Bipolarity This spring break I went to the Florida Keys with my friend Dan Granger. His uncle let us stay at his house, which I thought was cool. His wife told us how nice it was going to be to have us there. Then she told us how well everything was going with them. Which I didn't really care but I listened anyway. Come to find out that Dan's uncles wife is bipolar.

I had never met anybody who had a bipolar disorder. She seemed fine when I talked to her but then while we were eating she started to cry. I freaked out when she yelled she couldn't take this anymore. Luckily Dan's uncle wasn't there so I just played it off as nothing.

Then she started to tell Dan and I how bad off they were and that they were going bankrupt. After that I talked to Dan's uncle and he told me that she does this once in a while. He thought that I knew before I came down there. I guess Dan just forgot to warn me.

Now on with the good stuff. Bipolarity was only a theory at best in the 16 th and 17 th century when Dutch painter Vincent Van Gogh suffered from bipolar disorder. It appears that there are many people with the disorder yet, no true causes or cures for the disorder. Bipolarity severely undermines their ability to obtain and sustain social and occupational success. However, the journey for the causes and cures for the Bipolarity must continue. Affective disorders are primarily characterized by depressed mood, elevated mood or (mania), or alternations of depressed and elevated moods.

The classical term is manic-depressive; a newer term is Bipolarity. The two are interchangeable. Milder forms of a depressive syndrome are called dysthymia disorder, mild forms of mania are hypomania and the milder expressions of Bipolarity are called cyclothymia disorders. The use of the term primary disorder refers to the individuals who had no previous disorders or else only episodes of mania or depression. Secondary affective disorder refers to patients with preexisting psychological illness other than depression or mania (Goodwin, Guze. 1989, p.

7 Bipolarity affects approximately one percent or three million persons in the United States, afflicting both males and females. Bipolarity 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 may alternate with profound depressions characterized by a pervasive sadness, almost inability to move, hopelessness, and disturbances in appetite, sleep, in concentrations and driving. Bipolarity is diagnosed if an episode of mania occurs whether depression has been diagnosed or not (Goodwin, Guze, 1989, p 11).

Most commonly, individuals with manic episodes experience a period of depression. Mood is either elated, expansive, or irritable, hyperactivity, pressure of speech, flight of ideas, inflated self esteem, decreased need for sleep, , and excessive involvement in activities with high potential for painful consequences. Rarest symptoms were periods of loss of all interest and retardation or agitation (Weisman, 1991). As the National Depressive and Manic Depressive Association (NMDA) has demonstrated, bipolarity can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters. This devastating disease causes disruptions of families, loss of jobs and millions of dollars in cost to society.

Many times bipolar patients report that the depressions are longer and increase in frequency as the individual ages. Many times bipolar in a psychotic state are misdiagnosed as schizophrenic. Speech patterns help distinguish between the two disorders (Lish, 1994). The onset of Bipolarity usually occurs between the ages of 20 and 30 years of age, with a second peak in the mid-forties for women, but has been seen in the early teens. A typical bipolar patient may experience eight to ten episodes in their lifetime. However, those who have rapid cycling may experience more episodes of mania and depression that succeed each other without a period of remission (DSM IV).

The three stages of mania begin with hypomania, which people report that they are energetic, extroverted and assertive. The hypomania has led observers to feel that bipolar patients are 'addicted' to their mania. Hypomania progresses into mania as the transition is marked by loss of judgment. Euphoric characters are recognized as well as a paranoid or irritable character begins to manifest.

The third stage of mania is evident when the patient experiences delusions with often paranoid themes. Speech is generally rapid and behavior manifests with hyperactivity. When 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 yet another presentation of bipolarity. 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 disorder. 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 bipolarity. 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.

Which I don't blame them for refusing to tolerate them. People who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolarity. Among the problems associated with lithium includes the fact the long-term lithium treatment has been associated with decreased thyroid functioning in patients with bipolarity. 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 bipolarity 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 anti convulsant such as and. These drugs are useful as anti manic 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 co morbid alcohol or drug abuse. Neuroleptics such as 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, 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.

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.

Hypomania symptoms were experienced by 36% of bipolar patients in this study. Predominant hypo manic 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 hypo manic 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). A final type of therapy that I found is outpatient group psychotherapy. 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 References Bauer, M. S. , Kurtz, J. W.

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