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Bipolar is a serious mental chronic condition that may need a long-life treatment. People with this illness spend about three to five times more days in a mood depression episode then shift to mania episode. There are several types of bipolar disorder, and their diagnosis and treatment approaches are known to pose serious clinical problems. The illness has been identified as the sixth leading cause of disability and suicide cases, particularly in the developed places especially among the people between the age brackets of fifteen to forty-four years. Although the cause of bipolar is not apparent, neurological, environment and genetic factors are said to contribute to the occurrence of the illness significantly.
The first medical literature about bipolar disorder appeared in the 1850s when both mania and alternating melancholia appeared in a single condition. For some time, its diagnosis was referred as “manic-depressive disorder,” however, in 1980 the term was replaced by bipolar disorder after the release of the Diagnostic and Statistical Manual of Mental Disorders (Hirschfeld, 2015). The National Institution of Mental Habits, bipolar disorder is characterized by the occurrence of mood swings ranging from intense manic episodes and extreme depression lows (Chiu et al 2011). At other times, most patients have single or more depressive episodes. Bipolar disorder, which is also known as manic depression has been identified as a severe brain illness. It is normal for people with this condition to experience mood changes ranging from euphoric to despondent depression or irritable mania and each episode bookended by a euthymic state, which is a symptom-free period (Duffy et al. 2009). But, some patients experience milder symptoms that are can be identified using bipolar disorder challenging. The most commons symptom of bipolar disorder is depression and those with a severe type maybe unwell symptomatically nearly fifty percent of the time.
The mood swings experienced by patients vary from one individual to the other. In some cases, mild mania episodes can result in increased productivity and creativity while in other patients a manic episode may be severe that an individual would need urgent hospitalization or be committed under the Mental Health Act involuntarily. People who have this illness also go through cognitive challenges like limited focused attention and memory or experiencing occupational or relationships difficulties due to continuing problems resulting from past behavior. There is a 15% chance that bipolar disorder patients will most likely commit suicide than others from a universal population. Thus, bipolar disorders may be responsible for a quarter of all suicides s roughly ten to fifteen percent of people whose condition has not been treated can be expected to commit suicide. Research shows that early and accurate diagnosis of bipolar disorder may significantly decrease the mortality due to patients committing suicide.
Types of Bipolar Disorder
The first psychological expert to suspect that a person has this type of illness is mostly the general practitioners. Mania is the cardinal characteristic of the disorder, and the Psychiatrists use the condition’s severity to group the disorder among patients even though the most common symptom is depression.
Bipolar I Disorder
This type of bipolar is diagnosed after a patient experience one manic episode, which can occur when a person is as young as eighteen years, which is the average age that first mood disorder sets is experienced. But, the first onset of this condition is mostly diagnosed in people aged over sixty-five years (Viktorin et al. 2014). Many people suffering from this bipolar can function fully between the episodes; however, thirty percent of the affected people may be severely impaired while working hence resulting in reduced socioeconomic status, especially when experiencing recurrence episodes. The occurrence of the type of bipolar disorder is the same in both males and females.
Bipolar II Disorder
This type of bipolar disorder is identified in patient experiencing one episode of mania depressive and also a hypomanic incidence, yet have not had a full manic episode. The average age of people who may suffer this type of illness is in the mid-20s. 15% of the individuals with this type of bipolar experience dysfunction between several episodes and the reported clinical data show that female suffers from bipolar II disorder more than males (Chiu et al 2011). This fact may be associated with the idea that the suffering women are often tend to seek medical attention or treatment than men.
The disorder is identified after an adult has experienced many episodes of the sub-syndromal hypomanic and numerous episodes of depression in two years. Neither of these episodes meets full DSM-V diagnostic criteria for either depression or mania (Baldessarini et al. 2014). Mostly, in fifteen to fifty percent of people with this type of bipolar disorder, it is known to progress to Bipolar I or II.
This type of bipolar disorder is diagnosed after a patient experiences about four or more new episodes of mood swings including the mania, hypomania or major depression within one year. Reduced response to treatment programs and poor outcomes after treatment are related to the rapid moods cycling in the patients.
A “Mixed episode”
A “mixed episode is specified when a bipolar patient experiences depression and mania at the same time within or for more than one week (Hirschfeld, 2015). For instance, a patient reports feeling hopeless and having suicidal thoughts or sad when is experiencing a mixed episode. They may feel highly energized, but in the outward, they may seem distressed with significant changes in appetite and disturbed sleep patterns.
In the developed world, those people between the age brackets of fifteen to forty-four years, bipolar disorder has been identified as the sixth leading cause of disability. Recently, data analysis from the second U.S National Comorbidity Survey indicated that the rate of having bipolar disorder is similar in both males and females, ethnic groups, and different cultural backgrounds. A survey conducted by WHO in 2000 showed that the incidence and prevalence of the illness tend to be the same across the globe, but severity profoundly differs (Hirschfeld, 2015). In most cases, the standard age for bipolar disorder onset is seventeen to twenty-one years, and the condition can be very disabling. A study performed by WHO indicated that the suicide rates between the patients might be higher than in those with major depression and about 19% of people with bipolar disorder commit suicide.
The Cause of Bipolar
What causes bipolar disorder is said to be multifactor since there is no single identified cause. The cause can be an environmental, neurochemical or genetic factor.
Bipolar disorder can “run in families” as research has found out that half the people with the disorder have a member of the family who experiences mood swings or depression. Those children whose parent have bipolar disorder has a 15% to 25% of experiencing mood disorders. If an individual has a non-identical twin with bipolar disorder, it is likely that they might have the same condition while that with an identical twin is at a bigger risk of having bipolar disorder than a non-identical one (Hirschfeld, 2015). The condition is often inheritable, and 80% of the cause of the disorder accounts for genetic factors. If one parent has bipolar disorder, one or more of the children has a 10% chance of suffering from the condition, and when both parents are bipolar, their children have a 40% of having the disorder. But, the fact that one family member has the bipolar condition, it does not mean that other members will also have the same illness.
Dopamine, noradrenaline, and serotonin as some of the brain chemicals associated with bipolar disorder. For instance, both serotonin and norepinephrine are linked with mood disorder like depression as the chemicals are connected with many body functions including eating and sexual activities, sleep patterns, memory, and learning (Strakowski et al 2012). Any biochemical imbalance occurrence in brain activity can result in mood swings; thus, abnormal serotonin concentration in the brain causes bipolar disorder as it makes it vulnerable to episodes. The stress hormone can alter how gene function, which allows brain conditions like bipolar disorder.
If a major life event affects a certain person, it is possible that it can trigger a mood episode that looks like bipolar disorder genetically. Although it is not clear, changing health habits, abusing drugs or alcohol, and hormonal problems are known to trigger mood swings. Substance abuse is not associated with causing the illness; but there is change of that it can deteriorate the condition or interfere with the recovery process as they may induce a more severe episode (Laursen, 2011). Even though a stressful experience is often linked with the onset of the illness, it is unlikely that stress can lead to bipolar disorder — however, the rapid increase of stress trigger mania episode and depression.
Identifying Patients Suffering from Bipolar Disorder
For a patient to be diagnosed with bipolar disorder, it can take a period of time to identify the condition due to its cyclic nature. Both in the U.K and the U.S., the average delay from the symptoms beginning of the disorder to correct diagnosis of the condition is approximately ten years. The relatively infrequent swings to mania and mild symptoms to mania are linked with contributing to the diagnosis delay in patients. The patients suspected to have this mental illness should be referred to Psychiatrist or admitted to mental health program, which mostly depends on the severity of the disorder’s symptoms and the clinical suspicion of the accuracy degree (Laursen, 2011). It is likely for bipolar disorder to affect children although it is difficult to diagnose. Bipolar disorder in children tends to change between mood swings of irritability, and happiness, which depends on the development level and occasion.
Bipolar Disorder Diagnosis
A formal bipolar disorder diagnosis can only be performed by a Psychiatrist. The diagnosis depends on the experiences reported by the patient as well as those from the close family members and friends or co-workers. Besides, a social worker, nurse or psychiatrist among other experts can make secondary observations to make a clinical assessment (Gammn et al. 2010). But, there exist several procedures that an expert can use to diagnose the disorder. The criteria accounts on both the occurrence and duration of particular symptoms and signs of the illness. The most common methods of diagnosing the condition are the DSM-IV-TR and ICD-10. ICD-10 is widely used I Europe while DSM approaches are used in the U.S and other countries and prevail in most research studies (Chiu et al 2011). An initial assessment of the condition include a physician performing a physical exam on a patient, and due to the lack of biological tests that can confirm the disorder, it is possible to carry out various tests to exclude certain illnesses like HIV infection and hyper or hypothyroidism among others. Besides, while a CT scan is used to rule out brain lesions, the EEG is for epilepsy.
Managing Patients Diagnosed with Bipolar Disorder
While a Psychiatrist leads patient management, family and friends are offering a crucial support system and network for people diagnosed with mental illness, mostly in rural areas where it is difficult to access a mental health facility or services (Phillips et al. 2013). The primary care team of the patient liaises between the social services and the psychiatric multi-disciplinary team and the support system to provide maximum care. General Practitioners are responsible for giving repeat prescriptions and follow-ups to ensure that the patients adhere to the medication for effective treatment (Duffy et al. 2009). It is essential to monitor the patient since most of the medicines for bipolar disorder have numerous adverse effects including the risk of suffering from cardiovascular disease. Most of the patients also struggle with alcoholism, which can complicate the treatment process or patient mood’s assessment hence increase the risk of committing or attempting suicide.
Although self-management for patients with this illness and engagement with family or close friends is essential, medicines used for the condition are the mainstay of treatment. It is also essential to offer public education regarding bipolar disorder to the patients and their support network to help minimize any confusion between the condition and any other form of mental illnesses like schizophrenia as well as reduce stigmatization in the society (Ventimiglia et al. 2009). Relatively, ensuring that information provided to the involved people is understood and is presented culturally and appropriately is also a significant part of managing bipolar disorder patients. If patients gains a better understanding of the disorder, they would be in a better position to recognize when an episode is about to occur hence be ready to manage it appropriately.
Further, it is possible for the patients to minimize the rate at which the episodes or mood swings occur by ensuring that they maintain their daily routine including repeat medications, physical exercises, regular sleep patterns, and avoiding alcohol intake (Phillips et al. 2013). If a patient sustains a daily habit of various activities, it is likely that the chances of new mood episodes occurring will be significantly reduced (Duffy et al. 2009). People managing the patients should understand that treatment without adhering to medications is a great risk factor that can cause them to relapse. Thus, ongoing public education about the disorder helps in increasing the likelihood of having the patients adhere to the treatment plan.
Talk therapy and psychotherapy are some of the active treatment methods for the disorder. These approaches are known to offer guidance, education, and support needed the people managing bipolar disorder (Ventimiglia et al. 2009). Some of the psychotherapy include the Cognitive Behavioral Therapy that helps bipolar disorder patients learn to adjust the negative and harmful behavior and thoughts. The second form of psychotherapy is the Family-focused Therapy — this form of approach help in enhancing the coping strategies of the family like how to recognize a new episode or improve communication between them (Ventimiglia et al. 2009). Third, interpersonal and social rhythm therapy helps the patients improve their relationships with others as well as maintain their daily patterns. Besides, the psycho-education program is known to teach about the disorder and its treatment process. It helps the patients and their support network to recognize relapse signs to seek treatment as early as possible before the occurrence of a full-blown episode.
Studies have indicated that combining both psychological treatment and medication achieves the best results for bipolar treatment, especially in children. Psychosocial therapy helps in managing the symptoms and lessen their effects regardless of whether the patient is on medication or not (Gammn et al. 2010). When the psychosocial treatment is working well, it is possible to lower the medication dosage taken to treat the condition. Some types of psychosocial treatment include a self-help support group, talk therapy, education intervention, psychodynamic therapy, family, and cognitive therapy (Strakowski et al. 2012). Patient tend to do better, if they understand how to get their life to avoid events that can result in mood swings, recognize the triggers and accept the support network hence the psychosocial therapy is regarded as necessary during the recovery process.
A comprehensive psychosocial therapy treatment process combining both the psychosocial and medication helps in reducing family conflicts while improving performance and productivity. The self-help measures like proper nutrition, regular physical exercises and sleep, and taking part in support groups help in reducing and managing stress, which is also significant in the treatment process (Gammn et al. 2010). Family and individual therapy help the patient learn useful techniques to solve conflicts and problems, manage anger issues, and improve their communication with other people. Such coping methods can significantly help the most depressed patients who are even considering committing suicide.
Interpersonal and social-rhythm, family-focused, and cognitive-behavioral therapy have been proven helpful for people with bipolar disorder (Viktorin et al. 2014). The CBT help patient recognizes the mood triggers like negative thoughts and unwanted behaviors as well as offer strategies that they can utilize to change their current thoughts or actions. Its main focus is on teaching people with bipolar how to avoid stressful thoughts or situations that can trigger mood swings (Baldessarini et al. 2014). On the other hand, FFT focuses on promoting ways to solve family problems and conflicts to minimize the highly charged emotions and stressful situations. Contrary, the interpersonal therapy is mostly meant for bipolar disorder patients who are under mood stabilizers, and it is based on some of the social rhythms, interpersonal disruptions and problems make the patients more vulnerable to new mood episodes. Thus, the therapy is primarily focused on minimizing the potential triggers.
Side Effects of Antidepressant Drug
It is advisable to ask the Psychiatrist prescribing the medications about the side effects. Over the last few years, treatment for bipolar disorder has significantly improved hence some of the invented medications present fewer, tolerable or no side effects than the previous ones. But, every individual reacts differently to medications as some patients may not experience any side effects until the medication goes on for some time (Andreescu et al. 2008). Patients undergoing bipolar disorder treatment should adhere to the medication plan or otherwise consult their doctors first for further advice. If a patient suddenly stops taking medication, it could result in a “rebound” or worsen the symptoms. Other adverse side effects of the medication include withdrawal or restless of the patient.
Bipolar disorder is a severe mental disorder with significant adverse impact on patients and people in their lives. Since are no known exact diagnosis or treatment of the illness, the two tend to pose several clinical challenges from identifying the condition to treating it. While managing the condition, it is essential that both the psychosocial and pharmacological treatments are delivered collectively to achieve the best possible results.
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