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Bipolar Disorder and its Treatment A Research Paper
Johnny Stinson Surry Community College Psychology 281 Professor Deborah Patrick April 27, 2011
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Bipolar Disorder and its Treatment
Bipolar disorder, known as manic-depressive disorder in the past, is a debilitating mood disorder which causes extreme shifts in mood and energy, producing mood states called mania and depression. These mood states are two extreme fluctuating poles one involving a low mood of great sadness and low energy, and the other a state of elevated mood and energy. These states occur in cycles that can vary from months to as short as one day in ultra-rapid cycling cases. The states can also be experienced at the same time and are called mixed-episodes. The onset of the disease appears around the ages of 15-25. The prevalence of bipolar disorder is around 2% of the population in all sexes and races throughout the world. One pole of the bipolar spectrum is called a depression episode. Depression is a state of low mood, energy, and aversion to activities. These can affect a person’s behavior, feelings, thoughts, and psychical well-being. A great feeling of sadness, hopelessness, anxiety, worthlessness, restlessness, or guilt are present and can seem to be overwhelming for a person to deal with. This can lead to suicidal thoughts and suicide attempts. Suicide is most likely to happen during a depressive episode of a bipolar disorder and a patient should be under supervision or care. Estimates of suicide in bipolar disorder range from 9% to as high as 60%, with an average of 19% (Nathan, 205). People often experience cognitive impairments; such as difficulty concentrating, or making decisions. Psychical symptoms include changes in weight, excessive sleeping, fatigue, loss of energy, insomnia, aches, pains or digestive problems that can be resistant to treatment. Loss of interest in previously enjoyed activities can also occur, the most noticeable one being sex. In severe cases, a patient may become psychotic and “lose contact with reality”, having delusions and hallucinations. This condition is called severe bipolar depression
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with psychotic features. A depressive episode can last from two weeks to over six months if not treated. Depression is associated with changes and imbalances in chemical substances in the brain, known as neurotransmitters. The neurotransmitters involved appear to be serotonin, norepinephrine, and dopamine. Serotonin regulates many bodily functions including sleep, aggression, sexual behavior, and mood. A decrease in the production and concentration of serotonin cause disruptions in these functions and can lead to depression. Norepinephrine is used by our bodies to help recognize and respond to stressful situations. It has been suggested that people prone to depression may have norepinephrinergic systems that don’t handle the effects of stress very efficiently. Dopamine helps regulate and control our drive to seek rewards and allows us to feel a sense of pleasure. Low dopamine levels may explain why it is hard to find pleasure in normally pleasurable things or activities while in a depression. The other pole of the bipolar disorder spectrum is called mania. Mania is a mood state that involves an unusual elevated or irritable mood, arousal, and energy levels. It could be considered to be the opposite of depression, which is why they are each called polar opposites of each other and together are called bipolar disorder. Mania varies in its intensity, from mild mania known as hypomania to severe mania with psychotic features including, delusions of grandeur, paranoia or suspiciousness, aggression, and hallucinations. In a hypomanic mood state, a patient experiences an elated or irritable mood with a substantial increase in energy, lack of need for sleep, floods of ideas and a desire and drive for success. They do not experience psychotic symptoms such as delusions of grandiosity, and are able to function normally. They become very outgoing, exhibiting pressured speech which is rapid speech that can go on tangents that make it hard for a listener to understand. They can also becoming more competitive, productive and creative. It is thought that many creative people throughout history have
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exhibited states of hypomania and some even credit their work towards it. In a full blown manic episode is very debilitating and a person is not able to function properly without intervention. According to the DSM -IV (APA Diagnostic and Statistical Manual), a manic episode is “a period of seven or more days (or any period if admission to hospital is required) of unusually and continuously effusive and open elated or irritable mood … causing obvious difficulties at work or in social relationships and activities, or (b) requires admission to hospital to protect the person or others, or (c) the person is suffering psychosis.” They will exhibit the same features as a hypomanic episode, but the intensity will be increased and cause the person to lose contact with reality. They will be exhibiting psychotic features that will cause dysfunction and cause the person to believe strange things and may cause them to act in dangerous ways. There also exists a third mood state called a mixed state also known as a dysphoric manic episode. This is a condition where symptoms of mania and depression occur simultaneously such as difficulty sleeping, change in appetite, agitation, and suicidal thinking. The most common form, called depressive mania, is characterized by hyperactivity and psychomotor anxiety, global insomnia, combined with depressive thinking, weeping and emotional disruptions, and oftendelusional guilt feelings, all of which can be in various combinations. Severe depression or agitation in this state can also be accompanied by symptoms of psychosis. These symptoms include delusions and hallucinations. Studies show that only 40 percent of people who have both manic symptoms and a sufficient number of depressive symptoms are diagnosed as being in a mixed depressive and manic state. Studies have also shown that suicidal thoughts are increased in people with mixed episodes. The two different varieties of bipolar disorder are known as bipolar I, bipolar II. Bipolar I disorder is a mood disorder that is characterized by at least one manic or mixed episode with
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episodes of hypomania followed by states of depression. Bipolar I seems to affect both men and women equally, according to the DSM-IV. Type II bipolar disorders consist of a combination of major depressive episodes accompanied by at least one hypomanic episode. There tends to be periods of normal functioning between these episodes. Many type II bipolar patients are diagnosed and treated as if they were unipolar (only having depressive episodes) patients, because they only report to the doctor about their depressions, as their hypomanic episodes do not impair their functioning as drastically. The DSM indicates that women are more likely than men to suffer from bipolar II. People diagnosed with bipolar disorder commonly are diagnosed with other disorders, known as comorbidity. Comorbitiy is defined as “a presence of one or more disorders (or diseases) in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.” In a National Comorbidity Survey it was found that most (95%) of the respondents with bipolar disorder met the criteria for 3 or more lifetime psychiatric disorders. (Sagman) The most common comorbid disorders that occur along side bipolar disorder are anxiety disorders, substance abuse disorders, and ADHD and personality disorders. With bipolar disorder, anxiety disorder rates appear to exceed those in the general population. Bipolar disorder is a biologically based disorder with multiple psychological components. Among psychiatric disorders, bipolar disorder has been long considered one in which genetics play a key role, as bipolar disorder tends to run in families. Researchers have been studying the specific genes which they believe might play an important role. One of the more recent discoveries was made in 2003 by a group of American and Canadian researchers, who discovered that a mutation in the gene GRK3 is a possible cause of up to ten percent of the cases of bipolar disorder worldwide. This gene is directly associated with a kinase enzyme involved in
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dopamine metabolism, meaning that a possible target has been found for new drugs that could help to treat bipolar disorder more effectively. There is no cure for bipolar disorder, but the disorder can be managed with a regiment of psychiatric medicines depending on the severity. These regimens include anti-psychotics such as lithium, mood stabilizers such as certain anticonvulsants, and antidepressants such as Prozac. Each patient will have a different reaction to each group of medicines, so it takes time to get the right doses and combination that work. Medication is the foundation of bipolar disorder treatment. Taking mood stabilizer medication can help minimize the highs and lows of bipolar disorder and keep symptoms under control. Periods of depression are often treated by taking antidepressants. However, these antidepressants carry an increased risk of mania, especially if not taken with a mood stabilizer. Anti-psychotics are used to treat and prevent mania and hypomania. It is very important to stay on the medicine regimen, when mania onsets the patient is often unaware that they need to continue to take their medication. Therapy is also very beneficial to a person with bipolar disorder, as it causes many distressing experiences that, if left unresolved, can actually turn into a negative feedback loop. An example of this would be negative thoughts of self worth feeding into a depression making it worse. Working with a professional you can also work on repairing any damage that you may have caused between your relationships with others. Social rhythm therapy can also help you get into a routine sleep schedule, an exercise regimen, and learning how to minimize stress with behavioral therapy. Social support from family and friends also greatly benefits someone with bipolar disorder. Bipolar disorder can be a very hard thing to go through and having a strong support
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system in place can change your motivation and outlook. Support groups are also a great source of help, they introduce you to people who are experiencing the same things you are and you can share your experiences and learn from others. By using a holistic approach to bipolar treatment a person can attain control over their bipolar disorder, rather than it being in control of them. They can go on to have a normal functional life as long as they stay medicated. They might even teach us something someday.
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Colom, F., & Vieta, E. (2006). Psychoeducation manual for bipolar disorde . Cambridge, UK: Cambridge University Press. Frances, A., Pincus, H. A., & First, M. B. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association. Ketter, T. A. (2010). Handbook of diagnosis and treatment of bipolar disorders . Washington, DC: American Psychiatric Pub.. Nathan, P. E., Gorman, J. M., & Salkind, N. J. (1999). Treating mental disorders: a guide to what works. New York: Oxford University Press. Sagman, D., & Tohen, M. (2009, March 23). Comorbidity in Bipolar Disorder The Complexity of Diagnosis and Treatment. Psychiatric Times. Retrieved April 28, 2011, from http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1391541 Tohen, M. (1999). Comorbidity in affective disorders . New York: M. Dekker.
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