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Bipolar I: Manic-Depressive Disorder Medical Synopsis & Treatment

Introduction

Bipolar I, which is also sometimes referred to as manic depression or manic-depressive disorder, is a mental illness. The main feature of this condition is at least one manic episode during a lifetime. Researchers claim Bipolar I disorder to be “a recurrent chronic disorder characterized by fluctuations in mood state and energy” (Grande et al., p. 1561). This condition affects a person’s behavior by disrupting the usual conduct patterns, for instance, an affected person may get engaged in risky or dangerous behavior and may experience extreme joy followed by sadness. Bipolar I is a severe mental health condition that adversely affects the life of individuals, which will be demonstrated by the patient case scenario.

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Etiology, Prevalence, Signs, and Symptoms

Conditions that are characterized by extreme mood swings that cannot be explained by environmental factors have been a field of interest of mental health professionals for many years. This disease’s etymology traces back to ancient times when scholars were making their first attempts to classify people’s emotional types, placing focus on their specific personality traits. It was clear even then that some people, unlike the vast majority, experience a significant and rapid swing between the two extreme mood types – “melancholia” and “mania” (Mason et al., 2016). Hippocrates was the first to identify this phenomenon by outlining the so-called “melancholia disease.” However, further research on the matter was slow and unproductive until the 19th century when French scholar Jean-Pierre Falret identified the disorder he named circular insanity (Mason et al., 2016). Later in the 19th century, scholars defined that bipolar disorder was not only characterized by episodes of mania but also by patients’ severe depressive states. After acknowledging the presence of such a mental disorder, researchers a priori decided to dwell upon the causes behind the disease.

Etiology

Currently, the exact etiology of Bipolar I is unknown, although there are some hypotheses. According to Grande et al. (2016), the precise etiology of bipolar disorder is still undefined. Some researchers assume that the disease develops as a result of one of the factors — physical, environmental, and social factors. Some argue that a chemical imbalance of a person’s brain is the main cause leading to the development of Bipolar I. Mainly, this imbalance results in a change in the neurotransmitter’s patterns of work (Grande et al., 2016). Another factor is genetics because people who have a family history of Bipolar I are at a greater risk of being diagnosed with this condition. Some researchers and practitioners point out stress and other psychological triggers that may cause the development of Bipolar I (Grande et al., 2016). A combination of the mentioned factors may be responsible for the illness, however, more research is necessary to make conclusions. Some risk factors include physical illnesses like asthma, or psychological triggers like childhood trauma (Rowland & Marwaha, 2018). However, there is no clear indicator of the risk factor that would prevail within the study sample.

Prevalence

The overall statistics claim that more than 1% of the world population is currently struggling with bipolar disorder (Grande et al., 2016). The prevalence of the disease was consistent regardless of gender or ethnic affiliation, constituting a lifetime prevalence of 0.6% for type 1, 0,4% for type 2, and 2,4% for the bipolar spectrum. Hence, the overall patterns of the disorder’s geographical distribution and social dependence are relatively consistent across the globe due to its universal genesis nature.

Signs and Symptoms

Before speaking about the significant symptoms of Bipolar I disorder, it is of crucial importance to emphasize the two types of these symptoms characterized by each of the disorder episodes. The first episode is generally called manic, and the second one is a depressive mental state. First, the significant symptoms of the manic episodes will be outlined. Notably, there is a distinction between the symptoms of Bipolar I and Bipolar II in the DSM IV manual, and this paper will only focus on Bipolar I. According to Grande et al. (2016), manic episodes are characterized by sudden mood swings with no apparent explanation, for instance, a person may feel extremely happy, however, nothing in their environment is causing joy. Next, such an individual may get engaged in risky behavior without considering the consequences. The lack of logical thinking can also be paired with delusions or hallucinations (Grande et al., 2016). In general, this type of behavior is out of character for an individual. Finally, insomnia and lack of appetite are also signs of Bipolar I.

Following this manic episode, an individual with Bipolar I will experience a subsequent depressive episode. Its symptoms are apathy, feeling of sadness and hopelessness, lack of energy, inability to concentrate, feeling of guilt, self-doubt, pessimism (Grande et al., 2016). The danger of these signs is that a depressive episode may cause suicidal thoughts and some of the physical symptoms include having no appetite and insomnia.

Although people who are struggling with bipolar disorder experience similar symptoms during both episodes of the disease, the patterns of the episode’s appearance vary in the specific context. For example, some patients happen to experience “normal mood” stages between depressive and mania episodes, while others report having depressive episodes right after manic episodes. Moreover, although the majority of people with Bipolar I have mania and depressive episodes one at a time, some report experiencing a mixed state when they simultaneously experience the symptoms of both episodes (Grande et al., 2016). Hence, patients with Bipolar I may experience the illness differently.

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DSM-5

When dealing with the bipolar disorder diagnosis, it is of crucial importance to outline the specific criteria that define the presence of the disease, as some symptoms of bipolar disorder are quite generic about a spectrum of mental disorders. Hence, the DSM-5 criteria created by the American Psychiatric Association help define essential characteristics that allow a therapist to reach a diagnosis conclusion (“DSM-5 criteria: bipolar disorders,” 2017). Thus, the primary criteria for the diagnosis include the presence of a traceable period of abnormally elevated mood and mood swing that lasts approximately one week and is then followed by a central depressive state.

Instruments for Assessment

Patients with this condition usually report a variety of symptoms, which can make it challenging to diagnose Bipolar I. The screening procedures for Bipolar I are a questionnaire regarding depression and mania. The most commonly used tool is the Mood Disorder Questionnaire (MDQ) (Grande et al., 2016). It is a self-report evaluation that allows examining the patient’s lifetime history of manic and depressive episodes. It is important to consider involving family members or friends in the evaluation since it may be challenging for a patient to recognize their symptoms. Hence, the tools and instruments a professional can use to diagnose Bipolar I are questionnaires focusing on the patient’s mood changes and depressive episodes.

Patient Case

The patient is J. A., a 37-year-old Caucasian male who was married for five years with no children. After five years of marriage, the patient’s wife died in a terrible car accident. Having sold his business, the patient was going through a major depressive state. Almost half a year later, the man was surprisingly upbeat and willing to socialize. He decided to sell his house to invest in his new business idea. J. A’s friends reported that he began to have sudden mood swings, for example, he would “talk about the car accident in an unusually optimistic manner,” and in a few weeks, J. A. would be extremely depressed. These mood swings prompted J. A.’s family to ask him to refer to a mental health professional.

Moreover, since he drank much alcohol while barely eating, he began to have significant problems with the digestive system. As a result, J. A. was diagnosed with type 1 bipolar disorder. In general, it is possible that J. A.’s condition was triggered by the death of his wife. The main signs of the disease include mood swings — extreme joy followed by depression, risky behavior, since J. A. sold his property to invest in a new business, and appetite loss.

J. A. reported mood swings that lasted for a week or more. Upon assessment, J. A. reported having mood swings that he could not explain, each lasting for about a week or longer. He noted having those at least once times in the past year. J. A. also reported having insomnia and appetite loss, which led to the deterioration of his physical health. Because this patient experienced some physical symptoms, he was referred for further evaluation by his primary care provider. At the beginning of the treatment, the patient was prescribed mood-stabilizing medicine called Lamotrigine, starting with a small dosage that was steadily increasing over the first four weeks of intake. The man was also obliged to go through cognitive behavioral therapy for a least six months.

Comorbidity

Apart from being diagnosed with Bipolar I, J.A. reported having physical symptoms that affected his quality of life. In the case of J. A., the co-existing disorder is irritable bowel syndrome (IBS) was diagnosed by his provider. The comorbidity of the psychiatric and physical health condition, in this case, IBS and Bipolar I is common and the main symptoms include “abdominal pain, bloating, and disturbances in bowel habits without significant organic causes detected by routine medical examinations” (Tseng et al., 2016, p. 4617). Hence, patients diagnosed with IBS complain about having gastrointestinal symptoms that are not caused by a physical condition. Moreover, IBS and Bipolar I appear to share pathophysiology, with some researchers supporting the hypothesis that Bipolar may be caused by IBS (Tseng et al., 2016; Young, & Grunze, 2016). Notably, current medical practice guidelines advise prescribing antidepressants to patients with IBS because the two illnesses often develop simultaneously. Therefore, J. A.’s comorbidity of IBS, together with Bipolar II is common.

The exact prevalence rate of this comorbidity is currently unknown. However, in the systematic review of literature, Tseng et al. (2016) note that people who have Bipolar I are much more often diagnosed with IBS when compared to controls (Tseng et al., 2016). In terms of the general population, about 10% to 15% are affected by IBS, although only about 5% of patients have the diagnosis of IBS.

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The etiology of IBS is involved since the patients do not have any physical disorders that would explain their symptoms. Hence, the IBS diagnosis is typically based on the assessment of the following symptoms: abdominal pain, constipation, diarrhea, and bloating (Tseng et al., 2016). Treatment varies depending on the case, as mentioned, some individuals are prescribed antidepressants. In other cases, a change of diet and therapy for stress management can help control the symptoms. In the case of J. A., medication was prescribed to control the symptoms, as well as counseling from his primary care provider to adjust the patient’s diet.

IBS and Bipolar I’s occurrence has an impact on clinical assessment. As noted by Tseng et al. (2016), there is not enough evidence to establish a clear link between Bipolar I and IBS, but the symptoms of the two conditions often co-occur. Therefore, mental health professionals should check patients who have Bipolar I for the symptoms of IBS. In contrast, primary health providers should consider referring their patients for an additional evaluation if IBS appears with other psychological symptoms.

Conclusion

Bipolar I disorder is a severe mental issue that requires medical examination and treatment to live a good-quality life. While the disease had some significant characteristics in terms of symptoms, there were no established patterns of disease distribution and etiology. To justify the data found in secondary sources, a case scenario of the patient with type 1 bipolar disorder was provided in the second part of the research.

References

DSM-5 criteria: bipolar disorders. (2017). Web.

Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. Lancet, 387, 1561-1572. Web.

Mason, B. L., Brown, E. S., & Croarkin, P. E. (2016). Historical underpinnings of bipolar disorder diagnostic criteria. Behavioral Sciences, 6(3). Web.

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269.

Tseng, P., Zeng, B., Chen, Y., Wu, M., Wu, C., & Lin, P. (2016). A meta-analysis and systematic review of the comorbidity between irritable bowel syndrome and bipolar disorder. Medicine, 95(33), 4617. Web.

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Young, A. H., & Grunze, H. (2013). Physical health of patients with bipolar disorder. Acta Psychiatrica Scandinavica, 127, 3-10.

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