Essay Paper on Bipolar Disorder

Bipolar Disorder

Introduction

            Also known as manic-depressive disorders, bipolar disorder is defined as a psychological state in which a person experiences a mood disorder causing radical alterations in their moods which can vary from manic highs to depressive lows. Elevated levels of either manic and depression are some of the common experiences that are encountered by a person suffering from this order. During the course of this discussion we will look at some of the key aspects that influence the occurrence, causes, signs and symptoms and treatment of this disease.

    The term "bipolar disorders" already shows that it is not this is a common disease. The disease may be individually very different and take different courses. Always, however, the disease is usually in stages or episodes in which a certain mood prevails. There are two different episodes of illness, the manic episode or depressive episode and the high point or low phase.

                                                    What is Bipolar Disorder?

            In the United States over two million people are diagnosed with the psychological problem of bipolar disorder. One of the major reasons behind the unprecedented rise of people suffering from the disorder is contributed by the complications that hinder correct and accurate diagnosis of the disease. It is mainly because of the delay in the diagnostic process that the number of people suffering from the disorder has increased extraordinarily.

According to the National Depressive and Manic Depressive Association (NDMDA), half of the respondents reported visiting three or more medical proficients before being correctly diagnosed with the disorder. On the other hand the survey also included respondents who reported of being correctly diagnosed with bipolar disorder after waiting for ten years or even more than that. In order to carefully understand bipolar disorder it is important to know that there are actually two prominent categories namely Bipolar I and Bipolar II. The category I disorder is basically characterized by high depressive manic cycles. A person experiencing this disorder shows signs and feelings of self-importance, talkativeness, increased socialization and impulsiveness. Usually it has also been observed that people suffering from this specific category disorder sleep only for a couple of hours which in turn fosters depression among such people thus aggravating their instincts of anger and irritability. (Yatham, 24)

On the flip side Bipolar II patients are exemplified by a milder form of mania known as hypomania and the respective variations of depressive cycles that are observed in this category. Patients suffering from bipolar depression have extremely low energy levels, mental and physical processes show remarkable reduction with greater signs of fatigue and hypersomnia; a sleep disorder marked by the need of excessive sleep.

Another major aspect that needs to be mentioned and explained while discussing the dynamics of bipolar disorder is the phenomenon of cyclothymia. The term is usually applied to outline the cyclical prevalence of depressive episodes. The presence of cyclothymia is basically a prior indication that the patient will be developing bipolar disorder in subsequent years of his life. One other phenomenon that occurs in up to 20% of the patients suffering from bipolar I and bipolar II disorder is that of rapid cycling. In this particular process the occurrence of manic and depressive episodes occur frequently with considerable alternations.  

According to experts such cyclical changes take place up to four times in a year. In the case of ultra-rapid cycling, these changes and shifting of behaviors might take place innumerable times during time duration of 24 hours. Both these conditions are very difficult to differentiate from mixed states. (Lovelace, 75)

A bipolar disorder is not just affecting mood. Feelings, mind and body are affected as well as the ability to cope with daily life. The disease produces very intense psychological pressure. 

Those affected are just as sick as people who suffer, for example, from a rheumatic disease. People with bipolar disorders are not so ill, because they did something wrong, or because they have a weak personality. You are not to blame for their illness. Bipolar illness can strike anyone. Mostly people are diagnosed between20 and 30 of age. The disease occurs in men and women equally. However, the first stage in men more of a manic episode, women are more likely a depressive episode.

                                                       Causes of Bipolar Disorder

            Even though the causes of bipolar disorder cannot be clearly defined, it would not be inaccurate to state that hereditary predisposition has a pivotal role to play in the occurrence of this disorder. Two-third of the people who suffer from the disorder has a family history to which it be linked easily. A study that was conducted in the year 2003 found out that the occurrence schizophrenia and bipolar disorder can be linked to similar genetic causes which are mainly involved with the development of the myelin sheath that surrounds the axon fibers, this facilitating the salutatory conduction of nerve impulses in the central nervous system.

Another important factor that is linked with the occurrence of bipolar disorder and is currently under investigation is the accumulation of excessive calcium in the cells of bipolar patients. In addition to this the effect of different neurotransmitters like dopamine are also being investigated as they appear to be implicated in the happening of bipolar disorder. Another important feature to mention is that bipolar disorder is not only influenced by genotypic but also phenotypic features.

Life events and experiences that occur in the life of an individual are found to play a profound role which can beget bipolar disorder. Researchers have concluded that adults diagnosed with bipolar disorders usually report of undergoing traumatic and abusive experiences during their childhood and hence the repercussions of these experiences begin to manifest itself in later years of his or her life. (Earley, 123)

    In a bipolar disorder mood swings are very pronounced and often completely exaggerated. They occur without an external cause, but can remain in certain life situations, even if the situation changes again and actually there are no reasons for this mood. There may be periods of strong depression as well as being exaggerated to the euphoria (mania).Mania (manic phases) and depression (depth phases) are the two extreme moods of a bipolar disorder that used to be manic-depressive illness was called. Between these two extremes there is a broad spectrum of different symptoms. It may even come to a simultaneous occurrence of symptoms of mania and depression. 

The mixed state is a condition in which the patients suffer from a depressed mood and are also very restless. 

Bipolar illness can have very different shapes and customized courses.That is why the disease is not so clearly attributable and cannot be easily recognized such as high blood pressure or asthma.

                                      Signs and Symptoms of Bipolar Disorder

            The signs and symptoms that an individual suffering from bipolar disorder experiences can be divided into a number of categories which are dependent on the specific kind of behavioral change that the sufferer is going through. For instance in the depressive episode the patient experiences signs and symptoms which express anxiety, hopelessness, aggression, isolation, lack of sleep, lack of interest in sexual activity, indifference and depersonalization.

On the other hand the mania episode category provides a completely new list of signs and symptoms that are different from the depression episode. For instance a patient suffering from mania which is a signature characteristic of bipolar disorder shows low attention span and can easily be distracted, can easily indulge in drugs and anti-depressants such as cocaine and sleeping pills, shows intolerance in handling matters, sexual drive may enhance and judgment skills can undergo impairment. In addition to this signs and symptoms of hypomania episode are characterized by enhancement of feelings of optimism, dominating pressure feelings during speech and talking and alleviated need for sleep. Another profound sign related to hypomania is that it enhances the characteristic of creativity while in other cases patients manifest signs of poor judgment. Moreover in this particular category patients have been observed to become hypersexual which makes them more active than usual.

Depressive disorders can be divided proportionally as follows: About 65% of patients have a unipolar depressive state meaning to say that they suffer from a mere depression. 5% of patients have a unipolar manic state and 30% have a bipolar disorder that is to say that they suffer from the alternation of depression and mania.  
Basically, bipolar disorders occur in varying intensity and form. It may be in some cases, a symptom-free period (remission, a few months to years) between episodes. In other cases, the episodes are directly related to each other showing seasonal patterns. Of so-called "rapid cyclers" is called when the episodes alternate quickly and directly follow one another (four episodes in twelve months). 
There are two basic forms of bipolar disorder: 
Bipolar 1
In patients who suffer from Bipolar 1, the disease often begins with a manic episode. The number of manic episodes clearly outweighs that of the depressive episodes. 
Bipolar 2
Patients suffering from severe depression with this in the meantime at least undergo a slight manic episode. The mania is not as pronounced as with bipolar first
Mixed states
The so-called mixed states manic and depressive symptoms occur in rapid succession, sometimes simultaneously on (example: while stakeholders entertain suicidal thoughts, reveals a flow of words). 

Patients with bipolar disorder are at a very high level of suffering. This creates constant ups and downs of emotions and often identity disorders. People are not always able to plan their lives in order to cope with the struggle of everyday life. Living with this disease is often determined by others for their own safety. This disease also increases the risk of suicide and constant mood swings. 

    Bipolar disorders are serious mental illnesses that can often be life threatening. Those affected suffer from extreme, in phases extending mood swings, alternating between a sense of happiness and life situation of grief and despair. This regular alternation between mania and depression can barely be dealt with in normal daily life setting. According to studies, is among those affected, a 30-fold increased risk of suicide than the general population has been seen.

The World Health Organization (WHO) reported that bipolar disorders are one of the ten diseases that cause most widely permanent disability. Mostly people are diagnosed between 20and 30 years of age span. Since the disease is often not detected, no information about the exact number of those affected can be made accurately.

    The typical symptoms of mania, in addition to unfounded elation restless activity and agitation are pressured speech, and loss of social inhibitions, uncontrolled use of money, alcohol and drug use and a low need for sleep. In contrast, the symptoms of depression are often melancholy, joy and discouragement, loss of interest, increased fatigue, brooding, loss of confidence, fear and pessimism, guilt, and diminished concentration.

  Although the first symptoms are noticeable on average 15.5 years, it occurs on average at the age of 22 years to the first treatment (Berger, 2004 S 549). In severe cases often come measures such as massive forced assignments, forced medications used to protect the patients themselves and the environment from the effects of manic improper action. This often gives rise to traumas that are of importance for future rehabilitation and prognosis. 

The typical symptoms of mania are episodes inappropriately elevated mood, increased drive, fast-thinking, flight of ideas and self-esteem. In the mania often leads to excessive spending spree, in some cases to promiscuous behavior, binge-drinking, etc.. Instead of an elevated mood there may also be the domination of an impulsive, irritable and aggressive behavior. This second most common subtype is the above-mentioned "bipolar disorder" (formerly known as manic-depressive illness), with slight cases it is "cyclothymiacs" as described.  Depressive and manic phases vacillate to and fro very quickly, and then it is called "rapid cycling". 

Bipolar disorder usually begins with a (hypo-) mania, less related to depression. According to Berger, the development of bipolar disorder takes place usually after two unipolar depressive episodes. Following these depressive phases, the probability is that only very small causes could evolve into a bipolar phenotype. Bipolar disorders usually begin earlier than unipolar gradients, on average 18 - 20 years. 

                                                    Treatment of Bipolar Disorder

            Treatment mode applied for the cure of the disease is usually achieved by the help of medications. These medications mainly constitute those which prove helpful in controlling and stabilizing mood along with antidepressants, anticonvulsants and antipsychotics.

Different categories of medications involving the use of lithium such as Lithotabs and Lithonate are frequently prescribed for the treatment of bipolar mania and depression, but are normally not advisable for the treatment of mixed mania. In addition to this there are also a number of side effects that are accompanied with the prolonged use of lithium medications. These side effects mainly include nausea, tremors, hyperthyroidism and increase in weight.

In addition to this another group of medications that is usually prescribed by medical proficients is Carbamazepine. A major function of this drug is concerned with the function of mood stabilizing. It is often prescribed when lithium medications fail to produce effective results. Even the medication treatment of Carbamazepine is not side effect free which manifest itself in the form of blurred vision and abnormal eye movement. Last but not the least Valproate which includes valproic acid and Depakene have proven to be highly effective in the treatment of bipolar patients and those suffering from manic signs and symptoms.

Despite of being highly effective in terms of treatment the drug is not immune to different side-effects which occur in the form of indigestion, stomach cramps, nausea, unusual weight loss or gain and hair loss. Another prominent side-effect that is associated with the use of drug through the use of Valproate in bipolar disorder treatment is that it leads to a marked increase in suicidal tendencies. A scientific study conducted concluded that patients using Valproate for the treatment of their bipolar disorder are at greater risk of committing suicide than those using lithium as their mode of treatment. (Yatham, 2010)

The disease is usually treated with three consecutive therapies. Is the person living at the time of diagnosis in acute phase, the immediate-treatment is used. 

This attempts to extract the interested parties of its current phase and to treat the suffering. After normalization of mood followed by maintenance therapy in which the person is to be stabilized. The so-called relapse prevention can reduce the risk of relapse. In this case the person concerned is also helped reintegrate into the social environment and in his profession vigorously and actively. In most cases, the therapy is supported with medication. In addition, therapeutic discussions along with group therapy are prescribed. 

   The modern classification systems (ICD-10 and DSM-IV) have tried consciously to make theoretical assumptions about the root causes of mania, sacrificing the bipolar disorder or other disorders and make the definition possible only at objectively, writable and operational criteria.  This approach has roughly the advantage that with appropriate training to recognize the pre-established "criteria" psychiatrists and therapists of different schools, these criteria and then come to diagnosis the same result. That is to say when you attach the diagnostic experience of a doctor with a value that would have the disadvantage then the diagnosing doctors can rely just not their experience and intuition, but based on the manual with the diagnostic criteria, Furthermore, the different patterns of symptoms or complaints cannot be formulated in a diagnosis and that the "validation" of diagnostic manuals, ie the determination of whether really with the criteria set that is shown, which is specified (as depression or mania), only to the further development of the manual concerned scientists and high school teachers is reserved. Formulated pointedly and somewhat provocative: The local doctor is specifically trained to become a specialist in the application of a given diagnostic manuals and research shows that there is always a danger that it will produce only an evidence of the self-imposed assumptions and presumptions. On the basis of theoretical assumptions, it becomes near impossible to figure out the origins of disturbances on the part of patient because this is precisely the point when he or she more overcautious. 

  On these grounds, no one speaks more of the mania as a "disease" but is called a "manic syndrome" and a "manic or bipolar disorder." The term "manic syndrome" indicates that only a group of core symptoms must be present to make the diagnosis. The term "disorder" seems less powerful than "disease" and opens the door to a "fault-based" (ie, symptom-related) research and therapy. Philosophically hermeneutic understanding and approach towards research and psychodynamic therapies are less important as compared to a pragmatic research which is more focused on symptom-oriented research and therapy. This corresponds to the trend of the treatment and the further exploration of specific drugs, as well as more symptom-oriented psychotherapies (cognitive therapy, behavior therapy) to grant more importance to the healing. This treatment and research priorities are therefore also most likely to create a conceptual parallel in the modern classification systems of ICD-10 and DSM-IV.(Papolos, 85)

   

    The exact causes of mania and bipolar disorder are still unknown. There are only vague ideas as to model presumed differences in brain metabolism, but there is no hard evidence. There is evidence that the depressive phase of bipolar disorder causes unipolar depression compelling the psychologists to deal with altogether a different disorder.  For the medical treatment these assumptions have been proved irrelevant. 

   While treating the initial episode, the exclusion of an organic(physical) illness is necessary. This is the reason why a thorough physical, medical, neurological examination including laboratory screening and possibly imaging is strongly recommended.  
Along with bipolar disorders, there is also a separate version that is referred to as "hypomania". It is the symptoms of mania related to a lesser extent. Real "manic phase" refers to the majority of symptoms which are deferred to periods of depression. It is then a so-called "bipolar disorder (manic-depressive illness). This often starts with a mania, which then changes typically without free interval in a depression.(Greenberg, 54) 

  Very rarely is the sole occurrence of manic episodes, but whenever it happens it takes place in conjunction with organic brain changes.

    In the treatment of mania and bipolar disorder drug and psychotherapeutic methods are used. Drugs that are effective against the depressive episodes associated with bipolar disorder are called "antidepressants". There are several active groups among the antidepressants, such as the old tried and tested, proven effective, but rather toxic side effects ranging traditional antidepressants  also apparently highly effective, but dangerous for less held substances such as serotonin reuptake inhibitors (SSRI). It should be noted that in principle with all antidepressants, some very unpleasant side effects though temporarily can occur. For all antidepressants is true also that the immediate side effects that occur actually after about 14 days. Premature discontinuation or medication change means (apart from very serious side effects) usually just a waste of time. For the treatment of both the more common forms of bipolar course and in the rare simple mania, so-called mood stabilizers or Antimanika (valproic acid, carbamazepine, and lithium) are used. These materials have some as yet unknown mechanism of action, however, lead to a moderation of "mood swings." The methods, specialized psychotherapeutic approaches can be roughly divided into so-called "cognitive-behavioral procedures" and "deep psychological processes" divide.(Behrman, 345)

 In the acute manic cases, such treatments are not so much recommended.  Nevertheless, crisis intervention can be ensured through proper and good patient management and the rapid application of an anti-manic effective drug.This can be done when necessary to prevent self-or foreign threat against the will of the patient, if it cannot be avoided at all. After resolution of mania in psychotherapy attendance on patients for the processing of potentially traumatizing disease process, to psycho education and establishing a crisis plan is urgently recommended. But of course the psychotherapy can only be conducted and specific medical follow-up treatment performed with the consent of the patient. (Simon, 69)

    Since the exact etiology and development of mania and bipolar disorder is not known, conclusions about the diagnosis of these disorders in individual cases are difficult. The treatment certainly also depends on whether and when the disorder is diagnosed and treated. The trauma of the direct and indirect damages of the disease and the treatment course are a major problem in monitoring manic-depressive patients.

    The success of treatment also depends largely on whether it is possible for the patient to overlook stigma attached to it. Whether or not, they are ready to face traumatic situations in hospital settings.  The divorce rate in people with bipolar disorder is very high. The reason seems to be that partner cannot stand the extreme mood swings and in the aftermath of the disease often occurring social stigma. Such a regular rehabilitation obstacle is the frequent depressive-variation for manic or depressive episodes in bipolar disorders.

     

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