Bipolar Disorder
What is Bipolar Disorder?
Bipolar Disorder is a medical condition of mood disorder. Bipolar disorder or mania-depressive illness causes abnormal swings in mood and behavior. A person’s capacity to complete daily tasks can be severely affected due to its effect on behavior, concentration, energy level and sleep.This illness is characterized by severe symptoms that can damage relationships, lead to poor performance in the work or education and even increased risk for suicide. Bipolar disorder is treatable. People suffering from it can lead a full and productive life.
Bipolar disorder affects men, women, teenagers and children of various ethnic and social backgrounds. Approximately one to two percent of the U.S. population is affected with this disorder. Bipolar disorder is known to have a large genetic and biological component. If you have been diagnosed with this disorder, there is most likely nothing you could have done to prevent it. This disorder is not your control and the most important step is to learn about this disorder and seek appropriate treatment. Additionally, brain anatomy and neurochemistry also play a major role. Some mental health disorders have many environmental triggers such as past abuse, trauma, or severe stressful incidents. However bipolar disorder is ingrained in your DNA.
March 30 is celebrated as World Bipolar Day to raise awareness of this disorder.
Causes of Bipolar Disorder
Genetics: Bipolar disorder is hereditary. People with certain genes have a greater tendency of developing it. Children who have a parent or a sibling suffering from bipolar disorder are more vulnerable to it than children who don’t have any such member in their immediate families. Still, majority of the children with a family history of bipolar disorder may never develop it.
Brain structure and functioning: Bipolar disorder is widely believed to be the result of chemical (neurotransmitters) imbalances in the brain. Researchers use certain brain imaging tools like functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) to take pictures of the living brain. These images help the doctors to study the human brain’s structure and activities.
Other: Extreme stress or trauma, abuse, or physical illnesses can also lead to develop bipolar disorder.
Types and Symptoms of Bipolar Disorder
Bipolar Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with such persons and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances.There are different types of bipolar disorder depending on the severity of the symptoms and how long a person’s mood swings last.
Bipolar I Disorder: The person experiences at least one mania episode that lasts 7 days or more and severe mania requires hospitalization, although they will likely also experience depressive episodes that last 2 weeks or more.
Bipolar II Disorder: The person experiences at least one depressive episode and one hypomanic episode. A hypomanic episode is a less-severe version of a manic episode.
Cyclothymic / Cyclothymia Disorder: The person’s mood changes quickly between hypomania and depression and is rarely in a normal mood. Symptoms are not as extensive or as long lasting like full hypomanic episodes or full depressive episodes. Usually begins early in life, and it may eventually develop into a more severe form of bipolar disorder for some people.
Mixed States: These symptoms are much more severe and last longer than the regular ups and downs of life. Although most people’s moods change when they experience positive or negative events, the moods swings of someone with Bipolar Disorder occur without any external provocation and are not easily controlled by the person. Some individuals will experience a ‘mixed state’, which is Mania and Depression at the same time.
Mania Episodes: These occur most of the day, nearly every day for at least one week during which serious mood disturbances are noted in the patient. Symptoms may include:
Grandiosity or inflated self-esteem
High energy levels or excitement or activities
Racing thoughts
Less need for sleep or lack of sleep
Restlessness
Inability to make right decisions
Reckless or risky behaviors like alcohol / drug use or increased sexual activities
In severe cases, people can experience hearing or seeing something that isn’t actually there (hallucinations) or believing something that isn’t true even when confronted with proof (delusions)
Hypomania Episodes: These are similar to mania episodes and last for four consecutive days or longer, but don’t significantly interfere with the person’s ability to live their life. Because hypomania symptoms are less severe, they don’t always seem problematic to the person, even though they’re an obvious departure from their usual behaviour. Although a person may be very productive and accomplish many tasks when experiencing Hypomania, they also may become involved in risky behaviour or activities that result in painful consequences. This episode can be known using at least any three symptoms.
Depressive Episodes: These look similar to the depressive episodes experienced when someone has Depression. They occur nearly every day for at least two weeks and can include:
Feeling of sadness or hopelessness or worthlessness
Reduced self confidence or self esteem
Reduced energy levels or fatigability
Reduced or increased appetite
Reduced concentration
Loss of interest in daily activities
Inability to concentrate
Lack of sleep or over sleeping
Thoughts of suicide or death
How is Bipolar Disorder diagnosed?
While the exact causes of bipolar disorder are unknown so it can be difficult to diagnose Bipolar disorder because mood swinging is vary from person to person. The longer it goes untreated, the worse the disorder can get as episodes may happen more frequently or become more extreme.The evaluation for bipolar disorder is examined through several tests and exams and they may include:
Physical examination: A doctor may complete a physical exam as well as lab tests including blood and urine analysis to determine any extenuating medical problems that could be contributing to your symptoms.
Psychiatric assessment: A doctor may refer you to a psychiatrist if physical exam and lab tests don’t explain symptoms. A psychiatrist will talk to you about your thoughts, feelings, and behavior patterns. You may also be asked to complete a bipolar test via a psychological self-assessment. With your permission, family members or close friends may also be asked to provide information about your symptoms.
Mood and Sleep Charts: If the doctor thinks that your behavioral changes are the result of a mood disorder like bipolar, they may ask you to chart your moods. Keeping a daily record of your moods, sleep patterns, and other relevant information in a journal can help with finding the right treatment.
Criteria for bipolar disorder: During a bipolar assessment, a psychiatrist may compare an individual’s symptoms with the criteria for bipolar and related disorders in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the DSM-5, bipolar disorder is described as “a group of brain disorders that cause extreme fluctuation in a person’s mood, energy, and ability to function.”
Treatment options for Bipolar Disorder
The usual course of treatment is a combination of medication, psychotherapy and healthy lifestyle changes. Psychotherapy is not usually needed long-term. Person will always need to be on medication to level their moods. Remember that treatment is different for everyone, so often trials of various combinations of medication and therapy will be used until the right combination is found. This may also change over time if new symptoms develop or if symptoms are not responding as well as expected.Sometimes, during a manic or depressive episode, a person with Bipolar Disorder will need to be hospitalized until their condition improves.
Medications:
Only a psychiatrist can prescribe such medications and it’s essential for the patients to be in regular contact with their psychiatrist to adjust dosages and duration of the medicines based on their symptoms. Various agents are available that can be used to treat bipolar disorder. The choice of agent depends on symptoms like agitation, aggression, psychosis and sleep issues.Anticonvulsants:
Antimanic agents:
Antipsychotics:
Benzodiazepines:
Electroconvulsive Therapy:
Electroconvulsive therapy (ECT) is effective in instances where patients with bipolar disorder or mania-depressive illness (MDI) fulfill the following criteria:When fast, distinct psychiatric treatment is required.
When there is low risk in treating with ECT as compared to other forms of treatment.
When the bipolar disorder refracts to a sufficient number of trials with other treatment strategies.
When the patient chooses this treatment modality.
Psychotherapy:
Electroconvulsive therapy (ECT) is effective in instances where patients with bipolar disorder or mania-depressive illness (MDI) fulfill the following criteria:Cognitive behavioral therapy (CBT), can help people with bipolar disorder to alter their destructive or negative thought patterns and behaviors.
Family-focused therapy involves family members. It helps to improve a family’s coping strategies. For example: identifying new depressive episodes early and helping the patient accordingly. This therapy promotes communication amongst the family members, as well as creates a problem-solving outlook in them.
Interpersonal and social rhythm therapy may help people with bipolar disorder strengthen their relationships with others and manage their daily routines better. Regular daily routines and sleep schedules can assist in defending against new manic episodes.
Psychoeducation can be used to teach people with bipolar disorder about their illness and the kind of treatment needed. Psychoeducation can help them to recognize signs of an approaching mood swing so that they can seek early treatment before a full-blown episode. Psychoeducation done in a group can be effective for family members and caregivers.
