Bipolar Disorder

This research is devoted to the problems of bipolar disorder, its main causes and consequences, the way it should be treated and relapses, possible influence upon children and some other important issues. This type of disorder could be considered rather well-known as a lot of artists and musicians are said to suffer from it; but this seems necessary to study it from scientific point of view, as in reality many people with little in common with art or sophisticated mental activities suffer from the illness.

No doubts that changes in moods and energy levels exist since time immemorial. The modern words “depression” and “mania” could be traced in ancient Greece already. The word depression is closely related to the word and notion – melancholia, coming from “melas” that could be translated as black, and “chole” – as bile. The term originates in pre-Hippocratic humoral theories (Ghaemi N. , 2001). Thus the source of mania was seen in excessiveness of yellow bile or in blending with black bile. To define the real roots of the word “mania” seems not so easy, as there are various theories.

According to the Roman physician it came from the word “ania” meaning mental anguish and from “manos” that can be translated as relaxed, the combination of both would then mean the extreme relaxation of the mind (Ross J. Finklestein S. , Arana G. W. , May 1983). We could trace mentioning of mania and melancholia connection in the second century AD by Soranus of Ephesus, he considered them to be two separate diseases, not supporting the idea that melancholia could be a form of mania. In China the encyclopedist Gao Lian mentioned the malady in his Eight Treatises on the Nurturing of Life (Ts’un-sheng pa-chien) (Yatham L.

, Kusumakar V. , 1996). The famous medical philosopher Aretaeus of Cappadocia from Alexandria wrote several works about manic – depressive illnesses, uniting melancholia and mania by common roots – from “black bile”. Other scientists as Jules Baillarger, Jean-Pierre, Falret Baillarger studied the problems of mania and depression relationships. Finally in the 19th century, German psychiatrist – Emil Kraepelin presented his studies of bipolar patients, thus he is often considered to be the father of the modern conceptualization of bipolar disorder (Goodwin K, Jamison KR.

, 1990). John Cade, an Australian psychiatrist, investigated the veteran patients after World War II. He was also the founder of lithium medication for treating manic depression. This term appeared in 1958 for the first time, and even nowadays not all scientists use the modern term – bipolar disorder. Thus, the other name for bipolar disorder could be manic- depression; this diagnosis is related to the condition of mental health, when periods of extreme and unpredictable moods occur.

People suffering from this disorder could experience the states of mania, hypomania and mixed states, clinical depression or quick in comparison to other people and sudden change of moods. Moods of a person with bipolar disorder can change several times a day or on the contrary last for several months. Usually people, who have this type of disorder, see everything around them either in white or in black colors; there are only either negative or positive extremes for them. The disruption mood in this case could cause suicide risk (Ghaemi N.

, 2001). Bipolar disorder can be the reason of cognitive difficulties, like for example people can not concentrate on some certain plan, can not organize their activity. Due to this disorder people can misunderstand the emotions of others and distort the actual sense of their actions or words. They experience difficulties in personal relations, at their work place or at school. “Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live.

It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide. ” (Sachs G. , 2000). It was already mentioned that some talented artists suffer from this disorder because there is a connection between bipolar disorder and creativity according to some researchers. Unfotunately they fail to present the concrete scheme of the correlation between them.

Other consequences of the disorder could be marked rather positively than negatively, namely the increased desire to reach the goals and potential for hard work. The commonly accepted subdivisions of bipolar disorder are: Bipolar Type I and Bipolar Type II. The first type is characterized by full-blown mania, and the second one – only by hypomanic episodes, this will be in detail discussed later in this paper. In fact this is only general division, in reality there are a lot of other types of bipolar disorder and scientists didn’t come to an agreement about the total number of them.

The statistic research shows that 5. 7 million of adults and around 2. 6 % of teenagers suffer annually from bipolar disorder in America. Mostly this disorder starts to develop during the years of early adulthood, but there are cases of later occurrence as well. Unfortunately not all people realize that this is an illness and thus do not think of proper treatment. In fact as much as adults can also children and teenagers suffer from bipolar disorder, especially if their parents already experienced problems with this illness.

Children and adolescents also have rapid mood changes but as distinct from adults this happens several times a day and thus is more evident. Normal children are mostly happy and joyful, whereas those who suffer from bipolar disorder can be easily irritated and are inclined to tantrums. Teenagers usually have the same symptoms as adults. What presents a real problem for the parents is that it is really hard to distinguish the signs of bipolar disorder from the mixture of other problems children and adolescents encounter due to their age.

Irritation and aggression can be the consequences of not only bipolar disorder, but conduct disorder, attention deficit hyperactivity disorder, or any other mental disorder as well as results of drug or alcohol abuse by teenagers. The only way out would be to organize a serious and careful examination by a mental health professional, especially it is important to take care of children and adolescents talking about suicide. The National Institute of Mental Health in the USA confirmed that bipolar disorder is not a consequence of some single cause, but of a combination of different factors (Yatham L.

, Kusumakar V. (1996). When scientists started to study the genes, that are luckily to increase the chance of the illness, they came to the conclusion that one single gene can not cause the illness either. Still the idea that bipolar disorder can be genetically influenced is widely accepted. However it is not correct to consider genes the only reason of the illness, a vitally important role for its development is played by psychological factors as well. That’s why not only medication treatment is appropriate, but only in combination with the specially worked out psychotherapies.

Usually an individual has a depression in case of some failure or negative events in his life. On the contrary if a person gained a very important achievement this could be followed by hypomanic or manic episode. The range of examples of such events is rather wide, starting from falling in love or death of a close person and ending with acceptance to a very high position at work or vice verse loosing this position. Very often women suffer from bipolar disorder after giving a birth to a child. If four or even more episodes of the disorder occurred within one year, this person is considered to suffer from rapid-cycling bipolar disorder.

In the worst cases these cycles are experienced by individuals several times a month or even a day. Specialists state that rapid cycling is more frequent among women than among men. According to the “kindling” theory, people, who are genetically under the risk of bipolar disorder, experience rash change of moods after some stressful events (Ross J. Finklestein S. , Arana G. W. , May 1983). Genetic predisposition to bipolar disorder can often happen in the families where several generations suffered from this illness.

But what is important, as it was already said, many genes are needed for the development of this illness and usually in the family there are individuals with unbipolar and bipolar genes. On the other side a lot of other mental problems, including eating disorders, premenstrual dysphoric disorder, schizophrenia could be traced in the family history of an individual (Roy H. Perlis, 2005). From all the above stated it is clear that bipolar disorder is the result of many factors, genes, environmental and psychological influences.

The main symptoms of the depressive phase of the illness can include the states of anger, anxiety, sadness, isolation, hopelessness, problems with appetite and sleep, constant exhaustion, loss of interest towards the usual activities, difficulties in concentration, apathy, depersonalization, lack of sexual interest, in the worst case – suicidal ideas. People, who are disturbed by manic episodes, namely evince irritation, euphoria, suspicion most probably suffer from bipolar disorder. Very often such people become really active and their speech is racing.

They seem to have little need for sleep, but their attention span becomes very short and they can be easily distracted. They start to talk about great, not real ideas in a very optimistic way. As a result of their impracticality they can encounter financial problems or difficulties in personal relationships. Thus, the main symptoms of mania are: increased activity level, euphoric mood, extreme petulance, mixing up ideas and racing speech, lack of concentration, no need for sleep, incorrect conclusions and judgments, use of drugs, alcohol, aggression, not acceptance of the idea that something is not ok (Johnson SL.

, 2005). Arduous mania episodes or severe depression usually comprise psychosis symptoms, like for example hallucinations – seeing, hearing of the things which in reality are not there, delusions – developing the beliefs which are not derived from logical thinking. Delusions connected with beliefs that an individual is a great personality and occupies an important post in the state are distinctive for mania; those of guilt, worthlessness usually happen during depression. Sometimes all these symptoms can be mixed up with those of schizophrenia or some other mental problems.

Individuals with hypomania usually experience not so many symptoms as in the mania state and this period is usually shorter than that of manic episode. This state is also characterized by unusual ideas and energy increase. Scientists treat this mild level of mania as hypomania. Often people do not see this state in the negative light, they like their increase of productivity and functioning and they do not want to agree with their friends or family members, who notice the mood swings, that something is wrong with them.

Unfortunately, this state, although not as serious as mania, must also be treated in a proper way, otherwise it tends to develop into depression or severe mania in the future. “In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage)” (Geller B, Luby J.

, 1997). These episodes are unsteady due to extreme often change of moods. Suicide risk is very high during this state. In most cases people suffering from bipolar disorder only attempt committing suicide in reality never do it, however the average suicide rate of people with this diagnosis makes 0. 4 % of the general population (Perry A, Tarrier N, Morriss R, McCarthy E, Limb K, 1999). Researches prove that bipolar disorder is very dangerous for personal relationships as in the USA for example the divorce rate of the couples, where one of the spouses suffer from this illness, is up to 90 %.

At the moment four main types of bipolar disorder are distinguished: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified) (Goodwin K, Jamison KR. , 1990). The first type needs one or several manic or mixed episodes to be diagnosed. Although rather frequent, depression episode in this case is not necessary. Bipolar II is more frequent and is supported by an episode of hypomania or depression. To diagnose Cyclothymic Disorder it is necessary to ascertain the presence of several hypomanic episodes, blended with depression episodes.

The basis of this type is “a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. ” (Spitzer, R. , Feb 1998). In case a person seems to suffer from bipolar disorder, but it is difficult to define unambiguously to what of the above described types it could be related, his diagnosis will be Bipolar Disorder NOS. At the beginning of diagnostics it is very important to find out either from the patient himself or from his family and friends more about his manic or hypomaniac episodes, as in case of misdiagnosis and use of antidepressants the situation could get worse.

Physiologically it is not possible to identify this illness. The special Hypomanic Check List Questionnaire was worked out for precise diagnosing of the disorder type. Also it is necessary to pay immediate attention to people considering suicide committing, as risk of suicide is higher during the first stages of the illness. The main symptoms of suicide are: talking about wanting to die, stating that nothing can be changed for the better, indifferent attitude, alcohol or drugs abuse, making order in financial affairs, writing a note about suicide and some other (Geller B, Luby J.

, 1997). There are cases when suicide attempts were planned as well as those when a person acts under the influence of some impulse. If the proper treatment is applied suicidal feelings can be vanquished. The behavioral deviations connected with bipolar disorder can not be easily recognized either by specialists or all the more by patients themselves. This results certainly in the lack of professional help and treatment and worsening of the situation of the individual.

Unfortunately, even nowadays the delay of this kind of treatment is common fact, even taking into consideration the level of awareness of the people of the illness. With the help of TV programs specialists try to do their best to attract attention to the problem. In 2003 researchers of McLean Hospital started to work with echo-planar magnetic resonance spectroscopic imaging (EP-MRSI), noticing the evident improvements of the mood of the patients, and then they came to the idea to implement this method for treating bipolar disorder (Cade J. , 1949).

In their turn the specialists of NIMH organized a research in the USA in order to define the most effective treatment methods and techniques for patients with bipolar disorder. This program was worked out for 5-8 years. Talking about existing forms of bipolar disorder treatment, it is necessary to mention that mostly patients can achieve stabilization in their moods and mental state when proper treatment is applied. Mostly, treatment plan presents the combination of medication and psychological techniques. Usually more positive results are achieved in case of continuous treatment, this means without any breaks.

As the changes of the mood could be unexpected, doctors sometimes have to make changes in their initial treatment plans. In order to better understand and control the illness, patients and their family members need to consider everyday moods, life events, sleeps of the patient, as these facts when later reported to the doctor would contribute to the more effective treatment strategy. Medications for bipolar disorder patients are prescribed by doctors after the expertise and confirming the diagnosis. First of all “mood stabilizers” are needed for controlling bipolar disorder.

There are different types of mood stabilizers and they are mostly used continuously, whereas other medications are used for some short periods, for example to treat the mania or depression episodes (Cade J. , 1949). One of the most well known and frequently used is lithium, it was approved by the America Food and Drug Administration for treating and preventing mania and depressive episodes. Medications like valproate and carbamazepine have the same influence but are used for more sophisticated cases of bipolar disorder.

Other anticonvulsant medications include lamotrigine, gabapentin, and topiramate, they are used either in combination with lithium or with each other for the better effect (Roger S. Joanna K. and Konarski J. , 2006). Practically the same medicaments are used for treating children and adolescence suffering from bipolar disorder. However some researches proved that valporate could be the reason for hormone changes in girls and polycystic ovary syndrome in women under 20. This means that even if girls or young women start taking valporate, they should be also examined by a physician.

Women with bipolar disorder either planning or being pregnant should be aware of possible negative influence of the mood stabilizing medications upon fetus or baby. At the moment scientists study the possibilities to use other medications for pregnant women or during the period of lactation. During the process or treatment very often arises the need to make changes in the initial treatment plan based on the changes of the patient’s state. For the patients it is very important to inform their psychiatrists about other medications they are taking in order not to cause adverse reactions because of incompatible medications.

Also they should follow all the instructions given by the doctor in order to avoid the relapses. Other types of treatment include electroconvulsive therapy, which is usually used in cases when medication, psychological treatment or even the combination of both proves insufficient. ECT could be a very effective treatment, but all the details and risks should be carefully discussed with the family of the patient. Herbal of natural medicaments were not studied carefully yet and thus it is better to ask for doctor’s advice before taking them. St.

John’s wort or Hypericum perforatum is said by some researchers to reduce the effectiveness of certain medications and could lead to mania in people with bipolar disorder if used without mood stabilizers. Overall, this paper presents a brief research of the issues connected with bipolar disorder, explains the origins and historical facts connected with the illness, provides the main symptoms and methods of diagnostics of bipolar disorder by adults as well as children and adolescents, introduces the overview of the main methods of treatment, including their benefits and risks.

No doubts, that in reality this problem is versatile and sophisticated enough and needs further in-depth study. References: Cade J. F. J. (1949). “Lithium salts in the treatment of psychotic excitement”. Medical Journal of Australia 2: 349–352 Geller B, Luby J. (1997). Child and adolescent bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry. 36(9): 1168-76. Ghaemi N. (2001). Bipolar Disorder: How long does it usually take for someone to be diagnosed for bipolar disorder?. Goodwin K, Jamison KR. (1990). Manic-depressive illness.

New York: Oxford University Press. Johnson SL. (2005) Mania and dysregulation in goal pursuit: a review. Clin Psychol Rev. Feb;25(2):241-62. Perry A, Tarrier N, Morriss R, McCarthy E, Limb K (1999). “Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment” . Roger S. , Joanna K. and Konarski J. (2006). “Bipolar Disorder: Defining Remission and Selecting Treatment”. Psychiatric Times. Roger S. Joanna K. and Konarski J. (2006) “Bipolar Disorder: Defining Remission and Selecting Treatment” Vol. XXIII, No. 11 Ross J.

Finklestein S. , Arana G. W. (May 1983). “The predictive power of diagnostic tests and the effect of prevalence of illness”. Archives of General Psychiatry 40 (5): 569-573. Roy H. Perlis (2005). Misdiagnosis of Bipolar Disorder Sachs G. (2000) . Bipolar disorder therapeutics: maintenance treatment. Biological Psychiatry; 48(6): 573-81. Spitzer, R. (Feb 1998). “Diagnosis and need for treatment are not the same”. Archives of General Psychiatry 55 (2): 120. Yatham L. , Kusumakar V. (1996). “Treatment of Bipolar Depression” in conference on Mood Disorders: Recent Advances. Halifax, Canada. Oct 1996.

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