Tuesday, February 5, 2013

BIPOLAR DISORDER



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.