According to World Health Organization (WHO), health is a state of full physical, mental and social well-being and not just the non-existence of a disease or infirmity (WHO, 2016). Mental health is defined as emotional, psychological, and social well-being (Sinnott, 2013). WHO (2014, n.p.) also defines mental health as a state of well-being in which every person can achieve his or her full potential, can withstand normal stresses, is productive and fruitful at work, and can make a meaningful impact to his or her community. Mental health has an impact on individuals thinking, feelings, and actions. It also predicts how individuals handle stress, associate with others, and make life choices. Being mentally healthy is essential in all life stages, from childhood through adulthood
American Psychiatric Association (2015, n.p.) defines mental ill-health as conditions characterized by altered thinking, alter affective states or changes in behavior. Mental ill-health affects individuals normal functioning in the family, work, or social setting. Louise ill health was first manifested in her teenage years. At the tender age of 14, she showed extreme mood changes and depression. Unstable mood and depression is a manifestation of altered cognitive and affective states, hence mental ill health. While in her first year at the university, Louise depression worsened. She could not leave her room for days and could not eat or attend lectures as required. This is also a deviation from the normal. A healthy university student is expected to attend all the lectures as stipulated by universitys academic guidelines. Therefore, failure to do so is an abnormality. Moreover, by failing to eat and by locking herself in her room for many days, Louises struggle with her ill health is evident. Because of her ill health, she could not perform well in her academics like her normal counterparts.
According to NICE (2013, n.p.), emotional well-being includes individuals state of happiness and confidence as well as the absence of depressive symptoms. NICE (2013, n.p.) also defines social well-being as a state characterized by the presence of good relationships with other people as well as the absence of behavioral problems. Further, an individual who is socially healthy is not violent, a bully, or disruptive. The presence of emotional and social support predict mental health, while its absence predicts worse mental health and behavior (Reblin and Uchino 2008, p.4). If Louise were socially and emotionally supported during her teenage years, when her depressive symptoms started to emerge, her mental health would have been better.
Since childhood, Louise has experienced different types of mental disorders. At the age of fourteen, extreme mood changes and depression. Based on these symptoms, Louise must have been suffering from bipolar two disorder from the age of 14 until the time she joined the university. Bipolar disorder is characterized by recurrent depression accompanied by manic episodes (Sadock and Sadock 2011, p.571). Depression and Bipolar Support Alliance (n.d.) explains that an individual with bipolar disorder has moods that alternate between very extremely down mood and extremely up mood accompanied by depression. On the other hand, based on ICD-10 classification of mental disorders, Louise condition in her adolescence up to early adulthood can be classified as bipolar affective disorder (BPAD). BPAD is manifested by two or more episodes in which there is a disturbance of a patients mood and activity levels. This disturbance is comprised of elevated moods and energy and activity (hypomania or mania). Moreover, BPAD patients experience lowered mood and reduced energy and activity; depression (WHO 2003, n.p.).
At the first year of the university, Louise depression worsened, she could not leave her room for days, could not also eat, and even lost interest in her academics as manifested by her failure to attend lectures, suicidal thoughts, and her poor academic performance. Based on the ICD-10 classification of mental disorders, Louise had depressive episodes during her first year at the university. In depressive episodes, a person suffers from low mood, decreased energy, and reduced activity. Additionally, depressive episode s manifested by diminished interest in daily activities, reduced concentration, and fatigue. Moreover, insomnia and loss of appetite. Other symptoms of depressive episodes include feelings of worthlessness, psychomotor retardation, lowered self-esteem and self-confidence, loss of libido, and weight loss.
In her second year at the university, Louise struggled with suicidal thoughts. The suicidal thought is an indicator of bipolar disorder. Basco and Rush (2007, p.196) reported that suicidal ideation is common in individuals suffering from bipolar disorder, and it is estimated that up to 50% of bipolar patients attempt suicide during their lifetime. Louise took so long to be diagnosed with bipolar disorder because of many possible reasons. One likely reason is that bipolar disorder shares many symptoms with other types of depression, making it difficult for mental health clinicians to distinguish. Additionally, symptoms like moodiness can be mistaken by parents and clinicians as normal part of adolescence.
There is two classifications system used for mental illness: ICD and DSM. The ICD is the worlds official classification of most disorders in medicine. It has a section concerned with psychiatric disorders referred to as Mental and Behavioral Disorders. ICD classification provides diagnostic descriptions and guidance for mental disorders but does not have operational criteria. ICD is intended for use by all health practitioners. On the other hand, DSM is the United States classification for clinical diagnosis of mental illnesses. It is primarily used by psychiatrists for psychiatric care. In DSM, diagnosis is based on operational criteria; a polythetic system for most disorders. It might have been difficult to apply diagnostic criteria to Louise sooner due to the similarity in symptoms among various mental disorders.
There are challenges in applying the DSM or the ICD criteria in the diagnosis of mental disorders. One of the challenges pertains misdiagnosis. For instance, Singh and Rajput (2006, p.58) noted that bipolar disorder is usually misdiagnosed. More specifically, 69% of patients with the disorder have been reported to have been misdiagnosed initially, and more than a third have been misdiagnosed for more than ten years. Patients with bipolar disorder are often misdiagnosed because they seek treatment for depression. Additionally, the first episode of mood changes is usually depression instead of mania. Another problem associated with diagnosis of mental disorders is cultural and racial bias. African Americans are three times more likely to be diagnosed with schizophrenia because they are perceived not to be honest about their symptoms (Escobar 2012, p.847).
Some of the mental terms used in the case study include depression, bipolar disorder, and mania. Depression is defined as a mood disorder whose characteristics include intense feelings of sadness that continue for months. Depressed individuals have reduced concentration, loss of appetite, and insomnia. Bipolar disorder, on the other hand, can be defined as a mental disorder characterized by the presence of extreme mood swings with repeated depression and mania episodes. Lastly, mania is a feature of bipolar disorder whose symptoms include over-excitement, intense physical activity, and tangential thoughts.
Louises bipolar disorder might have been as a result of genetic factors. Bipolar run families and about half of individuals with this disorder have a family member with a mood disorder. Some of the treatment approaches of bipolar disorder include psychological treatments such as the early warning approach and cognitive behavioral therapy (CBT). In the early warning approach, the patients are given information about the disorder as well as its manifestations and are also helped to detect symptoms of potential relapse of the disorder. On the other hand, cognitive behavioral therapy involves the patient working collaboratively with a trained counselor to identify unhelpful thoughts and acknowledge their effect on the disorder. The primary goal of CBT is to change the patients pattern of thinking that is behind the patients mental illness and thus change the way they feel.
American Psychiatric Association, 2015. What is mental illness? [Online] (updated Nov. 2015). Available at: <https://www.psychiatry.org/patients-families/what-is-mental-illness> [Accessed 12 Nov. 2017].
Basco, M., Rush, A., 2007. Cognitive-Behavioral Therapy for Bipolar Disorder. Guilford Press, p.196.
Depression and Bipolar Support Alliance, n.d. What is bipolar disorder? [Online]. Available at: <http://www.dbsalliance.org/site/PageServer?pagename=education_brochures_bipolar_disorder_rapid_cycling> [Accessed 12 Nov. 2017].
National Centre for Biotechnology Information, 2008. [Online] (updated 2013). Managing depressive symptoms in substance abuse clients during early recovery. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK64063/> [Accessed 12 Nov. 2017].
NICE, 2013. Social and emotional wellbeing for children and young people. [Online] (updated Sep. 2013). Available at: <https://www.nice.org.uk/advice/lgb12/chapter/Introduction> [Accessed 12 Nov. 2017].
Singh, T., & Rajput, M., 2006. Misdiagnosis of Bipolar Disorder. Psychiatry (Edgmont), p.58.
World Health Organization, 2003. Mental and behavioural disorders. [Online] (updated 3 Jun. 2003). Available at: <http://apps.who.int/classifications/apps/icd/icd10online2003/fr-icd.htm?gf30.htm+> [Accessed 12 Nov. 2017].
World Health Organization, 2016. Mental health: strengthening our response. [Online] (updated Sep. 2013). Available at: <http://www.who.int/mediacentre/factsheets/fs220/en/> [Accessed 12 Nov. 2017].
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