Rapid Cycling Bipolar Disorder Essay, Research Paper

RAPID CYCLING BIPOLAR DISORDER

Bipolar Disorder, also known as manic depression, is a medical illness that affects how a person acts, thinks, and feels. It is identified by periodic episodes of mania (highs) and depression (lows), usually with periods of normal mood in between these episodes. An affected person’s mood can range from an excessive high to a profound hopelessness. The mood episodes can last for a few days or for as long as several months. There are different types of this disorder depending on the pattern and severity of the episodes. Most individuals with bipolar disorder experience their first mood episode while in adolescence, however some do not until after their twenties.

Symptoms of Mania and Depression

Mania is a period, of at least one week, when a person’s mood is abnormally euphoric or irritable. A manic episode represents a change form normal functioning that often interferes with work and relationships. Many times a person experiencing a manic episode requires hospitalization to return them to normal functioning. Symptoms of mania may include: increased energy, excessive euphoria, uncharacteristically poor judgement, excessive risk-taking behavior, and denial that anything is wrong. A manic episode also includes three or more of the following: inflated self-esteem (an individual may see them self as overly important or invincible); decreased need for sleep (an individual may get only a few hours of sleep, or go for days without sleep and feel refreshed and energetic); extremely talkative/pressured speech (speech becomes loud, fast, and difficult to interrupt; distractibility (an individual may have trouble concentrating on any one task or may be unable to carry on a logical conversation for any length of time); racing thoughts/flight of ideas (conversations may switch from topic to topic, with loose connections between topics); excessive involvement in pleasurable activities ( may spend more than they have, or experience hypersexuality- sexual behavior that is excessive and unusual for the individual); increase in goal- directed behavior (the individual may begin many different projects at one time or try to do more than is realistically possible); and agitation (People may find themselves restless or becoming easily irritated).

A manic episode sometimes also includes delusions. The three most common delusions associated with bipolar disorder are grandeur, reference, and persecution. Delusions of grandeur are when a patient feels that they are capable of doing things that they have no talent or training to do; they may also believe that they are a famous person. People with this delusion have known to think of as the president, a movie star, or Jesus Christ. Delusions of reference are delusions in which the patient believes that everything going on is about or because of them. These patients may believe that two people having a conversation are talking about them, or that the reason their hospital room was changed was because the nurses were angry with them. The last, and most dangerous of these delusions is that of persecution. A person suffering from this delusion will be on constant guard against “enemies.” Studies of patients suffering from the delusion of persecution have noted them as hiding from the government, the mafia, the police, and even Nazis.

The type, severity, and duration of a manic episode can vary. Hypomania is a milder form of mania with less severe symptoms. The main difference between mania and hypomania is that mania can cause a marked impairment in a person’s ability to function on a daily basis. The main features of mania are experienced in hypomania, except that delusions are never present and all other symptoms are generally less severe then they would be in a full manic episode.

The depression episodes of bipolar disorder tend to last longer than the manic episodes, usually for two weeks or longer. Symptoms of depression are: persistent sad, anxious, or empty mood; feelings of helplessness, pessimism; guilt or hopelessness; loss of interest or pleasure in ordinary activities, including sex; decreased energy, feelings of fatigue; difficulty in concentrating, remembering, or making decisions; change in appetite or weight; and thoughts of suicide.

A mixed state is when a person has symptoms of both mania and depression occurring at the same time, or alternating frequently throughout the day during a period of at least one week. The experiencing of a mixed state is most common within the later years of the disorder. Mixed episodes are also the most difficult to treat due to the conflict of symptoms.

Once a patient that has been suffering from this disorder for a period of time, they may become able to interpret warning signs that an episode is approaching. These warning signs may include changes in sleep patterns, changes in levels of energy (high or low), problems paying attention and concentrating, and changes in grooming or dress. This warning can give the person enough time to visit a doctor who may be able to prevent the episode.

Rapid Cycling

Bipolar disorder affects approximately one to two percent of the adult population. Around fifteen to twenty percent of these people develop rapid cycling at some time during their illness. While bipolar disorder is equally common within both sexes, around ninety percent of those with rapid cycling are women. Rapid cycling is defined as having four or more manic, hypomanic or depressive episodes in the period of one year. In most cases, these episodes occur in a random, chaotic pattern. Some individuals experience ultra-rapid cycling, cycling in which episodes last only for one day. Individuals with Bipolar I Disorder (those with manic or mixed episodes that may or may not alternate with depression) and Bipolar II Disorder (those with recurrent major depressive episodes and hypomania, but never a full manic episode) have equal rates of rapid cycling. However those with Cyclothymic Bipolar Disorder (those who experience numerous hypomanic and depressive symptoms over the period of at least two years that are not severe enough or long enough in duration to be considered a mood episode) have a much less rate of rapid cycling. Studies have shown that rapid cycling is more common in women and those with a history of hypothyroidism.

Some individuals experience rapid cycling from the beginning of the disorder. In other individuals, their condition gradually develops into rapid cycling. It is more common for a person to develop into rapid cycling. Many individuals experience shorter and more frequent episodes

as the illness progresses. This rapid cycling may be either temporary or permanent. An individual may exhibit rapid cycling for a time, then return to a pattern of longer, less frequent episodes, or continue a rapid-cycling pattern indefinitely.

Causes of Rapid Cycling

While the definite cause of rapid cycling is unknown, there are three theories which suggest the reasons. The first of these theories is the Kindling or Sensitization Theory. This theory states that episodes are initially triggered by life experiences. As the illness progresses, the individual becomes more sensitive to possible triggers, causing the episodes to become more frequent. The theory states that eventually the episodes will be caused by internal stimuli (stimuli inside the individual’s brain) instead of stimuli produced by the environment.

The second theory, the Biological Rhythm Disturbances Theory, states that the patient’s rapid-cycling episodes are caused by their biological rhythm being out of sync with the time giving events of the environment (such as sunrises and sunsets). This abnormal biological rhythm causes them to develop sleep disturbances and sometimes insomnia. This sleep deprivation causes the abnormal moods and can eventually develop into rapid-cycling bipolar disorder.

The last theory is the Hypothyroidism Theory. According to this theory, the rapid cycling is caused by in adequate amounts of the thyroid hormone in the brain. This theory also proposes that patients with rapid cycling have a blockage of this hormone at the blood-brain barrier. This is assumed because the patients have normal levels of the thyroid hormone throughout the bloodstream and levels are only low in the brain itself.

Studies have shown that the majority of those with the rapid-cycling disorder have a history of the illness in their family, suggesting a genetic link. Studies have also shown that there may be a link between the disorder and drug or alcohol abuse, suggesting that substance abuse may predispose an individual to the illness. Lastly, the use of antidepressant drugs can induce or worsen cycling in a patient. A bipolar patient, if misdiagnosed as only depressive and subscribed antidepressants, can develop into a rapid cycling patient.

In the United States there are currently 17.5 million people with bipolar disorder. Out of this 3.5 million are rapid cycling. Fifteen percent of these rapid-cycling patients commit suicide and another fifty-five percent will attempt it. The high percentage of suicide is most often due

to mistakes in diagnosing. The symptoms of mania are often close to those of metabolic disorders and drug abuse, and the symptoms of hypomania are often looked over altogether. These mistakes cause the patients to be prescribed inappropriate medications that often worsen the symptoms of depression.