Bipolar Disorder

Abstract This paper will provide an overview of bipolar disorder, as currently described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). It will explain how the symptoms of the disorder may manifest themselves, different treatment options, and evolving research in the field.

Bipolar disorder remains a complex mental disease that can often mispresent in its features to clinicians, depending on the type and stage of the mood cycle the patient is in, so a clearer understanding by psychiatric clinicians, sufferers, and family members is needed. Bipolar Disorder: An Overview Bipolar disorder was once more commonly known as manic depression. It is classified as a mood disorder, under the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

A variety of types exist of the disorder, but its predominant feature is rapid shifts of mood. The most common forms of the disorder, bipolar I and II affect an estimated 2% of the world’s population, although the disease may be underdiagnosed (Geddes & Miklowitz, 2013). The disorder can present very differently, depending on what phase the individual is currently in, and thus diagnosis may be difficult, particularly for a clinician who is not well-acquainted with the patient.

Symptoms of Bipolar Disorder According to the National Institute of Mental Health (NIMH), the most notable feature of bipolar disorder its shifts of abnormally intense emotions. During a manic episode, the sufferer may seem extremely happy, to the point of elation, have difficulty sleeping and eating, and seem to have abnormal levels of energy. Their thoughts, movements, and speech are rapid (“Bipolar Disorder,” 2016).

They may also take uncharacteristic risks, like spending money, or having sex with people they would not otherwise be tempted to have sex with (“Bipolar Disorder,” 2016). Many people with the disorder may not experience manic episodes, at least not initially, as unpleasant, given that they may feel more productive and accomplished. In fact, there is some evidence that historically, some very creative people may have suffered from bipolar disorder, before the disease was commonly diagnosed and well-known.

The depressive phase of the disorder, however, is much more rarely experienced as pleasant by sufferers. It contains many of the standard features associated with major, unipolar depression, such as slowed-down thought and speech, abnormally low levels of energy, and irregular sleep and eating habits (either too much or too little). The subject may have poor concentration, a preoccupation with death, and a feeling of hopelessness versus the feeling of invincibility characteristic of mania (“Bipolar Disorder,” 2016).

It is rarer, but some patients experience mixed mood episodes, in which they may feel depressed but abnormally “buzzed” and energized (“Bipolar Disorder,” 2016). These mood episodes are still characterized by abnormally intense feelings and disordered thinking that paints the world in a vastly worse or better light than a non-disorder person would likely see it.

Diagnosis: Different Forms of the Disorder The most recent edition of the DSM contains five separate potential classifications for bipolar disorder, including bipolar I, perhaps the best-known variety of the disorder, in which there are manic episodes lasting at least 7 days, or manic episodes with symptoms severe enough to warrant immediate psychiatric care (“Bipolar Disorder,” 2016). Depressive moods are of similarly long duration, usually as long as two weeks (“Bipolar Disorder,” 2016).

In bipolar II, there is a cycling between hypomanic (more mild forms of mania) and mild depression (but not severe enough to be characterized as a fully depressive episode (Purse, 2018; (“Bipolar Disorder,” 2016). Cyclothymic disorder is characterized by alternating hypomanic and depressive symptoms lasting for at least 2 years but do not meet the full requirements for either condition (“Bipolar Disorder,” 2016).

There are also diagnoses for substance-induced bipolarity (in which the symptoms have been triggered by the use of an illegal drug, for instance) and bipolar disorder associated with another medical condition although it is not the primary feature (“Substance Abuse Treatment,” 2005). Similarly, there are diagnostic options for bipolar disorder not otherwise classified. Treatment for Bipolar Disorder There is no one-size-fits-all approach to treating bipolar disorder.

However, while some mood disorders such as depression may be treated with a combination of drugs and therapy, or with therapy alone, in almost all instances, some form of drug treatment is used to stabilize the patient’s moods, even if therapy is also used in conjunction. According to Geddes & Miklowitz (2013), the major breakthrough in treating bipolar disorder with pharmacology occurred in the 1970s with the use of lithium and chlorpromazine.

Anti-epileptics such as valproate and carbamazepine were commonly used in in the 1980s and 1990s as a way of stabilizing mood (Geddes & Miklowitz, 2013). While these pharmacological approaches were found to be useful for some patients, not all patients responded equally well. Additionally, there were physical side effects which posed varying degrees of risk for these classes of drugs, such as renal failure in the case of lithium.

Lithium still remains the preferred treatment for bipolar disorder, however, and has been found to decrease the risk of suicidality as much as 50% (Geddes & Miklowitz, 2013). Today, there has been a trend in favor of using second-generation antipsychotics to control manic phases, but this is controversial, although one meta-analysis “found substantial and clinically important differences in terms of both efficacy and tolerability between agents. Antipsychotic drugs seem to be better than anticonvulsants and lithium in the treatment of manic episodes” (Geddes & Miklowitz, 2013, p.2).

It should be noted, however, that atypical antipsychotics carry considerable risks and side effects, and while they have been found effective for short-term clinical use to help patients come down from manic episodes, their efficacy must be once again weighed against their potential long-term side effects, and for extended use in treating the disorder as a whole lithium and its derivations are still often favored.

For treating the depressive phase of the disorder, antidepressants have not been found to be substantially more effective than a placebo and atypical antipsychotics have yielded mixed results and also have substantial side effects that many patients find unpleasant or debilitating such as weight gain (Geddes & Miklowitz, 2013). Regardless of the evolving research on pharmacology, the fact that such medication is recommended as a standard course of treatment does not mean that bipolar patients cannot benefit from standard talk therapy in addition to such treatments (Geddes & Miklowitz, 2013).

Biological, Social, and Demographic Causes According to Gavin (2017),.