Bipolar Disorder

Total words: 2062

Abstract

Bipolar disorder is a brain disorder that causes unusual shifts in a person's mood, energy and ability to function. It is also known as manic-depressive illness. The symptoms of bipolar disorder are severe and very different from the normal ups and downs that everyone goes through. It is the third most common mood disorder after major depression and dysthymic disorder. It affects about 1% of adults during their lifetime. The symptoms of bipolar disorder typically begin during adolescence or early adulthood, continuing to recur throughout life. Men and women are equally likely to develop this disabling illness. The consequences of the illness can be devastating, including marital break-ups, unemployment, alcohol and drug abuse. Bipolar illness is often complicated by co-occurring alcohol or substance abuse. Without effective treatment, bipolar illness leads to suicide in nearly twenty percent of cases. There are effective treatments available that greatly reduce the suffering caused by bipolar disorder, and can usually prevent its devastating complications. Unfortunately, bipolar disorder is often not recognized by the patient, relatives, friends, or even physicians. This causes people with bipolar disorder to suffer needlessly without proper treatment, for years or even decades. In addition, many patients do not respond to at least one drug, and many show no response to several. This means that combination treatment is often the rule. A combination of different drugs with different methods of action can be more effective without increasing the risk of side effects. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life. When treated properly, people with this illness can lead full and productive lives.

There are several causes as to why a person has bipolar disorder. In many cases, it is believed to be inherited, and tends to run in families (Cilag, 2005). More than two-thirds of people with manic-depressive illness have at least one close relative with the disorder, or with major depression (Cilag, 2005). Genetic factors are important, and it is likely that susceptibility to the illness is related to several genes (Cilag, 2005). "However, the specific genes involved have not yet been conclusively identified" (Cilag, 2005). "Once this is achieved it is hoped that it will be possible to better treatments and prevention strategies aimed at the underlying illness process" (Cilag, 2005).

"It may be that the development of bipolar disorder is due to a process of sensitisation (kindling)" (Cilag, 2005). This idea suggests that the first episodes of illness are triggered by stressful life events, but that each episode of illness causes changes in the brain which making the next episode more likely, and eventually episodes will occur spontaneously (Cilag, 2005). "This process was first describes as an explanation for epilepsy, and may explain why certain antiepileptic drugs are also effective in the treatment of bipolar disorder" (Cilag, 2005).

Another explanation for this illness involves neurotransmitters. They are the molecules that enable the transmission of nerve impulses from one nerve to the next. It is thought that faulty nerve transmission may be one cause of bipolar disorder, it is possible that these molecules are involved (Cilag, 2005). Examples include dopamine, serotonin (5-HT; 5-hydroxytryptamine), acetylcholine, GABA and glutamate (Cilag, 2005).

Bipolar disorder causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between (Cilag, 2005). Severe changes in energy and behavior go along with these changes in mood. These periods of "highs" and "lows" are called episodes of mania and depression (Cilag, 2005).

Signs and symptoms of mania (or a manic episode) may include increased energy, activity, and restlessness, excessively "high", overly good, euphoric mood, extreme irritability, racing thoughts and talking very fast, jumping from one idea to another, distractibility, unable to concentrate well, little sleep is needed, unrealistic beliefs in one's abilities and powers, poor judgement, spending sprees, a lasting period of behavior that is different from the usual, abuse of drugs, particularly cocaine, alcohol, and sleeping medications, provocative, intrusive, or aggressive behavior, and denial that anything is wrong (Goodwin, 2006). A manic episode is diagnosed when elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer (Goodwin, 2006). If the mood is irritable, four additional symptoms must be present (Goodwin, 2006).

Signs and symptoms of depression (or a depressive episode) include lasting sad, anxious, or empty mood, feelings of hopelessness or pessimism, feelings of guilt, worthlessness, or helplessness, loss interest or pleasure in activities once enjoyed, including sex, decreased energy, a feeling of fatigue or being "slowed down", difficulty concentrating, remembering, making decisions, restlessness or irritability, sleeping too much, or inability to sleep, change in appetite and/or unintended weight loss or gain, chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury, thoughts of death or suicide, or suicide attempts (Goodwin, 2006). A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer (Goodwin, 2006).

Hypomania is a mild to moderate level of mania (Goodwin, 2006). It may feel good to the person who experiences it and quite often is associated with good functioning and enhanced productivity. Family and friends may learn to recognize the mood swings as possible bipolar disorder; however, the person may deny that anything is wrong. Untreated, or without proper treatment, hypomania can become severe mania in some people or it can revert into depression (Goodwin, 2006). .

In some cases, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms) (Goodwin, 2006). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts) (Goodwin, 2006). The psychotic symptoms in bipolar disorder have the tendency to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is president or has special powers, may occur during mania; delusions of guilt or worthlessness, such as believing that one is penniless or has committed some terrible crime, may appear during depression (Goodwin, 2006). Unfortunately, people with bipolar disorder who have these symptoms are sometimes diagnosed incorrectly as having schizophrenia, another severe mental illness (Goodwin, 2006).

The various mood states in bipolar disorder could be thought of as a spectrum or continuous range. On one end is severe depression, less severe would be moderate depression, then least severe, mild low mood, which is often referred to as "the blues", when short-lived (Goodwin, 2006). When mild low mood is chronic, however, it is referred to as dysthymia (Goodwin, 2006). On the opposite end would be normal or balanced mood, more severe would be hypomania (mild to moderate mania), and most severe, mania (Goodwin, 2006).

Like other mental illnesses, bipolar disorder can not yet be identified physiologically (example, through a blood test or brain scan). Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. Descriptions offered by people with bipolar disorder have given valuable insight into the various mood states associated with the illness.

Some people with bipolar disorder become suicidal. "Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician, in addition, anyone who talks about suicide should be taken seriously" (Goodwin, 2006). Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide (Goodwin, 2006).

The episodes of mania and depression will typically recur across the life span. Between these episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. There are a small percentage of people that will experience chronic unalleviated symptoms despite treatment (Goodwin, 2006).

Bipolar I disorder is the classic form of the illness and involves recurrent episodes of mania and depression (Goodwin, 2006). Bipolar II disorder is a form of the illness in which people never develop severe mania but instead experience milder episodes of hypomania that alternates with depression (Goodwin, 2006). Rapid-cycling bipolar disorder is diagnosed when a person has four or more episodes of illness that occur within a twelve month period (Goodwin, 2006). Rapid-cycling bipolar disorder has the tendency to develop later in the course of illness and is more common among females than males (Goodwin, 2006).

Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication (Sachs, Printz, Kahn, Carpenter, Docherty, 2000). Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch (Sachs, et al.). Lithium and valproate are the most commonly used mood-stabilizing drugs today (Sachs, et al.). However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications. Atypical antipsychotic medications, including clozapine, olanzapine, risperidone ,quetiapine and ziprasidone, are being studied and sometimes prescribed as possible treatments for bipolar disorder (Sachs, et al.).

Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication. In order to reduce the chance of relapse or of developing a new episode, the patient should adhere to their treatment plan. People with bipolar disorder will often have abnormal thyroid gland function (Sachs, et al.). Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician (Sachs, et al.). Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment (Sachs, et al.).

"As an addition to medication, psychosocial treatments-including certain forms of psychotherapy (or "talk" therapy)-are helpful in providing support, education, and guidance to people with bipolar disorder and their families" (Grayson, 2005). "Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas" (Grayson, 2005). A licensed psychologist, social worker, or counselor will typically provide these therapies and often works together with the psychiatrist to monitor a patient's progress (Grayson, 2005). The number, frequency, and type of sessions should be based on the treatment needs of each person (Grayson, 2005).

Similar to other serious illnesses, bipolar disorder is hard on spouses, family members, friends, and employers. Often, the responsibility to care for these individuals, both financially and physically, becomes dependent upon a family member or friend. For these reasons, it is recommended that the people with bipolar disorder join support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA) (Grayson, 2005). Family and friends can also benefit from support groups offered by these organizations.

Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in onferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide. I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do (Jamison, K., 1995 p. 6).

References
Cilag, J. Psychiatry24x7. Retrieved March 15, 2006, from http://www.Psychiatry24x7.com
Goodwin, J. (2006, February 17). National Institute of Mental Health. Retrieved March 22, 2006, from http://www.nimh.nih.gov/publicat/bipolar.cfm#intro
Sachs, G., Printz. D, Kahn, D., Carpenter, D., Docherty, J. (2006, February 17). National Institute of Mental Health. The expert consensus guideline series: Medication treatment of bipolar disorder 2000. Postgraduate Medicine, 2000; Spec No:1-104.
Retrieved March 17, 2006, from http://www.nimh.nih.gov/publicat/bipolar.cfm#intro 4.
Grayson, C. (2005, March). WebMD Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harvard Review of Psychiatry, 2000; 8(3): 126-40.
Retrieved March 10, 2006, from https://www.webmd.com
Jamison, K., An Unquiet Mind, 1995, p. 6.

Add a Review for this free essay

Be the first one to review this free Essay

Sticky Note Text....

Welcome! Not a Member? Click here to Join Now!
Log in
Forgot Password?