Bipolar Disorder Bipolar Disorder is an affective disorder that is characterized by at least one episode of mania formerly referred to as manic depression (Ingram 723). It affects one percent of people throughout the world and knows no ethnic or status boundaries. In the United States, it is estimated that over two million people suffer from this incurable but treatable disorder. Bipolar disorder usually begins to show itself in males in their early twenties. Women however, typically may not exhibit any signs or symptoms until they reach their mid to upper thirties.
Bipolar Disorder is characterized by stages of mania and depression. Both the manic phase and the depressive phase are extreme and often disabling. They do not occur in equal amounts, but are very unpredictable and of varying length. They can also occur at the same time. When this happens, it is called mixed states. Usually the earlier in life bipolar disorder appears, the more difficult will be its lifetime course unless there is active treatment over many years to minimize the risk of recurrence (Francis 61).
People without bipolar disorder may think hypomania sounds like fun after hearing that it causes a euphoric or high feeling. Actually there is more to it than that. Some of the other symptoms associated with the manic episodes are high irritability, poor judgmental skills, and racing thoughts. Others are inability to concentrate, pressured speech, grandiose ideas, and inability to sleep. Some other reported symptoms are an increased sex drive and being easily distracted. When mania strikes, the bipolar person often exhibits full flights of fancy, you will notice a pre-emptive ability to argue aggressively and passionately for an intellectual position (FyrenIyce).
During this time the bipolar, will accomplish a lot of work with little or no sleep. They become impatient when they think others are moving too slowly and will have illusions of conquering the world. They may be prone to overgenerous behaviors, such as taking and paying for unexpected trips with friends and acquaintances; spending huge amounts of money on credit cards and in general being a bit of a challenge for the slower-moving folk of the world (FyrenIce). In its extreme form, mania may manifest itself as psychoses, complete with dissociative behaviors and a crippling inability to distinguish the real world from the one induced by the illness (FyrenIce).
Individuals in a manic phase lose friends, money, jobs, and may also wind up in the hospital. Child abuse, excessive debt, and divorce are also common. The effects can be devastating on family and friends, as the afflicted often has no idea anything is wrong. They may also become physically aggressive, becoming a danger to themselves and to others. Hospitalization is often necessary to keep the patient in a stable environment until the intensity of the phase begins to dwindle. Under no circumstances should one attempt to care for a person in an extreme state without the aid of a trained physician and hospitalization (FyrenIce).
The depression phase is most distinguished by a sad, anxious, or empty mood. During the depressive phase a person may experience lack of appetite, inability to sleep or excessive sleeping, suicidal thoughts, difficulty in decision-making, and extremely low self-esteem. They may also feel lethargic and weak and have a loss in interest of previously enjoyed activities. Some report feeling more creative during this stage. Nothing pierces the gloom; one becomes interiorized eyes staring and lifeless inwardly focused.
One can experience delusions and suicidal ideation: death being preferable to the current, and continuous, agony. This period may change rapidly for some rapid cycling bipolar, or it may be the more dominant mood (FyrenIce). In the depressive phase, people can go into a state of self-seclusion and despair. Negativity is all that enters the brain along with hopelessness. Having no desire to do anything previously enjoyed, the body becomes weak. Through lack of appetite, the body becomes undernourished.
Twenty percent of people diagnosed with bipolar disorder eventually commit suicide (NARSAD Spring 98). This is thirty times higher than the general population (Ikelman 4). Twenty to fifty percent of people with bipolar disorder attempt suicide at least once (Ikelman 4) Bipolar disorder gets its name because of its unpredictable swings in mood-often from spectacular overdriven highs to moribund lows and vice versa. Once you have had one clear manic episode, it is pretty certain you will go on to have many bouts of mania and depression throughout your life (First 61).
Some people, known as rapid cycles, go through four or more episodes of depression per year. Ultra-rapid cycles have episodes shorter than a week. Ultra radian cycles have distinct and dramatic mood shifts within a 24-hour period (Ikelman 2). People with bipolar disorders also may go years without any extreme ups and downs. This is classified as euthymia.
Some people also may have a seasonal aspect to their mood swings. Bipolar disorder is broken down into two specific classifications, Bipolar Bipolar II and I. Bipolar I is a recurrent disorder of which the hallmark characteristic is mania (Scher 725). Bipolar II disorder is characterized by periods of hypomania intermitted with periods of depression (Ingram 724). Hypomania episodes are shorter, less severe, and associated with less impairment. A DSM-IV criterion for Bipolar I Disorder is one or more manic or mixed episodes, commonly accompanied by a history of depressive episodes.
These episodes cannot be due to medical conditions, drugs, or toxins. The symptoms cannot be accounted for by a psychotic disorder. Mixed episodes are more common in younger patients, and episodes occur more frequently with age. Manic episodes tend to receive more clinical attention than depressive episodes. The lifetime prevalence of bipolar disorder is approximately 0.
5-1. 5% (FyrenIyce). In males, the first episode tends to be a manic one, while in females, the depressive episode is more likely to come first. Bipolar II Disorder is more characterized by depressive episodes with at least one hypomanic episode. As with Bipolar I Disorder, the mood episodes are not due to medical condition, medication, drug abuse, toxins, or treatments for depression. Hypomanic episodes tend to occur in close proximity to depressive episodes.
The episodes associated with this type also occur more frequently with age, have severe social and occupational consequences. The lifetime prevalence is 0. 5% and it is possibly more common in women (FyrenIyce). The classification of this disorder involve describing the most common mood episode that was with psychotic features, without psychotic features, with catatonic features, and with postpartum onset. The diagnosis requires the presence of at least four mood episodes in one year. Fortunately for people with Bipolar disorder, treatment options are available.
Prior to 1969, suitable treatment was not available and most individuals diagnosed were remanded to psychiatric facilities for indefinite periods of time. Mood stabilizers such as Lithium and the anticonvulsants have proven effective in the acute treatment as well as the prophylaxis of mood episodes. The discovery of the effect of Lithium (a mineral similar to salt) on the brain was a tremendous breakthrough 30 years ago. Yet 30 years later, doctors and scientists are still not sure how it works. ECT, electro convulsive therapy is very effective for bipolar disorders, but is usually used after conventional drugs have failed.
It is the most feared, although it is much less traumatic than when it originated. Antidepressants may be used if accompanied by a mood stabilizer to prevent a manic episode. It is often very frustrating to treat manic depression. What works for one person may not work for another (Ikelman 3) Dr. De Paulo Jr.
, a leading researcher in the field recently stated current treatments are only partially effective and that researchers till do not understand their precise mechanisms of action (NARSAD Spring 99). DePaul believes treatment should consist of mood stability, restoration of social functions, and education of family and friends. The most difficult part of the treatment process for the patient is acceptance of the illness and the lifestyle changes it demands. Staying on medication is crucial even when you are feeling fine. Having Bipolar Disorder means your brain is already on too tight a trip wire (Francis 75).
Adding any type of foreign substance to your body is asking for trouble. Bipolar Disorder is an unpleasant inconvenience in ones life but like hypertension or diabetes it is manageable. Pressure is mounting on the medical community to produce more effective treatment with fewer side effects. Genetic research has produced valuable information including the location of the carrier gene. With continued support and educated awareness, many members of the medical research community feel it may only be a short period of time before more profound answers are revealed. Depending on the severity of the symptoms exhibited by the bipolar person, they may need either temporary or long-term treatment at a hospital.
Whether this is voluntary or involuntary depends on the particular case. They may either stay in a general service facility with a psychiatric suite or they may entail confinement at an exclusively psychiatric center. For others there are halfway houses and group homes. A bipolar on a manic tear who is out of touch with reality, or one suffering severe suicidal ideation is likely to find themselves forcibly committed for treatment, while a lesser depression or hypomania will seldom warrant long term intervention (FyrenIyce) Long term treatment can either be inpatient or outpatient. Inpatient care involves extended stays in a psychiatric facility under careful monitoring. Outpatients can gradually restructure their lives while still attending treatments at a psychiatric facility.
It is extremely important to have a strong, caring, and working doctor / patient relationship because this relationship is so extended and enduring. Some family support groups, such as the Alliance for the Mentally Ill (AMI) and patient support groups such as Manic-Depressive Association (MDA) can be very helpful. They will learn to accept the reality of taking constant medication as well as the unpleasant side effects it causes. Bipolar disorder is tough to live with, but very manageable, if you take it seriously (Francis 77). Bipolar Disorder often goes undiagnosed for years. The average length of time to go without the proper diagnosis while under some sort of care is 10 years.
The wrong drugs and therapy may be applied to these patients. Bipolar Disorder has a biological basis, just like other illnesses and one cannot just snap out of it or cheer up. In fact, that is one of the worst things you can say because it makes the person feel that if they tried harder, they wouldn t be having the problems they are. With the care of family, friends, and doctors, someone with a bipolar disorder can live a full and semi-normal life. Works Cited Francis, Allen and First, Michael A Layman s Guide to the Psychiatrists Bible. New York: Scribner Publishing, 1998 Friedman, Howard S.
Encyclopedia of Mental Health Volume I. (features Rick Ingram and Christine Scher) Academic Press, 1998 FyrenIce (web fractal), Ikelman, Joy Ikelman s Info on Bipolar Disorder (Manic Depression) (web parrot / bip . html) NARSAD Research Newsletter Spring 1998, Great Neck, NY NARSAD Research Newsletter Spring 1997, Great Neck, NY.