Bipolar Disorder - Coursework Example

Bipolar Disorder Introduction Among many other disorders, one of the major disorders related to brain isBipolar disorder. Sometimes also known as manic-depressive disorder, bipolar disorder is associated to the category of mental illness which is characterized by fluctuations in the levels of activity and energy, and intense mood shifts or mood swings. The patient suffers from a disruption in moods which is also termed as mania often varying with phases of depression. The bipolar disorder can possibly impair the ability of patients to perform everyday tasks and do well in ordinary life. This manic-depressive illness can, many a times, prove to be a serious form of mental illness which is likely to spoil individuals relationships, weaken and destabilize career prospects, and have threatening affects on the academic or professional performance of the patient (Goodwin, Jamison, pp. 20-45). According to the American Psychological Association, due to such overwhelming emotional and mood shifts, the patient may also choose to end his life by committing suicide (Medical News Today, web). An individual suffering from bipolar disorder counters rigorous mood (poles) fluctuations and variation which ranges from depression to mania. These moods are often normal during the phase of peaks and troughs. When the individual becomes depressed, there is a feeling of extreme sadness and hopeless leading to lost pleasure or interest in many of the activities. On the other hand, when there is a mood swing in the opposite direction, the individual seems to be full of energy and feels euphoric. In bipolar disorder, the shifts in mood take place merely a few times within the duration of a year; or the mood shifts may also occur as often as several times a day. Many times, the individuals with bipolar disorder counter the symptoms of mania and depression simultaneously (Mayo Clinic, web). However, the variations in moods experienced by normal individuals sometimes are not concerned with the bipolar disorder; they are extremely debilitating, severe and incapacitating. However, the disorder can be treated provided the patient receives the right medication and proper care in order to perform well academically and at work to lead productive and complete life. According to the National Alliance on Mental Illness (MANI), there are more than 10 million people in the United States living with bipolar disorder. MANI also adds that, of all cases, a half start with the patients aged between 15 and 25 years old, affecting females and males equally (MNT, web). On the social levels, there exist extensive problems with prejudices, stereotypes, and social stigma that occur against the individuals with bipolar disorder. Signs and Symptoms Bipolar disorder is characterized by abnormally severe emotional phases that happen in different periods known as "mood episodes." During each of the mood episode, a drastic shift is presented with regards to the usual behaviour or mood of a person. An extremely overexcited or joyful condition is termed as manic episode; on the other hand a severely hopeless or sad situation is known as a depressive episode (Mueser, Goodman, Trumbetta, et.al. pp. 493-499). Many times, a bipolar disease represents the mood episode inclusive of both maniac and depressive symptoms termed as a mixed state (National Institute of Mental Health, web). These mood swings are accompanied by extreme shifts in activity, energy, behavior, and sleep. There are several subtypes into which the bipolar disorder is classified. Each of them is characterized by different sequences of symptoms. The bipolar disorder types: Bipolar I disorder In Bipolar I Disorder, the mood shifts become a prominent reason for the difficulty in the individuals school, jobs or relationships. There can also be dangerous and severe manic episodes (Mayo Clinic, web). Bipolar II disorder The Bipolar II disorder is known to be less severe in symptoms as compared with Bipolar I. The individual is likely to counter irritability and elevation in mood along with some other changes in the performance of everyday task and functioning. However, it is easier for the person to execute the normal daily routine. Cyclothymic disorder Cyclothymia, or cyclothymic disorders, refers to a milder type of bipolar disorder. During cyclothymia, depression and hypomania can prove to be disruptive, yet the lows and highs may not be as intense as in other classes of bipolar disorder (Miklowitz, Otto, pp. 419-426.). The defining features of the bipolar disorder are mania which occurs with varying intensity. At the milder levels, mania is commonly called hypomania, in which the person becomes excitable, energetic along with being highly productive. With the worsening of mania, an impulsive and erratic behavior is exhibited by the individuals, leading to poor decision making and having unrealistic thoughts and ideas regarding future, and less sleep. With mania reaching to intense heights, individuals are likely to experience extremely vague and distorted beliefs with respect to the world; this state is called psychosis. Individuals experiencing phases of mania also generally observe the depressive episodes; sometimes a mixed condition is countered by them which are characterized by the simultaneous occurrence of both depression and mania. These depressive and manic states continue from few days up to several months. Manic episodes A distinctive duration of irritable or elevated mood is known as mania, which may continue for a minimum duration of one week and occur as euphoria. The manic individuals generally observe an intense boost in energy and face a lesser requirement for sleep, some of them taking a mere sleep of three or four hours per night, while others can make it without sleeping (Miklowitz, Otto, pp. 419-426.). An individual with mania has racing thoughts and shows uninterruptible and pressured speech (rapid speech). Thus, a manic state is accompanied with: low attention span extreme distraction Impaired judgment Spending sprees Risky behavior Intolerant, aggressive, or intrusive behavior Incontrollable feelings on delusional ideas Increase in sexual drive The manic individual, at severe levels, breaks the reality and counters psychosis; thus, the mood and thinking are affected at the same time sometimes leading to violent behaviors (Dean, Walsh, p. 547–57). Hypomanic episodes An elevated mood from mild to moderate level is known as Hypomania, which has features such as pressure of activity and speech, optimism and a lesser need for sleep. Hypomania usually does not hinder the everyday functioning of the individual as mania does. Majority of the hypomania people are usually more productive, while those with mania face difficulties in performing the tasks for they have a reduced attention span. On the other hand, increased creativity is depicted by some hypo manic people, even though many other exhibit poor irritability and judgment (Mayo Clinic, web). The symptom of hyper sexuality is experienced by many people with generally increased activity and energy levels. People in such condition, however, do not have hallucinations or delusions. Depressive episodes The symptoms and signs in the depressive state constitute of constant feelings of: Anxiety, isolation, sadness, anger, guilt, or hopelessness; Disruptions ins appetite and sleep, loss of interest and fatigue Problems in focusing and concentrating Feelings of self-loathing, loneliness, indifference or apathy Lost interest sexual activity Depersonalization, social anxiety, shyness, chronic pain, irritability Lack of motivation; and morbid suicidal thoughts In extreme cases, the individual with bipolar disorder is likely to become psychotic which is showed by the symptoms as hallucinations or delusion, that are usually not pleasant. If not treated, the depressive episode is likely to continue for a period of minimum two weeks, and a maximum of over six months. Mixed affective episodes With regards to the bipolar disorder, a condition in which mania and depression occur simultaneously is known as mixed state. Some distinctive examples are racing thoughts in the course of a depressive episode or crying during a manic episode. The person is likely to feel intense frustration during this condition, for instance, having extravagant and grand thoughts along with the feeling of a failure at the same time (Mayo Clinic, web). Such mixed conditions are usually the most dangerous phases of mood disorders, due to the fact that, these phases are dominated by an increase in the risks of panic disorder, substance abuse, suicide attempts, and various other complications. Associated features The associated features pertain to the clinical phenomena which are usually attached to the disorder yet do not form the component of the diagnostic criteria. Bipolar disorders, in adults, are usually associated with the alternations in the cognitive abilities and processes, which include impaired memory and less executive and attention capabilities. The process and perception of individual of the world is also dependent upon the state of the disorder, having varying features between the depressive, hypomanic, and manic states (Mueser, Goodman, Trumbetta, et.al, pp. 493-499). Various studies have portrayed a prominent connection between creativity and bipolar disorder. While, many patients might face difficulties in retaining such relationships. Even in children, there are many general childhood signs of bipolar disorder which later develop into a complete disorder and are diagnosed. They include full major depressive episodes, mood abnormalities, and Attention Deficit Hyperactivity Disorder (ADHD). Co morbid conditions There can be complications in the diagnosis of bipolar disorder through the existence of co morbid (coexisting) psychiatric conditions which comprise of the following: Substance abuse, Obsessive-compulsive disorder, Panic disorder Eating disorders Social phobia (Goodwin, Jamison, pp, 41-45) Causes There are likely to be variations in the causes of bipolar disorder among individuals. Various twin studies are conducted for comparatively small sizes of sample yet have depicted considerable environmental influence and a significant genetic contribution. The modern studies regarding bipolar disorder type I have shown that, the rates of concordance (probandwise) are generally approximated at about 40% in same genes or monozygotic twins, in comparison to the dizygotic twins which stand at 0 to 10%. A blend of cyclothymia and bipolar I, II formed rates of concordance at 42% in comparison to the11%, where bipolar II has a comparatively lower ration which possibly reflects heterogeneity (Nurnberger, Foroud, pp. 147-157). The significant causes of the occurrence of bipolar disorder in the individuals are as follows: Physiological Various differences have been revealed in the brain imaging studies in the volume of different regions of brain between individuals with bipolar disorders and those with a healthy control. The outcomes indicate that the abnormalities in the function and/or structure of particular brain circuits can be a possible trigger for the development of bipolar. It has been reported by the analysis obtained by the structural MRI studies that an enhancement in the globus pallidus, volume of the lateral ventricles, and a rapid increase in the rates of deep white matter hyper intensities can contribute to bipolar disorder. It has been indicated by the findings of functional MRI that the occurrence of abnormal modulation between limbic regions and ventral prefrontal, particularly the amygdala, contribute largely to the development of mood symptoms and poor emotional regulation (Sachs, Thase, pp. 573-581). The "kindling" hypothesis show that, at time when the subjects, who are heritably prone towards bipolar disorder counter stressful events, the threshold of stress leading to the occurrence of mood changes gradually lowers down to the extent that there is an eventual start to the episodes and an spontaneous recurrence. Due to stress in bipolar disorder, evidences of hypothalamic-pituitary-adrenal axis (HPA axis) abnormalities have been found. Besides this, mitochondria are the other components of brain that have depicted a significant role. Any changes in these components are likely to result into cyclical intervals of mania (hypersensitive neuron firing) or depression (poor neuron firing). The melatonin activity and circadian rhythms are also observed to be changing. Environmental As suggested by various evidences, a major role is played in the development of bipolar disease and in its course by the environmental factors, and also of the interaction of the persons psychosocial variables with the genetic dispositions. The prospective studies have made a fairly reliable substantiation of the fact that interpersonal relationships and life events seem to play a vital part in the possibility of beginning and recurrences of the mood episodes in the bipolar disorder, along with the similar recurrences and onsets of the unipolar depression. The consistent findings through various studies have suggested that a three-half of adult population, that is diagnosed with the bipolar disorder, account for the abusive/traumatic experiences that they have encountered in their childhood. This is considered with the earlier onset ion average, and lead to a worse course, resulting in the co-occurrence of further disorders like ADHD and PTSD (Thase, Sachs, pp. 558-572). The aggregate stressful events that are reported in the childhood is higher in the individuals with the bipolar spectrum disorder diagnosis in adult in comparison to the individuals without, especially with respect to the incidents that stem from a cruel environment instead of from the own behavior of children. Neurological The bipolar-like disorder is the less common bipolar disorder which is likely to happen due to or in connection with any neurological injury or condition. These injuries or condition might comprise of (but are not restricted to) HIV infection, traumatic brain injury, multiple sclerosis, infrequent temporal lobe epilepsy stroke, and porphyria. Neuroendocrinological Neurotransmitter, also termed as dopamine, a major contributor of varying mood cycles, is depicted to have enhanced transmission in the phase of mania. It has been stated by the dopamine hypothesis that an enhancement in the dopamine leads to a secondary homeostatic down monitoring of major receptors and systems including an augmenting of dopamine intervening G protein-coupled receptors (Thase, Sachs, pp. 558-572). This leads to a decrease in the dopamine transmission features of the phase of depression. This depressive condition lasts with the homeostatic up regulation which restarts the cycle potentially again from the beginning. An additional if two neurotransmitters, glutamate and gamma-Aminobutyric acid (GABA), are discovered to have been a reason for the elevation of conditions and phases of mood. There is a prominent increase in the glutamate is in the prefrontal and left dorsolateral cortex in the course of the manic state of person suffering from bipolar disorder. At the completion of the phase, the glutamate recovered to its normal levels. Moreover, in individuals with bipolar disorder, GABA is indicated to be present in higher concentrations, generally resulting into a decline in the GABA (B) receptors. The augmenting in GABA is likely to be a result of the disruptions in early development which, in turn, leads to the formation of normal lamination and disruption of cell migration. Evolutionary Since, the major affects of the bipolar disorder are on the abilities of individual to perform and function in the society and the morbidity rate is high, it is suggested by the evolutionary theory that the genes contributing to it might possibly have been chosen naturally against, culling the disorder in an effective manner. However, there still exist higher bipolar disorder rates in numerous populations, which indicate an evolutionary benefit to the contributing genes (Miklowitz, pp. 28-33). The advocates of the evolutionary medicine have established the hypothesis that the genes which are the causes of extreme bipolar disorder, when made the part of hereditary in large quantities, are more likely to enhance fitness if made the small doses of such genes are inherited. During the course of history, the higher rates of the prevalence of bipolar disorder indicate that some evolutionary benefit on the humans from ancestor was conveyed by their capability of switching between manic and depressive moods. There have been theories that were provided to elaborate upon the depressive disorders evolutionary advantages; these theories also describe the depressive episodes adaptiveness. For instance, those people who counter enhanced stress are likely to find the depressive mood serving as a defensive strategy. This is because it helps them in retreating from any external stressor influencing them, preserves energy and resources for better times and increases their sleep. In addition to this, the individiuals suffering from mania are likely to the benefits in certain conditions. Confidence, creativity, and high levels of energy are all connected to hypomania and mania. The robustness and health of the ancestral humans might have enhanced through the ability to make use of and consume the symptoms of mild mania to think in a more creative manner and be more productive in the times when they were free of stress. The capability of employing both mild depression and hypomania convey benefits that are of advantage to the people a varying environment. However, the over activation of the genes facilitating the exploitation of mania and depression may lead to the triggering of severe manic or depressive moods that leads to the occurrence of full bipolar disorder. Current treatment and Management The bipolar disorder needs such a treatment which may last all life, even covering those periods when the individual feels better. Such a treatment is often lead by a skilled psychiatrist who has obtained expertise in the treating of such a condition. There are numerous psychotherapeutic and pharmacological techniques that are utilized for the purpose of treating the bipolar disorder. The patients may also pursue recovery through the use of self-help. There may be a need for hospitalization during the episodes of mania in the bipolar I disorder. This might be involuntary (civil commitment) or voluntary (if permitted by the legislation for mental health and different United States regulations of state-to-state). Support services are provided to the patients in replacement of the hospital admission, and these include patient-led and supported employment support groups, drop-in centers, visits from members of Assertive Community Treatment team, and many other intensive outpatient programs, also known as the partial-inpatient programs (Bowden, p. 51–55). Psychosocial The techniques of psychotherapy are undertaken with the purpose of identifying the episode contributors, eliminating the basic symptoms, lessening emotion that are expressed negatively in relationships, working upon the components that might result into remission maintenance, and recognition of prodromal symptoms before their complete recurrence. Besides this, therapies such as family-focused therapy, cognitive behavioral therapy, and psycho education are found to be most effective and efficient in terms of preventing any relapses, and the cognitive-behavioral therapy and social and interpersonal rhythm therapy have discovered to be the most effective with respect to the lingering symptoms of depression (Sachs, Thase, pp. 573-581). Medication Medication is one of the ways to cure the bipolar disorder in patients. One of the many medical treatments is undertaken through lithium. It is a medication producing the best evidence and is absolutely effective in the treatment of the intense episodes of mania, leading to relapse prevention. It also results in the reduction of risks of self-harm, suicide, and a feeling to end lives in the individuals with bipolar disorder (Huxley, Parikh, Baldessarini, pp. 126-140). Bipolar disorders are treated through four anticonvulsants and the manic episodes are treated with carbamazepine. It also carries greater advantage in psychotic symptoms, rapid-cycling bipolar disorder, or for individuals with multiple schizoaffective clinical pictures. Lamotrigine also carries certain efficacy for the treatment of bipolar depression, benefitting the patients more in the phases of severe depression, while topiramate still remains unknown with regards to efficacy (Sachs G.S., Nierenberg, et.al.pp. 1711-1722). The short-term treatment of manic episodes in bipolar disorder is effectively treated by antipsychotic medications which seem to be better than anticonvulsants and lithium. However, lithium and various other medications are used for the long-term treatment. The relapses are effectively prevented by Olanzapine. Alternative medicine The depressive symptoms may be affected in a beneficial manner through adding the omega 3 fatty acids (Sachs, Thase, pp. 573-581). Potential experiments to influence future understanding or treatment of the disease In order to influence the future understanding of the disease and its treatment, an experiment can be conducted. A sample of 20 people having bipolar disorder can be selected for the participation in the study. All subjects can be given maintenance and managed for treatment with any medication for mood stabilizer throughout the course of study. However, all the subjects have to be unsuccessfully treated through a minimum of one mood stabilizer or antidepressant previously. During the course of study, the first phase will comprise of random assignment of a single dose of placebo or ketamine to every individual. The treatment will be switched after one week, where the individual initially receiving placebo will now receive doses of ketamine, and vice versa. The investigators will make use of standard surveys to assess and analyze the effect of medication on the depression symptoms. Bipolar Disorder in Evolutionary Biology The hypothesis has been established by the evolutionary biologists that the emergence of bipolar disorder might have been from an adjustment and adaptation of the individuals to the intense conditions of climate during Pleistocene in the northern temperate zone. The hypothesis, also known as the Evolutionary Origin of Bipolar Disorder (EOBD) hypothesis, mentions that hypomania is more adaptive in the climatic zones with extreme temperatures during short summers, thus permitting the fulfillment of numerous tasks that are essential for the human survival in a short interval of time. On the other hand, the long winters of the extreme climatic zones make individuals adaptive to survival and group cohesion through hypersomnia, lethargy, overeating of depression, and lesser interest in social activities. There are evidences for the hypothesis maintained by the EOBD which constitutes of a connection between the cold-adapted build and bipolar disorder, thus correlating between mood changes and seasonality in the individuals having bipolar disorder. The evolutionary biology suggests lower rates of the occurrence of bipolar disorder in the individuals belonging to the African Americans origin. Thus, evolutionary biology provides further understanding of the subject through explaining the origin and affiliation of human with certain climatic conditions and temperature zones. Bibliography Bowden, C. L. Strategies to reduce misdiagnosis of bipolar depression. Psychiatric services (Washington, D.C.) 52(2010) 51–55. Dean, k; Walsh E, Morgan. Aggressive behaviour at first contact with services: findings from the AESOP First Episode Psychosis Study, Psychological Medicine 37 (2007) 547–57. Furukawa, T. A., Assessment of mood: Guides for clinicians, Journal of Psychosomatic Research 6(2010) 581–589 Goodwin F.K., Jamison K.R. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition. Oxford University Press: New York (2007). pp, 20-45 Huxley N.A., Parikh S.V., Baldessarini R.J. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harv Rev Psychiatry. 3 (2000), pp. 126-140. Mayo Clinic, Diseases and Conditions: Bipolar disorder, Mayo Foundation for Medical Education and Research, 2014. Medical News Today, What is bipolar disorder? What causes bipolar disorder?, MediLexicon International Ltd; 2012 Miklowitz D.J. A review of evidence-based psychosocial interventions for bipolar disorder. J Clin Psychiatry. 11 (2006), pp. 28-33. Miklowitz D.J., Otto M.W. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program (STEP). Arch Gen Psychiatry. 4 (2007). pp. 419-426. 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