2011). Factors associated with course of symptoms in bipolar disorder during a 1-year follow up: Depression vs. sub-threshold mixed state. Journal of Psychiatry, 65(6), 419-426.

Patrick, L. (2011). Gastroesophageal reflux disease (GERD): A preview of conventional and alternative treatments. Alternative Medicine Review, 16(2), 116-133.

Samuel, R., Atlard, A., & Kyriakopoulous, M. (2013). Mental state deterioration after switching from brand-name to generic olanzapine in an adolescent with bipolar affective disorder, autism, and intellectual disability: A case study. BMC Psychiatry, 13(1), 1-3.

Soletti, R.C., Rodrigues, N.A.L.V., Biasoli, D., Luiz, R.R., De Souza, H.S.P., & Borges, H.L. (2013). Immunohistochemical analysis of retinoblastoma and β- catenin as an assistant tool in the differential diagnosis between Crohn’s disease and ulcerative colitis. PLoS ONE, 8(8), 1-8.

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Winter, H.S., Illueca, M., Henderson, C., & Vaezi, M. (2011). Review of the persistence of gastroesophageal reflux disease in children, adolescents and adults: Does gastroesophageal reflux disease in adults begin in childhood? Scandinavian Journal of Gastroenterology, 46(10), 1157-1168.

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