Bipolar Disorder Research Paper
Bipolar Disorder
By Elliott Subervi
Bipolar Disorder “Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and abnormally depressed states for short, or significant periods of time; in a way that interferes with functioning .(web,Md) Bipolar disorder has been estimated to affect more than 5 million Americans—about 3 out of every 100 adults. [2] It affects people without regard to age, race, ethnicity, gender, education or occupation. Not everyone 's symptoms are the same and there is no blood test to confirm the disorder. Scientists believe that bipolar disorder may be caused when chemicals in the brain are out of balance. Bipolar disorder can look like depression. Distinguishing the illness …show more content…
is tricky, even for mental health professionals.
What makes bipolar disorder different is that in addition to depression, a person also experiences the "highs" of a manic phase. Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyed activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation.[3] In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features. Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person 's speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them.
They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen", are "on a special mission", or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood. [4] Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose.
Bipolar patients also go through manic and hypomanic stages at irregular times. In order to be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM) a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required. According to the National Institute of Mental Health, "A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present." [5] Hypomania is generally a less extreme state than mania, and people in the hypomanic phase generally experience fewer symptoms of mania than those in a full-blown manic episode. During an episode, one might feel an uncontrollable impulse to laugh at things he or she does not normally find funny. The duration is usually also shorter than in mania. This is often a very "artistic" state of the disorder, in which a flight of ideas, extremely creative thinking, and an increase in energy can occur.
There is no clear consensus as to how many types of bipolar disorder exist. [14] In DSMIV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists four types of mood disorders which fit into the bipolar categories: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified). In Bipolar I disorder, an individual has experienced one or more manic episodes with or without major depressive episodes. For a diagnosis of Bipolar I disorder according to the DSMIV-TR, one or more manic or mixed episodes are required. A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs. Bipolar II disorder is characterized by hypomanic episodes rather than actual manic episodes, as well as at least one major depressive episode. There has never been a manic episode or a mixed episode. Hypomanic episodes do not go to the full extremes of mania (i.e. do not usually cause severe social or occupational impairment, and without psychosis), and this can make Bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression.
For both disorders, there are a number of specifiers that indicate the presentation and course of the disorder, including "chronic", "rapid cycling", "catatonic" and "melancholic". Cyclothymia involves a presence or history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. Bipolar Disorder Not Otherwise Specified is a catch-all diagnosis that is used to indicate bipolar illness that does not fit into the other diagnostic categories.
If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified).
Treatment:
There are a number of pharmacological and psychotherapeutic techniques used for treating Bipolar Disorder. Individuals may use self-help and pursue a personal recovery journey. Hospitalization may occur, especially with manic episodes. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur.[73] Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment and patient-led support groups. [74] Mood stabilizing medications and psychotherapy that is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing prodromal symptoms before full-blown recurrence, and, practicing the factors that lead to maintenance of remission[86] Cognitive behavioral therapy, family-focused therapy, and psycho-education have the most evidence for efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and cognitive behavioral therapy appear the most effective in regard to residual depressive symptoms. Most studies have been based only on bipolar I, however, and treatment during the acute phase can be a particular challenge.[87] Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a therapeutic alliance in support of recovery.[88] For many individuals with bipolar disorder a good prognosis results from good treatment, which, in turn, results from an accurate diagnosis. Because bipolar disorder continues to have a high rate of both under-diagnosis and misdiagnosis, it is often difficult for individuals with the condition to receive timely and competent treatment. Bipolar disorder can be a severely disabling medical condition. However, many individuals with bipolar disorder can live full and satisfying lives. Quite often, medication is needed to enable this. Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes. .
Ultimately one 's prognosis depends on many factors, several of which may, in fact, be under the individual 's control, these may include: the right medicines; the right dose of each; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive and warm therapist; a supportive family or significant other; adequate health insurance; secure finances and housing, and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times.
There are obviously other factors that lead to a good prognosis as well, such as being very aware of small changes in one 's energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one 's doctor for how to manage subtle changes that might indicate the beginning of a mood swing.
Some people find that keeping a log of their moods can assist them in predicting changes.[89]” Although having a bipolar disorder can be crippling in many ways, the mania aspects of the disorder have been shown to give patients an elevated goal setting mind set and creative though process. Some historians believe that Vincent van Gogh had a bipolar disorder and perhaps if he did maybe his manic stages spawned his creative, meticulous painting style and moods expressed through his …show more content…
work.
Medications Used to Treat Bipolar Disorder:
· Lithium. Lithium (Lithobid, others) is effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder and has been used for many years. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth and digestive issues.
· Anticonvulsants. These mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Depending on the medication you take, side effects can vary. Common side effects include weight gain, dizziness and drowsiness. Rarely, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.
· Antipsychotics. Certain antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don 't benefit from anticonvulsants. The only antipsychotic that 's specifically approved by the U.S. Food and Drug Administration (FDA) for treating bipolar disorder is quetiapine. However, doctors can still prescribe other medications for bipolar disorder. This is known as off-label use. Side effects depend on the medication, but can include weight gain, sleepiness, tremors, blurred vision and rapid heartbeat. Weight gain in children is a significant concern. Antipsychotic use may also affect memory and attention and cause involuntary facial or body movements.
· Antidepressants. Depending on your symptoms, your doctor may recommend you take an antidepressant. In some people with bipolar disorder, antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm. Older antidepressants, which include tricyclics and MAO inhibitors, can cause a number of potentially dangerous side effects and require careful monitoring.
· Symbyax. This medication combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the FDA specifically for the treatment of bipolar disorder. Side effects can include weight gain, drowsiness and increased appetite. This medication may also cause sexual problems similar to those caused by antidepressants.
· Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.
Counseling and Therapies:
Psychotherapy is another vital part of bipolar disorder treatment.
Several types of therapy may be helpful. These include:
· Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
· Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what 's going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
· Family therapy. Family therapy involves seeing a psychologist or other mental health provider along with your family members. Family therapy can help identify and reduce stress within your family. It can help your family learn how to communicate better, solve problems and resolve conflicts.
· Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship
skills.
· Other therapies. Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with your daily routine and interpersonal relationships (interpersonal and social rhythm therapy). Ask your doctor if any of these options may be appropriate for you.
Finding the right medication or medications and therapies for this disorder will likely take some trial and error. This initial process can take months or longer, and medications may need to be adjusted as symptoms change..
Although Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year many diagnosed and treated have lived healthy productive lives with proper medications and counseling.
Works Cited
Web MD, Mayo-Clinic On-line, Clinical Guide to the Diagnosis and Treatment of Mental Disorders, Michael First, Myers, David G. Exploring Psychology, The Bipolar Workbook: Tools for Controlling Your Mood Swings, Monica Ramirez Basco , Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV-TR
By Elliott Subervi
Bipolar Disorder “Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and abnormally depressed states for short, or significant periods of time; in a way that interferes with functioning .(web,Md) Bipolar disorder has been estimated to affect more than 5 million Americans—about 3 out of every 100 adults. [2] It affects people without regard to age, race, ethnicity, gender, education or occupation. Not everyone 's symptoms are the same and there is no blood test to confirm the disorder. Scientists believe that bipolar disorder may be caused when chemicals in the brain are out of balance. Bipolar disorder can look like depression. Distinguishing the illness …show more content…
is tricky, even for mental health professionals.
What makes bipolar disorder different is that in addition to depression, a person also experiences the "highs" of a manic phase. Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyed activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation.[3] In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features. Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person 's speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them.
They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen", are "on a special mission", or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood. [4] Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose.
Bipolar patients also go through manic and hypomanic stages at irregular times. In order to be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM) a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required. According to the National Institute of Mental Health, "A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present." [5] Hypomania is generally a less extreme state than mania, and people in the hypomanic phase generally experience fewer symptoms of mania than those in a full-blown manic episode. During an episode, one might feel an uncontrollable impulse to laugh at things he or she does not normally find funny. The duration is usually also shorter than in mania. This is often a very "artistic" state of the disorder, in which a flight of ideas, extremely creative thinking, and an increase in energy can occur.
There is no clear consensus as to how many types of bipolar disorder exist. [14] In DSMIV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists four types of mood disorders which fit into the bipolar categories: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified). In Bipolar I disorder, an individual has experienced one or more manic episodes with or without major depressive episodes. For a diagnosis of Bipolar I disorder according to the DSMIV-TR, one or more manic or mixed episodes are required. A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs. Bipolar II disorder is characterized by hypomanic episodes rather than actual manic episodes, as well as at least one major depressive episode. There has never been a manic episode or a mixed episode. Hypomanic episodes do not go to the full extremes of mania (i.e. do not usually cause severe social or occupational impairment, and without psychosis), and this can make Bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression.
For both disorders, there are a number of specifiers that indicate the presentation and course of the disorder, including "chronic", "rapid cycling", "catatonic" and "melancholic". Cyclothymia involves a presence or history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. Bipolar Disorder Not Otherwise Specified is a catch-all diagnosis that is used to indicate bipolar illness that does not fit into the other diagnostic categories.
If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified).
Treatment:
There are a number of pharmacological and psychotherapeutic techniques used for treating Bipolar Disorder. Individuals may use self-help and pursue a personal recovery journey. Hospitalization may occur, especially with manic episodes. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur.[73] Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment and patient-led support groups. [74] Mood stabilizing medications and psychotherapy that is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing prodromal symptoms before full-blown recurrence, and, practicing the factors that lead to maintenance of remission[86] Cognitive behavioral therapy, family-focused therapy, and psycho-education have the most evidence for efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and cognitive behavioral therapy appear the most effective in regard to residual depressive symptoms. Most studies have been based only on bipolar I, however, and treatment during the acute phase can be a particular challenge.[87] Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a therapeutic alliance in support of recovery.[88] For many individuals with bipolar disorder a good prognosis results from good treatment, which, in turn, results from an accurate diagnosis. Because bipolar disorder continues to have a high rate of both under-diagnosis and misdiagnosis, it is often difficult for individuals with the condition to receive timely and competent treatment. Bipolar disorder can be a severely disabling medical condition. However, many individuals with bipolar disorder can live full and satisfying lives. Quite often, medication is needed to enable this. Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes. .
Ultimately one 's prognosis depends on many factors, several of which may, in fact, be under the individual 's control, these may include: the right medicines; the right dose of each; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive and warm therapist; a supportive family or significant other; adequate health insurance; secure finances and housing, and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times.
There are obviously other factors that lead to a good prognosis as well, such as being very aware of small changes in one 's energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one 's doctor for how to manage subtle changes that might indicate the beginning of a mood swing.
Some people find that keeping a log of their moods can assist them in predicting changes.[89]” Although having a bipolar disorder can be crippling in many ways, the mania aspects of the disorder have been shown to give patients an elevated goal setting mind set and creative though process. Some historians believe that Vincent van Gogh had a bipolar disorder and perhaps if he did maybe his manic stages spawned his creative, meticulous painting style and moods expressed through his …show more content…
work.
Medications Used to Treat Bipolar Disorder:
· Lithium. Lithium (Lithobid, others) is effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder and has been used for many years. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth and digestive issues.
· Anticonvulsants. These mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Depending on the medication you take, side effects can vary. Common side effects include weight gain, dizziness and drowsiness. Rarely, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.
· Antipsychotics. Certain antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don 't benefit from anticonvulsants. The only antipsychotic that 's specifically approved by the U.S. Food and Drug Administration (FDA) for treating bipolar disorder is quetiapine. However, doctors can still prescribe other medications for bipolar disorder. This is known as off-label use. Side effects depend on the medication, but can include weight gain, sleepiness, tremors, blurred vision and rapid heartbeat. Weight gain in children is a significant concern. Antipsychotic use may also affect memory and attention and cause involuntary facial or body movements.
· Antidepressants. Depending on your symptoms, your doctor may recommend you take an antidepressant. In some people with bipolar disorder, antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm. Older antidepressants, which include tricyclics and MAO inhibitors, can cause a number of potentially dangerous side effects and require careful monitoring.
· Symbyax. This medication combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the FDA specifically for the treatment of bipolar disorder. Side effects can include weight gain, drowsiness and increased appetite. This medication may also cause sexual problems similar to those caused by antidepressants.
· Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.
Counseling and Therapies:
Psychotherapy is another vital part of bipolar disorder treatment.
Several types of therapy may be helpful. These include:
· Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
· Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what 's going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
· Family therapy. Family therapy involves seeing a psychologist or other mental health provider along with your family members. Family therapy can help identify and reduce stress within your family. It can help your family learn how to communicate better, solve problems and resolve conflicts.
· Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship
skills.
· Other therapies. Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with your daily routine and interpersonal relationships (interpersonal and social rhythm therapy). Ask your doctor if any of these options may be appropriate for you.
Finding the right medication or medications and therapies for this disorder will likely take some trial and error. This initial process can take months or longer, and medications may need to be adjusted as symptoms change..
Although Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year many diagnosed and treated have lived healthy productive lives with proper medications and counseling.
Works Cited
Web MD, Mayo-Clinic On-line, Clinical Guide to the Diagnosis and Treatment of Mental Disorders, Michael First, Myers, David G. Exploring Psychology, The Bipolar Workbook: Tools for Controlling Your Mood Swings, Monica Ramirez Basco , Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV-TR