Definition and Overview

Bipolar disorder is a psychiatric disorder. Also known as manic-depressive disorder, it is characterized by highly unpredictable mood swings. There are episodes of mania, or elevated mood, interspersed with episodes of depression. Between episodes, patients can function normally.

Strictly speaking, bipolar disorder is diagnosed using specific criteria from the Diagnostic and Statistical Manual of Mental Disorders or DSM. There are two kinds of bipolar disorder: Bipolar I, when at least a single manic period or episode occurs; and Bipolar II, when a combination of a major depressive and a hypomanic episode occurs.

Approximately 1-3% of the world's population is affected by bipolar disorder. The onset of the disease is usually between the ages of 20 and 30 years. Although there is no gender predisposition for bipolar disorder, meaning men and women are affected equally; men are more likely to develop manic episodes while women are more likely to develop depressive episodes throughout their lives.

Cause of Condition

The specific causes of bipolar disorder and its symptoms are still unknown. However, it appears that genetics plays a role in the development of this condition. Inheritance is autosomal dominant, and a number of genes seem to be involved in its development. Individuals who have first-degree relatives with bipolar disorder are ten times more likely to develop the condition. Studies on twins have also shown approximately 40% concordance rates, further supporting a genetic factor.

Imaging techniques of the brain have shown changes in a person’s amygdala, that part of the brain that controls moods and emotions. Some experts believe that this, along with other abnormalities in brain circuits, may be a factor in the development of bipolar disorder.

Environmental factors are also believed to contribute to this condition. Stressful events and troubled relationships are typical in bipolar patients; approximately 30-50% of people with this condition have experienced some manner of abuse or a certain traumatic experience during their childhood.

Key Symptoms

The characteristic feature of bipolar disorder is mania. Mania is defined as a period where a person experiences a persistently elevated mood, occurring for a minimum of one week. At this time, the individual experiences at least three symptoms of elevated mood, which include a feeling of grandiosity, talkativeness, agitation, experiencing a flight of ideas or when thoughts jump from one subject to another, lesser requirement for sleep, inattention and getting distracted easily, and engaging in high-risk activities such as excessive shopping sprees or sexual transgressions.

These symptoms cause impairments in a person’s daily work, functions or social activities. These symptoms may be so severe, and patients may become violent, resulting in a need to hospitalize the patient so as not to cause any harm, whether it be to himself or people around him. Psychotic features, which are distorted or dysfunctional views, paranoia and delusional ideas may also be present. About half of the patients with bipolar disorder have hallucinations or delusions.

A slightly milder version of mania is hypomania. In comparison to mania, hypomania does not interfere significantly with the person’s daily activities and does not progress to psychosis. Many patients with hypomania are noted to have higher energy levels and tend to become more creative.

Episodes of major depression are characterized by a persistent hopelessness, anger or sadness. Patients are lonely and experience hatred or indifference towards themselves. Patients experience sleep disturbances, decreased appetite, irritability, and lack of interest in enjoyable activities. Some patients develop suicidal ideations and may also have associated psychosis or delusions.

Periods of mania usually begin over several days or even weeks. Loss of appetite, disturbances in sleep and anxiety may precede manic episodes. These episodes typically last for a few weeks but may last for up to a year, especially if untreated and no intervention is performed. A phenomenon known as rapid cycling may also occur. In rapid cycling, patients experience at least four episodes of mania or depression per year.

Who to See and Types of Treatments Available

Symptoms and behavioral changes in patients with bipolar disorder are usually identified and reported by the family, friends, or co-workers of the patient. Evaluation and clinical assessment are typically conducted by the primary physician or a psychiatrist. Patients may have to undergo several laboratory examinations to rule out certain medical diseases that present in the same manner, such as thyroid diseases or metabolic disorders.

If a patient is indeed diagnosed to have bipolar disorder, a combination of medications and psychotherapeutic interventions are used to treat the condition. If treated properly, majority of patients with bipolar disorder typically recover and are symptom-free after two years.

The foremost drug used in the management of bipolar disorder is lithium. Acute mania is controlled up to 80% of the time, and suicide risks are decreased. Lithium can also prevent recurrent episodes of both mania and depression. Close monitoring of lithium levels in the blood is necessary for these patients. Aside from lithium, several anticonvulsant and antipsychotic drugs are also used in managing bipolar disorder. These medications include carbamazepine, olanzapine, sodium valproate and lamotrigine. Combinations of drugs are typically prescribed.

Different kinds of therapies make up the necessary psychotherapeutic intervention for bipolar disorder. These include cognitive-behavioral therapy, patient education and family therapy, to name a few. The goal of psychotherapy is to relieve symptoms, identify specific triggers and prevent the recurrence of episodes. Vulnerable patients are also advised to avoid stressful situations, stay away from harsh environments and relationships, and utilize coping strategies. Substance abuse is commonly associated with bipolar disorder and should likewise be addressed.

Family support is vital for patients with mental health disorders, in order to ensure compliance to medications and keep the patient in remission.

In patients with severe forms of the disease, especially those with psychotic features, electroconvulsive therapy, also known as ECT or shock therapy, may provide some benefit.

In severe manic episodes, patients may have to be hospitalized. Many programs are shying away from long-term hospital stays and offer various out-of-hospital support services, such as home visits by mental health treatment teams, outpatient mental health programs and support groups.

References:

  • International Bipolar Foundation: ibpf.org/
  • National Institutes of Health: Bipolar Disorder - www.nimh.nih.gov/health/topics/bipolar-disorder/
  • Depression and Bipolar Support Alliance: www.dbsalliance.org/
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