Bipolar disorder: characteristics, diagnosis, and treatment

¶ … bipolar depression, the causes, symptoms, effects on brain and the various forms of treatment available for the disorder. Bipolar depression is an extreme disorder condition in which various situations from high to low, euphoria to depression and recklessness to listlessness occur and this situation can be serious produce the effects of a disabling mental disorder. The transformation of their loved ones into someone else they do not know and cannot communicate to, is watched in disbelief, by the members of the family and friends of the person concerned during occurrences of manic phases. Bipolar disorder consists of four different kinds of mood, which may be distinguished as Mania, Hypomania, Depression and Mixed Mood. Sleep and appetite disturbance, ongoing sad or blue mood, lack of interest or pleasure, trouble concentrating, withdrawal from family and friends, low energy, feelings of guilt or worthlessness and thoughts of death or suicide are some of the warning sign of turmoil. There are numerous reasons that are stated that may be responsible for causing this particular disorder. They may be hereditary, or because of brain chemicals, personality factors, reactions to medication, drugs, stress, and mental disorders. Bipolar disorder is a treatable and controllable illness even though there is no cure for it. Most people can be cured after a proper examination. People with bipolar disorder can be cured efficiently but under proper medication. There are certain psychosocial treatments like cognitive-behavioral therapy, interpersonal therapy, family therapy and psychoeducation, which help people to know the disease, and to develop skills to manage the strain that can cause severity.

Introduction:

Bipolar depression is an extreme disorder condition in which various situations from high to low, euphoria to depression and recklessness to listlessness occur and this situation can be serious produce the effects of a disabling mental disorder. Another well-known term for this disorder is also Manic-depressive illness. Bipolar depression affects nearly two million American adults, which is nearly like one percent of the population of the age 18 or older. It begins in early adulthood and may often continue into adult life and most of the time would stay the affected individuals through out their lives.

The kind of mania being encountered with, the time period it may last cannot be predicted and depends on the particular situation. A few persons may experience a preponderance of mania or depression, while at the same time some others may have feelings of both at the same time. If not treated well and at the right time their phases can last for a number of days or even months, but it has been noticed that the depressive periods last longer than the manic periods. An individual who has bipolar disorder may experience at least ten episodes of the disorder in his life but there are some other unfortunate ones who experience more frequent mood swings. It has been noticed that as time passes the frequency of these episodes increases and moreover people who have more than four episodes in a span of year are said to have rapid cycling. (Copeland, 34)

The American Physiatrist Association, has stated that bipolar disorder consists of four different kinds of mood, which may be distinguished as Mania, Hypo mania, Depression and Mixed Mood. To explain Mania is one in which the individual shows abnormal behavior during a particular period and then expresses constant elevated, expansive or irritable moods that most frequently last for a week or two at the maximum. Hypomania at the same time is a milder form of the mania and lasts for like four to eight days. Depression is a period during which the individual is in a state where he is either in a depressed mood or just does not have enough interest in the his day-to-day activities and usually stays for two or three weeks. The last kind of bipolar disorder, Mixed Episode is one in which the person usually has both feelings of manic and major depressive order symptoms and lasts continuously for a stretch of a week. (Goldberg, 40)

Symptoms and causes of Bipolar Disorder:

Sleep and appetite disturbance, ongoing sad or blue mood, lack of interest or pleasure, trouble concentrating, withdrawal from family and friends, low energy, feelings of guilt or worthlessness and thoughts of death or suicide are some of the warning sign of turmoil. It is common for an individual to feel rapid mood swings, he/she may be happy on one day or sad on another due to circumstances but when an individual is in the pangs of bipolar disorder, circumstance around him are not responsible for his moods. The individual tends to have major mood swings and may be very happy or very sad whether or not there is anything for him to be worried about. When an individual has rapid mood swings and most of which are grave and have no apparent reason, it may be considered that the individual has bipolar disorder. The individual may face the prospect of being at a loss of energy and interest in life. These periods of depression are not continuous a person may feel absolutely fine but may have a relapse of it after a few days or months or years. (Swartz; Frank, 18)

But what is the source and what causes the bipolar disorder? To say that X or Y as the cause would be superb. But it is not so simple an answer. An approach to the study of psychopathology, which makes psychological disorders resulting from several causal factors, which are interacting, is the belief most scientists have according to Durand and Barlow. These underlying factors are usually separated into biological and psychological explanations as it relates to bipolar disorder. How to put it simple words? The study of significant causes and processes in the development of mental illness is psychopathology. In overall terms, environmental causes, physical and mental and emotional causes are believed to be the reasons for the mental illnesses. (Coryell; Keller, Endicott; Maser; Klerman, 726)

There are numerous reasons that are stated that may be responsible for causing this particular disorder. They may be hereditary, or because of brain chemicals, personality factors, reactions to medication, drugs, stress, and mental disorders. An important cause of the disorder could be because of the fact that the individual in question is leading a very stressful life. The person may have experienced a stressful event in his recent past and this could be the reason behind him having to develop this disorder. The stressful event makes it easier for the individual to get sucked up into depression and then into further phases of mania. But actually considering facts, stress cannot be fully responsible for causing this disorder among the various individuals. (Berk; Segal; Janet, 1410) It has been found out by research that stressful life events can lead to the onset of symptoms in bipolar disorder. The disorder seems to develop a life of its own once it is activated and expanded. A psychological or pathophysiological process takes over after the beginning of the cycle and makes certain the continuation of disorder

Some Psychiatrists felt that the reason behind mental illnesses could also be because of early-childhood encounters. Another cause for this disorder could be the fact that the individual's personality may be responsible for the triggering the disorder. A positive family history for mood disorders, suicide, and/or alcohol and drug abuse is observed in most of the people suffering from bipolar disorder; hence researchers search for particular genes that might be concerned with the augmentation of the disorder. The genes concerned with bipolar disorder are at present being intensively identified. Serotonin, which is a neurotransmitter, is one candidate gene, which might cause bipolar codes for the serotonin transporter, is involved in a variety of behaviors including sleep, moods, and activity, all of which are affected to some degree in bipolar disorder. Both the genes, in identical twins that share all the same genes, and other aspects play a part in bipolar disorder according to studies. Research has failed to show that the identical twin of someone suffering from bipolar would always develop the illness; hence we can't say that bipolar disorder was caused entirely by genes. Hence, the cause for depression or the cause that affects the treatment for the disorder is believed to be social and developmental factors. (Weissman; Bruce; Leaf; Florio; Holzer, 35)

There is a possibility that an individual may have gained the gene from his family member or relative and he could possibly be of the moody kind, and may not be able to cope with stress very easily. As known, a lot of disorders can be inherited from family members and there are certain findings that go to state that the disorder may be due to a gene found in the body and also the fact that if some other individual has the disorder in the family there are chances that another develops and it is a commonly believed thought. But this does not go to state that if one individual has the disorder so will all the members of the family. The next probable cause could be Chemical disturbances. Lately, psychiatrics have come to the conclusion that it is not the parents who are responsible for the disorder, but the brain of the individual. People who suffer from this disorder usually are said to have a disturbance of chemicals in the brain. (Akiskal; Bourgeois, p.22) There is a possibility that it is a faulty gene that is the main reason behind the imbalance of chemicals.

The concept that mental illness was caused by a disparity of chemicals in the brain erupted in the 1950s when nearly the used psychiatric drugs were exposed by probability to assuage the symptoms of definite mental illnesses. Recent studies have said to prove that this manic depression is the result of the lack of the neurotransmitter serotonin. This serotonin is supposed to be responsible for the moods. (Falloon; Hole, p.72) Lack of serotonin is said to lead to depression and a sudden increase or decrease may lead to bipolar disorders or manic depression. The selective serotonin reuptake inhibitors or the SSRI's are said to help in controlling the brain's serotonin levels and also are said to relive the individual under depression. But this also has ultimately resulted in various complex data and some of which are not really convincing. The brain is said to consist of various different neurotransmitters and neuromodulators and these are considered highly interconnected. In such a situation the antidepressant Wellbutrin or bupropion is said to have like no component that has a reaction on the serotonin and several studies have been conducted that stand to prove that this is no less effective than the other antidepressants. (Goldberg, p.38)

To take pictures of the living brain while it is working, and in order to study its structure and its activities, researchers employ new brain-imaging techniques. The brains of people with bipolar disorder may vary from the brains of healthy individuals is obvious from imaging studies. In those with bipolar disorder, two major areas of the brain contain 30% more cells that send signals to other brain cells, which are described in a study published in American Journal of Psychiatry. Considering the symptoms of bipolar disorder, this report's assumption that the extra signal-sending cells may lead to a kind of overstimulation seems meaningful. The brains of people with bipolar disorder may be different from the brains of healthy individuals is clear from imaging studies. Scientists will get a better understanding of the fundamental causes of the illness, as the differences are more clearly recognized and defined through research and may ultimately lead to prediction of the types treatment that are more effective. (Coryell; Keller, Endicott; Maser; Klerman, 727)

The negative thoughts that are connected with the depressive episodes of bipolar disorder are due to abnormalities in the cerebral cortex since it is concerned with the thought process. A neuroanatomical foundation to bipolar disorder has been established by Structural imaging studies. In particular, a decrease in the volume of grey matter in parts has the medial and orbital prefrontal cortices, ventral striatum and mesoisotemporal cortexan enlargement of the third and lateral ventricles. In depression, the metabolic rate and blood flow to these areas are also disturbed. A decrease in the number of neurons and glial cells and in layers II and III in the forebrain of depressed patients is partly owing to shortened brain volume. In bipolar disorder, these two layers have been confirmed to be important. (Weissman; Bruce; Leaf; Florio; Holzer, 35)

The familiarities a person has in life should not affect whether he or she develops the disorder or becomes ill again subsequently if genes or biology were the only factors that influences bipolar disorder. Compared to those who do not become ill, the level of these problems will usually be higher for those who become ill. Additional periods of ill health will again often be preceded by difficulties in the period leading up to ill health returning, once a person has received the initial diagnosis of bipolar disorder. This apparent relationship between the experiences of people and their subsequent problems were suggested as confusing, in the past. The truth that people were beginning to become unwell and their behavior was becoming responsible for creating difficulties in day-to-day life is just reflected in the associated arguments. (Akiskal; Bourgeois, 26)

The events that could be described as dependent and those as independent were distinguished by Researchers, working first in the area of depression and later looking at bipolar disorder. Dependent variables meant which the person caused and independent variables were which are not under the control of the person. To demonstrate this distinction, an instance can be given. A person losing his or job is a dependent event if it were the result of the person's increasingly erratic behavior on the part of the person concerned in the weeks leading up to an incident of illness. However, if the person who has put a satisfactory job performance has lost his job because of firm the person worked for was in the process of reducing its workforce for economic reasons, and then it would be an independent event. Independent life events seem to be more in periods of good health for an individual, or for comparison groups who do not become ill when this distinction is made by researchers between dependent and independent life events. A person's own behavior being affected by the initial stages of the illness cannot be the only reason, as the experiences people have do constitute to have a promising impact on their mental health. (Copeland, 34)

Therefore, it can be said that our mental state depends upon our physical, chemical, and electrical properties of the brain. Many psychologists like B.F. Skinner have stated that scientists could and should control the human behavior and also try and predict how the individual's mood or how his reaction would be in future or else this should be at least tried and maintained with the help of drugs. By accepting the fact that human moods, motivation and emotion are caused by neurochemical state of the brain and these drugs enable to make the condition of the brain as neutral. When we are going to stop using these and actually bring into consideration as to which kind of neurochemical states that we want for the people, it will bring a stop to this drug abuse. When it comes to considering the actual severity of the condition we realize that if we take proper treatment for the illness at an earlier stage we may be able to curtail it at an earlier stage itself, otherwise we may have situations where the disorder becomes severe that we may have to even hospitalize the individual. The chance of this individual to be more prone to this disorder is more. (Coryell; Keller, Endicott; Maser; Klerman, 725)

Treatment of Bipolar Disorder:

Bipolar disorder is a treatable and controllable illness even though there is no cure for it. Most people can be cured after a proper examination. People with bipolar disorder can be cured efficiently but under proper medication. Though cases of mania or depression may occur and need a special treatment a maintenance treatment with a mood stabilizer can reduce the severity for many people. There are certain psychosocial treatments like cognitive-behavioral therapy, interpersonal therapy, family therapy and psychoeducation, which help people to know the disease, and to develop skills to manage the strain that can cause severity. During different stages of the illness changes in the medicines or the doses and treatment methods are necessary. Lithium (Eskalith of Lithobid) and divalproex sodium (Depakote) are the main mood stabilizers, which are used during mediation. For people with severe bipolar disorder Lithium has been used for a long time as a first line treatment. Lithium proves effective for preventing further disorders and for treating after it had begun. (Coppen, 5) Lithium is acceptable for only some patients while for some other people it show a variety of side effects that make the treatment unwelcome. Since 1983, Depakote was used as an anticonvulsant, but it has been used for many cases of bipolar disorder from 1995. (Goldberg, 38)

For treating mania with few side effects, Depakote seems to be as effective as lithium although it may not be suitable for people with a history of liver problems. To treat mania, other anticonvulsant medications like carbamazepine (Tegretol) and topiramate Topamax), including lamotrigine (Lamictal) which are used. Antipsychotic medications may also be used intensely for treatment of mania. Olanzapine (Zyprexa), which is FDA approved for the treatment of acute mania is a class of Antipsychotic medications. Additional treatment with an antidepressant medication is required for people with bipolar disorder during depressive incidents. (Swartz; Frank, 16)