Bipolar Disorder Overview

Bipolar Disorder

The word bipolar means having to or relating to two poles or extremities. For the many millions diagnosed with bipolar disorder around the world, life is split between two different realities; elation and depression. For a person transitioning between these emotional states it can feel impossible to find the balance essential to lead a normal life. The consequences of bipolar can be serious and if a person doesn’t acquire correct treatment. The illness can have a severe impact on an individual’s education, employment, financial situations, family and relationships. Those diagnosed with bipolar will experience the illness in different ways. According to (Headspace, 2019) some people may only have one or two episodes and then never have another, whilst others will have several episodes close together on more regular intervals. For some diagnosed, they can go many years without symptoms and go on to live happy fulfilled lives.

Classification – Bipolar is classified as a mood disorder. The illness has been classified into four categories. The National Institute of Mental Health describes them as;

Bipolar I – (Health, 2016)Classified by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.

Bipolar II – (Health, 2016)defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.

Cyclothymic Disorder (also called cyclothymia) – (Health, 2016) defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Other Specified and Unspecified Bipolar and Related Disorders – (Health, 2016) defined by bipolar disorder symptoms that do not match the three categories listed above.

Bipolar I & II are among the most common of the four cateorgories to be diagnosed worldwide.

Type I see’s the individual experience extreme highs together with lows whilst Type II has briefer less extreme periods of elation, intermingled with long periods of depression. 

Severity – Type I’s extreme highs are known as manic episodes. These episodes can make the individuals emotional state vary from irritable to invincible. These eurphoric episodes exceed normal feelings of joy causing troubling symptoms, this can include; rapid speech, racing heart, sleeplessness, impulsive actions and risky behaviours. Without treatrment these episodes become more frequent, intense and may even take longer to subside. The depressed phase of bipolar disorder manifests in many ways. The individual may experience a low mood, a disinterest in their normal hobbies, changes in their appetite, a strong feeling of worthlessness, guilt, sleeping too much or not enough and sadly persistant thoughts of suicide are common among those diagnosed with bipolar disorder. Aside from emotional disturbances, Bipolar sufferers can also display psychotic symptoms such as; disorganised speech and behaviour, delusional, thoughts and during extreme episodes individuals may show signs of paranoia and hallucinations. These pyschotic symptoms can be attributed to an overabundance of of a nurotransmitter called dopamine.

History –From as early as the Greek philosopher Hippocrates, scholars, philosophers and early psychologists had continually debated over the relationship between a person being in a state of depression and a state of elation. Most research concluded that they were both separate psychiatric syndromes. (Brian Krans, 2018) It wasn’t until 1851 that an article entitled “la folie circulaire,” written by a French psychiatrist Jean-Pierre Falret appeared. The article title translates to ‘circular insanity’ and it described patients that had been observed interchanging between both states of severe depression and manic elation. The article is noted as being one of the very first evidential papers on bipolar disorder. Our understanding of the illness was significantly re-defined when German psychiatrist Emil Kraepelin moved away from the previous ideology that manic depressive mania (now known as bipolar) and dementia praecox (now classified as schizophrenia) were entirely separate biological diseases. His work “The Kraepelinian dichotomy of psychoses” described all variants of mood, explicitly in manic-depressive insanity, according to (Brittany L Mason, 2016) ‘this described the full spectrum of mood dysfunction which could be exhibited through single episodes of mania or depression’.

Research has come a long way and today scientists believe that it is the human brains intricate wiring system that contributes significantly to the illness. Healthy brains maintain strong connections between neurons, thanks to the brains continuous efforts to prune itself of unused information and faulty connections. Using MRI technology, scientists have discovered that this pruning system in the brain is disrupted in patients with bipolar disorder. That means that in these individuals the pathways created are almost impossible for neurons to follow, thus creating abnormal thoughts and behaviour patterns.

Risk Factors – Although many efforts have been made, science has still been unable to pinpoint bipolar disorder down to a single cause. Evidence suggests that there are both genetic and social factors that contribute to a person being diagnosed with the illness. The condition tends to run in families, however, may not present itself if certain environmental factors (i.e. substance abuse, violence, stress) don’t exacerbate the condition. There is no evidence of a bipolar genome. According to (Orygen, The National Center of Excellence in Youth Mental Health, 2019), there are a few risk factors that may increase a persons chance of being diagnosed with bipolar disorder such as; Genetic vulnerability, Physiological or biological factors including complications during gestation or birth, or abnormal regulation of daily (circadian) rhythms, Psychological factors including a childhood history of physical or sexual abuse, Stressful life events.

• Treatment – There are many different treatment options available to those that have been diagnosed with bipolar disorder. This is usually a combination of both medications and psychotherapy. Each treatment and therapy are individualised according to the severity of the diagnosis. Because bipolar disorder is a lifelong illness treatment is ongoing and patients unusually have a good prognosis if it is detected early enough. Other forms of treatment include:
•  Medications such as: Mood Stabilizers, Atypical antipsychotics, Antidepressants

• Psychotherapy options: Cognitive behavioural therapy (CBT), Family-focused therapy, Interpersonal and social rhythm therapy, Psychoeducation.

Bipolar can sometimes be difficult for practitioners to diagnose due to several factors such as;

• A combination of other mental health disorders complicating diagnosis
• Bipolar can only be diagnosed after the person has shown clear signs of mania and hypomania. Therefore, is if an individual present in a state of depression they may be misdiagnosed.
• The patient may have a dual diagnosis, where their substance abuse complicates the health professional’s ability to make a clear diagnosis. (Orygen, The National Center of Excellence in Youth Mental Health, 2019)

Stats of drugs & alcohol use associated – It is common amongst bipolar sufferers to self-medicate with drugs and alcohol to help ease their symptoms. Therefore, there is a high prevalence of substance abuse among individuals diagnosed with bipolar disorder, and health professional are required to treat not only the illness but the substance abuse as well. According to statistics presented by the American Journal of Managed Care: (Diagnosis, 2019)

• About 56 percent of individuals with bipolar who participated in a national study had experienced drug or alcohol addiction during their lifetime.
• Approximately 46 percent of that group had abused alcohol or were addicted to alcohol.
• About 41 percent had abused drugs or were addicted to drugs.
• Alcohol is the most commonly abused substance among bipolar individuals.

Conclusion – Ongoing research aimed at pin pointing the genetic factors that pre-dispose individuals to bipolar disorder is essential. Further research could also potentially allow health care professionals to help an individual pre-disposed to the illness to identify, control or eradicate certain environmental factors that may contribute to a bipolar diagnosis. Beyond treatment, people with bipolar disorder can benefit from simple lifestyle changes such as; regular exercise, good sleep habits and above all sobriety from drugs and alcohol. Today doctors work with bipolar patients on a case by case basis to administer a combination of treatments and therapies that allow those diagnosed to live to their fullest potential and lead normal happy lives.

References

• Brian Krans, K. C. (2018). Bipolar Disorder. Retrieved January 19, 2019, from Healthline: https://www.healthline.com/health/bipolar-disorder/history-bipolar#bipolar-disorder-today
• Brittany L Mason, E. S. (2016). Historical Unerpinnings Of Bipolar Disorder Diagnostic Criteria. Behavioural Sciences. Retrieved January 18, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039514/
• Diagnosis, D. (2019). Bipolar Disorder and Addiction. Retrieved January 19, 2019, from Dual Diagnosis: https://www.dualdiagnosis.org/bipolar-disorder-and-addiction/
• Headspace. (2019). Understanding Bipolar Disorder. (© headspace National Youth Mental Health Foundation Ltd 2019.) Retrieved January 26, 2019, from Headspace: https://headspace.org.au/young-people/what-is-bipolar-disorder-and-the-effects-on-mental-health/
• Health, N. I. (2016). Underpinning Bipolar. Retrieved January 19, 2019, from National Institure Mental Health: https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
• Janelle M. Caponigro, S. L. (2012-09-01). Bipolar Disorder: A Guide For The Newly Diagnosed. New Harbinger Publications. Retrieved January 19, 2019
• Mood Disorders Association of BC. (2017). Retrieved January 18, 2019, from Here to Help: https://www.heretohelp.bc.ca/factsheet/bipolar-disorder-what-causes-bipolar-disorder
• Orygen, The National Center of Excellence in Youth Mental Health. (2019). Bipolar Disorder. Retrieved January 25, 2019 , from Orygen: https://www.orygen.org.au/Education-Training/Resources-Training/Resources/Free/Reference-Library/Bipolar-Disorder
• Roger D. Weiss M.D.Margaret L. Griffin Ph.D.Monika E. Kolodziej Ph.D.Shelly F. Greenfield M.D., M. M. (2007). A Randomized Trial of Integrated Group Therapy Versus Group Drug Counseling for Patients With Bipolar Disorder and Substance Dependence. The American Journal Of Psychiatry. Retrieved January 18, 2019, from https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2007.164.1.100