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Bipolar Disorder: Medical Analysis

Introduction

Previously known as manic depression, bipolar disorder is a psychological condition which affects moods causing them to swing to extremes. Bipolar disorder is a disorder of the brain and is a manic depressive illness which also causes shifts and swings in energy and activity levels hindering the ability of the affected individuals to function consistently in everyday life. The disorder can have negative effects on relationships, negatively impacting school and job performances and in extreme cases leading an individual to suicide. Research indicates that bipolar disorder develops during the latter part of teenage or during the early adulthood period with majority of cases initiating before the age of 25 years (Kessler, Berglund, Demler, Jin, Merikangas & Walters, 2005). The disorder is not easy to detect and is a long term illness which may not be recognised until the individual has suffered for several years prior to being recognised. The prevalence of bipolar disorder is estimated to be about 1% to 2% of the general population as per the DSM-IV-TR (Goodman, Jeong, and Triebwasser, 2009).

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Types of bipolar disorders

Bipolar disorders are of four main types and are diagnosed on the basis of the Diagnostic and Statistical Manual of Mental Disorders, or DSM.

  1. Bipolar I Disorder – According to the DSM, this disorder is defined by mania or mixed state between depression and mania. The state is usually believed to last for about a week and the condition of individuals could be severe enough to have them hospitalised and put in care. The maximum duration of the depressive and manic state is about two weeks and the person behaves extremely abnormally.
  2. Bipolar II Disorder – The DSM defines this disorder as a regular pattern of depression and mania with several mood swings, but no complete episode of any of the states of mania or depression.
  3. Bipolar Disorder Not Otherwise Specified (BP-NOS) – The DSM defines this disorder among individuals who do not classify for either bipolar disorder I or II and the symptoms indicate a disorder but not very strong. In this case the symptoms are weak and do not last long enough but clearly indicate a shift or change away from the normal behaviour of an individual.
  4. Cyclothymic Disorder – Cyclothymia – This is also a bipolar disorder but is a very weak form in which individuals have mild instances of depression with slight shifts in moods and behaviours lasting for a period of two years. The symptoms however, are not strong enough for the condition to be classified as a bipolar disorder.

Rapid-cycling bipolar disorder – Some individuals have also been diagnosed with another form of bipolar disorder popularly termed as rapid-cycling bipolar disorder, in which the person experiences four or more of mood changes including depression, mania, hypomania and mixed state lasting for a period of one year (Akiskal, 2005). People with this disorder experience several mixed episodes during a period of one day or even seven days. Research indicates that women are more prone to having this disorder than men and if left untreated, the frequency and severity of the episodes could increase resulting in problems impacting personal, social and work relationships (Schneck, Miklowitz, Calabrese et al. 2004).

Diagnosis

Patients reflecting mood swings and serious shifts in behavior should first be diagnosed by a qualified doctor through a mental health evaluation. The doctor could provide a referral to a trained mental health professional or psychiatrist who has experience and knowledge in diagnosing and treating patients of bipolar disorder. The mental health professional should conduct a diagnostic evaluation and discuss the history of bipolar disorder in the family, gaining a complete view of the symptoms. The professional should also speak to the relatives and family members of the patient and take not of their responses regarding the patient’s attitudes and behaviors. The professional should take a complete medical history of the patient and must ensure any records or instances of bipolar disorder within the family, through symptoms of mania or hypomania (NIMH).

Diagnosing bipolar disorder could be difficult due to the symptoms of instability, irritability and impulsiveness in the affected individuals. While mood episodes, impulsivity and quality of depression are the only major tools, these are clearly not very simple to help in the diagnosis (Goodman, Jeong, and Triebwasser, 2009). Diagnosis is based primarily on the symptoms reflected by individuals specifically the mood swings and behavioral changes occurring sue to the disorder. The duration and intensity of the symptoms is also a major diagnostic tool and enable doctors to classify the disorder based on the DSM scale.

Symptoms

Swings and episodes in moods is a major symptom among people with bipolar disorder. Individuals with the disorder could experience intense emotional states of being too overjoyed and ecstatic known as the manic state or could be very sad and unhappy known as depressive state (NIMH). Some individuals could also experience both the states together known as the mixed state and people with the disorder often tend to be extremely irritable and explosive (NIMH). In bipolar disorders, the swings and shifts in moods of an individual are spontaneous and last for long durations especially in the case of bipolar I disorder. However, the swings in moods are not continuous and there could be periods when the person does not experience any episodes in-between intervals (Goodman, Jeong, and Triebwasser, 2009).

Impulsivity is a behavioural change occurring in individuals experiencing bipolar disorder in which the person acts inconsistently without reflecting upon the context and the situation (Moeller, Barratt, Dougherty, et al., 2001). Impulsivity differs according to the manic or depressive state with motor impulsivity being associated with the manic state and non-planning impulsivity associated with the depressive state (Goodman, Jeong, and Triebwasser, 2009). Impulsivity among individuals occurs in episodes and persons with history of substance abuse are at a higher risk of impulsive and self harming behaviours (Goodman, Jeong, and Triebwasser, 2009). The case is more pronounced among persons with depressive symptoms due to the extreme hopelessness and despair they experience.

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Symptoms of Mania

Mood change is the most common symptom of bipolar disorder in which the person experiences a state of feeling ecstatic and extremely overjoyed (NIMH). There could be a sudden change in mood with the person becoming extremely irritable and agitated and could hyperactive. Mania could also be apparent through certain behavioural changes such as speaking extremely fast and jumping from one idea or thought to another, becoming distracted very easily, restlessness, reduced hours of sleep, being unrealistic about one’s self, impulsive behaviours or even high risk attitudes such as spending sprees, sexual impulses and taking impulsive business decisions (NIMH).

Symptoms of depression

Mood change in the most common symptom of bipolar disorder and is apparent through an empty of unhappy feelings, complete disinterest in daily activities including sex (NIMH). Behavioural changes like feeling fatigued or tires and concentration problems are also early indicators. Other symptoms of depression include restlessness and irritability, change in regular habits such as eating and sleeping, concentration problems and inability to make decision, and thoughts of death and suicide (NIMH). Mixed state bipolar disorder is apparent through symptoms including feelings of agitation, insomnia or trouble in sleeping, drastic changes in appetite and serious feelings of hopelessness and suicide, even while feeling extremely energetic and charged (NIMH). In some sever cases, individual may also show symptoms of psychosis such as hallucinations or delusion in which the person may experience manic feelings and could engage in alcohol and substance abuse.

Treatment of bipolar disorder

Treatment of bipolar disorder can be done through pharmacological or psychosocial intervention.

Pharmacological treatment

Pharmacological treatment in bipolar disorders has proven to be effective with the help of eleven FDA approved drugs to treat the disorder out of which 9 are for mania or mixed stages, 2 for depressive stages and 5 for therapy and maintenance (Goodman, Jeong, and Triebwasser, 2009). Patients of bipolar disorders are first treated with mood stabilisers and treatment varies with the different phases and the intensity with which they occur.

Psychosocial Interventions

Bipolar disorders are treated by mental health professional through a series of psychosocial interventions and psychotherapeutic interventions which focus primarily in the development and enhancement of skills to regulate emotions (Goodman, Jeong, and Triebwasser, 2009). Psychosocial interventions are an important aspect of treatment of bipolar disorders and include approaches of psycho-education, stress management techniques, techniques of regularizing daily activities (Goodman, Jeong, and Triebwasser, 2009). Psychotherapy also known as talk therapy is proven to be an effective treatment for bipolar disorder and can be provided through a variety of treatments such as cognitive behavioural therapy (CBT) which helps individuals to learn to change harmful and negative patterns of thoughts and behaviour, family-focused therapy which enhances communication and problem-solving skills between family members, interpersonal and social rhythm which helps people improve their social and personal relations and helps them to manage their daily routines, and psycho-education which educated people about their disorder and the treatment so that they can take an active part in the improvement process (NIMH).

References

Akiskal H.S. (2005). Mood Disorders: Clinical Features; In Sadock BJ, Sadock VA (ed). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Lippincott Williams & Wilkins: Philadelphia.

Goodman, M., Jeong J. Y., and Triebwasser J., (2009). Borderline personality disorder and bipolar disorder-distinguishing features of clinical diagnosis and treatment. (Category 1). Psychiatric Times 26.7: 55.

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Hirschfeld R.M. Psychiatric Management, from Guideline Watch: Practice Guideline for the Treatment of Patients With Bipolar Disorder, 2nd Edition. Web.

Kessler R.C., Berglund P, Demler O, Jin R, Merikangas K.R., Walters E.E. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry.; 62(6):593-602.

Moeller F.G., Barratt E.S., Dougherty D.M., et al (2001). Psychiatric aspects of impulsivity. Am J Psychiatry; 158:1783-1793.

National Institute of Mental Health. Web.

Schneck C.D., Miklowitz D.J., Calabrese J.R., Allen M.H., Thomas M.R., Wisniewski S.R., Miyahara S, Shelton M.D., Ketter T.A., Goldberg J.F., Bowden C.L., Sachs G.S. (2004). Phenomenology of rapid-cycling bipolar disorder: data from the first 500 participants in the Systematic Treatment Enhancement Program. Am J Psychiatry.;161 (10):1902-1908.

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