Bipolar Disorder - Coursework Example

Bipolar Disorder The given paper is dedicated to the topic of bipolar disorder and presents a concise summary of the available data concerning its various aspects. It makes references to numerous credible sources and trustworthy publications that can be found online. The work offers an insight into the course of the illness, both delimiting the patterns according to which bipolar disorder develops and explaining its influence on patients. Furthermore, the sufficient part of the paper exposes clinical features, including classification of the different types and episodes of the disorder as well as giving a brief account of the essentials of the treatment options and procedures. In addition, it is explained that although bipolar disorder can sometimes be misdiagnosed due to the similarity of symptoms, there are specific criteria that help to distinguish this illness from some other that are the most commonly confused with bipolar disorder. Introduction It was not long time ago as psychiatrists managed to arrive at the definition “bipolar disorder” – an illness that due to both the uniqueness of its course and the chronical character occupies a specific place among the mood disorders. Affecting people during the lifetime and bringing often severe symptoms, it produces strong influence on person’s well-being, interfering into personal and professional lives and altering the way one perceives the world and self. Therefore, researches actively investigate it with the aim of making a deep insight into its various implications, features, and treatment options. Although, the significant success has been gained in this regard, the complex of causes of the disorder is till poorly investigated today. Still, a person suffering from bipolar disorder can expect significant improvement of his/her condition and quality of life due to the fact that appropriate treatment options are developed. As a whole, bipolar disorder is a severe illness with quite complex clinical picture and being able to differentiate it from other illnesses is the condition of avoiding underdiagnosing and misdiagnosing. Course Bipolar disorder, or as it also known – bipolar affective disorder and manic-depressive illness, is a term used to describe a brain disorder resulting in extreme shifts in mood: from the elevated state, called mania, and high levels of activity, energy, and ability to perform daily tasks to the periods of prolonged, deep, and severe depression and low rates of activity. Bipolar disorder is chronic and persistent and should be appropriately managed during the lifetime. The changed between the high and low moods which a person with this disorder experiences differ much from normal mood shifts a common person may face from time to time. In contrast to an ordinary mood shifts, symptoms of bipolar disorder proceed severely and put an extensive influence on all aspects of the life of patients. For instance, one can become engaged in risky behavior, be unable to maintain relationships with people, damage career, experience suicidal thoughts and attempts, and face many other outcomes of the disorder. As a cyclical illness, bipolar disorder results in the appearance of episodic symptoms between which patients can return to the normal, or almost normal, state of health. It is noticeable that the sequence of episodes varies from patient to patient, but can have a regular pattern in the history of one patient, meaning that one can sometimes predict the time when the next episode will start. At the same time, alternation of episodes is rarely of the “mania - depression” pattern. ("Bipolar disorder ," ) In contrast, it is common for patients to experience prevalence of either depressive or manic episodes. For instance, although very rarely, but there can be patients with a dozen of manic episodes and, for example, with one depressive episode. Moreover, prevalence of depressive episodes is more common for women while manic for man. Clinical Features Bipolar disorder affects approximately 2 percent of the world’s population, near 4 percent of American population, and is more widespread in woman than in man. During manic and mixed manic it is common for one to feel reckless, restless, talkative, powerful in relationships, business, finances as well as have reduced need for sleep and flight of ideas. (Barlow, 2014) In contrast, the period of depression is characterized by anger, confusion, weakness, and feeling of being trapped. Typically, the number of episodes of depression or mania that one faces during the lifetime can be close to ten. However, the disorder can also by characterized by the rapid-cycling, which would result in a significantly greater amount of mood shift episodes. Other patients have one or more depressive episodes. During the intervals between the episodes a person can return to the normal life and well-being, until the next episode occurs. To diagnose bipolar disorder at least one manic or mixed manic episode should occur during the lifetime of a person. The primary tool that used by clinicians in diagnosing bipolar disorder is The Diagnostic and Statistical Manual of Mental Disorders IV and V editions – the manual published by APA (American Psychological Association) that includes features of all mental health disorders. At this point, it is crucial to differentiate between manic and hypomanic episodes. For manic period at least one week of abnormal mood characterized by irritability, elation, or euphoria (DSM IV) is required. Also, at least three of the symptoms, which are commonly associated with this diagnosis, must be present. The following include: grandiosity, diminished need for sleep, increased level of goal-directed activities, and other. (Barlow, 2014) Furthermore, in DSM V it was added that the change of the mood should “be accompanied by persistently increased energy and activity levels”. (Goodwin & Redfield, 2007; Angst, 2013) In general, hypomanic episodes are characterized by many of the same symptoms, such as clear evidence of distractibility, flight of ideas, etc, but their duration is shorter and extensity is less severe, in a way that does not demand hospitalization and which is not associated with psychosis. This difference in a degree of disorder manifestation rather than in symptoms often makes distinction between mania and hypomania problematic. At the same time, an episode can also be of a mixed character when the symptoms of both manic and major depressive episodes are present simultaneously. According to DSM V, a mixed feature is ascribed when at least three, or more, symptoms from the opposite pole are occurring during one mood episode. (Barlow, 2014) Subsequently, DSM also suggests differentiating between two main forms of bipolar disorder: bipolar I and bipolar II and cyclothymic disorder. (Mann, Roose & McGrath, 2013) Bipolar I is defined by severe manic episodes or by mixed episodes that last seven days and demand immediate hospitalization. At the same time, the primary symptom of bipolar II is hypomanic episode with major depressive episodes that are not severe to the extent that would cause a kind of impairment in occupational or social functioning, and therefore, hospitalization is not required. ("Bipolar disorder,") Clinicians also differentiate cyclothymic disorder, which is a “mild version” of bipolar I with periods of mild depression and hypomania which one can experience for at least two years, but which do not meet diagnostic criteria for any of the bipolar types. ("Bipolar disorder,") In addition, data show that some patients may experience symptoms that go beyond one’s normal range of behavior, but they presuppose fewer symptoms and shorter duration. Such cases are classified under bipolar disorder no other specified (BP-NOS) (Mann, Roose & McGrath, 2013; "Bipolar disorder,") At present, studies of bipolar disorder, its types, implications and criteria for classification are still actively conducted with every version of DSM modifying the clinical picture of the disorder and bringing some corrections into its diagnosis. Differential diagnosis Before being able to suggest a comprehensive account of the disorder and offering a full classification of the mood shifts that enabled to make accurate diagnosis united by the term “bipolar disorder”, specialists have come a long way during which symptoms of bipolar and other disorders, such as schizophrenia, unipolar depression, or cluster B personality disorders could be confused. The following, obviously, could lead to wrong prognoses concerning the development of a disorder as well as to ineffective treatment using inappropriate interventions and medications. As a result, the well-being and quality of patients’ life were significantly decreased. In contrast, today, there exist sufficient data that enables specialists to differentiate between disorders and, thereof, treat affected individuals safely and effectively without delays that result in years of delay to the right treatment. Among other, bipolar disorder should be differentiated from schizophrenia as both share many characteristics in common. Firstly, schizophrenia is characterized by positive symptoms, such as hallucinations, delusions, and thought disorder, which, according to Dr. Terence Ketter, Associated Professor of Psychiatry $ Behavioral Sciences, resemble manic episodes of bipolar disorder in near 50 percent. ("Differential diagnosis of,") Furthermore, negative symptoms, including apathy, low energy, withdrawal, and social isolation can look like symptoms of a depressive episode. ("Differential diagnosis of,") Secondly, positive symptoms of schizophrenia and mania are mediated in some way by dopamine signaling while negative symptoms of schizophrenia and depressive episode – by serotonin. However, despite certain similarities between them, the existence of principal differences is known today. For example, Basu (2013) emphasizes that the survey by Depression and Bipolar Support Alliance proves that in the initial onset of symptoms 33 percent of patients, diagnosed with bipolar disorder, mention depression as “their initial symptom experience” and 32 percent - mania. (Basu, 2013) By this, only 9 percent claimed experiencing psychotic symptoms first. Subsequently, the history of depression can be viewed as a significant clue to determine bipolar disorder, but not schizophrenia. At the same time, the onset of schizophrenia will be more insidious and is likely include odd and bizarre delusions. In addition, a patient with schizophrenia is likely to have this disease in a family history while one with bipolar disorder would have a family history of affective disorder. (Basu, 2013) In addition, bipolar disorder presupposes the presence of free, asymptomatic intervals between the episodes whereas the symptoms of schizophrenia are persistent. Apart from that, principal differences in the management options demand to distinguish between bipolar disorder and major depressive disorder. The similarity of their symptoms as well as the fact that patients are often unable to recognize their high and low moods can make it difficult to see the differences between the two conditions. However, the major differential symptom here is the presence of mania and hypomania in bipolar disorder. (Forty, Smith & Jones, 2008) In contrast, a patient with the major depression has no history of these conditions, but suffers from loss of energy, self-reproach, apathy, and other symptoms similar that that of the depressive episode of the bipolar disorder. Generally, the single most useful feature that helps to detect bipolar disorder is its course, and the change between mood episodes, one of which is manic, in particular. No other disorder shows such symptoms. Etiology The etiology of bipolar disorder has been a matter of the increased interest among specialists. At present, investigations of the roots of this disorder are still actively conducted with researches being not fully confident about the list of definite its causes. However, what is known with certainty is that factors causing bipolar disorder are multiple and can work in complex increasing the risk for its development. To start with, it is recognized that some people have genetic predisposition to the disorder since the higher its prevalence is detected among the first-degree relatives. The substantial base of researches, dedicated to the given issue, received similar results that clearly confirm the existence of the genetic roots. Namely, studies show that people who have first-degree relatives with bipolar disorder are under 5 to 10 times greater risk of becoming bipolar than the general population. (Juli, Juli & Juli, 2012) Furthermore, family and twin studies also revealed an extremely high concordance in monozygotic twins, which can vary from 45 percent to 75 percent and a lower (approximately 10 percent), but still a demonstrative concordance for the disorder in dizygotic twins. (Juli, Juli & Juli, 2012) Useful, in this regard, appeared to be the studies that received significant results in defining the list of chromosomes that show the convincing linkage of bipolar disorder. What is more, the conducted studies also enabled to conclude that the roots of the disorder can also be found beyond the genetics only. The fact that not all persons with the genetic predisposition to the disorder develop it is a serious ground to consider other influential factors. Among such has been the biological vulnerability, which refers to the brain biochemical imbalances, its abnormal functioning and structure. ("Bipolar disorder,") In particular, a disruption of the brain chemicals noradrenaline and serotonin is associated with psychiatric mood disorders, such as bipolar disorder while the abnormal functioning of brain circuits involving serotonin contributes to depression and bipolar disorder. (Marchand, Bennett & Dilda, 2005) Furthermore, brain imaging with the help of PET (position emission tomography) and fMRI (functional magnetic resonance) revealed differences in patterns of brain development among healthy children and children with bipolar disorder. ("Bipolar disorder,") Equally important, other studies prove that adults with bipolar disorder have smaller and less functioning prefrontal cortex than those who do not have this illness, which proves that the brain structure and functioning can be associated with unstable moods, common for bipolar disorder. Subsequently, Marchand, Bennett & Dilds (2005) emphasize that bipolar disorder should be regarded as a “complex neurobiological illness”, even yet its pathophysiology is still insufficiently comprehended. Treatment Although bipolar disorder is a chronic and long-term condition that cannot be completely cured today, effective treatment options are available. In general, it is recognized that effective treatment plan is the one comprising of medications and counseling or psychotherapy. The last is an important component of the process of treatment as it presupposes discussion of thoughts, problems, and feelings that disturb patient and aggravate his/her condition. It is targeted at helping patients to better understand the ways of coping with compulsive thoughts, behaviors, and other situations as well as encourage to remain on medications. As a whole, a variety of medications is used to alleviate symptoms of the disorder. Among the commonly used are antidepressants, atypical antipsychotics, and mood stabilizers with lithium being the most universal choice as it proved to be helpful for controlling depressive and manic episodes at different phases of their treatment. ("Bipolar disorder,") Importantly, the overall plan of treatment of bipolar disorder starts with considering options of treating manic and mixed episodes first and then approaching the depressive one. Further, the treatment is divided into three phases: acute, continuation, and maintenance treatment. The goal of the acute treatment is to suppress current symptoms. It continues until symptoms are taken under control for a period of time. The next phase prevents appearance of the same symptoms after they were diminished. Usually, it is gained by continuing regimen, which proved to be effective during the acute phase, but decreasing the dose of medications. In addition, maintenance or preventive phase aims at preventing recurrence of symptoms. The decision to resort to it is made on the basis of evaluating severity of the occurring episodes, their frequency and time of development as well as the side effects of medications used. As a rule, appropriate treatment can be very helpful even for the patients suffering from the most severe forms of the disorder. It would enable to take under control the mood swings and their symptoms. However, there is a need in a continuous treatment during the lifetime of a patient since, as it was mentioned above, bipolar disorder is a chronic illness and without interventions and treatment symptoms would continue disturbing patients. Moreover, mood swings can continue even after a patient was given appropriate treatment. The following was seen in a study conducted by the National Institute of Mental Health - Systematic Treatment Enhancement Program for Bipolar Disorder, which showed that lingering symptoms were present in almost a half of patients who recovered. ("Bipolar disorder,") Conclusion Bipolar disorder is a serious mood disorder resulting in extreme mood swings that negatively influence one’s normal well-being. Facing either heights, increased rates of activity, inspiration, and energy or lows with strong apathy and prolonged depression, a person loses the ability to maintain long term relationships with people or make a career as well as can make decisions threatening his/her health or life. Although it was revealed that bipolar disorder runs in families, other factors contributing to its development are still underinvestigated. Moreover, the course and development of illness can vary from patient to patient, making it difficult to diagnose bipolar disorder, which can remain untreated and aggravating for years. Subsequently, the research and classification of various implications of bipolar disorder are actively conducted. However, today, bipolar disorder remains not completely curable, thereof, when being diagnosed with bipolar disorder, a person should expect that he/she might need the treatment during the whole life depending on the severity and frequency of the occurring episodes. As a whole, bipolar disorder strongly affects one’s life and should be taken under control with medications and therapy. References Angst, J. (2013). Bipolar disorders in dsm-5: strengths, problems and perspectives. International Journal of Bipolar Disorders, 1(12), Retrieved from http://www.journalbipolardisorders.com/content/1/1/12 Basu, S. (2013). The Singapore Family Physician, 39(1), Retrieved from http://cfps.org.sg/publications/the-singapore-family-physician/article/10 Barlow, D. (2014). Clinical handbook of psychological disorders : a step-by-step treatment manual. (5 ed., pp. 462-469). New York: The Guilford Press. Retrieved from http://books.google.com.ua/books?id=FCTyAgAAQBAJ&pg=PA463&dq=manic and hypomanic episodes in bipolar disorder dsm 5&hl=uk&sa=X&ei=zGsRVO_6GeH9ygPkwoIg&ved=0CC8Q6AEwAw Bipolar disorder. National Institute of Mental Health, Retrieved from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml Bipolar disorder. (n.d.). Brown University, Retrieved from http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Bipolar Disorder.pdf Differential diagnosis of schizophrenia and bipolar disorder. Schizophrenia.com, Retrieved from http://schizophrenia.com/stanfordtalks/diffdiag.html Forty, L., Smith, D., & Jones, L. (2008). Clinical differences between bipolar and unipolar depression. The British Journal of Psychiatry, 192(5), 388–389-388–389. Retrieved from http://bjp.rcpsych.org/content/192/5/388.full.pdf Goodwin, F., & Redfield, K. (2007). Manic-depressive illness: Bipolar disorders and recurrent depression. (pp. 93-99). Oxford University Press. Retrieved from http://books.google.com.ua/books?id=rnr_OxfcqDcC&pg=PA95&dq=manic and hypomanic episodes in bipolar disorder&hl=uk&sa=X&ei=x2oRVLa5KMvMygPh9YAQ&ved=0CBsQ6AEwAA Juli, G., Juli, M., & Juli, L. (2012). Involvement of genetic factors in bipolar disorders: Current status. Psychiatria Danubina, 24(1), 112-116. Retrieved from http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol24_sup1/dnb_vol24_sup1_112.pdf Mann, J., Roose, S., & McGrath, P. (2013). Clinical handbook for the management of mood disorders. (pp. 11-13). Cambridge: Cambridge University Press. Retrieved from http://books.google.com.ua/books?id=3NPvLExs7X8C&pg=PA11&dq=manic and hypomanic episodes in bipolar disorder dsm 5&hl=uk&sa=X&ei=zGsRVO_6GeH9ygPkwoIg&ved=0CCgQ6AEwAg Marchand, W., Bennett, P., & Dilda, D. (2005). Evidence for frontal-subcortical circuit abnormalities in bipolar affective disorder. Psychiatry, 2(4), 26-33. 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