Essay/Term paper: Bipolar disorder

Essay, term paper, research paper:  Medicine

Bipolar Disorder

The phenomenon of bipolar affective disorder has been a mystery since the 16th century. Bipolar disorder or as the alternate names, manic depressive illness or affective bipolar disorder can be classified as a mood disorder characterized by mood swings from manis (exaggerated feeing of well-being) to depression. History has shown that this affliction can appear in almost anyone. Even the great painter Vincent Van Gogh is
believed to have had bipolar disorder. It is clear that in our society many people live with bipolar disorder; however, despite the abundance of people suffering from the it, we are still waiting for definite explanations for the causes and cure. The one fact of which we are painfully aware is that bipolar disorder severely undermines its" victims ability to obtain and maintain social and occupational success. It is also believed that the lithium level is what causes these mood swings. Because bipolar disorder has such debilitating symptoms, it is imperative that we remain vigilant in the quest for explanations of its causes and treatment. A smorgasborg of symptoms that can be broken into manic and depressive episodes characterized by affective disorders.
The depressive episodes are characterized by intense feelings of sadness and despair that can become feelings of hopelessness and helplessness. Either the manic or the depressive episodes can predominate and produce few mood swings or the patters of mood swings my be cyclic. Some of the symptoms of a depressive episode include

anhedonia, disturbances in sleep and appetite, psycomoter retardation, loss of energy, feelings of worthlessness, guilt, difficulty thinking, indecision, and recurrent thoughts of death and suicide (Hollandsworth, Jr. 1990 ). Some of the other symptoms that may occur in the depressive stage can be also fatigue that can last anywhere from weeks to months and a person may not be aware of why this is actually happening. Daytime sleepiness can also occur making it hard for a person with this illness to hold down any sort of a job for a length of time. Unintentional weightloss can make the doctor go in a different direction in this making it difficult for them in diagnosis because of all the possible symptoms that a person may exhibit. A person may also have some memory loss episodes or episodes of amnesia, going blank for a periods of time. They may not even be aware that they have a family to take care of their jobs.
The manic episodes are characterized by elevated or irratable mood, increased energy, decreased need for sleep, poor judgment and insight, and often reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). When a person is in the manic statge they may become agitated which makes them more talkative than usual or they feel pressured to keep talking, they also may wring their hands or fidget because they feel unsure of the situation that they are in and seem to have just extreme restlessness to them. They might appear to have put on quite a bit of weight and anger extremely easy.
Their erratic behavior can make it hard for their families to be around them. Eventually pushing their families aside and the diagnosis is harder to get because of the lack of support from others and their behavior is often so off. In this stage the sexual activity can be increased dramatically, making the patient seek other people to be with if

they are not fulfilled in their relationship at home. This can lead to the disruption of the family unit. This disease is very serious and can affect anyone.
Bipolar disorder affects approximately one percent of the population (approximately three million people) in the United States. Bipolar Disorder can affect both males and females and involves episodes of mania and depression.. Bipolar disorder is diagnosed if an episode of mania occurs whether depression has been diagnosed or not (Goodwin, Guze, 1989, p 11). Individuals with manic episodes most commonly experience a period of depression. The rarest symptoms were periods of loss of all interest and retardation or agitation (Weisman, 1991). As the National Depressive and Manic Depressive Association (MDMDA) has demonstrated, bipolar disorder can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters,loss of jobs and millions of dollars in cost in society.As the patient ages or get older they report that the depressions are longer and increase in frequency. Many times bipolar states and psychotic states are misdiagnosed as schizophrenia. Especially if the family history exhibits schizophrenia or some other illness. Bipolar is most distinguished with families that have mental illness in their background and can occur most often in those settings than in any other, although it can affect anyone. Speech patterns help distinguish between the two disorders (Lish, 1994). The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years of age, with a second peak in the mid-forties for women. A typical bipolar patient may experience eight to ten episodes in their bipolar Disorder 3 lifetime. However, those who have rapid cycling may experience more episodes of mania and depression that succeed each other without a


period of remission (DSM III-R). Rapid cycling means that their mood changes several times a day.
The three stages of mania begin with hypomania, in which patients report that they are energetic, extroverted and assertive (Hirschfeld,1995). The hypomania state has led observers to feel that bipolar patients are "addicted" to their mania. Hypomania progresses into mania and the transition is marked by loss of judgment (Hirschfeld, 1995).Often, euphoric grandiose characteristics are displayed, and paranoid or irritable characteristics begin to manifest. The third stage of mania is evident when the patient experiences delusions with often paranoid themes. Speech is generally rapid and hyperactive behavior manifests sometimes associated with violence (Hirschfeld, 1995).
When both manic and depressive symptoms occur at the same time it is called a mixed episode. Those afflicted are a special risk because there is a combination of hopelessness, agitation, and anxiety that makes them feel like they "could jump out of their skin"(Hirschfeld, 1995). Up to 50% of all patients with mania have a mixture of depressed moods. Patients report feeling dysphoric, depressed, and unhappy; yet,
they exhibit the energy associated with mania. Rapid cycling mania is another presentation of bipolar disorder. Mania may be present with four or more distinct episodes within a 12 month period. There is now evidence to suggest that sometimes rapid cycling may be a transient manifestation of the bipolar disorder. This form of the disease exhibits more episodes of mania and depression than bipolar.


Lithium has been the primary treatment of bipolar disorder since Bipolar Disorder 4 its introduction in the 1960's. It is main function is to stabilize the cycling characteristic of bipolar disorder. In four controlled studies by F. K. Goodwin and K. R. Jamison, the overall response rate for bipolar subjects treated with Lithium was 78% (1990). Lithium is also the primary drug used for long- term maintenance of bipolar disorder. In a majority of bipolar patients, it lessens the duration, frequency, and severity of the episodes of both mania and depression. Unfortunately, as many as 40% of bipolar patients are either unresponsive to lithium or can not tolerate the side effects. Some of the side effects include thirst, weight gain, nausea, diarrhea, and edema it may also heighten the suicide potential that is present with sustained depression. Patients who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder. One of the problems associated with lithium is the fact the long-term lithium treatment has been associated with decreased thyroid functioning in patients. Preliminary evidence also suggest that hypothyroidism may actually lead to rapid-cycling (Bauer et al., 1990). Pregnant women experience another rporblem associated with the use of lithium. Its use during pregnancy has been associated with birth defects, particularly Ebstein's anomaly. Based on current data, the risk of a child with Ebstein's anomaly being born to a mother who took lithium during her first trimester of pregnancy is approximately 1 in 8,000, or 2.5 times that of the general population (Jacobson et al., 1992). There are other effective treatments for bipolar disorder that are used in cases where the patients cannot tolerate lithium or have been unresponsive to it in the past.

The American Psychiatric Association's guidelines suggest the next line of treatment to be Anticonvulsant drugs such as valproate and carbamazepine. These drugs are useful as antimanic agents, especially in those patients with mixed states. Both of these medications can be used in combination with lithium or in combination with each other. Valproate is especially helpful for patients who are lithium noncompliant, experience rapid-cycling, or have comorbid alcohol or drug abuse. Neuroleptics such as haloperidol or chlorpromazine have also been used to help stabilize manic patients who are highly agitated or psychotic. Use of these drugs is often necessary because the response to them are rapid, but there are risks involved in their use. Because
of the often severe side effects, Benzodiazepines are often used in their place. Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms of rapid control of agitation and excitement, without the severe side effects. Some doctors as treatment for bipolar disorder have used antidepressants such as the selective serotonin reuptake inhibitors (SSRI"s) fluovamine and amitriptyline. A double-blind study by M. Gasperini, F. Gatti, L. Bellini, R.Anniverno, and E. Smeraldi showed that fluvoxamine and amitriptyline are highly effective treatments for bipolar patients experiencing depressive episodes (1992). This study is controversial however, because conflicting research shows that SSRI"s and other antidepressants can actually precipitate manic episodes. Most doctors can see the usefulness of antidepressants when used in Bipolar Disorder in conjunction with mood stabilizing medications such as lithium. In addition to the mentioned medical treatments of bipolar disorder, there are several other options available to bipolar patients, most of which are used in conjunction with

medicine.
One such treatment is light therapy. One study compared the response to light therapy of bipolar patients with that of unipolar patients. Patients were free of psychotropic and hypnotic medications for at least one month before treatment. Bipolar patients in this study showed an average of 90.3% improvement in their depressive symptoms, with no incidence of mania or hypomania. They all continued to use light therapy, and all showed a sustained positive response at a three month follow-up (Hopkins and Gelenberg, 1994). Another study involved a four week treatment of bright morning light treatment for patients with seasonal affective disorder and bipolar patients. This study found a statistically significant decrement in depressive symptoms, with the maximum antidepressant effect of light not being reached until week four (Baur,Kurtz, Rubin, and Markus, 1994). Hypomanic symptoms were experienced by 36% of bipolar patients in this study. Predominant hypomanic symptoms included racing thoughts, deceased sleep and irritability. Surprisingly, one-third of controls also developed symptoms such as those mentioned above. Regardless of the explanation of the emergence of hypomanic symptoms in undiagnosed controls, it is evident from this
study that light treatment may be associated with the observed symptoms. Based on the results, careful professional monitoring during light treatment is necessary, even for those without a history of major Bipoler Disorder. Another popular treatment for bipolar disorder is electro-convulsive shock therapy. ECT is the preferred treatment for severely manic pregnant patients and patients who are homicidal, psychotic, catatonic, medically compromised, or severely suicidal. In one study, researchers found marked

improvement in 78% of patients treated with ECT, compared to 62% of patients treated only with lithium and 37% of patients who received neither, ECT or lithium (Black et al., 1987).
A final type of therapy is outpatient group psychotherapy. Dr. John Graves, spokesperson for The National Depressive and Manic Depressive Association has called attention to the value of support groups, and challenged mental health professionals to take a more serious look at group therapy for the bipolar population. Research shows that group participation may help increase lithium compliance, decrease denial regarding the illness, and increase awareness of both external and internal stress factors leading to manic and depressive episodes. Group therapy for patients with bipolar disorders responds to the need for support and reinforcement of medication management, and the need for education and support for the interpersonal difficulties that arise during the course of the disorder.
The bipolar disorder can affect anyone at anytime. It is still unclear as to what and why this happens. Some doctors believe that the bodies" chemical sometimes get out of whack and that the treatment of lithium as well as the other drugs will help combat the normal levels in our bodies. Whether we ever fins a cure or really how this genetic and emotional disorder does come about, we all can agree that this does occur in families and most of the time it affects women more so than that of the men. I think that is because women are so emotional to begin with and that aids in the manic depression episodes. Hopefully scientist will continue to study and dissect this disorder that affects so many people.