BIPOLAR DISORDER By Samantha Past

Bipolar Disorder

Bipolar disorder or bipolar affective disorder (historically known as manic–depressive disorder or manic depression)• psychiatric diagnosis for a mood disorder• individuals with bipolar disorder experience episodes of a frenzied state

known as mania or hypomania, typically alternating with episodes of depression

• The manic phase may last from days to months • involves swings of mood from high to low and affects about 1% of the

world′s population

HistoryAretaeus of Cappadocia: first recognized some symptoms of mania and depression, and felt they could be linked to each other… his findings went unnoticed and unsubstantiated until 1650, when a scientist named Richard Burton wrote a book, “The Anatomy of Melancholia,” which focused specifically on depression… Burton= father of depression as a mental illness

Jules Falret coined term "folie circulaire" (circular insanity) in 1854, and established a link between depression and suicide…able to find a distinction between moments of depression and heightened moods.

Emil Krapelin established the term manic-depressive, with an exhaustive study surrounding the effects of depression and a small portion about the manic state (1913)

1957- sub classification of bipolar disorder first proposed by Karl Leonhard• Leonhard= a German physicist• first to introduce terms bipolar (for those with mania) and unipolar (for those with depressive

episodes only)

Symptoms of the DiseaseBipolar disorder I:• Easily distracted• Little need for sleep• Poor judgment• Poor temper control• Reckless behavior and lack of self

control • Binge eating, drinking, and/or drug use• Poor judgment

• Sex with many partners (promiscuity)

• Spending sprees• Very elevated mood • Excess activity (hyperactivity• Increased energy• Racing thoughts• Excessive talking• Very high self-esteem (false

beliefs about self or abilities)• Very involved in activities• Very upset (agitated or

irritated)

(In people with bipolar disorder II, the symptoms of mania are similar but less intense.)

Symptoms of the Disease

Depressed phase:• Daily low mood or sadness• Difficulty concentrating, remembering, or making decisions• Eating problems • Loss of appetite and weight loss• Overeating and weight gain• Fatigue or lack of energy• Feeling worthless, hopeless, or guilty• Loss of pleasure in activities once enjoyed• Loss of self-esteem• Thoughts of death and suicide• Trouble getting to sleep or sleeping too much• Pulling away from friends or activities that were once enjoyed

Effects of the Disease • It may be extremely difficult for the loved ones

of those affected with bipolar disorder• Must endure the constant mood swings• Endure the various stages of the disease from

mania to depression• Care-giver burden

Subjective burden: caused by the stress that having somebody ill in the family causes on family and friends

Objective burden: patients with bipolar disorder often do not do that well in life= anxiety, depression, financial hardship

Cause of the Disease The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:

Biological differences:- physical changes in the brains- significance of changes→ still uncertain but may eventually help pinpoint causes

Neurotransmitters:

- imbalance in naturally occurring brain chemicals called neurotransmitters

- play a significant role in bipolar disorder and other mood disorders

Hormones:

- imbalanced hormones → may cause or trigger bipolar disorder

Inherited traits:- bipolar disorder more common in people who have a blood relative (such as a sibling or parent)

with the condition- researchers; trying to find genes that may be involved in causing bipolar disorder

Environment:

- stress, abuse, significant loss or other traumatic experiences may play a role in disease

Treatments for the Disease• no cure for bipolar disorder but proper treatment helps

gain better control of mood swings and related symptoms• Because bipolar disorder→ lifelong and recurrent illness=

need long-term treatment to maintain control of bipolar symptoms

• effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity

MedicationsLithium:

- effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder

- periodic blood tests are required→ lithium can cause thyroid and kidney problems

- common side effects include restlessness, dry mouth and digestive issues

Anticonvulsants:

- mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal)

- the medication asenapine (Saphris) may be helpful in treating mixed episode

- common side effects include weight gain, dizziness and drowsiness

- rarely, certain anticonvulsants cause more serious problems= skin rashes, blood disorders or liver problems

Antipsychotics:

- certain antipsychotic medications= aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don't benefit from anticonvulsants

- only antipsychotic specifically approved by U.S. Food and Drug Administration (FDA) for treating bipolar disorder= quetiapine

- doctors can still prescribe other medications for bipolar disorder= off-label use.

- side effects can include weight gain, sleepiness, tremors, blurred vision and rapid

- antipsychotic use may also affect memory and attention and cause involuntary facial or body movements

Medications Antidepressants:

- antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer

- most common antidepressant side effects= 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:

- combines antidepressant fluoxetine and the antipsychotic olanzapine

- works as a depression treatment and a mood stabilizer

- approved by the FDA specifically for the treatment of bipolar disorder

- side effects can include weight gain, drowsiness and increased appetite… may also cause sexual problems similar to those caused by antidepressants

Benzodiazepines:

- anti-anxiety medications may help with anxiety and improve sleep

- clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax)

- 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

Therapy Cognitive behavioral therapy: individual therapy, focus= identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones

Psychoeducation: counseling to help you learn about 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: seeing a psychologist or other mental health provider along with your family members= help identify and reduce stress within your family & can help your family learn how to communicate better, solve problems and resolve conflicts

Identification of the Disease When doctors suspect someone has bipolar disorder, they typically do a number of tests and exams (Exams can help rule out other problems, pinpoint a diagnosis and also check for any related complications)

Physical exam: measuring height and weight; checking vital signs, ex. heart rate, blood pressure and temperature; listening to heart and lungs; and examining abdomen

Lab tests: blood and urine tests- help identify any physical problems that could be causing symptoms

Psychological evaluation: doctor or mental health provider talk to you about your thoughts, feelings and behavior patterns, may fill out a psychological self-assessment or questionnaire… family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression

Mood charting: identify exactly what's going on, doctor may have you keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment

Diagnosis To be diagnosed with bipolar disorder, one must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Bipolar I disorder: had at least one manic or one mixed episode, may or may not have had a major depressive episode (more specific subcategories of diagnosis based on ones particular signs and symptoms)

Bipolar II disorder: had at least one major depressive episode and at least one hypomanic episode (but not a fully manic or mixed episode)…symptoms cause distress or difficulty in some area of life

Cyclothymic disorder: had numerous hypomanic episodes and periods of depression but never had a full manic episode, a major depressive episode or a mixed episode.., symptoms last two years or more (one year in children and adolescents)… during time symptoms never go away for more than two months= significant distress or difficulty in some area of your life

Bioethical Considerations• Bipolar people may be suicidal (sometimes even if they're taking their

medication)

• Sometimes those that are depressed try and treat themselves, using unprescribed prescription drugs, illegal drugs, or turn to alcohol

• It can be difficult finding a job for those with bipolar disorder because someone may not want to hire one with the disease as they may think that person would freak out or scream due to sudden mood changes, at a potential client/customer

References

"Bipolar Disorder." CNN. Cable News Network, 18 Jan. 2012. Web. 28 Feb. 2013.

"Bipolar Disorder." NIMH RSS. The National Institute of Mental Health (NIMH), n.d. Web. 28 Feb. 2013

Board, A.D.A.M. Editorial. "Bipolar Disorder." Bipolar Disorder. U.S. National Library of Medicine, 18 Nov. 0000. Web. 28 Feb. 2013.

Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 18 Jan. 2012. Web. 28 Feb. 2013.