Bipolar Disorder Essay, Research Paper

Bipolar Disorder:Wellness Paper

The aspect of bipolar disorder has been a mystery since

the 16th century. It was rumored that Vincent Van Gough

suffered from bipolar disorder. There is a large group of

people suffering from this disorder, however there are no

causes or cures for it. Bipolar disorder impairs one?s

ability to obtain and sustain social and occupational

success. The journey for even a cause will continue for

many years to come. Affective disorders are characterized

by a depressed mood, an elevated mood or an alternation of

depressed and elevated moods. The basic term for the

manic-depressive illness is Bipolar disorder. There are

milder and heavier forms of each. A patient can be placed

in two different categories of this disorder: dysthymic

disorder and cyclothymic disorder depending on how strong

the symptoms are with each individual patient. ?The use of

the term primary affective disorder refers to the

individuals who had no previous psychiatric disorders or

else only episodes of mania or depression. Secondary

affective disorder refers to patients with preexisting

psychiatric illness other than depression or mania?

(Goodwin, Guze. 1989, p.7 ).

Bipolar affective disorder affects around 1% or three

million people in the United States. Both males and females

can become a victim of this disorder. ?Bipolar disorder

involves episodes of mania and depression. The manic

episodes are characterized by elevated or irritable mood,

increased energy, decreased need for sleep, poor judgment

and insight, and often reckless or irresponsible behavior?

(Hollandsworth, Jr. 1990 ).

These episodes can alternate with heavy depressions

characterized with complete sadness with almost an inability

to move, hopelessness, and agitation in appetite, sleep and

makes is hard to concentrate while driving.

?Bipolar disorder is diagnosed if an episode of mania occurs

whether depression has been diagnosed or not? (Goodwin,

Guze, 1989, p 11). The common symptoms for a manic

depressive episode consist of elated, expansive, irritable

or hyperactive mood. Their speech becomes hard to

understand, they have ideas racing through their head, they

have incredibly high self esteem, they rarely feel tired and

they are often involved in activities that could possibly

harm them. ?Rarest symptoms were periods of loss of all

interest and retardation or agitation? (Weisman, 1991).

As the National Depressive and Manic Depressive

Association (MDMDA) has demonstrated, bipolar disorder can

participate in developmental delays, marital and family

problems, loss of jobs and an inability to keep a steady

income. Many bipolar patients report that the depressions

are longer and come more frequent when the individual gets

older. Schizophrenia has commonly been diagnosed to

patients suffering from bipolar and can be misdiagnosed for

most of their lives. The speech patterns help doctors to see

a difference between the two disorders. ?The first signs or

symptoms of Bipolar disorder usually occur between the ages

of 20 and 30 years of age, and then are seen again in women

in their 40?s. A typical bipolar patient will most likely

experience eight to ten episodes in their lifetime. However,

there are those who have rapid cycling and can experience

more episodes of mania and depression that succeed each

other without a period of remission? (DSM III-R). The three

stages of mania begin with hypomania, this is where the

patients are often very energetic , hyper and assertive. The

hypomania state has shown doctors that a person suffering

from bipolar almost feels addicted to their mania.

Hypomania progresses into mania as the transition is marked

by loss of judgment. Often, a paranoid or irritable

character begins to manifest. The third stage of mania is

becomes clear when the patient experiences delusions with

often paranoid themes. Speech is generally rapid and

behavior manifests with hyperactivity and sometimes

assaultiveness.

When both manic and depressive symptoms occur at the

same time it is called a mixed episode. These people are a

special risk because of the combination of hopelessness,

agitation and anxiety make them feel like they “could jump

out of their skin”(Hirschfeld, 1995). Up to 50% of all

patients with mania have a mixture of depressed moods.

Patients report feeling very dysphoric, depressed and

unhappy yet exhibit the energy associated with mania. Rapid

cycling mania is another symptom of bipolar disorder. Mania

may be present with four or more distinct episodes within a

12 month period. There is now evidence to suggest that

sometimes rapid cycling may be a transient manifestation of

the bipolar disorder. This form of the disease experiences

more episodes of mania and depression than bipolar.

Lithium has been the primary treatment of bipolar

disorder since its introduction in the 1960’s. It is main

function is to stabilize the cycling characteristic of

bipolar disorder. In four controlled studies by F. K.

Goodwin and K. R. Jamison, the overall response rate for

bipolar subjects treated with Lithium was 78% (1990).

Lithium is also the primary drug used for long- term

maintenance of bipolar disorder. In a majority of bipolar

patients, it lessens the duration, frequency, and severity

of the episodes of both mania and depression. Unfortunately,

there are up to 40% of bipolar patients who are either

unresponsive to lithium or who cannot tolerate the side

effects. Some of the side effects include thirst, weight

gain, nausea, diarrhea, and edema. Patients who are

unresponsive to lithium treatment are often those who

experience dysphoric mania, mixed states, or rapid cycling

bipolar disorder (those patients who experience at least

four distinct episodes within one month period). Among the

problems associated with lithium includes the fact the

long-term lithium treatment has been associated with

decreased thyroid functioning in patients with bipolar

disorder. Preliminary evidence also suggest that

hypothyroidism may actually lead to rapid-cycling (Bauer et

al., 1990). ?Another problem associated with the use of

lithium is its use by pregnant women. Its use during

pregnancy has been associated with birth defects,

particularly Ebstein’s anomaly. Based on current data, the

risk of a child with Ebstein’s anomaly being born to a

mother who took lithium during her first trimester of

pregnancy is approximately 1 in 8,000, or 2.5 times that of

the general population? (Jacobson et al., 1992).

There are other effective treatments for bipolar

disorder that are used in cases where the patients cannot

tolerate lithium or can become unresponsive to it in the

past. The American Psychiatric Association’s guidelines

suggest the next line of to be anticonvulsant such as

valproate and carbamazepine. These drugs are useful as

antimanic agents, especially in those patients with mixed

states. Both of these medications can be used in combination

with lithium or in combination with each other. Valproate is

especially helpful for patients who are lithium

noncompliant, experience rapid-cycling, or have a problem

with alcohol or drug abuse. Neuroleptics such as

haloperidol or chlorpromazine have also been used to help

stabilize manic patients who are highly agitated or

psychotic. Use of these drugs is often necessary because the

response to them are rapid, but there are risks involved in

their use. Because of the often severe side effects,

benzodiazepines are often used in their place.

Benzodiazepines can achieve the same results as Neuroleptics

for most patients in terms of rapid control of agitation and

excitement, without the severe side effects.

In addition to the medical treatments mentioned for

bipolar disorder, there are several other options available

to bipolar patients, most of which are used in conjunction

with medicine. One such treatment is light therapy. One

study compared the response to light therapy of bipolar

patients with that of unipolar depresses patients. Patients

are free of psychotropic and hypnotic medications for at

least one month before treatment. Bipolar patients in this

study showed an average of 90.3% improvement in their

depressive symptoms, with no incidence of mania or

hypomania. They all continued to use light therapy, and all

showed a sustained positive response at a three month

follow-up (Hopkins and Gelenberg, 1994). Another study

involved a four week treatment of morning bright light

treatment of patients with seasonal affective disorder,

including bipolar patients. This study found a statistically

significant decrement in depressive symptoms, with the

maximum antidepressant effect of light not being reached

until week four. Hypomanic symptoms were experienced by 36%

of bipolar patients in this study. Predominant hypomanic

symptoms included racing thoughts, deceased sleep and

irritability. Surprisingly, one-third of controls also

developed symptoms such as those mentioned above. Regardless

of the explanation of the emergence of hypomanic symptoms in

undiagnosed controls, it is evident from this study that

light treatment may be associated with the observed

symptoms. Based on the results, careful professional

monitoring during light treatment is necessary, even for

those without a history of major mood disorders. Another

popular treatment for bipolar disorder is electro-convulsive

shock therapy. ECT is the preferred treatment for severely

manic pregnant patients and patients who are homicidal,

psychotic, catatonic, medically compromised, or severely

suicidal. In one study, researchers found marked improvement

in 78% of patients treated with ECT, compared to 62% of

patients treated only with lithium and 37% of patients who

received neither, ECT or lithium (Black et al., 1987).

According to Dr. John Graves, spokesperson for The

National Depressive and Manic Depressive Association have

called attention to the value of support groups, challenging

mental health professionals to take a more serious look at

group therapy for the bipolar population.

Research shows that group participation may help increase

lithium compliance, decrease denial regarding the illness,

and increase awareness of both external and internal stress

factors leading to manic and depressive episodes. Group

therapy for patients with bipolar disorders responds to the

need for support and reinforcement of medication

management, the need for education and support for the

interpersonal difficulties that arise during the course of

the disorder.

Bauer, M.S., Kurtz, J.W., Rubin, L.B., and Marcus, J.G.

(1994). Mood and Behavioral effects of four-week light

treatment in winter depressives and controls. Journal of

Psychiatric Research. 28, 2: 135-145.

Gasperini, M., Gatti, F., Bellini, L., Anniverno, R.,

Smeralsi,E., (1992). Perspectives in clinical

psychopharmacology ofamitriptyline and fluvoxamine.

Pharmacopsychiatry. 26:186-192.

Goodwin, F.K., and Jamison, K.R. (1990). Manic Depressive

Illness. New York: Oxford University Press.

Goodwin, Donald W. and Guze, Samuel B. (1989). Psychiatric

Diagnosis. Fourth Ed. Oxford University. p.7.

Hirschfeld, R.M. (1995). Recent Developments in Clinical

Aspects of Bipolar Disorder. The Decade of the Brain.

NationalAlliance for the Mentally Ill. Winter. Vol. VI.

Issue II.

Hollandsworth, James G. (1990). The Physiology of

Psychological Disorders. Plenem Press. New York and London.

P.111.

Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of

Bipolar Disorder:How Far Have We Come? Psychopharmacology

Bulletin.30(1): 27-38.

Jacobson, S.J., Jones, K., Ceolin, L., Kaur, P., Sahn, D.,

Donnerfeld, A.E., Rieder, M., Santelli, R., Smythe, J.,

Patuszuk, A., Einarson, T., and Koren, G., (1992).

Prospective multicenter study of pregnancy outcome after

lithium exposure during the first trimester.

Laricet. 339: 530-533.

Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A. and

Hirschfeld, R.M. (1994). The National Depressive and Manic

Depressive Association (DMDA) Survey of Bipolar Members.

Affective Disorders. 31:

pp.281-294.

Weisman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P.,

Holzer, C. (1991). Psychiatric Disorders in America.

Affective Disorders. Free Press.