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Bipolar disorder

Definition


Disease: Bipolar disorder Bipolar disorder
Category: Psychiatric diseases
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Disease Definition:

Bipolar disorder, also called manic-depression or manic-depressive illness, is a mental illness, the extremes of which are: high to low, mania to depression, and recklessness to languor. This illness is characterized by mood instability which can be serious as well as disabling. Mood shifting phases could last for weeks and months which cause great annoyance to family members and friends, too. Now, a great amount of research says that bipolar disorder occurs accompanied by a range of symptoms and a lot of people are misdiagnosed. The suicide rate among people with bipolar disorder is high because when this disorder is left without treatment, it gets worse. But, with proper treatment, people can live an enjoyable and productive life despite the disorder.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Symptoms are set to patterns alternating between emotional highs (mania) and lows (depression). The severity of these signs rate from mild to intense.  At some times, a person’s life doesn’t seem to be affected.

Signs and symptoms of the manic phases
may include:

  • Euphoria
  • Drug abuse
  • Insomnia
  • Poor judgment
  • Rapid speech
  • Spending flings
  • Hastening thoughts
  • Inability to concentrate
  • Agitation and turmoil
  • Extreme optimism
  • Amplified self-esteem
  • Aggressive and wild  behavior
  • Increased physical activity
  • Increased impulse to perform or achieve goals
  • Increased sexual impulse
  • Inclination to be easily distracted

Signs and symptoms of the depressive phase of bipolar disorder may include:

  • Sadness
  • Fatigue
  • Anxiety
  • Irritability
  • Desperation
  • Feeling of guilt
  • Sleep problems
  • Appetite problems
  • Concentrating Problems
  • Suicidal thoughts or behavior
  • Loss of interest in daily activities
  • Continuous pain without a reason

TYPES OF BIPOLAR DISORDER:

Bipolar I disorder:
In this type, at least one manic episode happens with or without previous depression attacks.

Bipolar II disorder:
At least on depression attack happens and one hypomanic episode. A hypomanic episode is similar to a manic episode but briefer (lasting for few days), and not as serious. Someone may have elevated mood, bad temper along with some change in function. Generally, they can carry on normal daily routine and affairs, and don’t need hospitalization.  But, in bipolar II disorder, the phases of depression are much longer than hypomania.

Cyclothymia:
It’s a mild form of bipolar disorder which includes mood shifting; its highs and lows are not as bad as those of full-blown bipolar disorder.

Mixed state bipolar disorder:
Symptoms of both mania and depression occur at the same time.

Rapid cycling bipolar disorder:
Some people might have the occurrence of 4 or more different mood shifts within a year. This could happen very rapidly, within just hours.

Psychosis:
Severe episodes of either mania or depression may result in psychosis or a withdrawal from reality. Symptoms may be:

  • Delusions, which are false but strongly held beliefs
  • Hallucinations, which is when someone hears or sees things that aren't there.
     

Causes:

Though it’s not acknowledged what causes bipolar disorder, but a variety of biochemical, genetic and environmental factors seem to help in causing and activating bipolar episodes:

Biochemical:
High-tech scanning studies show that people who suffer bipolar disorder undergo physical changes in their brains, the significance of which is still uncovered. Yet, this may aid in pointing out the causes. Naturally occurring brain chemicals known as neurotransmitters, which are tied to mood may also play a role. Imbalances in hormones are also thought to be a contributing factor.

Environment:
environment plays a causal role in one way or another. A study of identical twins showed that one had the disorder while the other was just fine. This means that genes are not the only cause. Environmental causes may include problems with self-respect, significant loss, lack of confidence or high stress.

Genes:
Research shows that bipolar disorder is most common among people who have someone in their family with this illness. More studies are attempting to discover the genes involved in causing the disorder. Other studies link between bipolar disorder and schizophrenia, referring to a shared genetic cause.
 

Complications

Complications:

Severe emotional, financial and even legal problems that affect every bit of a person’s life might result from this disorder in case it is left untreated.

Some of the complications that bipolar disorder may cause or be related to include:

  • Isolation
  • Suicide
  • Legal problems
  • Financial problems
  • Relationship problems
  • Substance and alcohol abuse
  • Poor work or school performance
     

Treatments:

Bipolar disorder is a long-term condition that requires a constant treatment even when the person feels better. The treatment necessitates a skilful psychiatrist to guide the condition. Psychologists, social workers and psychiatric nurses may also be in the treatment team because the condition can affect so various fields of the patient’s life.

In order to bring down the frequency and severity of manic and depressive episodes and allow the patient live a more equilibrated and joyful life, efficient and suitable treatment is quite important.
Maintenance treatment, which is a continuous treatment during periods of remission, is very significant. Skipping maintenance treatment means a high risk of symptoms relapse or turning minor episodes into full-blown mania or depression. If someone has alcohol or any substance abuse, they should be treated because they can aggravate bipolar symptoms. The major treatments for bipolar disorder are:

MEDICATIONS:
Medications can cause severe but rare side effects which could make the patient hesitate to take them. The best medication regimen could be easily found with the help of a psychiatrist. Medication options include:

Mood stabilizers:
These medications are the most used and prescribed for bipolar disorder. Mainly, they are used to order and stabilize the mood so that the patient doesn’t swing between depression and mania. Widely used as a mood stabilizer, lithium  is the first line for mania treatment.  Sometimes, the patient might be recommended taking mood stabilizers for the rest of their life to block and treat manic episodes.

Anti-seizure medications:
These medications are used to prevent mood swings, especially in people who suffer rapid cycling bipolar disorder. Medications like valproic acid , divalproex  and lamotrigine , which are called anticonvulsants, are used as mood regulators.

Antidepressants:
Using antidepressants was once common but now totally controversial. Relying on the patient’s case, sometimes antidepressant might not be suggested at all. The data are very limited in showing how efficient antidepressants are. And at some points, they could arouse manic episodes. The patient is strongly recommended to consult their doctor about the advantages and disadvantages of antidepressants.

Other medications:
People, who don’t find anti-seizure medications beneficial, may find some specific antipsychotic medications useful, like olanzapine  and risperidone . Anti-anxiety medications like benzodiazepines may help in sleeping. One medication that has been approved by the Food and Drug administration for treating manic and depressive episodes of bipolar disorder is quetiapine . Moreover, various medications are available for curing bipolar disorder. So, the patient can simply explore another one if anyone didn’t work well for them. Sometimes, the doctor might advise the patient to combine certain medications for utmost effect. It generally needs several weeks after starting medications to begin noticing the improvement of symptoms.

All medications have side effects. So, a person should be careful. The risk of diabetes, obesity and high blood pressure increase by antipsychotic medications. These health problems should be monitored by a doctor. A developing fetus or nursing infant might also be harmed by the use of mood-stabilizing medications. Thus, women with bipolar disorder, who want or are already pregnant, must take heed with the help of their health care professionals to the risks, options and benefits of medications.


PSYCHOTHERAPY:
Psychotherapy is another important kind of bipolar disorder therapy that has various helpful types.

Cognitive behavioral therapy:
It’s a common type for individual therapy. The main focus in this therapy is to recognize unhealthy, negative thoughts and behaviors and exchange them with healthy, positive ones. In this method, the patient can learn a lot about the treatment of bipolar disorder and what might activate its episodes. Moreover, the patient also learns about strategies to manage stress and disturbing situations.

Family therapy:
As indicated by its name, this method involves the patient's family members. Family therapy helps the patient identify and reduce stress factors within his/her family.  It also aids family to better communication styles, problem-solving abilities, and resolving conflicts. 

Group therapy:
This method provides a forum to communicate, learn from others’ experiences and build up better relationship skills.

Electroconvulsive therapy(ECT):
This method is mainly targeted to people who have severe depression episodes with suicidal thoughts or people whose symptoms did not improve with other treatments. Electroconvulsive therapy works by electrical currents passed through the brain to trigger a seizure. Researches don’t exactly know how this ECT works but it’s believed that the seizure makes changes in brain chemistry that could lead to mood improvements.

HOSPITALIZATION:
Sometimes people with bipolar disorder can benefit from hospitalization for psychiatric treatment in stabilizing their mood, whether in full-blow mania or deep depression episodes. Day treatment programs are also another option.

Prognosis:

Not available

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