Bipolar disorder

Mental Health and Society

STUDENT ID:
Table pf content

ABSTRACT..................................................................................................................................................... 2
INTRODUCTION............................................................................................................................................ 4
DISCUSSIONS:............................................................................................................................................... 7
TREATMENT................................................................................................................................................. 9
LONG-TERM MANAGEMENT....................................................................................................................... 10
CONCLUSIONS AND STRATEGIES FOR THE FUTURE......................................................................................12
REFERENCE:................................................................................................................................................ 13
Abstract
Mood changes are a normal thing in life, especially during stressful events. However, if mood swings

are confusing and persistent, leading to obvious disorders or disorders, there may be serious causal Affective

disorder or illnesses. Affective disorders can be categorised based on a scale that is determined by the

degree and severity of mood swings from unipolar to bipolar II to bipolar I. People with unipolar disorder

experience only depressive episodes, and those with bipolar II or I show more episodes that are expressed

about changes mood. Over 1% of the world's population are affected by Bipolar disorder, regardless of

nationality, ethnicity, or socioeconomic status (Kesebir et al., 2015).

Bipolar disorder is a recurring chronic illness, typified by mood and energy fluctuations and

one of the leading causes of disability in young people. This causes cognitive and functional

impairments and increased mortality, especially deaths from suicide. The high prevalence of

psychiatric and medical comorbidities is characteristic of those affected (Kessing, Vradi and

Andersen, 2014).

Bipolar disorder belonged to a group of mood disorders that are collectively characterized by

depressive and manic or hypomanic episodes and they include: Type I bipolar disorder (Manic and

depressive episodes, which can be diagnosed from a manic episode); type II bipolar disorder (hypomanic

and depressive episodes); cyclothymic disorders (hypomanic symptoms and depression that do not meet the

criteria for depressive episodes); and bipolar disorder, unless stated otherwise (depressive and hypomanic

symptoms that do not meet the diagnostic criteria for the above disorders). (Kessing, Vradi and Andersen,

2014) Type II bipolar disorder is very difficult to diagnose because it is difficult to distinguish this disorder

from recurrent unipolar depression (recurrent depressive episodes) in patients with depression.
 Identification of the unbiased biomarkers that represent different pathophysiological processes

between bipolar disorder and unipolar depression can provide a diagnosis of bipolar disorder and biological

goals for the development of new and personal treatments. Neuroimaging can help identify biomarkers

that distinguish bipolar disorder from unipolar depression. However, the problem of finding clear

boundaries between these disorders implies that they might be better represented as a series of

affective disorders. The novel mixture of neuroimaging approaches and pattern recognition can

identify individual models of neural structures and roles that determine precisely where patients

can be on the behavioural balance. Finally, an integrative method, with several biological

measurements making use of varying scales can provide a biomarker model to identify biological

goals for personalized and new treatments for all mood disorders.
Introduction
Bipolar disorder can be described as any mental health ailment or disorder which alters the mood

of an individual, liveliness and to which that individual is not able to function properly is called

bipolar disorder. It has several types and these Include cyclothymic disorder, bipolar I, bipolar II,

bipolar disorder. All the Bipolar disorder types commonly share symptoms. However, the severity

and intensity vary. Some individuals often go through certain stages of "normal" temperament,

while within episodes (Kesebir et al., 2015). Bipolar disorder is a life time ailment; Nevertheless,

there are remedies which can relieve the symptoms and provide relief to the patient. And these

could Include medications, conversation therapy and lifestyle of healthy living (Kessing, Vradi and

Andersen, 2014).

In a worldwide mental health survey, the prevalence of bipolar disorders was consistent across

diverse cultures and ethnic groups, with an aggregate lifetime prevalence of 0·6% for bipolar I disorder, 0·4%

for bipolar II disorder, 1·4% for subthreshold bipolar disorder, and 2·4% for the bipolar disorder spectrum.

Access for patients to mental health systems, however, differs substantially across countries, making

management of this disorder especially difficult in low-income countries. With respect to sex, bipolar I

disorder affects men and women equally whereas bipolar II disorder is most common in women. Bipolar

disorder is a lifelong episodic illness with a variable course that can often result in functional and cognitive

impairment and a reduction in quality of life. In WHO’s World Mental Health surveys, bipolar disorder was

ranked as the illness with the second greatest effect on days out of role. Because bipolar disorder is mainly

diagnosed in young adulthood, it affects the economically active population and, therefore, connotes high

costs to society. The onset of mania in later life might be indicative of an underlying medical comorbidity.

Due to the relapse and chronicity of bipolar disorder, intense management of mood episodes is

highly fundamental, while pharmacological and psychological treatment for restraint of further episodes are

equally imperative.
 This report addresses issues related to bipolar disorder, including clinical presentation,

diagnostic classification systems, current root causes, prognosis, symptoms, and severity. A person

with bipolar disorder might have a well-defined manic or depressed condition, but sometimes there

are longer periods of time, such as a year without symptoms. Such people can experience extreme

and / or rapid succession at the same time. Acute bipolar manifestations of hysteria or depression

can include psychotic indications such as apparitions or hallucinations (John M. Grohol, 2020).

Usually this psychotic indication reflects an individual's acute mood. Schizophrenia could be

mis-diagnosed in patients with bipolar disorder with symptoms of psychosis. Bipolar disorder is

typified by extreme moods or episodes, described as:

 Panic-stricken or hyperactive episodes (feeling emotionally high)

 Depressing occurrences (feeling emotionally low)

 Likely symptoms of phobia– incidents of delusions or phantasms.

These manifestations are far more serious than the "ups and downs" of normal life that every

individual undergo. They can last for weeks or months and make the feeling of being out of control

or controlled by their moods. Affected individual may not quickly realize that are going through a

manic episode. Such extreme mood can make work and relationships difficult, and those with

bipolar disorder have an increased threat of suicide (Fighting Stigma - Depression and Bipolar

Support Alliance, 2015).

Psychiatric illnesses are usually diagnosed mainly through careful behavioural assessment combined

with idiosyncratic reports of abnormal experiences among groups of patients in the disease category.

However, this category covers considerable heterogeneity. As an instance, the diagnosis of

schizoaffective syndrome is frequently provided to people who have affective and psychotic

symptoms or who take turns or live side by side, which raises doubts about the conventional
contrasts, which delineates moods and psychotic disorders into various categories of illness.

Without definite and objective biomarkers for pathophysiological behavioural processes which are

associated with conventionally defined categories of psychiatric disorders, vis a vis the heterogeneity within

and significant overlap of these behaviours, adequate diagnosis and treatment for many psychiatric

disorders is difficult. Bipolar disorder belongs to a group of psychiatric disorders which are difficult to

diagnose accurately. While this disorder, along with other psychiatric disorders, is one of the ten most non-

communicable diseases, misdiagnoses of the disease, such as recurring unipolar depression occurs in 60% of

patients seeking treatment.

Discussions:
The current system of classification, denotes bipolar disorder as belonging to a group of mood

disorders where patients experience depressive episodes caused by bad moods and related

symptoms (e.g. pleasure loss and unelevated vigour) and each episode of Mania is characterized by

mood swings , increased or irritated, or both, and related symptoms such as increased energy and

decreased sleep or hypomania, symptoms that are less severe or less lingering than symptoms of

mania (NIMH » Bipolar Disorder, 2014).

As per the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical

Manual of Mental Disorders (DSM-IV), there are four major sub-types of bipolar disorder and these

are: bipolar disorder type I (depressive episodes and at least one episode of full-blown mania); type

II bipolar disorder (several episodes of prolonged depression and at least one hypomanic episode

but no manic episodes); cyclothymic disorders (many periods of hypomanic symptoms and

depression in which depressive symptoms do not meet the conditions for depressive episodes); and

bipolar disorder, unless stated otherwise (depressive and hypomanic symptoms and episodes that

can change quickly but do not meet the complete diagnostic criteria for the above disease) (Sklar et

al., 2002).

The 10th publication of International Classification of Diseases (ICD-10) makes no difference

between type I and II bipolar disorder. ICD-10 similarly entails two separate mood episodes to

diagnose bipolar disorder, at least one of which must be manic or hypomanic. However, in DSM-IV,

one episode of mania (or mixed moods) or one episode of hypomania plus one episode of severe

depression is satisfactory for a diagnosis

Why is bipolar disorder so difficult to diagnose accurately?
Bipolar type I and II disorders are clinically very difficult to diagnose accurately, especially at the

early stages. Barely 20% of bipolar disorder patients who experience a depressive occurrence are

diagnosed with the disorder in the first year after treatment, and the average delay between onset

and diagnosis is 5 to 10 years. The main reason for the complex diagnosis is the challenge of

distinguishing type I or II bipolar disorders from unipolar depression, which is a disease typified by

recurring depressive episodes, particularly in patients presently showing signs of depressive

episodes and in patients without a clear history of mania or hypomania. Unipolar depressive

episode has been described as the most common misdiagnosis in patients with bipolar disorder,

especially bipolar disorder type II, because, episodes of mania never occur in patients with this

disease. See (figure 1)

Figure 1

Mood changes over time in bipolar disorder type I, bipolar disorder type II, and recurrent unipolar depressive

disorder: M=mania. m=hypomania. D=depression .

Additional challenge in distinguishing type I or II bipolar disorder from unipolar depression is that the

pervasiveness of depressive symptoms is greater than hypomanic or manic symptoms during type I or II

bipolar disorder, and this disorder often begins with depressive disorder. People with type II bipolar disorder

typically spend most of their lives more depressed than in hypomanic or manic episodes, which exacerbates

diagnostic problem.

Treatment
The initial phase in treating bipolar disorder is to validate the diagnosis of mania or hypo-mania and

determine the patient's mood, because the healing approach is significantly different in depression

hypomania, depression, euthymia and mania. Various factors can influence pharmacological and emotional

approaches. These comprise medical and psychiatric comorbidities, earlier or present treatments, responses

to medication or side effects in patients and the likes, including the patient's desire to be treated. These

factors must be considered in any clinical management, especially when treating acute episodes for the first

time, to enhance effectiveness, curtail the risk of side effects, lack of compliance, and avoid changing drugs.

In management of acute cases, the primary objective will be to ensure the safety of patients and those

closest to them as to achieve clinical and functional stabilization with minimal side effects. In addition,

commitment and the development of a therapeutic grouping are important in any lifelong disorder that

requires long-term compliance, and this grouping is especially true in the first episode. In continuing

management, the main goal is to avert relapse of episodes and provide functionality while improving

treatment.
Long-term management
Given the chronic nature of recurring bipolar disorder, optimal long-term supervision is a

prevention strategy which combines the psychological, lifestyle and pharmacological procedures of

the first episode (Figure 2). In Clinical Practice Guidelines (CPG) Lithium was considered as the most

powerful first intervention as an effective mood stabilizer to support the treatment of bipolar

disorder and preventing manic episodes and depression, with relatively simple support for the

treatment of acute bipolar depression (Bipolar Disorder-What Increases Your Risk, 2015). However,

its management is complex and often requires close supervision. When managing bipolar disorder

with the use of lithium therapy, the recommendations contained in any internationally recognised

Clinical Practice Guidelines (CPG), must be strictly followed, although lithium was associated with

decreased kidney function, hypothyroidism, and hypercalcemia.

Figure 2: Neuro-progression of bipolar disorder.

 Continuing therapeutic approaches differ in the dominant polarity of bipolar disorder patients. While

patients with dominant manic polarity respond better to a typical antipsychotic, patients with predominantly

depressed polarity respond best to lamotrigine and are probably need additional antidepressants. There is

evidence that psychotherapy during the first episode must be adjusted to the age or stage of the disease in

young people. Psychoeducation has shown long-term prophylactic effects in people with bipolar disorder.

Another useful treatment for patients includes cognitive behavioural therapy, relational and social rhythmic

therapy, and family-centred therapy. Practical recovery has also been shown to work effectively in patients

with bipolar disorder and Type bipolar with psychosocial dysfunction. An internet-based approach is starting

to develop.

Conclusions and strategies for the future

Though medical approaches to enhance the diagnosis of bipolar disorder comprise evaluation scales;

intended to identify subthreshold hypomanic or subclavian manic symptoms, yet this approach alone cannot

recognise objective biomarkers that represent important pathophysiological procedures. Favourable results

from studies with distinct neuroimaging methods indicate that neuroimaging actions can help identify

biomarkers to distinguish bipolar disorder from unipolar depression (Bipolar disorder: assessment and

management, 2014). Nevertheless, the difficulties in identifying clear boundaries between the two disorders

indicate that they can be better described as affective disorders’ range with expression of the bipolarity

variable, which is the most important dimension of the pathophysiological process. Many researches in

neuroimaging studies had already began to embrace this approach (Collins, Drake and Deacon, 2013). In

addition, enlivening new combinations of neuroimaging approaches and pattern identification can recognise

different structural and functional models of neural circuits, both of which can help to divide patients into

different categories and to bring individuals to the point of the behavioural scale.

However, in the future, the usage of biological measurements from hereditary, molecular, cellular,

neuron tracks and behavioural levels will be very important to obtain biomarker models that represent the
most important dimensions of pathophysiological procedures in bipolar disorder and other mood disorders.

In the long run, this combining approach has the utmost possibility of identifying biological targets for

adapted treatment and developments of new treatment of all these diseases. Areas of study that raise high

expectations include new animal models, mitochondrial biogenesis, human stem cells obtained from

patients with bipolar disorder, metabolism, optogenetics and proteomics. (Norman and Ryrie, 2018)

Advances in translation can improve pathophysiological understanding and help young people

diagnose the accuracy of detecting bipolar disorder at an earlier stage. Hopefully objective

biomarkers can be identified that represent the underlying pathophysiological process.

Models and strategies for personalizing drugs are being examined for their promise in

increasingly sophisticated biological and psychosocial interventions. Patients will soon be able to

receive a combination of pharmacological and psychological management tailored to each stage of

the disease and age (Anderson, Haddad and Scott, 2012). Though, despite its potential

effectiveness, the health system can overcome the rising costs of this complex approach and offer

more practical strategies - for example, faster and more effective psychotherapy proprieties. This

integrative process can identify potential biological targets for new drugs and specific treatments

for bipolar disorder.

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