This paper examines bipolar disorder (BD) as a complex mental health condition affecting nearly six million American adults. It explores the neurobiological basis of BD, including differences in brain structure and biochemistry, as well as genetic and environmental triggers such as stress and trauma. The paper details the diagnostic categories defined by the DSM, distinguishes between manic and depressive episodes, and outlines evidence-based treatment approaches combining medication, psychoeducation, and psychosocial interventions. Emphasis is placed on long-term management strategies and prevention measures for both children and adults living with this lifelong condition.
Every human being is susceptible to mood changes, sometimes feeling happy and energetic, and other times feeling melancholic and miserable. However, a persistent feeling of sadness and hopelessness is a mood disorder known as depression, which is very common and requires medical attention. In the nineteenth century, Abraham Lincoln was so depressed that he described himself as "the most miserable man living" (Leonard & Jovinelly, 2012).
Leonard and Jovinelly go on to describe Bipolar Disease, also referred to as manic depressive illness, as the most complex type of depression. According to the National Institute of Mental Health (NIMH, 2015), nearly six million American adults suffer from this disorder. Bipolar Disease (BD) is a condition characterized by drastic changes in energy and moods which are often not related to prevailing circumstances. The condition makes a person's moods alternate between two extreme emotional states: mania and depression (Leonard & Jovinelly, 2012). Depression makes the person feel low and become withdrawn from others, while a manic state makes them extremely active—both physically and mentally. However, BD patients struggle with depressive symptoms more than they struggle with symptoms caused by elevations in their mood (Ketter, 2012).
This paper examines Bipolar Disorder in detail and explores its causes, symptoms, diagnosis, treatment, and prevention in both children and adults.
For a long time, scientists have tried to establish the causes of BD. Most recent brain imaging technology, including magnetic resonance imaging (MRI) and positron emission tomography (PET), has made it possible for doctors to monitor bipolar disease in the brain. They established that the structure and functioning of the brain of a BD patient differs from that of a non-affected person. For example, one MRI revealed similarities in brain development between children with multidimensional impairment and children with BD, which makes symptoms overlap and leads to mood swings (NIMH, 2015).
The prefrontal cortex, the brain structure used in decision-making and problem-solving, has been found to be smaller in BD patients and functions with reduced capacity. Preston and White (2009) also note that the brain's biochemistry plays a significant role in BD due to unstable transmission of nerve impulses.
Studies have found that BD is genetic. Children with a family history of BD are more likely to suffer from the condition than those whose siblings or parents have never had it. However, the National Institute of Mental Health (2015) notes that this does not mean all children with a family history of BD will acquire the condition when they grow up.
The most popular triggers of BD symptoms among adults are stress and lack of sleep. Strenuous activities that are not accompanied by adequate amounts of rest are likely to cause mood elevation. According to Preston and White (2009), trauma experienced in an individual's childhood hastens the onset of severe BD.
The following are the signs and symptoms of BD (White & Preston, 2009; NIMH, 2015):
The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides guidelines that help doctors diagnose the various types of BD. When a person's manic symptoms are very extreme with episodes lasting a whole week, they are diagnosed with Bipolar I Disorder (NIMH, 2015; DBSA, 2015). Bipolar II Disorder is characterized by less severe mania and depression. When a person is not acting normally but does not have either Bipolar I or II, they are diagnosed with Bipolar Disorder Not Otherwise Specified (BP-NOS). Milder episodes of BD characterized by depression and hypomania are classified as Cyclothymic Disorders (NIMH, 2015; DBSA, 2015).
NIMH also explains a more severe type of BD where a patient experiences more than four episodes of extreme depression and mania in one year. This is known as Rapid Cycling Bipolar Disorder and is rather prevalent in women.
The diagnosis of bipolar disorder involves a thorough evaluation of a patient's family history with tests and examinations to ascertain the type of BD suffered from. Brain scans enable doctors to identify the causes of mood changes by checking for tumors. NIMH and DBSA (2015) also state that BD may become worse if wrongly diagnosed or not treated. Patients that experience manic or depressive episodes should consult professionals, which will enable them to lead normal and productive lives.
There are two stages involved in the treatment of BD: acute treatment, which seeks to end ongoing depressive and manic episodes, and preventive treatment, which uses psychotherapy and medication to prevent recurrence of these episodes in the future (White & Preston, 2009). The main aim of treatment is to enable patients to become stable and lead normal lives while continually managing episodes that may occur, since BD is classified as a lifelong illness. Three strategies—education, medication, and psychotherapy—are used to treat the disease.
According to Preston and White (2009), medication is applied on a trial-and-error basis, and the medicine that proves successful is chosen for the patient. For mania, common drugs prescribed include Zyprexa (olanzapine), Depakote (divalproex), Seroquel (quetiapine), Trileptal (oxcarbazepine), and Tegretol and Equatro (carbamazepine). Frequently prescribed drugs for depression are Symbyax (fluoxetine and olanzapine), Seroquel (quetiapine), Lamictal (lamotrigine), and antidepressants such as Prozac (fluoxetine).
Miklowitz et al. (as cited in White & Preston, 2009) reported that "a recent large-scale study found that the average number of medications taken concurrently by bipolar patients is three to four." Leonard and Jovinelly (2012) refer to these as "medication cocktails"—combinations of medicines necessary to acclimate patients to the drugs and make the treatment effective.
BD patients must educate themselves on the causes, symptoms, diagnosis, treatment, and prevention of the disease. This enables them to get the right treatment and monitor episodes and symptoms with the help of doctors. Ignorance of the disease makes it difficult to identify the first phases of the condition which may occur in children or teenagers. Pregnant women should learn which medications are considered harmful for them and their infants, and they face different and unique challenges that can only be addressed by an experienced medical practitioner. Friends and family should also educate themselves in order to provide the support their loved ones need to conquer this condition and to live, learn, and work normally.
"Lifestyle and clinical preventive strategies"
Although there are no specific ways to prevent BD, there are some precautions one can take to prevent worsening of the condition. These include:
Bipolar Disease is a mental illness characterized by depression and mania, with mood changes different from the typical ups and downs most individuals experience. It is a cyclic disorder with alternating high and low moods which may negatively affect a patient's life if not diagnosed and treated. Doctors assess the various symptoms and categorize the condition into any of the five categories explained in this paper. Although classified as a lifelong illness, patients can undertake prevention measures to reduce the severity of symptoms and avoid relapse. Patients must also embrace recovery as a process and not just a one-time event.
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