Nursing

Running Head: THE DIAGNOSIS OF BIPOLAR DISORDER 1

The delay in the diagnosis of bipolar disorder

Chamberlain College of Nursing

NR 326: Mental Health

00/ 2018

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BIPOLAR DISORDER 2

Introduction

Bipolar disorder has a significant cause to morbidity and mortality rate. Although we

have an active treatment, there is an extensive wait before diagnosis and treatment are initiated.

This research was done to examine factors associated with the delay of bipolar disorder before

the diagnosis and the onset of treatment. Bipolar disorder is also called manic depression. This

disorder is characterized with the events of mood swings ranging from depressive lows to manic

highs. The history of bipolar disorder presents with depression, so initial episodes look very

similar to a major depressive disorder. Therefore, there is often a prolonged delay in the exact

diagnosis of bipolar disorder, and any significant wait influence the initiation of appropriate

treatment. This paper investigates whether the delay in the diagnosis of bipolar disorder is

inescapable. This means is the delay in diagnosing bipolar disorder unavoidable or unpreventable

(Fritz et al, 2017).

Article summary

Bipolar disorder frequently beings with an early diagnosis of depression. This creates a

delay in the exact judgement and treatment of bipolar disorder. Although research has focused on

predictors in the analytic change from the depression stage to bipolar disorder. The research on

this prolonged diagnosis is scant. These researchers examine the time it took to diagnose one

with bipolar disorder after an early diagnosis of major depressive disorder to understand the

patient features and psychological factors that may explain the delay. However, when manic

signs are evident, the diagnosis changes to be bipolar disorder. Research shows that the time

from diagnosing a major depressive disorder to the time of diagnosing bipolar disorder is about

10 years. This means before the optimal treatment for bipolar disorder can be made, there might

be a delay in treatment for almost a decade. This is one of many reasons why it is important to

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BIPOLAR DISORDER 3

investigate the cause, and the delay from the diagnosis of major depressive disorder to time of

bipolar disorder (Fritz et al., 2017).

One of the most common predictors of exploratory conversion from major depressive

disorder to bipolar disorder is with antidepressant treatment resistance. There is a rise in the rate

of diagnostic conversion to bipolar disorder after a failure to respond to two treatments with the

use of antidepressant. Another factor that is associated with the diagnostics change from major

depressive disorder to bipolar disorder is with the initial onset of depression. Studies show that

patients who were formerly diagnosed with major depressive disorder are likely to be diagnosed

with bipolar disorder if they had an early onset of depression and were unresponsive to

antidepressant treatment. Also, the conversion to bipolar disorder has been found related to the

patient family history, but the findings are not truly reliable (Fritz et al., 2017).

The information from the article could be used in nursing practice because it educates the

nurse on the factors that might affect the early diagnosis of bipolar disorder. For example, some

statistical data from this research proves the delay as it was stated in this article. The conversion

time from major depressive disorder to bipolar disorder was about 42.8% lesser in female than it

was in male. Also, for every 1-year increase in the initial diagnosis of major depressive disorder,

the time for bipolar disorder conversion decrease by 2.8%. This data was made after a clinical

evaluation of 382 patients by a psychiatrist and with the of use series of questionnaires. When

there is an increase in the diagnosis of major disorder there is a decrease in the diagnosis of

bipolar and verse versa. Another example is to understand those factors associated with the delay

in bipolar disorder which will help the nurse better understand why some patients are diagnosed

with bipolar and other patients showing the same behavior have not been diagnosed. This article

will help the nurse better understand the diagnosis and the delayed process of bipolar disorder

(Fritz et al, 2017).

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BIPOLAR DISORDER 4

Article critique

Based on the study done, the delay is due to the disease process and other factors that

prolong the diagnosis. This article is informative about the process it takes to diagnose bipolar

disorder. The researchers put together resources from various aspect from their research to

provide why the delay is present. For example, Fritz et al. (2017) found an undesirable

correlation between the age at which the disease is initialed to the time of diagnostic conversion.

This means the younger the age of the patient, the longer the delay in diagnosing the patient.

Therefore, understanding the patient’s features and psychological behavior are also reasons that

may delay bipolar disorder from being diagnosed after an early diagnosis of a major depressive

disorder (Fritz et al, 2017).

Weakness

I feel that although the article did tell us about the factors that are associated with the

delay to diagnose bipolar disorder, the researchers did not show how those factors can be

evitable. Within the article there should have been a clear picture or graph explaining ways to

reduce the long process to diagnosing one with bipolar disorder. The weakness I believe in this

article is not especially from the article presentation, but it is from the disease process. The

weakness in this article is seen in the length of time it takes to diagnose one with bipolar.

Recommendations

I will recommend this article to a colleague because it gave a detailed explanation of the

aim of this research. This article is a good starting point to know why there is a prolonged wait in

the diagnosis of bipolar disorder. As a nursing student, this article makes me understand why

most people who exhibit similar behavior with people diagnosed with bipolar disorder have not

been medically diagnosed. As it was explained in the article, age makes a big difference to

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BIPOLAR DISORDER 5

diagnose a person with bipolar disorder because of patient characteristics and psychological

factors. Younger patients are not mentally developed as an adult patient would be.

Conclusion

In conclusion, this study shows that certain individuals experience a significant delay in

diagnosis and treatment of bipolar disorder which varies depending on different factors. I believe

when there is a better understanding of the factors associated with the delay to diagnose bipolar

disorder, then there will be developmental strategies to reduce them. These findings indicate the

need for an early recognition and initiation of active treatment of bipolar disorder which will

most likely diminish disability and improve outcomes.

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BIPOLAR DISORDER 6

References

Fritz, K., Russell, A., Allwang, C., Kuiper, S., Lampe, L., Malhi, G., (2017). Bipolar disorder: Is

a delay in the diagnosis of bipolar disorder inevitable? 19, 396–400. doi:10.1111/bdi.12499.

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NR326 Mental Health Nursing

RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 1

Purpose The student will review, summarize, and critique a scholarly article related to a mental health topic.

Course outcomes: This assignment enables the student to meet the following course outcomes. (CO 4) Utilize critical thinking skills in clinical decision-making and implementation of the nursing process for

psychiatric/mental health clients. (PO 4) (CO 5) Utilize available resources to meet self-identified goals for personal, professional, and educational

development appropriate to the mental health setting. (PO 5) (CO 7) Examine moral, ethical, legal, and professional standards and principles as a basis for clinical decision-making.

(PO 6) (CO 9) Utilize research findings as a basis for the development of a group leadership experience. (PO 8)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible: 100 points

Preparing the assignment 1) Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

a. Select a scholarly nursing or research article, published within the last five years, related to mental health nursing. The content of the article must relate to evidence-based practice. • You may need to evaluate several articles to find one that is appropriate.

b. Ensure that no other member of your clinical group chooses the same article, then submit your choice for faculty approval.

c. The submitted assignment should be 2-3 pages in length, excluding the title and reference pages. 2) Include the following sections (detailed criteria listed below and in the Grading Rubric must match exactly).

a. Introduction (10 points/10%) • Establishes purpose of the paper • Captures attention of the reader

b. Article Summary (30 points/30%) • Statistics to support significance of the topic to mental health care • Key points of the article • Key evidence presented • Examples of how the evidence can be incorporated into your nursing practice

c. Article Critique (30 points/30%) • Present strengths of the article • Present weaknesses of the article • Discuss if you would/would not recommend this article to a colleague

d. Conclusion (15 points/15%) • Provides analysis or synthesis of information within the body of the text • Supported by ides presented in the body of the paper • Is clearly written

e. Article Selection and Approval (5 points/5%) • Current (published in last 5 years) • Relevant to mental health care • Not used by another student within the clinical group • Submitted and approved as directed by instructor

f. APA format and Writing Mechanics (10 points/10%)

2

NR326 Mental Health Nursing RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 2

• Correct use of standard English grammar and sentence structure • No spelling or typographical errors • Document includes title and reference pages • Citations in the text and reference page

For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library. Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned in the review module.

NR326 Mental Health Nursing RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 4 3

Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.

Assignment Section and Required Criteria

(Points possible/% of total points available)

Highest Level of Performance

High Level of Performance

Satisfactory Level of Performance

Unsatisfactory Level of

Performance

Section not present in paper

Introduction (10 points/10%)

10 points 8 points 0 points

Required criteria 1. Establishes purpose of the paper 2. Captures attention of the reader

Includes 2 requirements for section. Includes 1 requirement for section.

No requirements for this section presented.

Article Summary (30 points/30%)

30 points 25 points 24 points 11 points 0 points

Required criteria 1. Statistics to support significance of the topic to

mental health care 2. Key points of the article 3. Key evidence presented 4. Examples of how the evidence can be incorporated

into your nursing practice

Includes 4 requirements for section.

Includes 3 requirements for section.

Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Article Critique (30 points/30%)

30 points 25 points 11 points 0 points

Required criteria 1. Present strengths of the article 2. Present weaknesses of the article 3. Discuss if you would/would not recommend this

article to a colleague

Includes 3 requirements for section. Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Conclusion (15 points/15%)

15 points 11 points 6 points 0 points

1. Provides analysis or synthesis of information within the body of the text

2. Supported by ides presented in the body of the paper 3. Is clearly written

Includes 3 requirements for section. Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Article Selection and Approval (5 points/5%)

5 points 4 points 3 points 2 points 0 points

1. Current (published in last 5 years) Includes 4 Includes 3 Includes 2 Includes 1 No requirements for

NR326 Mental Health Nursing RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 4 4

2. Relevant to mental health care 3. Not used by another student within the clinical group 4. Submitted and approved as directed by instructor

requirements for section.

requirements for section.

requirements for section.

requirement for section.

this section presented.

APA Format and Writing Mechanics (10 points/10%)

10 points 8 points 7 points 4 points 0 points

1. Correct use of standard English grammar and sentence structure

2. No spelling or typographical errors 3. Document includes title and reference pages 4. Citations in the text and reference page

Includes 4 requirements for section.

Includes 3 requirements for section.

Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Total Points Possible = 100 points

Contents lists available at ScienceDirect

Archives of Psychiatric Nursing

journal homepage: www.elsevier.com/locate/apnu

The Effects of Anger Management Education on Adolescents' Manner of Displaying Anger and Self-Esteem: A Randomized Controlled Trial

Neslihan Löka, Kerime Bademlib,⁎, Muammer Canbazc

a Selçuk University, Faculty of Health Science, Turkey b Akdeniz University, Faculty of Nursing, Turkey c Selçuklu Anatolian School, Turkey

Introduction

Adolescence, one of the key stages of development, is a period when many fundamental physical and psychological changes occur. Adolescents must cope with a higher number of the biopsychosocial changes compared to children. They may have difficulties in managing their emotions and behavior because they still do not have sufficient levels effective coping experience (Blakemore & Mills, 2014; Holder & Blaustein, 2014). One of the keys to a trouble-free adolescence is to recognize the emotions intensely felt during this period and to control the behaviors displayed because of these emotions (Kidwell, Van Dyk, Guenther, & Nelson, 2016). Anger is one of the common feelings with potentially destructive consequences experienced by everyone at one time or another in daily life (Berkowitz & Harmon-Jones, 2004). Anger is a constructive force when it is used to solve problems, correct an injustice or a mistake, or restore self-esteem and pride. Although anger is a natural, healthy, appropriate, life-enhancing emotion, it none- theless may be destructive to a child's psychological and physical well- being if not appropriately managed (Ayebami & Janet, 2017; Modrcin- McCarthy, Pullen, Barnes, & Alpert, 1998).

Anger is an important emotion expressed by adolescents as it is in all age groups, and so is the way they express their anger. Anger and the way it is expressed represent a major public health problem for ado- lescents today. It may cause physical, psychological, and social pro- blems for adolescents if not expressed in an appropriate manner (Starner & Peters, 2004). Prevalence reports show that anger-related problems, such as oppositional behavior, verbal and physical aggres- sion, and violence, are some of the more common reasons children are referred for mental health services (Blake & Hamrin, 2007). If adoles- cents do not learn how to manage their anger, future problems are inevitable for them. Anger can be destructive if it rages out of control and can cause problems in school, social life, personal relationships and the overall quality of one's life (Cui, Morris, Criss, Houltberg, & Silk, 2014; Down, Willner, Watts, & Griffiths, 2011; Hoogsteder et al., 2015; Shahbazi et al., 2017).People may feel compelled to move away when anger is not expressed in an appropriate manner. This may make the angry person have a negative self-perceptions and a low level of self-

esteem, and feel guilty (Albayrak & Kutlu, 2009; Edwards, 2013; Özmen, Özmen, Çetinkaya, & Akil, 2016).

When adolescents become able to cope with the controversial and problematic situations, their self-perception improves and matures. Anger affects self-perception because it is displayed in a situation where individuals are restrained or challenged. An adolescent's reaction to- ward anger is largely related to his/her personal characteristics, ex- periences, and expectations from previous experiences, and thus, to the concept of self-perception. Meta-analyses have found that adolescents' anger is related to constant anxiety, depression, stress, exposure to violence, hostility, low self-esteem, and insufficient social support (Mahon, Yarcheski, Yarcheski, & Hanks, 2010). Anger enables people to maintain the borders of self-perception and self-esteem, and to advocate for themselves (Kernis, Grannemann, & Barclay, 1989; Papps & O'Carroll, 1998). Self-esteem reflects individuals' positive and negative attitudes about themselves. It can be defined as an individual's per- ception of his or her own worth (Rosenberg, Schooler, Schoenbach, & Rosenberg, 1995).

When people see their rights are violated, receive threats, or face an unbearable accusation, anger enables them to feel right or approved, and ensures them to maintain their self-esteem (Arslan, 2009). A study that examined the relationship between the psychosocial variances and anger in adolescents found a positive relationship between anger and negative experiences, anxiety, drug use, depressive symptoms (Puskar, Ren, Bernardo, Haley, & Stark, 2008). However, it showed that opti- mism had a negative relationship with the family support perceived by the adolescent and their self-esteem (Puskar et al., 2008).

Adolescence is a period when people search for their identities. Therefore, self-perception gains importance during this period. Self- perceptions closely related to how people regard themselves: who they are, and how they think and feel about themselves. A person may feel either esteemed or worthless because of his/her self-perception. D'zurilla, Chang, and Sanna (2003) reported that low self-esteem was related to anger and hostility. Adolescents with a low level of self-es- teem may have mental problems, including anxiety and depression (Klemanski, Curtiss, McLaughlin, & Nolen-Hoeksema, 2016; Orth, Robins, & Roberts, 2008).

https://doi.org/10.1016/j.apnu.2017.10.010 Received 1 May 2017; Received in revised form 5 September 2017; Accepted 12 October 2017

⁎ Corresponding author at: Akdeniz University, Faculty of Nursing, 07050 Antalya, Turkey. E-mail address: [email protected] (K. Bademli).

Archives of Psychiatric Nursing 32 (2018) 75–81

0883-9417/ © 2017 Elsevier Inc. All rights reserved.

T

Numerous behavioral intervention programs have been developed to help adolescents cope with anger. Anger management interventions aim to develop an awareness of the types, functions and meaning of anger, its physical and psychological effects, and its expression (Deffenbacher, Oetting, & DiGiuseppe, 2002; Feindler & Engel, 2011; Yılmaz & Ersever, 2015). The meta-analysis conducted by Candelaria, Fedewa, and Ahn (2012) indicated that anger management interven- tions teach coping-skills to adolescents, and that emotional awareness, relaxation techniques, problem-solving cognitive-behavioral ap- proaches, and coping skill training are successfully used in these in- tervention. Commonly used therapeutic techniques for managing anger include affective education, relaxation training, cognitive restructuring, problem-solving skills, social skills training, and conflict resolution. These techniques, adapted to the needs of the adolescent, can foster anger management and adolescents' psychological and physical well- being (Blake & Hamrin, 2007).

Maintaining and enhancing health is a fundamental part of nursing care. Nurse practitioners working with adolescents who show the above-mentioned symptoms should consider anger as a possible pre- cursor of the symptomatology (Mahon et al., 2010). Mental health nurses can play a pivotal role in fostering change in the social climate of schools and helping youth to achieve better anger management (Thomas & Smith, 2004). Psychiatric-mental health nurses are re- sponsible for identifying at-risk adolescent during health assessment. They are well-qualified to provide this psychoeducational intervention (Thomas, 2001). Furthermore, as part of their health promotion and health education practices in schools or community, psychiatric-mental health nurses and primary care nursing specialists can easily teach adaptive coping skills to adolescents to regulate their anger (Puskar, Ren, & McFadden, 2015). Teaching adolescents the adaptive coping skills for anger is an important nursing intervention.

Schools are the most appropriate places where adolescents can re- cognize their anger and learn how to display this feeling in the best possible way. Therefore, comprehensive curricula are needed to teach adolescents how to properly recognize and display their emotions (Adana & Arslantaş, 2011).Practices related to the anger management program within the nursing department of schools can be carried out under the leadership and supervision of the psychiatric mental health nurse. Considering the anger-related issues and the number of Turkish adolescents who have anger problems, it is clear that an easily applic- able and effective anger management program should be implemented. The improved anger management program aims to help students be- come competent in anger management. Systematic, planned and con- tinuous anger management programs have yet to be implemented in Turkey to improve the adolescents' ability to cope with anger. This study aims to develop and implement an effective anger management program, to examine the effects of this program on senior students' manner of expressing their anger and self-esteem and the relationship between them, and to popularize this program in schools.

Study aims and hypotheses

This study aims to examine the effects of anger management edu- cation provided to adolescents on the manner they display their anger and self-esteem.

Hypothesis 1a. The intervention and control groups will obtain significantly different mean scores on the anger symptoms subdimension of the multi-dimensional anger scale.

Hypothesis 1b. The intervention and control groups will obtain significantly different mean scores on the situations causing anger subdimension of the multi-dimensional anger scale.

Hypothesis 1c. The intervention and control groups will obtain significantly different mean scores on the anger-related ideas subdimension of the multi-dimensional anger scale.

Hypothesis 1d. The intervention and control groups will obtain significantly different mean scores on the anger-related behavior ssubdimension of the multi-dimensional anger scale.

Hypothesis 1e. The intervention and control groups will obtain significantly different mean scores on the interpersonal anger subdimension of the multi-dimensional anger scale.

Hypothesis 2. The intervention and control groups will obtain significantly different mean scores on the Rosenberg Self-Esteem Scale.

Methods

Design and Sample of Study

This experimental pretest-posttest study was designed as a single blind, randomized controlled trial. It was conducted in a secondary school in Kepez county of Antalya, Turkey. The study population con- sisted of all final-year students in this school. Sample size calculations revealed that 56 participants were required to significantly test effects sized d = 0.78, when the alpha- and beta-error margins were accepted to be lower than 0.05 and0.2, respectively. Accordingly, the study sample consisted of 60 students: 30 in the experimental group and 30 in the control group. The inclusion criteria were being voluntary to par- ticipate, obtaining parents' approval, obtaining specified scores on the multi-dimensional anger scale (35 points from the first section, 105 from the second, 75 from the third, 115 from the fourth, and 65 from the fifth), having low or medium levels of self-esteem according to the Rosenberg self-esteem scale, and participating in all sessions. The ex- clusion criteria were any emotional disabilities and failure to partici- pate in two or more than two sessions. Independent variables of the study were anger management education and sociodemographic char- acteristics, and the dependent variables included the manner of dis- playing anger and the level of solving interpersonal problems.

Measurements

The data were collected using a students' sociodemographic in- formation form, the Multi-Dimensional Anger Scale (MDAS), and the Rosenberg Self-Esteem Scale.

Multi-Dimensional Anger Scale (MDAS)

The Multi-Dimensional Anger Scale aims to determine anger-relat

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