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Overdiagnosis of Bipolar Disorder & Depression
Overdiagnosis of Bipolar Disorder & Depression
Vasavi Ganesan Shanthi
Department of Psychology, Eastern Michigan University
PSY 743: PsychopathologyDr. Alexandros Maragakis
October 7, 2021
Introduction
Mental illness is classified into many categories in psychiatry.The definitions establish the boundary between normal and abnormal as far as what counts as a disorder and
how someone qualifies to be disordered. The boundary has radically changed in the past
century. As new disorders are added and old ones are revised in succeeding classifications. With increasingly complex forms of suffering identified, diagnoses have increased rapidly. More people qualify for diagnosis and more treatments are deemed necessary when psychiatric classifications cast a wider net. Bipolar Disorder and Depression have been overdiagnosed the past two decades and this paper will cover literature based on overdiagnosis, limitations of DSM 5 leading to overdiagnosis, reasons for overdiagnosis in clinical setting, case examples from peer reviewed literature and ways to improve as patients and clincians to get an accurate diagnosis.
According to the study conducted by Bolton,” states that there have been criticisms of psychiatry for over diagnosing, for pathologizing normality since at least the antipsychiatry critiques of the 1960s. Psychiatrists
were making the ICD and DSM classifications at approximately the same time, a process that has resulted in the progressive revision of both classifications.Revising diagnostic manuals of diseases and disorders, such as the International Classification of Diseases and the Diagnostic and Statistical. Manual(DSM), inevitably leads to further criticism, and the revision of the DSM V has been the focus of debate for quite some time about overdiagnosis. There is almost no consensus on the question of whether a particular illness or illness in general depends on a decisive marker, but rather the relative medical, psychosocial, and financial harms and benefits the illness may cause. (Merten et.al) States that children and
adolescents are diagnosed with mental disorders in increasing numbers every five years. Study findings of time trends of prevalence of mental disorders are mixed. We can now address previously neglected mental health issues by broadening the definitions of mental illness. By becoming more commonplace, mental illness is likely to be less stigmatized.
(Ghouse et.al) The first description of bipolar disorder was by Jules Falret in 1854, as Case Circulaire (circular insanity). It was later renamed as manic-depressive psychosis. Bd is said to be one of the most disabling mental conditions and the reason is it’s high rates of morbidity, disability and premature death from suicide.
Until recently, bipolar disorder was thought to be an uncommon condition, however the concept of soft bipolar spectrum disorder gained traction in the mid-1990s and early 2000s, leading to the current focus on subthreshold bipolar disorders. In response, the pharmaceutical industry is increasingly interested in treatment for BD. Diagnostic criteria for BD II have widened dramatically, with increasing rates of diagnosis. Mitchell in his article suggests that there are many valid reasons to be concerned about overdiagnosis.
In recent years, the mainstream media and lay public have become more aware of the condition of BD. “We are being presented with mood disorders that are based on “refined mood swings” that are produced by Google.” Says clinician Reddy from India in his article “Are we overdiagnosing bipolar disorder” .
According to Ghouse et al. in her article reveals that the potential downsides of over diagnosing BD are several. They include the negative effects of unnecessary labeling, the risk of harm related to unnecessary treatments, and the misuse of health care resources, with important human and financial implications. The phenomenological distinction between BD and some personality disorders may be challenging, not only because of the overlap between some personality disorder features and the diagnostic criteria for mood episodes but also because of the lack of reliability of the time criteria for BD says the Ghouse study on “overdiagnosis of bipolar disorder”. It may be the issue of differential diagnosis versus comorbidity which is most critical to think about when discussing BD and personality disorders. Ghouse et al “This is confirming especially when it involves patients with borderline personality disorder. Bipolar disorder and borderline personality disorder are quite common co-occurring disorders, but the similarities between the two may cause diagnostic confusion”.
“The rates of comorbidity between substance use disorders and BD are extremely high “ (Kenneson et al.). The behavioral consequences of various psychoactive substances, on the other hand, can easily imitate the mood symptoms seen in bipolar disorder patients. Patients frequently experience typical manic or hypomanic symptoms associated with cocaine and stimulants, and alcohol has well-documented mood-depressing effects. Although the DSM-IV suggests diagnosing mood disorder due to substances in patients whose mood symptoms appear to be limited to periods of substance use, clinical practice can make this distinction challenging.
According to Zimmerman, the study indicated that while some people who fulfilled the criteria for bipolar disease were never diagnosed with it, considerably more people were incorrectly classified as bipolar. Part of the explanation, he says, is aggressive marketing to doctors by corporations that make bipolar illness medicines. Zimmerman (2017) According to the 2016 review, the limited amount of time that some clinicians spend with patients could also contribute to incorrect diagnoses. People with bipolar disorder frequently have another mental health issue or condition, such as anxiety disorder, an eating disorder, or a substance abuse problem, which can also contribute to difficulty getting the right diagnosis, according to the NIMH. “The finding about overdiagnosis aren’t surprising”, says Schwartz a psychotherapist in Brooklyn, New York. Bipolar disorder can be hard to diagnose, he says, because people often seek professional help only during their down periods and neglect to mention their up, or manic, periods. Furthermore, some younger patients with bipolar disorder may have had depression but not yet had a manic episode, resulting in a misdiagnosis of depression. The mania may not always be visible, which adds to the patient’s and provider’s confusion.
Researchers from Rhode Island Hospital and Brown University found a year ago that after employing a complete, psychiatric diagnostic interview instrument, fewer than half of individuals previously diagnosed with bipolar disorder acquired a genuine diagnosis of bipolar disorder. Their study included 82 psychiatric outpatients who said they had previously been diagnosed with bipolar illness but that their diagnosis had not been validated using the SCID. These patients’ diagnosis were compared to 528 persons who had never been diagnosed with bipolar illness. The research took place between May 2001 and March 2005.
The difficulty of the DSM-based diagnosis of BD to detect bipolar patients without a typical history of classic manic or hypomanic symptoms, that is, a patient whose index episode is depressive, is the most significant limitation (Ghouse et al.). The description of traits that, if present in a patient with depression, are highly suggestive of bipolar illness, has been attempted to mitigate this restriction.
Being properly diagnosed is crucial to receiving the appropriate therapy for your bipolar disorder, allowing you to control your symptoms and enjoy a healthy, active, and full life. According to Schwartz, talking with your doctor about all of your symptoms and emotions, both positive and unpleasant, is one of the most critical things you can do to improve your odds of receiving an accurate diagnosis.
References
Bolton, D. (2013). Overdiagnosis problems in the DSM-IV and the new DSM-5: Can they be resolved by the distress—impairment criterion? The Canadian Journal of Psychiatry, 58(11), 612–617. https://doi.org/10.1177/070674371305801106
Ghouse, A. A., Sanches, M., Zunta-Soares, G., Swann, A. C., & Soares, J. C. (2013). Overdiagnosis of Bipolar Disorder: A Critical Analysis of the Literature. The Scientific World Journal, 2013, 1–5. https://doi.org/10.1155/2013/297087Gray, B. S. K. T. C. (2013, March 18). Are we over-diagnosing mental illness? CNN. https://edition.cnn.com/2013/03/16/health/mental-illness-overdiagnosis/index.htmlHaslam, N., & Fabiano, F. (2020, July 16). Is psychiatry shrinking what’s considered normal?
Hutto, B. (2001). Potential Overdiagnosis of Bipolar Disorder. Psychiatric Services, 52(5), 687. https://doi.org/10.1176/appi.ps.52.5.687
Iordache, I. (2010). The overdiagnosis of bipolar disorder. Journal of Psychiatry & Neuroscience, 35(3), 216. https://doi.org/10.1503/jpn.100032Kelly, T. (2018). Prospective: Is bipolar disorder being overdiagnosed? International Journal of Methods in Psychiatric Research, 27(3). https://doi.org/10.1002/mpr.1725Merten, E. C., Cwik, J. C., Margraf, J., & Schneider, S. (2017). Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child and Adolescent Psychiatry and Mental Health, 11(1). https://doi.org/10.1186/s13034-016-0140-5Mitchell, Philip B. “Bipolar Disorder: The Shift to Overdiagnosis.” The Canadian Journal of Psychiatry, vol. 57, no. 11, 2012, pp. 659–665., https://doi.org/10.1177/070674371205701103.
Reddy, M. S., Vijay, S. M., & Reddy, S. (2017). Are we Overdiagnosing Bipolar Disorder? Indian Journal of Psychological Medicine, 39(5), 698–702. https://doi.org/10.4103/ijpsym.ijpsym_419_17Scott, J. A., & Young, A., MD. (2021, January 18). Why Bipolar Disorder Is Often Misdiagnosed | Everyday Health. EverydayHealth.Com. https://www.everydayhealth.com/news/why-bipolar-disorder-is-often-misdiagnosed/If Bipolar Disorder Is Over-diagnosed, What Are The Actual Diagnoses? (2009, July 29). ScienceDaily. https://www.sciencedaily.com/releases/2009/07/090729100936.htmThe Conversation. https://theconversation.com/is-psychiatry-shrinking-whats-considered normal-142477
Outsourcing
Outsourcing
Name
Institution
Outsourcing
Section A
Introduction
Outsourcing is a business practice that is utilized by companies to condense costs or to improve efficiency by shifting tasks, jobs, activities, operations, or processes to an external third party for a significant time. This has been adopted by most small businesses in the United States as they seek to improve operations and reduce production costs (Akinyemi, 2016). Many organizations have turned to outsourcing as a means of achieving organizational growth but at the same time restricting payroll and other expenses. In this practice, companies are required to discuss their needs and concerns openly. This can be achieved by creating and developing a proper communication channel that facilitates transparency, responsibility, and accountability. It is a situation where two companies enter into a legal contractual agreement involving an exchange of ideas, services, payrolls, as well as expertise. It fuels innovation because companies develop flexible budgets that they can control and manage efficiently. Outsourcing has some good and bad qualities that impact the engineering community and the business industry.
Section B
The Pros of Outsourcing
Outsourcing is a source of cheap labor. The fluctuation of tasks and operations gives the other company a higher bargaining power. As a result, the workers are oppressed and exploited and their payroll reduced. This indicates that companies end up minimizing their labor costs because workers are poorly paid. Cheap labor hinders the production of quality goods and services because the workers are not motivated since their payrolls are poor. This shows that outsourcing can help companies to incur lower costs because labor is cheap and readily available. This exploitation of workers minimizes their input and companies end up lagging behind in terms of growth and development. Outsourcing is believed to reduce and control the operating costs to as it has been a recurring trend amongst U.S. companies. Outsourcing is an incentive that may have a more significant impact for these companies due to the country’s high corporate taxes and directed benefits like OSHA regulations and social security.
Outsourcing has been a prevalent initiative in the United States, and recent studies indicate that it is more efficient and effective (Hoecht & Trott, 2006). The approach has been initiated by a good portion of companies in the higher economy. The results have been assessed, analyzed, and evaluated to identify its significance. Results, however, indicate that outsourcing is more efficient as companies that come to agreement benefit and grow during the course of action. Organizations do not require to hire more employees because they work as contractors. In such a scenario, companies avoid hiring an employee, and this saves more money from employing, benefits to training employees. This shows that outsourcing has a positive impact on the growth and development of a company. Saving money and incurring lower costs helps companies to collect vast revenues that can assist them to achieve various goals and objectives as stipulated in their plan (Hoecht & Trott, 2006). Therefore, it is essential for firms to realize and understand the significance of outsourcing considering their urge to achieve organizational sustainability and development. This could be achieved through outsourcing and companies can increase their level of global competitiveness.
Cons of Outsourcing
The initiative is also accompanied by disadvantages despite being efficient and effective in the business sector. Outsourcing facilitates the creation of more rules and regulations. The parties involved are required to adhere to the terms and conditions of the contract. This enables the development of an environment that workers cannot cope with as they perform tasks (Zirpoli & Becker, 2011). Employee-employer relations are altered, and there exist poor communication channels. This rules and regulations change the organizational structure of the parties involved. Workers are introduced to new regulations that may be harsh for them as they carry out their operations. Therefore, more rules and regulations limit companies to perform specific terms and adhere to the conditions stipulated in the agreement (Chen, & Tseng, 2017). Companies give up some control when they outsource, and they cannot do as they desire because they are bind by a contract. This may slow organizational growth and development because operations are conducted based on some rules and regulations.
Another disadvantage of outsourcing is that it enhances the loss of jobs and no opportunities are created. Outsourcing has led to fewer jobs in America because the program runs on a contract. The workers are not hired by the affiliates, and they are poorly paid. In outsourcing, the third party acts as a contractor, and this indicates that it is not necessary to bring employees into the organization (Akinyemi, 2016). Therefore, employees are uncomfortable, and this affects their productivity and the quality of goods and services. This increases the problems within an organization because the employees may find it difficult to work in unsupportive environments. Fewer jobs facilitate the growth of immorality in the country, and it paves the way for poverty.
There arise the problems with quality because employees are not motivated and goal-oriented. They work in harsh conditions that affect their psychological and physical development. Recent studies indicate that outsourcing is only a good initiative when companies are achieving the quality they expect. This, however, becomes problematic because the organizational culture is altered with and workers fail to adapt to the new organization structure and setting (Zirpoli & Becker, 2011). It limits research and development because the associates are subjected to limited control. As a result, firms fail to become innovative, and the workers are paid to do the same thing. This challenges developmental plans and organizations end up lagging behind in terms of growth and development. In business, it is essential to focus on quality because it instills customer satisfaction and loyalty. Companies fail to achieve sustainability because they undermine the significance of customer satisfaction. Total quality management should be developed to assist companies that outsource attain their objectives and goals. Outsourcing upsets the employees because they feel as if they are being substituted. Thus, they work in fear of being fired, and this affects their overall productivity where they produce goods of low quality. A business venture could fail to succeed in outsourcing if they fail to meet the needs of customers. Quality is a concept that should be emphasized to attract more consumers.
Section C
Outsourcing in the early nineties and before was a foreign concept to many companies and organizations. Most companies built teams ground up to address the various aspects of a business. Later on, this proved to be expensive and inefficient (Akinyemi, 2016). This led to the emergence of firms that specialize in specific ventures such as accounting, consulting, and technology. Companies could not move of their operations to this companies. This was the onset of outsourcing.
Later on, organizations realized they could outsource all aspects of the business without compromising quality and offerings. One reason why outsourcing grew was because of trust. If company A could trust company B to perform specific tasks on its behalf without compromise on confidentiality, integrity, and trust; then company A continued outsourcing that particular aspect to company B.
It is also important to note how important it was and still is for companies to maximize profits, reduce costs, and increase revenues. Companies, therefore, are unable to grow profit due to competition or other reasons resulted in cost-cutting. One of the most effective ways to do this was to outsource different aspects of the business if it resulted in reduced costs and increased revenues.
The author lived during the transition period; that is when most companies were getting into outsourcing their businesses. The author was able to view the issue from different perspectives because he lived in both times; pre-transition, and post-transition period. The author considered outsourcing as a market need – the need to maximize profits and reduce costs at the advent of competition from Asia and Eastern Europe.
Section D
Conclusion
Outsourcing has been a prevalent initiative in the U.S. amid the economic struggles that both small and big businesses face in their operations. The country is familiar with outsourcing and most Americans today understand the concept. Furthermore, companies have gained a better understanding of what it takes to outsource, and the managers have tried to weigh options. This has revolutionized the U.S economy because small businesses have thrived through outsourcing. However, firms should be cautious because there are negative impacts of outsourcing. They should understand the emerging trends especially in a society that is characterized by consumer preference and satisfaction. Companies that have outsourced should focus on improving quality to avoid various organizational challenges like customer complaints. This generation has radicalized the business sector because companies have attempted to adopt new strategies and measures to achieve lower costs, increase revenue, and develop as they seek to achieve organizational sustainability.
References
Akinyemi, A. (2016). Outsourcing to the developing economy: Its impacts on GDP and unemployment. A case study of India and the United States of America. South Dakota State University
Burdon, S., & Bhalla, A. (2005). Lessons from the untold success story:: Outsourcing
engineering and facilities management. European Management Journal, 23(5), 576-582.
Chen, L., & Tseng, Y. (2017). How it outsourcing impacts on value creation of engineering and facilities management. European Management Journal, 23(5), 576-582.
Gonzalez, R., Gasco, J., & Llopis, J. (2006). Information systems offshore outsourcing: A descriptive analysis. Industrial Management & Data Systems, 106(9),12331248. 10.1108/02635570610712555
Hoecht, A., & Trott, P. (2006). Innovation risks of strategic outsourcing. Technovation, 26(5), 672-681. 10.1016/j.technovation.2005.02.004
manufacturer? Paper presented at the, 123 00022.
Parry, G., James-Moore, M., & Graves, A. (2006). Outsourcing engineering commodity procurement. Supply Chain Management: An International Journal, 11(5), 436-443. 10.1108/13598540610682453
Zirpoli, F., & Becker, M. C. (2011). The limits of design and engineering outsourcing: Performance integration and the unfulfilled promises of modularity. R&D Management, 41(1), 21-43. 10.1111/j.1467-9310.2010. 00629.x
Stary Cats in Fanling
Outline
In the recent past, the residents of Ka Fuk Estate in Fanling have been witnessing a decrease in the number of stray cats around the area. This issue has raised some concerns, especially among some of the residents and other persons within the vicinity of the area. A particular key concern of animal lovers around the area is that the administration of the Estate does not look into the issue of handling the stray cats at all.
Concerned individuals that were interviewed expressed concerns about seeing injured and scarred cats around the area in relation to the decreasing number of cats. The matter as to who is responsible for caring for the many kittens in the area has also come across as a rather sensitive issue. The writer brings out the necessary information in this article, which is obtained from interviewing a number of relevant persons around the area.
Interview Schedule
The potential interviewees for this article will include random individuals in the vicinity to find out what their views are, home owners within Ka Kuk Estate, and personnel in the department of Agriculture and Fisheries and Administrative personnel within the Estate. The methods applied in interviewing the subjects will mainly involve face to face interviews and making phone calls so as obtain the necessary information.
Some of the useful questions that might be of importance during the interviews are:
How often do you pass by Ka Fuk Estate in a week?
How long have you lived in Ka Fuk Estate? What do you think about the oresences of stray cats in the Estate? Who do you think is responsible for the cats among others.
Stray Cat Menace gets out of hand in Fanling
According to the residents in Fanling, the sight of stray cats wandering about the streets and other public as well as residential areas has become common. None of the authorities around seem concerned about the problem, instead they keep shifting the blame and responsibilities to one another.
Concerned residents in Fanling are worried about the living conditions and protection of these stray cats, especially the large number of kittens which has arisen as a result of abandonment of the cats by their owners. On any single day, when taking simple walk in Ka Fuk Estate in Fanling one can be assured of running into a number of stray cats in the estate. These cats move from house to house, going in the backyards and scavenging for food through the trash.
In the process of trying to understand how long this stray cat situation has been going on and how it affects the residents, an interview with one of the local residents provided some revealing information about the problem. Miss Siu has been living in Ka Fuk Estate for more than 20 years.
“Many cats are usually hiding in the bushes under the hedges, especially from aound 7 to 8 pm in the evening. A times they go as far out as to the car park at the mall. The usually cause a big mess by leaving their waste everywhere and the car park attendants are forced to clean up the area in the morning. However they do not bother people living around the mall by making noise.”
When she was asked if the people feed the cats, she replied that: “I have once seen a sign allowing people to feed the cats in the park. But there isn’t any specific department that is completely responsible for looking after or controlling the cats.” She also revealed upon further questioning that in the past year, the number of stray cats that come around the Estate has reduced significantly. She also added that she had once seen somebody feeding the cats on the road side.
A picture of part of the car park road at the shopping mall that is usually dirtied by stray cats
Another interview with Miss Winnie Lai, a 21 year old student, revealed that she began seeing the strays when she was still in high school. She has been living in Ka Fuk for 17 years. When asked what she had observed on the stray cat phenomenon, Miss Winnie also echoed Miss Siu’s comments, “Compared to a few years back, the number of strays around Ka Fuk has reduced. But I think that it is due to the ongoing engineering roadwork projects taking place on the other side.” She also made an alarming report stating that she had hardly seen any kittens in the recent past. She added that no one seemed bothered to look after the cats because she had never seen anyone feeding them.
Following up the matter further, an interview with the conservator of the Estates, Mr. Kenny Chueng, explained the policy on having cats. “The Estate allows residents to have cats as pets. We however do not allow pet dogs in the Estate.” As such, he explains that the stray cat issue is not a problem for them to deal with. He argued that the cat problem should be dealt with by organizations in charge of the road Government (Hong Kong Housing Authority and Housing Department) and the car park (Parking Shroff).
Ka Fuk Management offices and the Parking Shroff offices which both deny responsibility in dealing with the stray cat problem
To find a possible solution to dealing with this phenomenon, a phone call to an official in the Department of Fisheries and Conservation department provided some usefull information as to how to put a stop to this problem. The officer advices that people should not feed the stray cats as this will encourage the cats to live a life of scavenging for food. He added that it was more suitable for the cats and those concerned about their welfare, to adopt the cats and keep them in a home environment. They people should ensure that the adopted cats are well taken care of. They should be well fed at regular times of the day, cleaned regularly and given a checkup occasionally.
The officer also advices the residents to contact some animal rights volunteer organizations which are well equipped to deal with wounded cats, should they happen to come across an injured feline. Taking these measures can help ensure that the stray cat menace is diminished in the area and that the cats are well taken care of.
References
Miriam, M (2013) Dubai: Stray cats continue to menace residents. Available online at http://gulfnews.com/news/gulf/uae/health/dubai-stray-cats-continue-to-menace-residents-1.1210777