In America today, more than two million people have been diagnosed or are living with the psychological disorder known as bipolar disorder. Researchers and clinicians have attributed this increased number of cases to the complications that impede the accurate and correct diagnosis of the disorder. Notably, a major reason for this is often a delay in the diagnostic procedure whereby majority of the reported cases confess to having visited three or more professionals before being correctly diagnosed with the disorder. Others speak to a 10 year or more waiting period before proper diagnosis. The major causes for this delay in most cases is the fact that many patients only seek treatment when depressed and not during manic episodes. Bipolar disorder is however, a serious mental illness that can greatly impact on the process of human development as well as socialization. This paper explores the bipolar disorder, its symptoms, causes and treatments.
Describing Bipolar Disorder
According to Fusar-Poli et al (2012) bipolar disorder, also referred to as manic-depressive disorder, is a neurobiological disease that is characterized by cycling periods of depression or mania (Fusar-Poli, Howes, Bechdolf, & Borgwardt, 2012). Specifically, the term ‘bipolar disorder’ is used to describe a psychological state in which an individual experiences radical variations in their moods manifesting recurrently in episodes of elevated or high moods (hypomania and mania) and depression which varies from agitated highs to depressive squats. Occasionally, patients may experience both highs and lows at the same time, while others may experience the ‘highs’ only. Additionally, patients suffering from this disorder will often experience normal moods in between the high-low episodes. It should be noted that bipolar disorder manifests differently and uniquely in each individual with some patients experiencing episode just once in a decade, whereas others may experience daily mood swings. Furthermore, these changes in moods maybe be subtle in some patients or dramatic in others and characteristically vary over the duration of the individual’s life (Levy & Manove, 2012).
According to the DSM-IV, Bipolar disorder (henceforth BP) is categorized into four main categories; Bipolar I, Bipolar II, Cyclothymic Disorder and Bipolar NOS (Parens & Johnston, 2010). The Bipolar I disorder is considered as the most severe illness which primarily features high depressive manic cycles. Patients with this type of the disorder experience severe, longer ‘highs’ (lasting for days or weeks) and psychotic episodes (characterized by hallucinations and/or delusions), often requiring hospitalization. Clinicians observe that patients of this specific type of BP lack adequate sleep which in turn promotes depression among them subsequently aggravating their anger and irritability instincts. Conversely, the Bipolar II disorder is considered as a less severe form of BP characterized by an absence of psychotic episodes and relatively short manic episodes. Patients of this BP subcategory experience a mild, less severe ‘highs’ also known as ‘hypomania’ and depressive cycles. Episodes may last for a few hours to a few days. Normally, due to the lack of manic episodes and mildness of the ‘highs’, BP II patients do not require hospitalization.
The third category of BP is cyclothymic disorder or cyclothymia which is characterized by chronic unstable moods. Patients in this category experience mood changes over a period of years, approximately a year for children and two years for adults. Primarily, a patient with cyclothymia will experience episodes of ‘highs’ or ‘lows’ for approximately half of the one or two year period featuring hypomania but without full mania or depressive episodes. Another major category of BP is Bipolar NOS (“not otherwise specified”) which features frequent alternate manic and depressive episodes and does not meet the specified criteria for the other subcategories of BP. Patients with BP NOS may experience such cyclical episodes up to four times annually but never experience full hypomanic episodes. Some patients may even undergo cases of ultra-rapid cycling, where episodes occur countless times within a 24 hour period.
Extensive research shows that Bipolar disorder has a significant impact on the way patients behave and develop and in many cases, untreated patients may experience tremendous suffering often culminating in substance abuse or suicidal tendencies (Post, et al., 2010). Studies show that BP begins at childhood though it is often diagnosed among teenagers from about the age of twelve or early twenties. Other people may however develop a late onset BP whereby their first episode occurs in the mid to late adulthood (Parens & Johnston, 2010).
Causes and risk factors of Bipolar Disorder
While research on the causes of bipolar disorder has not elicited definite answers, most literature on the subject suggest that a combination of physical, social and environmental factors plays a pivotal role in the onset and occurrence of the disorder. The first factor linked to the onset of BP is genetic or hereditary predisposition or vulnerability whereby studies show that first degree relatives of patients with BP are at a higher risk of developing the disease (Fusar-Poli, Howes, Bechdolf, & Borgwardt, 2012). The second causal factor is biological vulnerability where probable chemical imbalances in the brain may cause mood alterations. Researchers are also investigating the possibility that the accumulation of excessive calcium in the cells of patients may trigger the disorder. Additionally, the effects of various neurotransmitters such as dopamine and serotonin appear to be involved in the onset of bipolar disorder. Another causal factor that has been identified is life events, stress and experiences that take place in an individual’s life. Researchers and clinicians conclude that many patients diagnosed with BP usually recount traumatic, abusive and stressful experiences especially during childhood leading to manifestation of the disease in later life (MacCabe, et al., 2010).
In addition to these factors a variety of risk factors have been suggested as possible trigger factors among individuals with genetic or biological vulnerabilities. These include substance abuse, maladaptive or poor coping strategies, erratic daily routines, stress and interpersonal conflicts (Hosang, et al., 2010). The greatest risk factor in BP is not getting treatments early enough since it lead to other health problems such as heart disease, stroke or cancer.
Clinical Manifestation of Bipolar Disorder
The clinical manifestation of bipolar disorder vary according to the episodes or nature of subcategory the individual is suffering. For example during a depressive episode the signs and symptoms exhibited by the patient experiences may include anxiety, lack of sleep, hopelessness, indifference, aggression, isolation, irritability, lack of interest in sexual activity, inability to concentrate, depersonalization, increased fatigue, impaired decision making, low esteem and suicidal tendencies.
On the other hand, the mania and hypomania episode manifests in symptoms such as surges of energy, low attention span, feelings of increased creativity, intelligence and sexual drive, impaired judgment, irritability, and substance abuse or spending sprees. In addition, hypomania or mania episodes may also manifest as unsubstantiated elation, restlessness and agitation, loss of social inhibitions, pressured speech, and a low need for sleep.
According to Parens & Johnston (2010), bipolar disorder in children may manifest as restlessness/fidgetiness, separation anxiety, hyperactivity, rages and explosive temper tantrums, destruction of property, goofiness, impulsivity, low self-esteem, silliness, difficulties waking up in the morning, lying, bed-wetting (especially in boys)and social anxiety (Parens & Johnston, 2010).
Treatment of Bipolar Disorder
This disorder is often treated using pharmacological agents as well as lifestyle interventions. The main pharmacological intervention used include medications that act to control and stabilize moods co-indicated with anticonvulsants, antidepressants, and antipsychotics. Some of the medications for mania prescribed to patients include lithium (Eskalith or Lithobid), carbamazepine (Tegretol), divlproex sodium (Depakote), quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), aripiprazole (Abilify), and ziprasidone (Geodon). Those for bipolar depression include a combination of olanzapine, quetiapine (Seroquel), and luoxetine (Symbyax). The psychosocial interventions for BP involves developing managing and effective coping abilities. First, patients must accept their condition and be ready to make relevant lifestyle changes. Next, they are required to develop the ability to disregard the stigma associated with the disorder by gathering as much information about the disorder as much as possible. Others coping strategies may be joining support groups, partnerships with care providers and healthy living.
Fusar-Poli, P., Howes, O., Bechdolf, A., & Borgwardt, S. (2012). Mapping vulnerability to bipolar disorder: a systematic review and meta-analysis of neuroimaging studies. J Psychiatry Neurosci, 37(3), 170-184.
Hosang, G., Korszun, A., Jones, L., Jones, I., Gray, J., Gunasinghe, C., . . . Farmer, A. (2010). Adverse life event reporting and worst illness episodes in unipolar and bipolar affective disorders: measuring environmental risk for genetic research. Psychological medicine, 40(11), 1829-1837.
Levy, B., & Manove, E. (2012). Functional Outcome in Bipolar Disorder: The Big Picture. Depression Research and Treatment, vol. 2012, , Article ID 949248.
MacCabe, J., Lambe, M., Cnattingius, S., Sham, P., David, A., Reichenberg, A., . . . Hultman, C. (2010). Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. The British Journal of Psychiatry, 196(2), 109-115.
Parens, E., & Johnston, J. (2010). Controversies concerning the diagnosis and treatment of bipolar disorder in children. Child and Adolescent Psychiatry and Mental Health, 4(9), 1-14.
Post, R., Leverich, G., Kupka, R., Keck, P., McElroy, S., Altshuler, L., . . . Suppes, T. (2010). Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood. The Journal of Clinical Psychiatry, 71(7), 864-872.