Bipolar Disorder Essay, Research Paper
Bipolar Disorder:Wellness Paper
The aspect of bipolar disorder has been a mystery since
the 16th century. It was rumored that Vincent Van Gough
suffered from bipolar disorder. There is a large group of
people suffering from this disorder, however there are no
causes or cures for it. Bipolar disorder impairs one?s
ability to obtain and sustain social and occupational
success. The journey for even a cause will continue for
many years to come. Affective disorders are characterized
by a depressed mood, an elevated mood or an alternation of
depressed and elevated moods. The basic term for the
manic-depressive illness is Bipolar disorder. There are
milder and heavier forms of each. A patient can be placed
in two different categories of this disorder: dysthymic
disorder and cyclothymic disorder depending on how strong
the symptoms are with each individual patient. ?The use of
the term primary affective disorder refers to the
individuals who had no previous psychiatric disorders or
else only episodes of mania or depression. Secondary
affective disorder refers to patients with preexisting
psychiatric illness other than depression or mania?
(Goodwin, Guze. 1989, p.7 ).
Bipolar affective disorder affects around 1% or three
million people in the United States. Both males and females
can become a victim of this disorder. ?Bipolar disorder
involves episodes of mania and depression. The manic
episodes are characterized by elevated or irritable mood,
increased energy, decreased need for sleep, poor judgment
and insight, and often reckless or irresponsible behavior?
(Hollandsworth, Jr. 1990 ).
These episodes can alternate with heavy depressions
characterized with complete sadness with almost an inability
to move, hopelessness, and agitation in appetite, sleep and
makes is hard to concentrate while driving.
?Bipolar disorder is diagnosed if an episode of mania occurs
whether depression has been diagnosed or not? (Goodwin,
Guze, 1989, p 11). The common symptoms for a manic
depressive episode consist of elated, expansive, irritable
or hyperactive mood. Their speech becomes hard to
understand, they have ideas racing through their head, they
have incredibly high self esteem, they rarely feel tired and
they are often involved in activities that could possibly
harm them. ?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
participate in developmental delays, marital and family
problems, loss of jobs and an inability to keep a steady
income. Many bipolar patients report that the depressions
are longer and come more frequent when the individual gets
older. Schizophrenia has commonly been diagnosed to
patients suffering from bipolar and can be misdiagnosed for
most of their lives. The speech patterns help doctors to see
a difference between the two disorders. ?The first signs or
symptoms of Bipolar disorder usually occur between the ages
of 20 and 30 years of age, and then are seen again in women
in their 40?s. A typical bipolar patient will most likely
experience eight to ten episodes in their lifetime. However,
there are those who have rapid cycling and can experience
more episodes of mania and depression that succeed each
other without a period of remission? (DSM III-R). The three
stages of mania begin with hypomania, this is where the
patients are often very energetic , hyper and assertive. The
hypomania state has shown doctors that a person suffering
from bipolar almost feels addicted to their mania.
Hypomania progresses into mania as the transition is marked
by loss of judgment. Often, a paranoid or irritable
character begins to manifest. The third stage of mania is
becomes clear when the patient experiences delusions with
often paranoid themes. Speech is generally rapid and
behavior manifests with hyperactivity and sometimes
assaultiveness.
When both manic and depressive symptoms occur at the
same time it is called a mixed episode. These people are a
special risk because of the combination of hopelessness,
agitation and anxiety make 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 very dysphoric, depressed and
unhappy yet exhibit the energy associated with mania. Rapid
cycling mania is another symptom 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 experiences
more episodes of mania and depression than bipolar.
Lithium has been the primary treatment of bipolar
disorder since 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,
there are up to 40% of bipolar patients who are either
unresponsive to lithium or who cannot tolerate the side
effects. Some of the side effects include thirst, weight
gain, nausea, diarrhea, and edema. Patients who are
unresponsive to lithium treatment are often those who
experience dysphoric mania, mixed states, or rapid cycling
bipolar disorder (those patients who experience at least
four distinct episodes within one month period). Among the
problems associated with lithium includes the fact the
long-term lithium treatment has been associated with
decreased thyroid functioning in patients with bipolar
disorder. Preliminary evidence also suggest that
hypothyroidism may actually lead to rapid-cycling (Bauer et
al., 1990). ?Another problem associated with the use of
lithium is its use by pregnant women. 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 can become unresponsive to it in the
past. The American Psychiatric Association’s guidelines
suggest the next line of to be anticonvulsant 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 a problem
with 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.
In addition to the medical treatments mentioned for
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 depresses patients. Patients
are 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 morning bright light
treatment of patients with seasonal affective disorder,
including 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. 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 mood disorders. 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).
According to Dr. John Graves, spokesperson for The
National Depressive and Manic Depressive Association have
called attention to the value of support groups, challenging
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, the need for education and support for the
interpersonal difficulties that arise during the course of
the disorder.
Bauer, M.S., Kurtz, J.W., Rubin, L.B., and Marcus, J.G.
(1994). Mood and Behavioral effects of four-week light
treatment in winter depressives and controls. Journal of
Psychiatric Research. 28, 2: 135-145.
Gasperini, M., Gatti, F., Bellini, L., Anniverno, R.,
Smeralsi,E., (1992). Perspectives in clinical
psychopharmacology ofamitriptyline and fluvoxamine.
Pharmacopsychiatry. 26:186-192.
Goodwin, F.K., and Jamison, K.R. (1990). Manic Depressive
Illness. New York: Oxford University Press.
Goodwin, Donald W. and Guze, Samuel B. (1989). Psychiatric
Diagnosis. Fourth Ed. Oxford University. p.7.
Hirschfeld, R.M. (1995). Recent Developments in Clinical
Aspects of Bipolar Disorder. The Decade of the Brain.
NationalAlliance for the Mentally Ill. Winter. Vol. VI.
Issue II.
Hollandsworth, James G. (1990). The Physiology of
Psychological Disorders. Plenem Press. New York and London.
P.111.
Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of
Bipolar Disorder:How Far Have We Come? Psychopharmacology
Bulletin.30(1): 27-38.
Jacobson, S.J., Jones, K., Ceolin, L., Kaur, P., Sahn, D.,
Donnerfeld, A.E., Rieder, M., Santelli, R., Smythe, J.,
Patuszuk, A., Einarson, T., and Koren, G., (1992).
Prospective multicenter study of pregnancy outcome after
lithium exposure during the first trimester.
Laricet. 339: 530-533.
Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A. and
Hirschfeld, R.M. (1994). The National Depressive and Manic
Depressive Association (DMDA) Survey of Bipolar Members.
Affective Disorders. 31:
pp.281-294.
Weisman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P.,
Holzer, C. (1991). Psychiatric Disorders in America.
Affective Disorders. Free Press.
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