The Impacts of COVID-19 on People With Bipolar Disorder

In Part 1 of this video, Psych Congress Steering Committee Member, Craig Chepke, MD, FAPA, adjunct associate professor of psychiatry, Atrium Health, adjunct assistant professor of psychiatry, UNC School of Medicine, and medical director, Excel Psychiatric Associates, Huntersville, NC, discusses the recent Harris Poll survey conducted on behalf of Alkermes and the Depression and Bipolar Support Alliance (DBSA), which examined the burden on people living with bipolar I disorder. Dr Chepke addresses the important topics of isolation, medication trial and error, side effects, challenges, and stigma.

In the upcoming Part 2, Dr Chepke, also the Psych Congress Network bipolar disorder section editor, will share his insights and key takeaways from this survey as well as the importance of person-centered care.

Read the transcript:

Craig Chepke:  Hi. My name's Dr. Craig Chepke. I'm the medical director of Excel Psychiatric Associates in Huntersville, North Carolina. I'm an adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine and an adjunct associate professor of psychiatry for Atrium Health. I'm also a member of the steering committee for Psych Congress.

Today, I'm here to talk about the results of the survey that was done in over 300 patients with bipolar I disorder. The results of the survey were just released in a press release. I want to talk about some of the interesting findings that were seen.

This was a very interesting survey because it dives into the heart of the functionality and what it's like to live life and live the experience of having bipolar I disorder. There was a lot of isolation that came out of the results of this survey. Eighty-one percent of people in the survey felt that no one could understand what they're going through because they're bipolar I.

Seventy-seven percent of people felt that they were more isolated and felt more alone because of their bipolar I. Almost half of the patients felt like they had the need to hide their symptoms or their diagnosis of bipolar disorder because they, again, didn't think that anyone would understand.

I'd like to start by talking about some of the symptoms of bipolar I disorder that the participants in the survey felt were most bothersome. About a quarter of patients each felt that the symptoms of sleep disruption, motivation and energy, and the frequency of the depressive episodes were the most bothersome symptoms that they felt.

Those are very common ones that we do see in bipolar I disorder. Those aren't surprising to rise up near the top. What was striking about the survey is how challenging it was for people to get proper treatment that they felt was adequate to address those symptoms.

Over 50% of the patients who were surveyed felt that it took over 5 medications trials in order to find a medication that correctly adequately addressed their symptoms and did not have adverse side effects.

Then, there was actually a huge percentage, almost 20% of people, that tried 10 or more different medications. We do see this in practice quite a bit. It's very difficult to find a medication that both has the right amount of efficacy for the symptoms, but also, doesn't have too many detrimental side effects.

Side effects that the survey found were most common were weight increase, anxiety, which could be related to potentially inactivation or akathisia in some cases in many patients who received. Certainly, in psychotic medications.

Also, excess sedation or sleepiness were some of the most bothersome ones that were outlined in the study. About half of patients each for each one of these different side effects responded of that.

Also, another one that was pretty common. Almost a quarter of patients reported that the medications had some detrimental effects on their sexual functioning, which is also an extremely important one and a common cause of nonadherence for not just patients with bipolar I disorder, but any psychiatric condition.

I mentioned that the results of the survey showed that a significant number of people with bipolar I felt that they had to hide their symptoms, that no one understood their symptoms. I think that ties back into a lot of the stigma that people with all mental disorders face.

I think people with bipolar I disorder face an even greater uphill challenge. Historically, as in popular culture, the term schizophrenia or schizophrenic was commonly used to denote crazy in layman's terms. I personally don't hear that much anymore in pop culture. Unfortunately, bipolar seems to have replaced that in movies, TV shows.

On the street listening to people talk, I often hear bipolar used as a pejorative term that can mean many different things, but all of them bad. That, unfortunately, leads into the amount of stigma that people with bipolar disorder face.

When the diagnostic term itself, which should be neutral, is meant as a pejorative term in most cases, it obviously leads people feeling like they don't want to have it known. They feel like it can be a mark or a brand on them that they don't want to have known, whereas no one would think about not revealing that they have diabetes, hypertension, or any other medical illness.

Bipolar disorder is a brain disease like all other psychiatric disorders, but there seems to be a sense of shame and stigma associated with it. The most detrimental outcome of stigma is that it can be potentially fatal. Stigma can kill.

Stigma can lead people to not seek treatment, to not adhere to treatment, to discontinue treatment. That can lead to tremendous functional difficulties. Potentially, suicide is the potential worst common case.