Bi-Polar Disorder and Its Treatment - Coursework Example

Bi-Polar Disorder Introduction Bipolar Disorder has been characterized as, "an affective disorder that is characterized by at least one episode of mania formerly referred to as manic depression" (Francis 1997, p. 60). Nearly one percent of the world’s population is afflicted with it, and the illness seems to affect all nations and ethnic groups. The research contained herein is an examination of contemporary scientific understanding of bi-polar disorder. The essay considers the potential causes, as well as major treatment and coping methods implemented by practitioners and patients. I. Causes Contemporary research among biomedical experts and psychotherapists has been attempting to determine the exact cause of bi-polar disorder. While no ultimate conclusions have been determined, studies have revealed a number of consistent results. Most research attests that bi-polar is oftentimes found in families, which logically implies a genetic basis for the disorder. Generally it begins to take hold in individuals at different times, based on gender. The onset in males occurs most frequently in their early 20s, while in females in occurs much later – as late as the mid to their mid to upper thirties. Also differentiating the disorder along gender lines is the way it affects the patients, as in males the manic stage sets in first, whereas females first experience the depressive stage of the manic cycle. "The lifetime prevalence of bipolar disorder is approximately 0.5-1.5%." (FyrenIyce) Sadly, not much more has been determined about the primary causes of the illness. While psychoanalysis, and certain cognitive therapies investigate the patient for instances of past childhood experiences or social dysfunctions that might lead to onsets of the illness, no conclusive results have been developed. II. Treatment Options Medicine: Anticonvulsants and Antipsychotics While Bipolar disorder may be a highly debilitating disease, there exist a number of treatment options. Treatment for the disorder before the 1970s was non-existent. Patients were often sent to psychiatric wards or in less severe instances instructed to merely cope with their disorder. Since the early 1970s, a number of treatment options have emerged that have progressively reshaped the therapeutic climate. While many of these treatments are medicinal treatments, there is a wide-variety of options for patients suffering from Bi-polar symptoms. Historically Lithium has been the most prescribed drug for treatment of Bi-polar disorder, but recent developments have shifted the focus to other anti-mania inducing alternatives. In a chance discovery, scientists realized that many of the anticonvulsant medications, including Depakote which has been implemented for the treatment of epileptic seizures, are effective in reducing the manic episodes. However, it wasn’t until 1995 that the Food and Drug Administration approved the use of Depakote for the treatment of manic depression. Since that time, Depakote has gradually become the most consistently prescribed drug for treatment. While Depakote is one of the most consistently prescribed treatments, it has not entirely usurped the implementation of lithium. Yet, Depakote remains a highly viable alternative for many patients who found the therapeutic effects of Lithium to be limiting, and wish to avoid deleterious side effects that Lithium oftentimes causes. For instance, doctors have indicated that patients on Depakote oftentimes report that they are able to think more lucidly, and research attests to the long-term avoidance of kidney problems that Lithium sometimes causes (Hardwood 118-120). Another frequently prescribed drug is an antipsychotic known as Clozaril. Clozaril has emerged as a viable alternative when the outside treatment options of Depakote or Lithium fail to respond. While Clozaril is an effective treatment option for a number of patients, it carries with it a number of side effects. One of the major negative impacts of Clozaril is that it has been shown to inhibit the production of white blood cells in a small amount of patients. Even though the numbers of this occurring have been deemed to be less than 1%, the severity of the side effect makes it so that doctors must use extreme caution when prescribing it for treatment. Medicine: Combination While anticonvulsants and antipsychotics are effective in reducing the manic symptoms, it’s usually necessary for patients to be on more than one medication to adequately control their disorder. One of the main challenges of treating bi-polar disorder with medicine is finding the most effective combinations of medicine and dosage level for the patient’s particular symptoms. In most instances, mood stabilizers such as Depakote and Seroquel are implemented for the manic phases, and then augmented with a series of treatments for the depressive cycle. As one except, the anti-depressants are an effective means of treatment for this period. Anti-depressants that have been coupled with mood stabilizers include SSRIs (Selective Serotonin Re-uptake Inhibitors), Tricyclics, MAOIs (Monoamine Oxidase Inhibitors), and Bupropoin. Generally, psychiatrists prescribe an anti-depressant such as Wellbutrin, along with an anti-convulsant or antipsychotic such as Seroquel to effectively address both phases of the manic depressive cycle. Medicine: Pregnant Patients Treating pregnant women with bi-polar disorder is a specifically difficult task to undertake. Women in pregnancy have demonstrated a significantly high level of manic cycles, particularly in the post-partum phase. Regular medicinal treatments pose a challenge to doctors as the side-effect of antipsychotics are oftentimes too risky for them to be effectively implemented with pregnant patients. Some of the most common medications implemented in treating manic depression during pregnancy are oral contraceptives such as carbamazapine. When spotting occurs on the patient this is a sign to the doctor that the implementation of carbamazapine has interfered with outside medication, so it’s very important for doctors to attend regularly to pregnant patients. In these instances, altered levels of estrogen, or entirely alternative means of birth control have been deemed effective. It remains extremely important that the correct medicinal balance be achieved, since carbamazapine and lithium can cause complications in giving birth. Some bi-polar medications have also been indicated to cause difficulties in the menstrual cycle, and have even completely entirely stopping the cycle altogether. Current genetic research into gender differences is being conducted to determine the exact extent to which female hormones, and pregnancy states, directly affect or cause onsets of manic phases. ECT While medication is successful in treating the vast majority of cases of Bipolar disorder, in more severe cased more extreme measures must correspondingly be taken. In these severe cases the use of electroconvulsive therapy (ECT) has frequently been implemented. While the mainstream social conception of ECT is that it is a highly barbaric form of treatment, where the patient is shackled like Frankenstein, this is a misconception; ECT has been successfully implemented to treat bi-polar manic episodes. In fact, all major research attests that ECT is just as successful in treating mania as Lithium and the antipsychotics. Indeed, ECT was the most implemented treatment throughout most of the 20th century, before the advent of Lithium in the early 1970s. One case study illustrates the continued contemporary effectiveness of ECT treatment, "In one study, all of 28 manic patients responded to ECT, while only 18 of 28 similar patients responded to the antipsychotic drug chlorpromazine. In another study, ECT was given for eight weeks to 17 patients who had not responded to lithium, and all of them recovered (Hardwood 2005, p. 119)." Ultimately it seems that electroconvulsive therapy is most effective when dealing with the manic phases, effectively stabilizing the patient’s mental and emotional demeanor. Hospitalization In some instances the bi-polar patient will become increasingly violent and lash out at family and friends. During manic phases they lose sense of rationality, having gone non-compliant with medication and relapse into dangerous states. Many times with the patient becomes aggressive and poses a threat to themselves and others, it is oftentimes necessary for the patient to seek in-house treatment at a hospital or similar medical facility. Oftentimes this is involuntary, as patients that are perceived as suicide risks may be committed without their will, "A bipolar on a manic tear who is out of touch with reality, or one suffering severe suicidal ideation is likely to find themselves forcibly committed for treatment, while a lesser depression or hypomania will seldom warrant long term intervention" (FyrenIyce) Possible placements include general service facilities that treat psychiatric disorders, or confinement in institutions specifically designed to treat unstable patients. Long term treatment options include group living situations and half way houses. Long term care can involve both inpatient and outpatient treatment options. The inpatient options are beneficial to patients that necessitate constant monitoring, oftentimes those who as previously stated pose a risk to themselves and society. Outpatient options are beneficial for more stable patients that are ready to be reestablishing their lives after a trying period and bout with bi-polar disorder. As one might imagine, it’s necessary for patients to have a highly functional and open relationship with their caring practitioner, as there are frequent relapses that accompany outpatient options. Indeed, "Under no circumstances should one attempt to care for a person in an extreme state without the aid of a trained physician and hospitalization" (FyrenIce). Alternative Treatment More recent investigations into the treatment of Bi-polar disorder have explored natural remedies. One of these alternative approaches that has gained mainstream acceptance within the medical establishment is the promotion of dietary changes to affect mental functioning. The most prominent of the dietary recommendations have been the consumption of fish oil and its associated products. Traditional science recognizes that consuming Salmon or Mackerel has long-term beneficial effects on the prevention of heart disease. Contemporary science now indicates that the consumption of these foods may greatly reduce the occurrences of manic episodes in bi-polar patients. It seems that the key therapeutic element in fish oils is the omega-3 fatty acids, of which the fish are greatly composed. Indeed, a case study conducted at Mclean Hospital in Massachusetts demonstrated that patients that regularly took fish oil supplements as a supplement to their antipsychotic medication reported that their symptoms alleviated in greater numbers than the patients who only took the medicine. (Finkelman 201) While their implementation in bi-polar treatment is still highly contentious and difficult to define, researchers believe that one day they may be used to as a safe and cheap alternative to other neurological therapeutic interventions. One of the leaders in biomedical research and bi-polar treatment stated, “current treatments are only partially effective and that researchers till do not understand their precise mechanisms of action" (NARSAD Spring 99). DePaul understands the most effective means of treatment to be a combination of a series of approaches. These approaches include the previous mentioned medicinal treatments, such as mood stabilizers and anti-depressants but also incorporate a broader range of cognitive therapeutic methods. DePaul believes that bi-polar disorder should be approached from just as much from the cognitive scale as it has been approached from the bio-medical. While he acknowledges the impossibility of general talk therapy to always treat severe cases of mania, he understands the underlining causes of the disorder to be rooted more in mental functioning than most theorists, and subsequently promotes a process of mental stabilization and cognitive behavioral therapy. Genetic Interventions Most mainstream theorists understand the genetic ramifications of disorders such as manic depression. Future research is seeking means of treating bi-polar by locating the genetic ramifications of the disorder and then attempting to formulate a treatment around them. Currently, researchers are seeking to discover the exact mood-disorder genes that are causing manic episodes. However, as with much research into biomedical technology, researchers have encountered resistance from conservative groups who deem such methods anti-religious. When considering the implications of mood-gene experimentation, conservative groups have protested the research as it would require testing to occur on unborn fetuses. Other moral concerns are that upon discovering their unborn child has bi-polar disorder, people may opt for abortion. However, it’s hoped that through researching mood-genes, medicinal alternatives would be developed that would make the disorder virtually non-existent, effectively eliminating the need for concern (Finkelman 176). III. Coping While treatment options are highly successful when adhered to by the patient, it’s necessary the patient accept their necessity and follow them accordingly. Indeed, it seems that one of the most crucial means of handling bi-polar disorder is for the patient to develop adequate means of coping with the illness. Many times patients will stay on their medication for a period and as they begin to feel stable and functioning decide to cease taking the drugs. In these instances, it’s been noted that patients usually relapse to pre-medication states, and the intervening time without the medication can result in oftentimes result in dramatically bad effects. For instance, patients have been documented as going as large spending sprees, engaging in similar reckless behavior, and in some instances even committing suicide. Indeed, "Having Bipolar Disorder means your brain is already on too tight a trip wire." (Francis 75) It seems many bi-polar patients that have been medicated miss the euphoric highs associated with the manic phases of the cycle – many patients believe it creates heightened awareness and improves creativity – and in an effort to achieve that high go non-compliant with their medication or begin self-medicating with street drugs. (Robbins 78). Notably, taking illicit drugs in addition to the medication already prescribed can deleterious effects, as the combination of stimulants can have a negative effect. There are a number of support groups that have been organized to aid patients in coping with bi-polar disorder. Currently the most prominent of these is the National Alliance for the Mentally Ill (NAMI), but others include the Manic-Depressive Association (MDA). NAMI has organizations throughout the country that have organized support groups and outreach programs for people afflicted with the disorder. They also often give lectures for family members on how to help manage the disorder. In many instances family members have difficult understand the behavior of their bi-polar children or siblings and often attribute it to irresponsibility and general carelessness. NAMI and other organizations help these people better cope with their family members illness by teaching them that the disorder is genetic and has nothing to do with a conscious decision to act out. Ultimately, "Bipolar disorder is tough to live with, but very manageable, if you take it seriously." (Francis 77). Conclusion In conclusion, while the ultimate cause of bi-polar disorder has yet to be determined, one can reasonably assume that it is genetically derived. Even as no all consuming ‘cure’ has been developed, a number of highly successful treatment options exist. These options vary in proportion to the severity of the disorder. They include medicinal treatments, electroconvulsive therapy, as well as behavior therapies, and in severe cases hospitalization. In addition to gaining treatment through these methods, patients must learn to cope with their disorder through support groups and other management methods. Ultimately, bi-polar disorder is a highly manageable illness when confronted with the options modern science has available. References Finkelman, Anita-Ward (1997). Psychiatric Home Care. Aspen Publishers; 1st edition Francis, Allen and First, Michael (1998) A Laymans Guide to the Psychiatrists Bible. New York: Scribner Publishing. Friedman, Howard S. (1998) Encyclopedia of Mental Health Volume I. (features Rick Ingram and Christine Scher) Academic Press FyrenIce (http://users.wantree.com.au:8080/~fractal) Great Neck, NY NARSAD Research Newsletter Spring 1997, Great Neck, NY Harwood AJ. Ikelman, Joy Ikelmans Info on Bipolar Disorder (Manic Depression) (http://www.frii.com/~parrot/bip.html) NARSAD Research Newsletter Spring 1998 Lithium and bipolar mood disorder: the inositol-depletion hypothesis revisited. Mol Psychiatry. 2005;10:117–126 Robbins, SM, et al. Mood and anxiety disorders. Psychiatry. 2006 Read More