Bipolar Disorder

 
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Abstract

I chose to write about Bipolar Disorder because a few people I am close to have been greatly affected by this disorder. I want to learn about different ways I can help them to cope with the disorder. I want to be able to be there to encourage them to seek help if needed, instead of them trying to cope with it on their own. Overall, I just want to have a better understanding of a disorder that afflicts many people. This paper goes over the various types of bipolar disorder, prevalence, various types of treatment offered and the research being done to help people with this disorder

Bipolar Disorder

Introduction

Bipolar disorder is a form of mental illness that is associated with abnormal changes in the mood, activity levels, energy and concentration of an individual. Such changes usually have a toll-effect on an individual’s normal daily functioning. Bipolar disorder is also referred to as the manic-depressive illness. The study of bipolar disorder is important in present world where the levels of mental illness are on the rise. WHO (2018) estimates that more than 300 million people are affected by mental illness, especially depression. One out of thirteen people is affected by mental anxiety. Secondly, understanding the distinguishing features of Bipolar disorder from mental illnesses such as depression is imperative for quick treatment. Additionally, given that mood swings; good or bad, high or low moods; can result from temporary circumstances and not necessarily mental illnesses, it is critical to developing a deep understanding of this illness to distinguish it from normal mood swings. The high rate of suicide in the world, [it is estimated that 800,000 people take away their lives annually (WHO, 2018)], is another reason to study Bipolar disorder carefully. People with this illness are more likely to commit suicide than other mental disorders (Anxiety and Depression Association of America, ADAA, 2018).

  1. Diagnostic Features of Bipolar.

1.1 Mania which is an extreme sense of euphoria or happiness

Mania is a more severe condition of Bipolar disorder than hypomania. The most common diagnostic features of this condition include the belief that everything is fine, impaired judgment, over-confidence, and an exaggerated sense of self-esteem. Sometimes an individual may exhibit uncontrolled rapid talking that keeps shifting from one unrelated topic to another. Due to impaired judgment individual in mania can engage in very risky behavior such as over-spending, over-speeding, careless sexual interactions and drug abuse.

1.2 Depression which is guilt, sadness or loneliness

Unlike in mania stage where an individual feels optimistic, the depressive episode comes with low self-esteem, less hope for tomorrow and big desire to withdraw from usual life and the world. Key symptoms include loss of interest in activities that bring pleasure, weight loss, sleeplessness, hopelessness, despair and extreme anxiety over things that do not matter, missing school or work. In some depressive episodes, individuals may be preoccupied with the thought of committing suicide, and if not helped, they may end-up taking their own lives. During the depression, a person may experience psychosis. Psychosis occurs when an individual is unable to distinguish between reality and what is not real (Burke et al. 2016). It is possible for someone to feel worthless and of low self-esteem especially when experiencing depression. Psychosis can also occur during manic in Bipolar disorder. When someone is feeling over-confident, he may think to be to have a high social ranking or connection, when actually the thought is a fantasy.

1.3 Mixed episodes duration 7 days

Individual experiencing mixed episodes exhibit both symptoms of both manic and depressive episodes (Burke et al. 2016). Such people feel happy, energetic but at the same time hopeless and very empty. The mixed episode is different from psychosis because the latter does happen at the same time while the former happens at the same time.

1.4 Cyclothymia                           

This is a condition where a person may experience a low level of depression that usually alternates with moments of hypomania. These symptoms may last for two years in adults while lasting for one year among children and adolescents. These symptoms usually do not necessitate a diagnosis of either depressive or hypomanic episodes (Burke et al. 2016).

  • Course of Bipolar
  1. A) Bipolar 1 lasts 7 days without any depression

Bipolar I disorder is normally characterized by manic episodes that can stay for seven days. Studies have indicated that Bipolar I disorder usually begins at the age of 18 in both men and women (Rashmi et al. 2017). However, Bipolar I disorder may develop in early childhood or senior years of life in some people. An individual can live with Bipolar I Disorder for seven days without experiencing any form of depression. It is even possible for individuals to suffer for years without the condition being recognized. Studies point out that, women with Bipolar I disorder experience intense mixed feature episodes than men (Rashmi et al. 2017). Furthermore, females experiencing depressive episodes are likely to engage in risky behaviors such as excessive drinking and careless sex.

  1. B) Bipolar 2 no more than 4 days with mixed episodes or hypomania

It is characterized by a model of depressive episodes and hypomania episodes which are less severe than manic episodes. Bipolar II disorder is said to begin at an average age of 20 years in both male and female (Rashmi et al. 2017). Like the Bipolar I, Bipolar II may begin in early childhood or middle adulthood. Individuals with Bipolar II experience frequent mood swings than Bipolar I.

3.0 Prevalence

  1. A) Family history.

Studies indicate that bipolar disorder may occur in a person from a family with a history of mental disorders. The risk of contracting the illness is 15 to 30 percent for a person born by one parent who is affected and 50 to 70 percent when all the two parents are affected. Close to genetic causes of the Bipolar disorder are biological traits of an individual. Individuals who suffer from physical changes in their brains are likely to experience Bipolar disorder.

  1. B) Highest number of people affected by disorder is in the United States

According to World Health Organization (2018), more than 60 million people in the world suffer from Bipolar disorder. Most children and adolescents suffering from depression are likely to be experiencing the initial stages of bipolar disorder. The lifetime prevalence of bipolar disorder in the US in 2012 was 6.9 percent. This is closely related to the risk of 3 to 10 percent risk of all Americans suffering from Bipolar disorder (WHO, 2018). It is further anticipated that 10 million Americans are likely to suffer from bipolar disorder in their lives (WHO, 2018).

4.0 Differential Diagnosis/ Rule Outs

Some people may be diagnosed with the major depressive disorder because of duration and severity of depression. Major depressive disorders are clinically diagnosed using DSM-5 procedure (Burke et al. 2016). The same DSM-5 criterion is used to diagnose the cyclothymic disorder.

5.0Special Features

  1. A) Bipolar with mixed features

Bipolar with mixed features occur when a person experiences episodes of depression and mania simultaneously. A person with mixed features in Bipolar may be experiencing depression with at least three symptoms of mania or vice versa (Burke et al. 2016). A person may also experience major depression episode alongside other manic or hypomania symptoms. In this case, most symptoms are of major depression while at least three are of mania.

 

 

  1. B) Bipolar with psychotic features

Bipolar with psychotic features occurs when individuals are unable to differentiate between what is imaginable and real (Buke et al. 2016). For instance, when an individual is depressed, they may feel unwanted and rejected by everyone, when this is actually not true. On the other hand, an individual with mania could experience hallucinations or in possession of supernatural powers which they do not have.

  1. C) Bipolar with rapid cycling

Bipolar with rapid cycling occurs when an individual experiences more than four episodes of depression, manic or hypomania (Burke et al. 2016). Rapid cycling could be caused by multiple sclerosis, injuries to the head or unexpected stress. Rapid cycling affects people diagnosed bipolar disorder but more common in women than men (Burke et al. 2016).

  1. D) Bipolar with seasonal pattern

Bipolar with seasonal pattern occurs when individuals experience episodes of depression, hypomania or mania during certain seasons of the year (Burke et al. 2016). Lack of enough sunlight during certain months of the year is associated with increased level of depression among patients with bipolar disorder. One way of managing Bipolar with a seasonal pattern is by beginning medication before the onset of the season to control mood variation due to changes in seasons.

6.0Treatment

  1. A) Medications
  2. i) Lithium

Lithium which is a mood stabilizer is what most doctors prescribe as a first line treatment. It works differently among patients by healing others completely, while others failing to respond positively. The genetic composition of an individual, especially the non-coding ribonucleic acids (RNAs), influences the response of patients to lithium (Wang et al. 2018). Therefore, it is important for physicians to determine patients’ genetic composition to enhance precision in the prescription of medication.

  1. ii) Anticonvulsants used for mania

Anticonvulsants are also used as mood stabilizers, and mainly they were used as an alternative to patients who failed to respond positively to lithium. Currently, anticonvulsants can be applied independently or as a combination with other drugs such as lithium and antipsychotic specifically to control mania, in patients experiencing rapid cycling (Goldberg, 2016). Some of the common anticonvulsants prescribed for mania include Depakote, Tegretol, Lyrica, Neurontin, and Topamax (Goldberg, 2016). Use of anticonvulsants could cause certain side effects such as fatigue, rash, dizziness, and nausea among others.

iii) Antidepressants

Antidepressants are not recommended for treatment of bipolar disorder. According to Salvi et al. (2008) antidepressants are effective in the treatment of unipolar disorders rather than bipolar disorders. The use of antidepressants among patients with Bipolar I may cause rapid cycling. Nonetheless, effective antidepressants for bipolar disorders only take one and half months for patients to recover.

7.0 Psychotherapy

Psychotherapy is an intervention technique that aims at helping individuals to take control of their situations by enabling them to identify and control their behaviors, thoughts, and emotions.


 

  1. Family Focused treatment is to educate the family on the disorder

Family Focused Therapy is a family-education based technique that aims at educating family members on symptoms and medication (Burke et al. 2016). Family members learn communication skills and conflict resolution skills that help them support ailing members.

  1. Cognitive Behavioral Therapy

Cognitive behavioral therapy aims at helping the patient take control of his or her situation. It is objective is to help individuals challenge the negative emotions they may be experiencing and equip them with coping techniques (Burke et al. 2016). CBT can be applied as an alternative to medication, coping technique or to manage symptoms caused by the mental illnesses.

  • Interpersonal and social rhythm psychotherapy (IPSRT)

IPSRT is psychotherapy method that helps individuals with Bipolar disorder to maintain regular patterns of their life such as sleep routines to avoid disruption. The method is used based on the fact that failure to maintain such routines could lead to rapid cycles or worsen the symptoms of bipolar disorders. It is one of the effective methods of achieving consistent regular desired mood patterns.

8.0 Research on Bipolar

  1. A) Psychiatric Neuropharmacology the way atypical antipsychotics bind to molecular structures of the brain

This is ongoing research that may help in the development of improved medical intervention to mental illnesses, especially bipolar disorders. The existing antipsychotics exhibit limitations in dealing with cognitive and social impairments leading to other risks such as weight gain, drug abuse among others effects. A clear understanding of molecular functioning will help in developing drugs with the right components to eliminate the resulting side effects.

  1. B) Genome Study- markers on chromosomes that show the responsiveness of lithium

The purpose of the research is to show the effect of genetic variation on the level of patient response to some mood stabilizers like lithium. So far, the research has proven that four single-nucleotide polymorphisms (SNPs) found on chromosome 21 enhances patient responsiveness to lithium (Hou, 2016).

Conclusion

The effect of bipolar disorder is increasingly becoming alarming. The mental illness is associated with increased rate of suicide, which is the second leading cause of death in the United States. Although the symptoms of the mental illnesses especially depression are easy to identify, selecting the best medical intervention is not easy. While there is research underway to improve precision in prescription, physicians, and other stakeholders should heavily invest in proactive methods such as IPSRT, Family Focused Therapy and Cognitive Behavioral Therapy that enables patients to be self-dependent in controlling the effects of mood swings.

 

 

References

ADAA (2018). Facts and Statistics. Retrieved from: https://adaa.org/about-adaa/press-room/facts-statistics

Burke, B. L., Trost, S. E., DeRoon-Cassini, T.A., & Bernstien, D.A. (2016). Chapter 5 bipolar disorders and suicide. In Abnormal psychology (2nd ed., pp. 173-204). Academia Media solutions.

Goldberg, J.  (2016 September 23). Anticonvulsants medications for bipolar disorder. Retrieved from: https://www.webmd.com/bipolar-disorder/guide/anticonvulsant-medication

Hou, L. (2016, January 28). Genome-Wide Study Yields Markers of Lithium Response. Retrieved from https://gopher.nimh.nih.gov/news/science-news/2016/genome-wide-study-yields-markers-of-lithium-response.shtml

Rashmi, N., Dombeck, M., & Patricelli, K. (2017). Bipolar disorder; Prevalence and course of bipolar disorder. Retrieved from: https://www.gulfbend.org/poc/view_doc.php?type=doc&id=11200&cn=4

Salvi, V., Fagiolini, A., Swartz, H. A., Maina, G., & Frank, E. (2008). The use of antidepressants in bipolar disorder. The Journal of clinical psychiatry69(8), 1307-1318.

Wang, C., Levit, A., Schoichet, B. K., & Roth, B. L. (2018, January 29). Molecular Secrets Revealed: Antipsychotic Docked in its Receptor. Retrieved from: https://www.nimh.nih.gov/news/science-news/2018/molecular-secrets-revealed-antipsychotic-docked-in-its-receptor.shtml

WHO (2018). Depression. Retrieved from: http://www.who.int/mediacentre/factsheets/fs369/en/

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