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.
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.
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)
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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