BIPOLAR
DISORDER
1.
Define Bipolar Disorder
According
to Basco (2006), mental disorders are common all over the world. The disorders
affect children, adolescents, and adults. More than half of adults in the
United States will suffer some form of psychological problem at some point in
their life. Internationally, mental disorders are listed second, only after
cardiovascular disorders. These disorders have been common to man as a minimum
for as long as there as been recording of human history. Misinterpretation,
stigma and prejudice have always characterized the mental disorders. Mental are
health disorders that are distinguished by abnormality in judgment, thinking,
mood or behavior, related to stress and/or damaged functioning. There are
different types of psychological disorders that have been known to affect humans.
One of the common examples is bipolar disorder (McIntyre, Soczynska and
Konarski, 2006).
Each
person has what is normally known as “ups and downs” or “on and off” days.
However, when an individual is suffering from bipolar disorder, the peaks
become more severe. There are various other terms that are used in reference to
this mental disorder: manic-depressive
disorder, bipolar mood disorder, manic depression, manic-depressive disease,
and bipolar effective disorder. McIntyre, Soczynska and Konarski (2006) suggest
that bipolar disorder is a brain disorder which result to abnormal changes in
mood. An individual affected by bipolar disorder goes back and forth between
incidents of irritable or good mood and depression. This is a common problem,
evident in all parts of the world. It is approximated that millions of individuals
have a depressive disorder in the United States only per year.
Kempton,
Geddes and Ettinger (2008) argue that studies in the area of bipolar disorder
have identified different types of bipolar disorders. The disorder has
therefore been categorized into bipolar I, bipolar II, and cyclothymia, and
others. The categorization is on the basis of factors such as nature and
seriousness of the changes in the mood and other factors. The range is usually
referred to as the bipolar spectrum. Clinical experts divide bipolar disorder
into the different kinds due to the fact that the symptoms are revealed in a
different way in different persons. Knowledge of the exact kind of disorder is
helpful in the decision of the type of treatment to offer to a patient.
2.
The Characteristics of the Disorder
The
disorder is characterized by the incidence of one or more episodes of
abnormally high mood, energy levels, and cognitive with or without depressive
periods. Mania or hypomania is a term that is used medically to refer to the
elevated moods. Individuals suffering the manic episodes also most of the time suffer
depressive episodes, or symptoms, or an assorted state in which elements of
both depression and mania take place at the same time. The incidents are generally
broken up by periods of normal mood, but, in a few persons, mania and
depression may alternate in a rapid manner. McIntyre, Soczynska and Konarski
(2006) refer to this condition as rapid cycling. Severe manic episodes can at
times cause psychotic symptoms like delusions and hallucinations.
a)
Etiology
The
etiology of bipolar disorder has been researched by different experts for a
long time. It has been found out that the causes vary from person to person.
According to Basco (2006) some of the common causes include: genetic factors,
physiological factors and environmental factors:
Genetic factors play a
significant part in the development of the disorder. The factors contribute significantly
to the likelihood of suffering from the disorder. In the bipolar disorder I,
concordance rates in the recent researches have been constantly estimated to
around 40% in monozygotic twins. This is as compared to 0 to 10% in dizygotic
twins (Arnone et al, 2009). A research combining the first three kinds of
bipolar disorders provided concordance rates of 42%t vs. 11%. However, there
was a relatively lower ratio for the second type of bipolar disorder, bipolar
disorder II. This low ratio possibly reflects heterogeneity. The general
heritability of the spectrum has been estimated at 0.71 (Arnone et al, 2009). It
is suggested that genes have the possibility of having only a limited effect.
Another
possible cause is deformity is the structure and/or function of some brain
circuits. Some meta-analysis of MRI researches in the disorder have reported “a
increase in the volume of the lateral ventricles, globus pallidus and increase
in the rates of deep white matter hyperintensities” (Arnone, et al, 2009:195).
The “kindling” theory posit that persons who are genetically predisposed toward
the disorder can have episodes of stress, each of which decreases the point at
which the changes in mood can occur. Eventually, a mood episode can start (and
become regular) by itself. There is evidence of hypothalamic-pituitary-adrenal
axis impairment in the disorder due to stress. The major brain structures that
play an important part are the sodium APTase Pump and the mitochondria. Deformity
in the structures leads to cyclical episodes of poor neuron firing, which
depression, and hypersensitive neuron in firing, which is the mania (Arnone, et
al, 2009).
There
is also a strong contribution of environmental factors to the commencement and
course of the disorder. Personal psychosocial environment may operate with
genetic dispositions to cause bipolar disorder. Modern research reveals that
modern life events and interpersonal relationships play a major role in the
development and course of the episodes. There have been frequent research
findings that between 30% and 50% of adults with the disorder report victimization
in their childhood. This is related to the development of the disorder early in
life (Arnone et al, 2009).
b)
Pathology- include the course of the
disorder over the lifespan
The
pathophysiology of the disorder is the changes to the usual biochemical and physiological
functions associated with the disorder. The pathophysiology of this condition
is not well understood. However, this understanding is an ultimate objective of
most researchers in this area. It is still not yet known the physical factors
which are involved in the onset of the disorder, but it is noted that
researchers and learning new information everyday. Different imaging studies have
suggested the working of structural deformities in the basal ganglia, the amygdale
and prefrontal cortex. Current studies are also showing that the disorder is
related to abnormal brain levels of norepinephrine, serotonin, and dopamine. It
has been showed by imaging studies that individuals with the disorder tend to have
structural changes in the brain which might have a relationship with its
causes. Parts of the brain like the basal ganglia, amygdala, and prefrontal
cortex have revealed physical differences in individuals suffering the
condition compared to those without the disorder. Additionally, persons with
the disease also reveal irregular myelination in some parts of their brain.
Such indications reveal some damage to some parts of the brain regulating emotion.
3).
Identify Interventions
Basco
(2006) posits that bipolar treatment is treatable. The treatment for the
disorder is more effective if sought early. Living with the problem without
seeking treatment can have detrimental effects, both to the patient and the
people close to the patient. The disorder requires long-term treatment and
care. Due to the fact that the disorder is chronic, treatment usually takes a
long period of time. Persons suffering from the disorder usually require
medication to eliminate the symptoms and prevent occurrence of new episodes.
Nevertheless, medication is not enough for individuals suffering from the
disorder. This is because medication may deal with the condition, but not its
causes and risk-factors. The most effective strategy in the treatment of the
bipolar disorder is a combination of medication, therapy and social support (Family
and Larger Systems Theory). This entails the engagement of the family in
providing care and management of bipolar disorder. Family therapy has been
found effective in the management of the symptoms (McIntyre, Soczynska and
Konarski, 2006).
McIntyre,
Soczynska and Konarski (2006) suggest that there is no cure for bipolar
disorder. Treatment is used in stabilizing moods and helping the patient in
management and control of signs and symptoms. In treatment, the psychiatrist
seeks to identify the trigger behind the mood episode. Other emotional and
medical issues associated with the disorder are identified in the diagnostic
stage are also treated. There are various medications, generally known as mood
stabilizers which are usually normally used in the treatment of bipolar
disorder. They include: lamotrigine, carbamazepine, lithium, and valproic acid.
Other kinds of medications used for the treatment include anti-anxiety drugs
and antipsychotic medications. To treat depression, antidepressants can be
used. However, antidepressants are necessary for individuals using mood
stabilizer. Electroconvulsive therapy can be utilized in the treatment of manic
or depressive stage of the disorder, especially if it does respond to the
medications. Transcranial magnetic stimulation can be used for the treatment of
the affected areas of the brain. It is most effective when done after
Electroconvulsive therapy (Basco, 2006).
4).
Critique the Research Literature
A
lot of studies have been carried out in the area of psychological disorders
with the aim of understanding their causes and seeking proper treatment for
them. Bipolar is one of the psychological disorders that have been intensively
studied. Research in this area is much, but it is varied as far as different
aspects of the disorder are concerned. For instance, researchers have given
different estimates of the lifetime prevalence of the disorder. On the other
hand, researches normally give values of the order of one percent. Higher
values are shown in researches with looser definitions of the disorder
(Kempton, Geddes and Ettinger, 2008). There
has also been a limitation by considerably small sample sizes in Twin studies
to find out different aspects related to the disorder such as the causes. Even
if the early genetic connection research findings for mania were in 1969, the
connection studies have not been consistent. Meta-analysis of connection
researches reveals no considerable genome-wide results or, using diverse
methods, only two genome-wide substantial peaks.
References
Arnone, D., Cavanagh,
J., Gerber, D., Lawrie, S.M., Ebmeier. K.P., McIntosh, A.M. (2009).
Magnetic
resonance imaging studies in bipolar disorder and schizophrenia: meta-analysis.
Br J Psychiatry 195 (3): 194–201.
Basco, M. R. (2006). The Bipolar Workbook: Tools for Controlling
Your Mood Swings. New
York:
The Guilford Press.
Kempton, M.J, Geddes,
J.R., & Ettinger, U. (2008). Meta-analysis, Database, and Meta
regression
of 98 Structural Imaging Studies in Bipolar Disorder. Arch Gen Psychiatry 65 (9): 1017–32.
McIntyre, R.S.,
Soczynska, J.K. & Konarski, J. (2006). Bipolar Disorder: Defining
Remission
and Selecting Treatment". Psychiatric
Times. Retrieved on October 12, 2012 from http://www.psychiatrictimes.com/article/showArticle.jhtml?articleId=193400986.
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