Bipolar Disorder 1 Bipolar Disorder The event of bipolar disorder has been a mystery since the 16 th century. Records have shown that this problem can appear in almost anyone. It is clear that in our social world many people live with bipolar disorder. Regardless of the number of people suffering from the disease, we are still waiting for an explanation regarding the causes and cure.

One fact of which we are aware, is that bipolar disorder severely undermines its' victims ability to obtain and maintain social and occupational success. Bipolar disorder has such devastating symptoms, that it is important we remain determined in searching for explanations of its causes and treatment. Bipolar disorder affects approximately one percent of the population in the United States. Bipolar disorder involves feelings of mania and depression. Which is where individuals with manic episodes experience a period of depression. The depression episodes are characterized by a persistent sadness, almost inability to move, hopelessness, and disturbances in appetite, sleep, in concentration, and driving.

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). As the National Depressive and Manic Depressive Association (MD MDA) have demonstrated, bipolar disorder can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters. In addition, bipolar states and psychotic states are misdiagnosed as schizophrenia, but a closer look at speech patterns can help distinguish between the two (Lish, 1994). The beginning of Bipolar disorder usually occurs between the ages of 20 and 30.

A typical bipolar patient may experience eight to ten episodes in their lifetime. However, those who have larger cases may experience more episodes of mania and depression closer and more frequent, without a period of remission (DSM III-R). The three stages of mania begin with hypomania, in which patients report that they are energetic, extroverted and assertive (Hirschfeld, 1995). Hypomania then progresses into mania and the transition is marked by loss of judgment (Hirschfeld, 1995). Lastly, the third stage of Bipolar Disorder 2 mania is evident when the patient experiences delusions with often-paranoid themes.

Speech is generally rapid and hyperactive behavior is apparent, and sometimes associated with violence (Hirschfeld, 1995). When both manic and depressive symptoms occur at the same time it is called a mixed episode. Those afflicted are at a special risk because there is a combination of hopelessness, agitation, and anxiety that makes 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 unhappy; yet, they exhibit the energy associated with mania. Rapid cycling mania is also a presentation of bipolar disorder.

Mania may be present with four or more distinct episodes within a 12-month period. However, there is now evidence to suggest that sometimes rapid cycling may be a brief demonstration of the bipolar disorder. This form of the disease exhibits more episodes of mania and depression than bipolar. There are medications that can be prescribed, that can help control the disease, and let people affected lead normal lives. Lithium has been the primary treatment of bipolar disorder since its introduction in the 1960's. Its main function is to stabilize the cycling characteristic of bipolar disorder.

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, as many as 40% of bipolar patients are either unresponsive to lithium or cannot tolerate the side effects. Some of the side effects include thirst, weight gain, nausea, diarrhea, and edema. Patients who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder.

Another problem associated with lithium is the fact the long-term lithium treatment has been associated with decreased thyroid functioning in patients with bipolar disorder. Preliminary evidence also suggest that hypothyroidism may actually lead to rapid cycling (Bauer et al. , 1990). Pregnant women experience another problem associated with the Bipolar Disorder 3 use of lithium. 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 bipolar disorder that are used in cases where he patients cannot tolerate lithium or have been unresponsive to it in the past. The American Psychiatric Association's guidelines suggest the next line of treatment to be Anticonvulsant drugs such as and. These drugs are useful a 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 is rapid, but there are risks involved in their use. Because of the often-severe side effects, Benzodiazepines 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. Antidepressants such as the selective serotonin re uptake inhibitors (SSRI's) and have also been used by some doctors; as treatment for bipolar disorder. A double-blind study by M. Gasper ini, F. Gatti, L. Bellini, R.

Anniv erno, and E. Smer aldi showed that and are highly effective treatments for bipolar patients experiencing depressive episodes (1992). This study is controversial however, because conflicting research shows that SSRI's and other antidepressants can actually precipitate manic episodes. Most doctors can see the usefulness of antidepressants when used in conjunction with mood stabilizing medications such as lithium. Bipolar Disorder 4 In addition to the mentioned medical treatments of bipolar disorder, there are several other options available to bipolar patients. One study compared the response to light therapy of bipolar patients with that of unipolar patients.

Patients were 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 bright morning light treatment for patients with seasonal affective disorder and 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 (Baur, Kurtz, Rubin, and Markus, 1994). 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 has called attention to the value of support groups, and challenged 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, and the need for education and support for the interpersonal difficulties that arise during the course of the disorder. Bipolar Disorder 5 In closing, this once crippling disease can now be sedated and livable with the help of medication and alternate methods.

Modern technology and medicine have outwitted the scientists of the past, and most of the dangers one who had this disease would experience have been evaporated. Still a puzzling sickness, the advances and steps that take us closer to the answer are proving hopeful for the future and knowledge of bipolar disorder. Bipolar Disorder 6 References Bauer, M. S. , Kurtz, J. W.

, Rubin, L. B. , and Marcus, J. G. (1994). Mood and Behavioral effects of four-week light treatment in winter depressives and controls.

Journal of Psychiatric Research. 28, 2: 135-145. Bauer, M. S. , Whybrow, P. C.

and Winokur, A. (1990). Rapid Cycling Bipolar Affective Disorder: I. Association with grade I hypothyroidism. Archives of General Psychiatry. 47: 427-432.

Black, D. W. , Winokur, G. , and Nasr allah, A. (1987). Treatment of Mania: A naturalistic study of electro convulsive therapy versus lithium in 438 patients.

Journal of Clinical Psychiatry. 48: 132-139. Goodwin, F. K. , and Jamison, K. R.

(1990). Manic Depressive Illness. New York: Oxford University Press. Goodwin, Donald W. and Gaze, Samuel B. (1989).

Psychiatric Diagnosis. Fourth Ed. Oxford University. p. 7. Hirschfeld, R.

M. (1995). Recent Developments in Clinical Aspects of Bipolar Disorder. The Decade of the Brain. National Alliance for the Mentally Ill. Winter.

Vol. VI. Issue II. Hollandsworth, James G. (1990).

The Physiology of Psychological Disorders. Plenum Press. New York and London. P. 111. Hopkins, H.

S. and Gelenberg, A. J. (1994). Treatment of Bipolar Disorder: How Far Have We Come? Psychopharmacology Bulletin. 30 (1): 27-38.

Jacobson, S. J. , Jones, K. , Colin, L. , Kaur, P. , San, D.

, Donner feld, A. E. , Rider, M. , Sant elli, R.

, Smythe, J. , Patuszuk, A. , Einar son, T. , and Koren, G. , (1992).

Prospective multi center study of pregnancy outcome after lithium exposure during the first trimester. Lari cet. 339: 530-533. Lish, J. D. , Dime-Meen an, S.

, Whybrow, P. C. , Price, R. A. and Hirschfeld, R. M.

(1994). The National Depressive and Manic Depressive Association (DMD A) Survey of Bipolar Members. Affective Disorders. 31: pp.