Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. Different from normal ups and downs that everyone goes through, the symptoms of bipolar disorder can be server. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treating and people with this illness can go on to lead full and productive lives.
What are the symptoms of bipolar disorder?
Bipolar disorder causes dramatic mood swings; from overly “high” and or irritable to sad and hopeless and back again, often with periods of normal mood in between. Server changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Signs and symptoms of mania include:
Increased energy, activity, and restlessness
Excessively “high”, overly good, euphoric mood
Racing thought and talking very fast, jumping from one idea to another
Distractibility can’t concentrate well
Little sleep needed
Unrealistic beliefs in one’s abilities and powers
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for one week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression or a depressive episode includes:
Lasting sad, anxious, or empty mood
Feeling of hopelessness or pessimism
Feeling of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed, including sex
Decreased energy, a feeling of fatigue or being slowed down
Difficulty concentrating, remembering and making decisions
Restlessness or irritability
Sleeping too much or can’t sleep
Change in appetite and or unintended weight loss or gain
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day nearly every day for a period of two weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with effective functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes severe episodes of mania or depression include symptoms of psychosis or psychotic symptoms. Common psychotic symptoms are hallucinations, (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood stat E at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania. Delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continues range. At one end is severe depression, then moderate depression, and then mild low mood. This condition is termed “dysthymia” when it has become chronic. There is also normal or balanced mood, then hypomania (mild to moderate mania) and then server mania.
In some people, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant changes, in appetite, psychosis, and suicidal thinking. A person may have very sad, hopeless mood while at the same time feeling extremely energized.
Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder has yet to be identified physiologically through blood tests or other diagnostic measures. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association social worker, or counselor typically provides these therapies and often works with the psychiatrist to monitor a patient’s progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.
What is the course of Bipolar Disorder?
Episodes of mania and depression
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression. This form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than men.
People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared (Goodwin & Jamison, 1990). But in most cases, effective treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.
Children and Adolescents with Bipolar Disorder
Both children and adolescents can develop bipolar disorder. It is most likely to affect the children of parents who have the illness themselves.
Unlike adults with bipolar disorder whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day (Geller & Luby, 1997). Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.
Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder,
For any illness, effective treatment depends on an accurate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.
Cause of Bipolar Disorder
Scientists are learning about the possible causes of bipolar
Since bipolar disorder tends to run in families, researchers have been searching for specific genes passed down through generations that may increase a person’s chance of developing the illness. The influence that genes contribute to the disorder may provide a partial answer to discovering the causes of bipolar disorder. Studies of identical twins who share the same genes indicate that genes and other factors do play a role in bipolar disorder. If bipolar disorder was caused entirely by genes, however, an identical twin of someone with the illness would always develop the illness. Research has shown that this is not the case. If one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling (National Institute of Mental Health [NIMH], 1998).
As mentioned previously, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene (Hyman, 1999). It seems likely that many different genes act together, and in combination with other factors of the person or the person’s environment to cause bipolar disorder. Identifying these genes (each of which contributes only a small amount toward the vulnerability to bipolar disorder) has been extremely difficult. Scientists predict that the advanced research tools now available will lead to these discoveries and to new and better treatments for bipolar disorder.
New brain-imaging techniques are allowing researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.
Most individuals with bipolar disorder, even those with the most severe forms, can achieve substantial stabilization of their mood swings and related symptoms with appropriate treatment (Sachs, Printz, Kahn, Carpenter & Docherty, 2000; Sachs & Thase, 2000; Huxley, Parikh & Baldessarini, 2000). Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and is almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. Even when treatment is continuous mood changes can occur and should be reported immediately to the healthcare provider.
In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help healthcare provider to track and treat the illness more effectively.
Medications for bipolar disorder are prescribed by psychiatrists with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry may also prescribe
Medications known as “mood stabilizers” are usually prescribed to help control bipolar disorder (Sachs et al., 2000). Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression
• Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treating mania, is usually very effective and works to prevent the recurrence of both manic and depressive episodes.
• Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), can also have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
• Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
• Anticonvulsant medications may be combined with lithium for maximum effect.
• Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents.
• There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20 (Vainionpaa, et al., 1999). Therefore, young female patients taking valproate should be monitored carefully by a physician.
• Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant (Llewellyn, Stowe & Strader Jr., 1998). Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.
As an addition to medication, psychosocial treatments-including certain forms of
Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. National Institute of Mental Health (NIMH) researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.
• CBT and DBT helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
• Psychoeducation involves teaching people with bipolar disorder about the illness, its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.
• Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person’s symptoms.
• Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
• As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.
In situations where medication, psychosocial treatment, or the combination of these interventions prove ineffective (or work too slowly to relieve severe symptoms such as psychosis or suicidality), electroconvulsive therapy (ECT) may be considered as a treatment option. ECT may also be considered to treat acute episodes when medical conditions such as pregnancy make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems was a concern in the past; however, this problem has been significantly reduced with modern ECT techniques. The potential benefits and risks of ECT and of available alternative interventions should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends (U.S. Department of Health and Human Services, 1999).
Herbal or natural supplements, such as St. John’s wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain varying amounts of active ingredients. Before trying herbal or natural supplements, encourage your patients to discuss this with their healthcare provider. There is evidence that St. John’s wort can reduce the effectiveness of certain medications (Henney, 2000). In addition, like prescription antidepressants, St. John’s wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken (Nierenberg, Burt, Matthews & Weiss, 1999).
Omega-3 fatty acids found in fish oil are also being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder (Stoll et al., 1999).
Bright light therapy can ease bipolar depression patients, according to a study published in the journal Bipolar Disorders. Researchers from the University of Pittsburgh School of Medicine’s Western Psychiatric Institute and Clinic studied nine women with bipolar disorder to examine the effects of light therapy in the morning or at midday on mood symptoms.Occupational therapy is used to help someone overcome boundaries that they experience on a daily basis in order to live a “normal” life. These therapists are trained on all aspects of life, be it cognitive, emotional or motivational. Bipolar disorder affects exactly these aspects and sometimes medication alone is not effective enough to allow a patient to live a normal life. The process begins by the therapist observing the patient. Ultimately, a treatment plan is created and therapy begins. By re-teaching these individuals how to conduct everyday living activities, they, in essence, help them re-think, therefore alleviating some of the negative thoughts they have. Occupational therapy is effective on depression in that therapists train the patient to change his cognition (thought patterns). Usually, depressed individuals lack any sort of motivation and feel so down that they are uninterested in any regular activities. An OT helps them, through real life experiences (such as going to the grocery store and facing the public), by not only facing their fears but providing them with the outline necessary to change their thoughts. The flip side of bipolar disorder, mania, is extremely difficult to work with. These individuals are elated, out of touch with reality and hyper. Keeping this in mind, occupational therapists use the wise methods of keeping everything strictly goal-oriented and time managed. If not put under these restrictions, attention would almost surely not be paid to the therapist. By imposing these strict guidelines, they are able to get the individual to focus, allowing them the opportunity to work on their emotions and thoughts.
Music Therapy is an interpersonal process in which the therapist uses music and all of its facets-physical, emotional, mental, social, aesthetic, and spiritual-to help clients to improve or maintain their health. It is used with clients of all ages and with varying problems, including mental illnesses. Sometimes, the needs of the client are addressed directly through the music; however, at other times, the client’s needs are addressed through the relationship between them and their therapist (and music is just the tool).
Place on the web that might offer more information for help with bipolar disorders.