Bipolar Disorder

Three percent of the general population in this country (CME) will wake up not knowing if they will spend the day in a euphoric blissful state, a balanced reasonable emotional state, or if they will face crippling depression rendering them barely able to get out of bed. Bipolar Disorder has various severe symptoms and causes that if treated properly can be minimized, allowing for a productive life style. To reach this goal it is important to recognize the symptoms, find the causes, and produce effective treatments.

Symptoms of bipolar disorder can be, at times illusive, deceiving and at other times promenade and unmistakable. Bipolar disorder is a common, recurrent, severe psychiatric illness that affects an individual’s mood, behavior and ability to think clearly (CME). This disorder typically develops in late adolescence or early adulthood, but it is not uncommon for children to have the illness as well. The condition has a high rate of recurrence and if left untreated, there is approximately a fifteen percent risk of death by suicide. (Neurochemistry pg 273)

The proper diagnosis of Bipolar I and Bipolar II is important to elicit proper treatment. A person with Bipolar I disorder experiences euphoric highs, and crippling emotional lows. At times these two distinct states can happen at once, causing what is known as a mixed state. In a mixed state the patience will experience both the highs and lows at the same time. Racing negative thoughts, increase agitation, and insomnia become prevalent (NIHMI).

Bipolar II however has similar but less severe symptoms. The patient will have the emotional mood swings, but has a tendency to experience depression and milder symptoms of mania, called hypomania. Not complicated by psychotic symptoms, the hippomanic state in Bipolar II is additionally not as debilitating as Bipolar I.

An accurate diagnosis of Bipolar disorder often requires a manic episode to occur, otherwise it will often be misdiagnosed as depression. (SYNERGY) This is because the psychologist is observing only the depressive lows of the patient, and is oblivious to the not-as-common manic states. This could lead to treatment that may actually stimulate a mixed state in a patient. (SYNERGY)

Causes of these symptoms are attributed largely to genetics and psychological difficulty. Bipolar disorder, among all psychiatric illnesses, may have the greatest genetic contribution. If an individual has a parent with bipolar disorder, the chance that the individual’s child will have bipolar disorder is about nine-fold greater than in the general population (mental 2), with the risk rising from about 1% to about 10%. The inheritability of this illness is estimated to be anywhere from 50% to 80%.( CME). The concordance rate for monozygotic (identical) twins is 43%; whereas it is only 6% for dizygotic (non-identical) twins. (Am J Psychiatry 161)

Due to the rate of monozygotic twins isn’t 100% suggests that environmental or psychological factors likely play a role in causation (Am J Psychiatry 161). It has been found the psychological difficulty can trigger mania in patients. These difficulties can included giving birth, sleep deprivation and major stressful life events. (Bipolar 122)

Magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI) are technologies that may offer more information to help treat Bipolar disorder. There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. By further understanding the causes of Bipolar disorder, the more effective the treatments will become. (NIHMI)

Problems Associated with Bipolar are many, and are highly common. (J Clin Psychiatry 65) Some of the more common disorders that co-occur with bipolar disorder are anxiety, substance use and conduct disorders. (J Clin Psychiatry 65) Some other mental disorders include alcoholism, drug addiction, Anorexia Nervosa, Bulimia Nervosa, Attention-Deficit Hyperactivity Disorder, Panic Disorder, and Social Phobia. (Internet) Despite the difficulties that face patience’s with Bipolar disorder, usually treatment results in a dramatic decrease in suffering, and causes an 8-fold reduction in suicide risk. (Internet)

The clear evidence that a genetic as well as a physiological link to the causes of Bipolar disorder means that obtaining an effective treatment will subdue the symptoms. Although there is no cure for bipolar disorder, with proper treatment, most are able to control the occurrences and severity of episodes (Practice 2) Research has shown that the most effective treatment is a combination of supportive psychotherapy, psycho education, and the use of a mood-stabilizer. (Internet)

Some mood stabilizers commonly used are Lithium and Divalproex are among other stabilizers. (Mental 2) Studies conducted over 25 years ago consistently reported lithium to be more effective than placebo with regard to the proportion of patients who did not relapse (Practice 32). Divalproex was superior to placebo on rate of early termination for any mood episode (24% versus 38%, respectively), early termination for depression (6% versus16%), and termination due to failure to adhere to protocol, undercurrent illness or administrative reasons (16% versus 25%). (Practice 33)

Psychotherapy is used in bipolar disorder to help people cope with this illness. However, psychotherapy does not change the symptoms themselves; medication appears to be required for that. (SYNERGY) By attacking both the genetic problems via medication, and managing environmental and psychological factors via psychotherapy, the patience is more likely to lead a normal life style.

Most people with bipolar disorder-even those with the most severe forms-can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. (NIHMI) Carefully examining the symptoms and classifying between Bipolar I and Bipolar II as other mood disorders like depression is important to properly treating a patient. Studying the cause of these symptoms will reveal better treatments. We know that the disorder is largely genetic; therefore we know to look to biological treatments such as mood stabilizing medications. Perhaps metal disorders will never be erased from society, but with strides toward understanding symptoms, causes, and finding more efficient treatments those that suffer from them will be able to lead more complete fulfilling lives.

© Joshua Keyes 2005

Works Cited

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