Mood Disorder Mood/bipolar disorder, also called manic-depressive illness, is a disease of the brain, which leads to unusual changes in mood, levels of activity, energy, as well as the ability to conduct day-to-day activities. Symptoms of mood disorder could be quite serious. They vary from the usual ups and downs that everyone experiences. Bipolar disorder symptoms could lead to broken relationships, poor school or job performance, or even suicide. Bipolar disorder is, however, treatable and individuals suffering from this disease can lead full and fruitful lives. Bipolar frequently surfaces in the early adult or late teen years. More than half all cases begin at the age of 25 (Bergink, Bouvy, Vervoort, Koorengevel, Steegers & Kushner, 2012). Some individuals experience their first symptoms during childhood, whereas others might develop symptoms later during adulthood. This disorder is not easily detectable when it begins. There are individuals that suffer for years prior to proper treatment and diagnosis. Similar to heart disease or diabetes, bipolar disorder is a long-term sickness that ought to be cautiously managed all through one's life (Jaya, Kumar, Lalit & Tanuja, 2013).

Epidemiology

Amidst the ages of 15 to 44, bipolar disorder is the sixth leading cause of disability in the developed nations. The suicide rate amidst patients suffering from this disorder is possibly greater than in patients without the disorder (Lu, 2015). According to the latest study of data from a second U.S. National Co-morbidity Survey, 1% met lifetime incidence criteria for bipolar I, 1.1% for bipolar II, and 2.4% for sub-threshold symptoms. Across varying groups and cultures, the rates are the same for both men and women.

Etiology and Pathophysiology

Genetic Elements within Bipolar Disorder

Bipolar disorder has the tendency to actually be familiar; it "runs within families." Nearly half the individuals suffering from bipolar disorder have a family member suffering from a mood disorder, like depression. An individual with one of the parents suffering from bipolar disorder has a 15 to 25% chance of having the disease, a similar risk in case both parents are bipolar. An individual with an identical twin that is bipolar is even at more risk of developing the disease around an eightfold greater risk compared to a non-identical twin (Jaya et al., 2013). Bipolar disorder is habitually inherited, along with generic factors being responsible for about 80% of the cause of the illness. If one parent is bipolar, there is 10% likelihood that his/her kid shall be bipolar. If both parents are bipolar, there is 40% chance that their kid shall develop the illness as well. Nonetheless, just because a single family member has the disorder, it is not essentially the case that other members of the family shall also develop the disease (Stone, Meisner & Baker, 2012).

Neurochemical Factors in Bipolar Disorder

Three essential brain chemicals are noradrenalin, dopamine, and serotonin. Noradrenalin and serotonin have been constantly associated with psychiatric mood disorder like depression and bipolar depression. Serotonin is linked to several body functions, such as learning, memory, and sleep, among other things. In accordance to a recent notion regarding the cause of bipolar disorder, the disorder is associated with abnormal serotonin chemistry in the brain. Serotonin is an example of neurotransmitters in the brain, and one of the chemicals that greatly influences an individual's mood. An imbalance is thought to be as a result of irregular production of hormone that serves as a messenger between nerve cells. Generally, the most functional imaging studies, Positron Emission Tomography (PET) and single-photon emission computer tomography (SPECT), have noted anterior and prefrontal paralimbic hypoactivity in bipolar depression, whereas preliminary studies of manic patients have produced variable results (Stone et al., 2012; Jaya et al., 2013).

Environmental Factors in Bipolar Disorder

A life experience might trigger a mood episode in an individual having a genetic disposition for bipolar disorder. Amidst those at risk for the disease, bipolar disorder is being noticed at increasingly early ages. The clear increase in earlier incidences might be because of under diagnosis of the disease in the past or even because of environmental and social factors, which are not yet understood. Even though substance abuse is not regarded as a cause of bipolar disorder, it could aggravate the illness by hindering recovery (Moore, Little, McSharry, Goodwin & Geddes, 2014).

Symptoms of Bipolar Disorder

Bipolar disorder is a merge of depressive and manic symptoms. Firstly, mania symptoms include: increased energy levels, agitation, and activity; extreme high-joyous mood; excessive petulance; speaking very fast; distractibility, cannot focus properly; unrealistic beliefs; increased sexual drive; and poor judgment (Jaya et al., 2013; Lu, 2015).

Types of Bipolar Disorder

Bipolar-I disorder

Here, the individual has manic episodes and almost always faces depression at some stages. In addition, the individual normally...

In this disorder, the suffering individuals have encountered one or more manic episodes. The majority of individuals encountered both depression and mania and a small number of individuals have manic episodes alone (Di Florio, Forty, Gordon-Smith, Heron, Jones, Craddock & Jones, 2013).
Bipolar-II disorder

The individual has only one hypomanic (a milder type of mania) encounter. This disorder might be difficult to notice if the individual is seen as usually excitable, greatly energized, and quite productive.

Cyclothymia (Rapid Cyclic Bipolar Disorder)

In whichever combination of depression, hypomania, or mania, there are at least four episodes annually. This is evident in 5 to 15% of individuals suffering from bipolar disorder. It is actually a more recurring mood disorder.

Bipolar Disorder Not Otherwise Specified (BP-NOS)

This refers to a condition whereby individuals have encountered periods of elevated mood; however, do not satisfy criteria for any of the other three described bipolar subtypes. For instance, an individual might have various symptoms of hypomania followed by a depression episode. Given that the symptoms of hypomania were temporary, the individual would not meet the criteria for a bipolar II diagnosis. However, he/she would be eligible for a diagnosis of bipolar NOS. Certain health care providers offering this diagnosis might also refer to bipolar NOS as "a typical bipolar" disorder (Jaya et al., 2013; Di Florio et al., 2013).

Diagnosis

There exists a list of criteria for an individual to be diagnosed. These rely on the duration and presence of particular signs and symptoms. Evaluation is normally conducted on an outpatient basis; admission to an inpatient facility is only considered when there is a risk to others or oneself. The commonly utilized criteria for diagnosing bipolar disorder are from the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, currently the ICD-10, and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (Lu, 2015; Moore et al., 2014).

Medication

Mood stabilizers are used as medication. Lithium is the first mood stabilizing medication permitted by the U.S. Food and Drug Administration (FDA) for mania treatment. Anticovulsant medications like valproate or carbamazepine are also used as mood stabilizers and might be particularly helpful for hard to treat bipolar episode. FDA approved the use of valproate for manic condition in 1995. There is some proof that valproate results to polystic ovary in women and hormonal variations in teenage girls. Expectant women face difficulties due to negative or dangerous effects of mood stabilizing drugs in the fetus (Jaya et al., 2013). The new treatment shall minimize risk of pregnancy as well as lactation.

Atypical Antipsycotic Medications

For individuals who do not respond to lithium or anticonvulsant clozapine, olanzapine, riseperidone, and ziprasidone might be useful mood stabilizer (Lu, 2015). Olanzzpine is helpful in case of psychotic depression and is available in injectable form. If insomnia is an issue, drugs like clonazepine and iorazapam could be helpful. Aripoprazole is also approved for the treatment of manic or mixed episode. It is utilized during maintenance treatment, following a serious or unexpected episode. Quetiapine eases the symptoms of unexpected or severe manic episode. It became the first atypical antipsychotic to also gain FDA approval for bipolar disorder treatment in 2006.

Psychotherapy

Psychotherapy and talk therapy could be quite effective treatments for bipolar patients. Some psychotherapy treatments include: Cognitive Behavioral Therapy (CBT) - assists the bipolar individuals to alter adverse thought patterns and behaviors; Family-focused therapy- assists in enhancing family coping methods (Lu, 2015). This therapy also enhances problem-solving and communication. Interpersonal and social rhythm therapy- assists patients improve their interactions with others and manage day-to-day routines; and Psyco-education- it educates about the bipolar disorder and its treatment (Jaya et al., 2013; Moore et al., 2014).

Side Effects of Antidepressant Drug

Lithium at times results to side effects like: restlessness; acne; dry mouth; abnormal discomfort to cold temperatures; indigestion or bloating; weak nails or hair; and pain at the muscles or joints. Side effects of most antipsychotics are: fast heartbeat; drowsiness; skin rashes; menstrual issues for women; and unclear vision. Antidepressants that are most frequently prescribed for treatment of bipolar symptoms have temporary mild effects. They include: headaches, nausea, sleep issues like drowsiness or insomnia, anxiety, and sexual issues that could affect both men and women (Bergink et al., 2012; Jaya et al., 2013).