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  Bipolar Disorder

Bipolar Disorder is a psychiatric condition that describes an extended pattern of behaviors that alternate between mania and clinical depression. Mania is also referred to as mixed states or hypomania. Clinical depression can also be depressed or euthymic mood. Moods can vary in degree and length. Bipolar disorder may involve extreme distress and disruption. There is a high risk of suicide in patients with bipolar disorder. Individuals with bipolar disorder can be high functioning and considered extremely creative during hypomania.

Bipolar Disorder
Bipolar Disorder


Symptoms

Symptoms depend on the phase or cycle the individual is experiencing. Bipolar disorder consists of elevated and depressive moods. The length and strength of the mood varies between patients. Switching from one mood to the other is referred to as cycling. Mood swings can result in impaired functioning or improved functioning depending on the direction of the cycle (manic or depressive) and the intensity of the mood (mild or severe). Changes in energy level, sleep patterns, social behavior, cognitive functioning and activity levels are common symptoms. Some patients have difficulty functioning during cycling to depressive moods.

There are three phases of bipolar disorder, depressive phase, hypomania phase and mixed states.

Symptoms of the depressive phase are anxiety, guilt, anger, isolation hopelessness, sleep or appetite irregularities, fatigue, loss of interest in daily life, irritability, and chronic pain without cause, thoughts of suicide, sadness and problems concentrating.

Depression that is severe can also present with symptoms of psychosis. Psychosis involves hallucinations, delusions and paranoid thoughts. Hallucinations can involve hearing, seeing or sensing the presence of people or things that are not there. Delusions are incorrect personal beliefs that are in contrast with the obvious and are unreasonable. Paranoid thoughts involve the belief that the individual is being persecuted, investigated or watched by some powerful being such as the government or fear of being abandoned.

Hypomania is a milder form of mania that does not become a state of psychosis. Symptoms of mania are similar to hypomania but without the same amount of energy or intensity. Symptoms of hypomania are energetic, confident, having numerous ‘new’ ideas and euphoria. The euphoria can quickly turn aggressive, if a patient feels they are being challenged. Hypomania dose not prevent an individual from being coherent or participating in daily activities.

Mixed state is the condition in which hypomania and clinical depression co-exist. In up to thirty percent of patients, the mixed state will occur as the total bipolar episode. Mixed states are possibly the most dangerous of mood disorders. Patients can have panic attacks, abuse illegal drugs and attempt suicide during the mixed state phase.

Dysphoric mania occurs when a manic episode also has depressive symptoms such as energy and anger that ranges from irritation to rage. Symptoms of dysphoric mania are auditory hallucinations, confustion, insomnia, persecution delustions, restlessness, racing thoughts and suicide ideation.

A patient who has four or more episodes per year is termed as rapid cycling. Ultra-ultra-rapid cycling occurs when the mood switches daily or possible hourly, though this type of cycling is less common.

Cognition is affected even when a patient is in remission. A patient can have disturbances in attention, visual memory and executive functioning.

Diagnosis

The DSM-IV-TR defines four categories of bipolar disorder: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified).

Bipolar disorder is a condition marked by change, from patient to patient and in each patient. The change in energy, thought, sleep, activity and mood are the biological markers of bipolar disorder. The categories are descriptions of a particular state of the patient, which can change to another category.

Bipolar I presents as one or more manic or mixed episodes. A depressive episode is not necessary for the diagnosis if Bipolar I. Most patients however, with Bipolar I do have depressive episodes.

Bipolar II is the most common form of this condition, but not consider less severe of the two distinctions. Bipolar II is diagnosed when one or more episodes of hypomania and one or more severe episodes of depression. This diagnosis is used to make a distinction between unipolar depression. A patient may be depressed; therefore it is important to determine if there has been an episode of hypomania.

Cyclothymia is a disorder in which a patient has frequent and mild mood swings between elation and depression. The depression does not meet the full requirements to be diagnoses as major depressive episodes. This is more of a low intensity cycling of depression and hypomania and is considered a form of bipolar disorder.

Individuals who obviously are experiencing mood swings, but do not meet the exact criteria for any of the subtypes of Bipolar disorder are diagnosed as Bipolar disorder, NOS (Not Otherwise Specified).

Accuracy, relevance and reliability are problems with symptoms in diagnosing bipolar disorder. These challenges often result in a misdiagnosis.

Because of the misdiagnosis of bipolar disorder, patients may not get the treatment the need when they need it.

Children with bipolar disorder have mixed cycling and rapid cycling of depression and hypomania. The cycling occurs quickly within the same day and even the same hour. Many times other disorders are diagnosed in children who actually have bipolar disorder. Some of the co-morbid conditions present in children with bipolar disorder are Tourette syndrome, depression, Attention-Deficit Hyperactive Disorder (ADHD), Oppositional Defiance Disorder (ODD) and schizophrenia.

Misdiagnosis, unfortunately leads to incorrect treatment. Incorrect treatment can cause mania, suicidal thoughts and suicide attempts. Suicidal thoughts are extremely concerning in children because of their energy, lack of control, maturity and impulsiveness.

Children who experience sever mania or mixed states may display psychosis. The psychosis can be negative or positive. Medications for children are available, but determining the right combination and dosage can be difficult. This difficulty is exacerbated by the reality that children grow quickly, weight, height, metabolism, hormones and brain structure changes. Children need to be monitored often and medication adjustments are usually required frequently.

Children with bipolar disorder may be bullies or victims of bullying. These children do not readily view their behavior as social problems in their environment. Parent, teachers and professionals are commonly confused by the cyclical behavior of children with bipolar disorder.

Cause

Bipolar disorder is caused by many factors acting together. There is no single specific cause of bipolar disorder. This disease can run in families, making hereditary factors significant. Current genetic research does not indicate a single bipolar gene, but possibly genes acting in conjunction.

Abnormalities in the brain have been detected which relate to anxiety and decreased tolerance of stress. A person who is not accustomed to stress may have their first major depressive episode after an significant loss or life changing event. On the other hand, a person who achieves or accomplishes something of significance may experience their first episode of hypomania.

The psychopathology and psychotherapeutic factors of bipolar disorder are important pieces in treating the core symptoms. The factors that need to be evaluated as part of the therapeutic process are determining a episode (whether depressive or hypomania) trigger, defining or noting symptoms that occur before a recurrent swing in mood and employing tactics the individual develops to maintain an even mood with normal affect.

Another theory of the cause of bipolar disorder is referred to as the kindling theory. This theory states that certain individuals are genetically predisposed to bipolar disorder. These individuals when experiencing a continuous parade of stressful events or life changes begin to have a lowered ability to regulate mood changes, which are normally healthy, non-severe and automatic. Eventually a mood cycle will develop that becomes recurrent. Not all individuals who develop bipolar disorder, however experience intense positive or negative events in life.

Bipolar disorder has been referred to as a multi-factorial illness because of the biological, psychological, environmental and genetic factors act in conjunction to cause the disease.

Treatment

Bipolar disorder can be managed successfully, but not completely cured. Treatment methods include pharmacological and psychotherapeutic methods. The most successful treatment has been a combination of medication and talk therapy. Prognosis is dependent on accurate diagnosis and appropriate intervention. Bipolar disorder however has a high instance of being misdiagnosed as another disorder or it is under diagnosed. This is a challenge for people seeking treatment. Bipolar disorder can be severely debilitating. In the world, it is the sixth leading cause of disability. Appropriate treatment enables patients to experience a good quality of life and function successfully.

Prognosis for the disease depend on the individual’s commitment to medication regimens, determining the correct medication and the right dosage for treatment, the individuals knowledge of the disorder, a competent medical doctor, a competent, connected therapist, a balanced, focused lifestyle and supportive family, partner or friends.

Regulating stress is of great help to a person with bipolar disorder. Stress can be controlled with regular exercise, regular sleep and meditation. Being extremely self aware of one’s moods and small changes the precipitate episodes also increases a good outcome.

The goals of treatment are to enable patients to achieve the highest level of functioning and to avoid relapses.

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