Jennifer Cava
Foundations of Leisure
Dr. Koesler
April 2, 2012
I have neither given nor received help on this work, nor am I aware of any infraction of the
Honor Code. Jennifer C. Cava
References
Rosa, A., Reinares, M., Franco, C., Comes, M., Torrent, C., Sánchez-Moreno, J., & Vieta, E.
(2009). Clinical predictors of functional outcome of bipolar patients in remission. Bipolar
Disorders, 11(4), 401-409.
In the article, “Clinical Predictors of Functional Outcome of Bipolar Patients in
Remission,” a study is conducted with patients with bipolar disorder who are in remission and
are assessed on areas of functioning. It has been shown by other studies that persons with bipolar
disorder tend to have trouble functioning while in remission. Many aspects of a person’s life can
help in predicting “functional impairment” of a bipolar patient (Rosa et al., 2009, p.401). These
aspects are gender, age, marital status, socioeconomic status, support groups, amount of times
recently in the hospital, and number of recent episodes.
For this study, a group of seventy-one patients who suffer from bipolar disorder and
sixty-one healthy participants were assessed on areas of functioning. Each group had to maintain
certain conditions to participate in the study. The group of patients had to have bipolar disorder
and meet the standards for the “Hamilton Depression Rating Scale” and the “Young Mania
Rating Scale” (Rosa et al., 2009, p.402). The healthy participants were accepted into the study if
they did not have any history of psychological or neurological problems (Rosa et al., 2009,
p.402).
During the actual study, the two groups were given the “Functioning Assessment Short
Test” which assessed the participants’ “functional impairment” (Rosa et al., 2009, p.402). This
test considers six aspects that are essential to a person’s functioning. These six aspects are
independence, job-related functioning, intellectual functioning, monetary problems, social
relationships, and free time. (Rosa et al., 2009, p.403) The results of the study conducted
consisted of the healthy group of participants having a higher overall level of functioning,
especially in the domains of independence, job-related functioning, intellectual functioning,
monetary problems, and social relationships. The study also suggested that patients with bipolar
disorder lead a life with a good amount of “morbidity and dysfunction even during remission.”
(Rosa et al., 2009, p.407)
This article shares a study that can be pertinent to recreational therapists while working
with persons with bipolar disorder. It explains the type and amount of function a person with
bipolar disorder can have trouble with. This can help a recreational specialist assess the person’s
function level and create ways to help them increase it. A therapist can use recreational and
leisure tactics to help a person in all six of the domains of functioning. This article helps
therapists to be aware of the dysfunction is a patient’s life and find ways to reduce the
dysfunction and help create a better quality of life.
Chand, P., Mattoo, S., & Sharan, P. (2004). Quality of life and its correlates in patients with
bipolar disorder stabilized on lithium prophylaxis. Psychiatry and Clinical Neurosciences,
58(3), 311-318.
The article, “Quality of Life and its Correlates in Patients with Bipolar Disorder
Stabilized on Lithium Prophylaxis,” takes a look at the rate of quality of life in patients with
bipolar disorder verses healthy persons and patients with Schizophrenia. This study focuses on
patients who have bipolar disorder and take lithium prophylaxis. Lithium prophylaxis is used
with bipolar patients to stabilize their condition. To measure the subjects’ quality of life, many
self-report assessments are required for collecting information. Other studies look at the quality
of life of a bipolar patient, but do not compare the patients with other subjects. This article shares
the impact on life that everyday tasks have on a person with bipolar disorder, schizophrenia, and
a person who is healthy.
During this study of the quality of life, a group of patients with bipolar disorder, ranging
in age from twenty to fifty years old, were chosen on the following criteria: they were taking
lithium prophylaxis for one year, their lithium levels were between 0.6 and 1.0, and they had not
had an episode in a year. In addition to the patients with bipolar disorder, there were two control
groups for this study. The two groups were patients with schizophrenia and a healthy subject
group. The criteria for the healthy group consisted of a “normal” psychiatric level. For the
patients with schizophrenia, the criteria consisted of being in a stable state and not increasing
their drug dosage for three months. (Chand et al., 2004, p.312)
For the actual study, the subjects were given a series of assessment tests. These tests
consisted of rating the person’s “quality of life and enjoyment,” daily struggles, stress level,
support group, and “dysfunction” (Chand et al., 2004, p.312). Many of these tests consisted of a
rating scale of one to three or one to five. In comparing the data of the assessments between the
three groups, the studies showed evidence that persons who suffer from bipolar disorder have a
higher quality of life than those with schizophrenia. The healthy group of subjects had a higher
quality of life and score than the group with schizophrenia in all aspects except for physical. The
group of persons with bipolar disorder scored higher in leisure activity than the healthy group.
These results show that people with bipolar disorder that are stabilized with lithium prophylaxis
have a rather good quality of life. (Chand et al., 2004, p.317)
This article demonstrates the struggles a person with bipolar disorder and even
schizophrenia deal with from day to day. It is helpful in explaining the aspects of life that affect a
person’s quality of life. Comparing the two control groups to the experimental group can help a
recreational therapist understand the different aspects of life for patients with bipolar disorder.
This article can help a therapist create activities that will help the patient to better their quality of
life. To do this, therapists must assess the patient’s beginning rate of quality of life and work
toward a greater quality of life. This article can also help a recreational therapist understand the
aspects of a patient who is on lithium prophylaxis versus and patient who is not and provide the
correct assistance needed for each.
Wang, J. (2006). Perceived work stress, imbalance between work and family/personal lives, and mental
disorders. Social Psychiatry and Psychiatric Epidemiology, 41(7), 541-548.
In the article, “Perceived Work Stress, Imbalance Between Work and Family/Personal
Lives, and Mental Disorders”, a study is conducted to understand the amount of pressure on a
person in their everyday lives, whether from a mental disorder or work. The three major aspects
that are assessed are the individual’s job, social life, and mental health. While looking at the
person’s job, the amount of knowledge and responsibility needed is looked at to identify if stress
is coming from the person’s place of work. When evaluating the participant’s social life, the
“imbalance between work and family/personal lives” is also explored (Wang, 2006, p.541). To
evaluate mental disorders, the type of disorder is important. This study seems to focus on the
disorders that are considered manic or mood disorders, which includes bipolar disorder. (Wang,
2006, p.541)
During this study, a survey was sent out to participants, ages fifteen and above, who were
residents of Canada. The survey sent out was the “Canadian Community Health Survey- Mental
Health and Well-being” (Wang, 2006, p.542). This survey then broke down the amount of
participants, and by random selection, chose individuals for the study. The participants were then
asked to participate and invited to an interview. The overall amount of participants for this
survey ended up to be 36,984 people with only a seventy-seven percent reply rate. There was
only one criterion that each participant had to have: the individual had to be employed in the past
twelve months. (Wang, 2006, p.542)
The second part of the study was the “Job Content Questionnaire,” which asked the
participants about the kind of work they do in their job and how much stress it causes them
(Wang, 2006, p.542). From these assessment tools, there was great evidence shown that people
with mental disorders have little balance in their social and work lives. Some people stated that
they never had control and balance over their lives which showed that they had extremely high
occurrence of manic or mood disorders. It was also found that individuals who experienced more
pressure in their profession were more likely to experience mood disorders, such as bipolar
disorder. Household income seemed to be a big stressor for many individuals; this also seemed to
be common in participants with mood and anxiety disorders.
This article explains the struggles that persons with mood and anxiety disorders deal
with. This issue may be the same as others without the disorder, but it takes a greater toll on
those who have a mood or anxiety disorder. A person with bipolar disorder handles stressors
differently than a person who is not affected by the disorder. Many times the pressure of a job or
a social situation can become too great for the person to deal with. A recreation therapist can
help these individuals find ways to cope with the stress or anxiety that their work or social
situation can develop. Helping the person find an activity to release frustration and anger toward
these aspects of life is important. A recreational therapist can learn what effects individuals with
mood disorders such as bipolar disorder, and help them to function with the disorder in a calm
manner.
Rosa, A., Reinares, M., Michalak, E., Bonnin, C., Sole, B., Franco, C., & ... Vieta, E. (2010).
Functional impairment and disability across mood states in bipolar disorder. Value In
Health (Wiley-Blackwell), 13(8), 984-988. doi:10.1111/j.1524-4733.2010.00768.x
The article “Functional Impairment and Disability across Mood States in Bipolar
Disorder” focuses on how a patient with bipolar disorder operates in his or her daily life. To look
at the daily operating of patients, researchers observed the different conditions of mood and
compared them to a group of healthy individuals. Some examples of these conditions are “mania,
euthymia, and depression” (Rosa et al., 2010, p.984). This article explains that bipolar disorder
affects individuals at all ages at extreme rates by high medical bills, daily impairments, and
missing days of work. These have a huge impact on the person’s “quality of life” (Rosa et al.,
2010, p.984).
There were two groups of individuals involved in this study. The first group was
individuals who were diagnosed with bipolar disorder and were under current treatment. This
group went through a few assessment tests before proceeding. The first test was the “Hamilton
Depression Rating scale” which rated the participants on whether they were in the “depressive
group” (Rosa et al., 2010, p.985). The second test was the “Young Mania Rating Scale.” This
scale decided whether the individual was considered to have a “manic” condition (Rosa et al.,
2010, p.985). The second group was full of healthy participants who had no record of mental
issues in their past or present. Each individual had to be eighteen years or older to participate in
the study.
The first step to this study was to find the size of each subject group, which came out to
be twenty-two participants in each group. For the assessment part of the study, an interview was
completed to understand each patient’s full diagnosis. After the interviews were finished, the
“Functioning Assessment Short Test (FAST)” was administered to both subject groups (Rosa et
al., 2010, p.985). This test focuses on different areas of functioning that person’s with bipolar
disorder tend to struggle with.
After all the results were calculated, researchers found that sixty-eight of the bipolar
patients were considered “euthymic,” thirty-two considered depressive, thirty-one considered
“manic,” and sixty-two considered of good health (Rosa et al., 2010, p.985). It was found that
patients had a higher depression level than those who were in the health group. Patients with
“manic and depressive” symptoms showed worse “functioning” than those with “euthymic and
healthy groups” (Rosa et al., 2010, p.986).
This article, like many others, focuses on the functioning in a person’s everyday life. A
person with bipolar disorder can have trouble with many aspects of functioning. This is activity
done during the day such as a job, finances, or free time. As the article explains, with the right
treatment and intervention, a recreational therapist can help a person with bipolar disorder to
function at a normal and comfortable level. It is important to help the patient become more
independent through activities that can help them learn the different aspects of functioning in
life.
Morriss, R., Scott, J., Paykel, E., Bentall, R., Hayhurst, H., & Johnson, T. (2007). Social
adjustment based on reported behaviour in bipolar affective disorder. Bipolar Disorders,
9(1-2), 53-62.
In the article, “Social Adjustment Based on Reported Behaviour in Bipolar Affective
Disorder,” research is conducted on whether a person’s attitude and other medical variables are
connected to their adjustment in social aspects of life. A big question that researchers have is if a
person’s “mood episodes” or “clinical variable” affect the person’s “outcome of social
adjustment” (Morriss et al., 2007, p.54). The goal for this study is to understand what aspects of
bipolar disorder are associated with being able to function socially. Many studies before have
used self-report to collect their data, but this study uses the interview process and other
assessment tests to get a more reliant amount of data. (Morriss et al., 2007, p.54)
The sample consisted of patients with bipolar disorder who had a recent relapse in the
previous year. There were a number of standards that needed to be followed in order for the
patient to partake in the study. First the patient needed to be eighteen years or older, have a past
of bipolar disorder, and have been in treatment for at least six months. Some standards that were
not allowed were not being able to read, not allowing signed permission, and substance abuse.
There were also quite a few assessment tools that were used.
The first tool was a borderline interview, which each participant had to partake in. After
the interview the patients who passed through, were assessed by the “Social Adjustment Scale”
(Morriss et al., 2007, p.55). This scale scored according to four domains. These domains were
similar to working within routine, being sociable, being resistance, and lack of independence.
The second part of the study was another interview that consisted of understanding the basis of
the client’s disorder. The third part of the study, comprehended each patients’ background
information. For example, researchers looked at the sex, job status, and time period of diagnosis
for their disorder. The fourth part of the study continued with more tests to understand the
patient’s rate of depressive and mania aspects. The fifth and final part of the study was when the
patients rated themselves on their health, depression, and self-confidence. (Morriss et al., 2007,
p.56)
After narrowing down the number of patients in the study, the final number of patients
was two-hundred and fifty-three. Some results that were found stated that there was a slight
overall “impairment with social adjustment” amongst the whole sample of bipolar patients
(Morriss et al., 2007, p.59). The greatest difficulty relayed in the domain of free time and being
sociable. This study also showed that patients who live alone and are of the male sex have a
lower score in the social aspects.
This article shares at the end that many of the social aspects that patients with bipolar
disorder are lacking in can be worked on with the help of recreational therapy. Recreational
therapists can learn from this article the aspects in life, socially, that patients with bipolar
disorder struggle with. This article can help therapists to understand the opportunity to help
clients who struggle at work, in relationships, and in discretionary time pursuits.
Rodriguez, L. J. (2007). A closer look: the benefits and effectiveness of cognitive behavioral
therapy on a female-specific unit for treatment of bipolar disorder. Issues In Mental
Health Nursing, 28(5), 533-542. doi:10.1080/01612840701344498
This article is a case study which explains how “cognitive behavior therapy” helps
patients who struggle with bipolar disorder (Rodriguez, 2007, p.535). The study consisted of the
treatment given to a female patient. This patient had a history of violence and aggression toward
family and friends. The patient’s family became so afraid of her capabilities that they put a
restraining order against her. This patient had a history of drug usage which has affected her
disorder and behavior greatly. This article explains that for many patients with bipolar disorder,
continually taking medication daily is difficult. Many patients begin to feel better while taking
their medication and feel as though they do not have to take anymore. The patients think that
they have gotten better and no longer need the medication. After being off their medicine for a
while, the patient goes back into the hospital and the cycle continues. This has happened quite a
few times with the female patient in this study. (Rodriguez, 2007, p.536)
To begin the study of helping this client, she was put in a care facility that was directed
toward women who need help with behavioral issues. This facility works on “cognitive
behavioral therapy” with women who suffer from bipolar disorder and other manic conditions.
While working with the female patient, the course of treatment studied was the intervention. The
study closely watched how the patient reacted to the therapy. The first part of the patient’s
treatment was to start her back on the medication she had stopped taking, while adding a mild
anxiety pill to relax her. The patient was put on a healthy diet and asked to exercise daily. The
next part of the study consisted of seeing how the patient responded to therapy sessions. These
sessions focused on helping her to understand that the medication was important and to control
her reactions to different situations. They also provided help in understanding how to love
oneself and have the self-esteem to continue in working through the situation at hand.
(Rodriguez, 2007, p.535-536)
The main idea of “cognitive therapy” is to help the patient understand the importance of
taking medication, to become educated on their disorder, and to learn a better way to deal with
frustration (Rodriguez, 2007, p.537). The patient in this study began to feel and act better after
continuing medicine for two weeks. After the two weeks, therapy was started to help the patient
understand the importance of continuing medication on a daily basis. The client responded well
to this therapy and understood that medication was the only way for them to get better. The
patient’s attitude continues to show progress by wanting to know and understand more about
bipolar disorder. With more intensive therapy sessions, the patient understood that taking a deep
breath and thinking through the situation is more affective then getting into a fight. This study of
“cognitive therapy” showed huge results in the patient’s life (Rodriguez, 2007, p.540).
This study proves that behavior therapy does work in many cases. A recreational therapist
can take this article and understand the initial concept of trying to improve the patient’s quality
of life. The patient in this study worked hard for two months and has benefited from it by getting
a new start. A recreational therapist can use this article to help them understand behavior therapy
and understand that it is important when working with a person who suffers from bipolar
disorder.
MacQueen, G., Parkin, C., Marriott, M., Bégin, H., & Hasey, G. (2007). The long-term impact of
treatment with electroconvulsive therapy on discrete memory systems in patients with
bipolar disorder. Journal Of Psychiatry & Neuroscience, 32(4), 241-249.
In this article, a study is conducted to find how “electroconvulsive therapy” has an effect
on an individual’s memory when treating bipolar disorder. This study explains that
“electroconvulsive therapy” is therapy for people who suffer from bipolar disorder or depression
which can affect longer thinking and memory ability (MacQueen et al, 2007, p.242). There have
been many cases that have noticed the effects of this therapy. Two of these effects are memory
loss and functioning impairments. This study wants to take a closer look at patients with bipolar
disorder who have had the treatment to see if there are any negative effects.
To start this study, there were two groups: the patients and the healthy participants. Some
important standards had to be fulfilled by each patient in order to proceed with the study. These
consisted of being between the ages of thirty and sixty-five, having the ability to give permission
for the study, and having their disorder confirmed by a medical interview. (MacQueen et al,
2007, p.242) There were also a few eliminating factors that participants could not have. These
consisted of substance reliance for the past few months and discrepancies in reading and writing.
Once these standards were met, each participant went through a series of assessment tests.
The first test was the “Cognitive Failures Questionnaire” (MacQueen et al, 2007, p.242).
This provided the study with evidence on memory deficiency. The next tests consisted of visual
and verbal tasks. For many of these tests, the participant was asked to match words and images
to finish statements. As for the results of the study, there were discrepancies between the patients
and the healthy participants that helped prove the idea of memory loss in patients who had the
“electroconvulsive” treatment (MacQueen et al, 2007, p.242). The memory loss for the healthy
individuals seemed to be less than those who had received the treatment for bipolar disorder.
From the results, there was little amount of visual memory issues in both sets of participants.
This article and study can be a big help to recreational therapists that work with patients
who suffer from bipolar disorder and who have had “electroconvulsive therapy” (MacQueen et
al, 2007, p.243). A recreational therapist working with a client who has gone through this
treatment can use this study to understand the types of limitations that the client has. This can
help the therapist understand what tasks and activities that can be used to work on memory
impairments. Helping a client to work through issues to help improve the memory loss is
important. It is also important for the therapist to understand all aspects of the therapy and any
other side effects that can result because of it. A therapist can then understand what situations
may require this treatment and help the client get the treatment. The therapist can also try to find
other ways to help clients who may need this treatment. This can save the client from memory
loss and work on the behavior disorder as well.
While reading each article about different studies that affect a person with bipolar
disorder, I learned more about the development and concerns for the patients who have the
disorder. Bipolar disorder is important to me because my cousin was diagnosed with it at a
young age. These articles have explained how and what can help a person to strive and push
through the disorder in order to live a better life.
A big factor in most of these articles is how taking the right medication can help a patient
with bipolar disorder tremendously. The article “Quality of Life and Its Correlates In Patients
With Bipolar Disorder Stabilized on Lithium Prophylaxis” explains how a person’s life can be
improved by taking “lithium prophylaxis”(Chand et al., 2004, p.312). It studies the effects of this
drug, but also emphasizes that taking medicine is important to the overall better lifestyle.
Another article that stresses this is “A Closer Look: The Benefits and Effectiveness of Cognitive
Behavioral Therapy on a Female-specific Unit for Treatment of Bipolar Disorder” (Rodriguez,
2007, p.540). This article explains that a patient with bipolar disorder feels that they have no
need for taking their medication. This happens after the patient has been taking it for a while and
begins to feel better. Many patients do not understand that the medication is what is making them
feel better. In order to help the client to understand, a therapist has to work with them daily to
show and explain that the medication is the reason they are doing well.
Another big issue that I learned was that many patients with bipolar disorder have a low
functioning level in aspects such as work, relationships, and finances. There were quite a few
articles that consider this aspect of the disorder. One is “Perceived Work Stress, Imbalance
Between Work and Family/Personal Lives, and Mental Disorders” (Wang, 2006, p.541). This
article showed that individuals with bipolar disorder have a lower functioning in certain areas
versus health control participants. This article showed that certain therapists can help a patient
with bipolar disorder to function better in all aspects of life, working on being social and
independent.
The information from these articles can help recreational therapists to understand the
functioning and behaviors of patients with bipolar disorder. Many activities can be used to help
patients become more sociable and active in their everyday lives. For example, helping a client
who struggles with being independent, the therapist could have the patient work through a word
puzzle by taking a deep breath and thinking through the outcomes. This could help the client
become more independent and can help them work toward taking control of their own life. The
possibility of working toward being more sociable can also come from this. For example, if a
person becomes less dependent on others, they can start to make friends and have better
relationships with family. The process takes time and is done in multiple steps.
In the future, as a recreational therapist, these articles will help me if I work with a
patient who suffers from bipolar disorder. I will better understand where the patient is coming
from and what kind of environment they may be living in. These articles can help me work with
the client in many ways, such as making sure they are taking their medication, as well as help me
to understand their functioning level. The article, “A Closer Look: The Benefits and
Effectiveness of Cognitive Behavioral Therapy on a Female-specific Unit for Treatment of
Bipolar Disorder”, explains the process of “cognitive therapy” that is used on other patients with
bipolar disorder (Rodriguez, 2007, p.540). This therapy could be a huge help in providing
information on how to go about it and what benefits are received from it. Helping the client to
better understand their disorder and their medication is important for continuing treatment.
As a recreational therapist, my job will be to help the client obtain the best quality of life
possible and I feel that these articles can help me do this in the future. They helped me
understand the disorder and how to work with clients who may not even understand what their
struggles are. Theses eight articles have taught me that a person’s disorder does not define who
they are, but it is just another struggle in life that can be overcome.