A Person-centered Approach to Diagnosis and Care for Bipolar Disorder and Alcoholism

Main Article Content

Ihsan M. Salloum

Abstract

Person-centered Medicine proposes the whole person in context, as the center and goal of clinical care and public health.  Person-centered Integrative Diagnosis (PID) is an emerging model for conceptualizing the process of clinical diagnosis and care implementing the vision and goals of person-centered medicine.  Person-centered Integrative Diagnosis entails a broader and deeper notion of diagnosis, beyond the restricted concept of nosological diagnosis and intends to provide the informational basis for person-centered organization of health care. It involves the dynamic integration of both positive health and ill health and emphasizes the formulation of the health status through true partnership with interactive participation and engagement of clinicians, patients, and families using all relevant descriptive tools (categorization, dimensions, and narratives). The applicability of this model to chronic, complex comorbidity with emphasis on the recovery process and health restoration is particularly pertinent. This paper focuses on the applicability of the PID to the challenging comorbidity of bipolar disorder and alcoholism. The PID provides an integrated formulation of multiple complex problems as well as positive aspects of health and strengths that are key to formulating and implementing personalized treatment and recovery plans.  

Article Details

Section
Regular Articles
Author Biography

Ihsan M. Salloum

Ihsan Saloum, MD, MPH, is a Professor of Psychiatry and Chief, Division of Alcohol and Drug Abuse: Treatment and Research, University of Miami Leonard M. Miller School of Medicine. Dr. Salloum graduated from the University of Bologna School of Medicine, in Bologna, Italy and completed the National Institute of Alcohol Abuse and Alcoholism (NIAAA) post graduate fellowship program in alcohol research at the Department of Psychiatry of the University of Pittsburgh Medical Center. Dr. Salloum’s research interest has focused on developing effective interventions for comorbid mood and addictive disorders and on addressing the diagnostic and therapeutic complexity of comorbidity and on Person-centered Medicine. He has published on the treatment of co-occurring disorders and is a frequent speaker at National and International scientific meetings. Dr. Salloum is the recipient of grant awards from the National Institute of Health. He is a member of the National Institute of Health Scientific Review Group and a diplomat of the American Board of Psychiatry and Neurology with added Qualifications in Addiction Psychiatry. Dr. Salloum is Member of the Board of the Executive Committee of the International Network on Person Centered Medicine. He is also the Chair, Section on Classification Diagnostic Assessment and Nomenclature of the World Psychiatric Association, and he is also the Secretary of the International Society on Bipolar Disorders. Dr. Salloum is a Distinguished Fellow of the American Psychiatric Association and Honorary Member of the World Psychiatric Association.

References

. Kraepelin E. Manic-Depressive Insanity and Paranoia. Edinburgh, UK: Livingstone; 1921.

. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry. 1993 Feb;50(2):85-94.

. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994 Jan;51(1):8-19.

. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27.

. World Health Organization: The World Health Report 2003 - Shaping the future. Geneva, Switzerland 2003.

. Stang P, Frank C, Yood MU, Wells K, Burch S, Muma B. Bipolar Disorder Detection, Ascertainment, and Treatment: Primary Care Physician Knowledge, Attitudes, and Awareness. Prim Care Companion J Clin Psychiatry. 2006;8(3):147-152.

. Pirkola SP, Poikolainen K, Lonnqvist JK. Currently active and remitted alcohol dependence in a nationwide adult general population: Results from the Finnish Health 2000 study. Alcohol Res Health. 2006 May-Jun;41(3):315-320.

. Rehm J, Gmel G, Sempos CT, Trevisan M. Alcohol-related morbidity and mortality. Alcohol Res Health. 2003;27(1):39-51.

. Anton RF. Naltrexone for the management of alcohol dependence. N Engl J Med. 2008 Aug 14;359(7):715-21.

. Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006 May 3;295(17):2003-17.

. Johnson BA. Update on neuropharmacological treatments for alcoholism: scientific basis and clinical findings. Biochem Pharmacol. 2008 Jan 1;75(1):34-56.

. Hirschfeld RM, Vornik LA. Recognition and diagnosis of bipolar disorder. J Clin Psychiatry. 2004;65 Suppl 15:5-9.

. Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004 Aug;61(8):807-16.

. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990 Nov 21;264(19):2511-8.

. Sachs and S.-B. Investigators (2010). "Impact of Substance Use Disorders on Recovery From Episodes of Depression in Bipolar Disorder Patients: Prospective Data From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)." American Journal of Psychiatry 167(3): 289-297.

. Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006 Feb;67(2):247-57.

. Frye MA, Salloum IM. Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord. 2006 Dec;8(6):677-85.

. Kupfer DJ, Frank E, Grochocinski VJ, Cluss PA, Houck PR, Stapf DA. Demographic and clinical characteristics of individuals in a bipolar disorder case registry. J Clin Psychiatry. 2002 Feb;63(2):120-125.

. Salloum, I. M., L. Williams and A. Douaihy (2008). Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders. Psychiatric Annals 38(11): 716-723.

. Weiss, R. D., M. J. Ostacher, M. W. Otto, J. R. Calabrese, M. Fossey, S. R. Wisniewski, C. L. Bowden, A. A. Nierenberg, M. H. Pollack, I. M. Salloum, N. M. Simon, M. E. Thase, G. S. Sachs and S.-B. D. I. for (2005). "Does recovery from substance use disorder matter in patients with bipolar disorder?" Journal of Clinical Psychiatry 66(6): 730-735; quiz 808-739.

. American Psychiatric Association, DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. 2000, Washington, DC: American Psychiatric Association.

. Janca, A., Kastrup MC, Katschnig H, Lopez-Ibor JJ, Mezzich JE, Sartorius N The ICD-10 multiaxial system for use in adult psychiatry: structure and applications. Journal of Nervous & Mental Disease, 1996. 184(3): 191-2.

. Berganza, C.E., Mezzich J.E., and Jorge M.R. Latin American Guide for Psychiatric Diagnosis (GLDP). Psychopathology, 2002. 35(2-3): p. 185-90.

. Mezzich, J.E., The WPA International Guidelines for Diagnostic Assessment. World Psychiatry, 2002. 1(1): p. 36-9.

. Salloum I.M., Mezzich JE, and Cordoba SE, Conceptual and methodological considerations in comorbidity, in Psychiatric Diagnosis: Challenges and Prospects. Salloum IM, Mezzich JE (Editors). 2009, Wiley-Blackwell.: Oxford, UK.

. Judd, L. L., P. J. Schettler, H. S. Akiskal, W. Coryell, A. C. Leon, J. D. Maser and D. A. Solomon (2008). "Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence." Archives of General Psychiatry 65(4): 386-394.

. Cox JL. Medicine of the Person and Personalized Care: a stitch in time saves nine? Journal of Evaluation in Clinical Practice, Apr;16(2):315-7.

. . Mezzich JE. World Psychiatric Association perspectives on person-centered psychiatry and medicine. Int J Integr Care.10 Suppl:e003.

. Mezzich, J.E., Salloum IM, Cloninger CR, Salvador-Carulla L, Kirmayer L, Banzato CE, Wallcraft J, Botbol M: Person-centred integrative diagnosis: Conceptual bases and structural model. Can J Psychiatry, 2010. 55(11): 701-8.

. Salloum, I.M. and Mezzich JE. Outlining the bases of person-centred integrative diagnosis. Journal of Evaluation in Clinical Practice, 2011. 17(2): 354-6.

. Drake, R., E. , H. Goldman, E. , H. Leff, Stephen, A. Lehman, F. , Dixon, Lisa, K. Mueser, T. and W. Torrey, C. Implementing evidence-based practices in routine mental health service settings. Psychiatric Services. 52(2) Feb 2001, 179-182.

. Berk L, Hallam KT, Colom F, Vieta E, Hasty M, Macneil C, Berk M. Enhancing medication adherence in patients with bipolar disorder. Hum Psychopharmacol. 2010 , 25:1-16.

. Leggio L, Kenna GA, Fenton M, Bonenfant E, Swift RM. Typologies of alcohol dependence. From Jellinek to genetics and beyond. Neuropsychol Rev. 2009 Mar;19(1):115-29.

. Strat YL, Ramoz N, Schumann G, Gorwood P. Molecular genetics of alcohol dependence and related endophenotypes. Curr Genomics. 2008 Nov;9(7):444-51.

. Gelernter J, Kranzler HR. Genetics of alcohol dependence. Hum Genet. 2009 Jul;126(1):91-9.

. Stacey D, Clarke TK, Schumann G. The genetics of alcoholism. Curr Psychiatry Rep. 2009 Oct;11(5):364-9.

. Ivleva E, Thaker G, Tamminga CA. Comparing genes and phenomenology in the major psychoses: schizophrenia and bipolar 1 disorder. Schizophr Bull. 2008 Jul;34(4):734-42.

. Stacey D, Clarke TK, Schumann G. The genetics of alcoholism. Curr Psychiatry Rep. 2009 Oct;11(5):364-9.

. Cloninger CR. The positive health domain in person-centered integrative diagnosis. Int J Integr Care. 2010,10: Suppl: 73-74.

. Mezzich JE. Positive health: conceptual place, dimensions and implications. Psychopathology. 2005 Jul-Aug;38(4):177-9.

. Huppert FA, Whittington JE. Evidence for the independence of positive and negative well-being: implications for quality of life assessment. Br J Health Psychol. 2003 Feb;8(Pt 1):107-22.