Bipolar Affective Disorder Condition - Essay Example

? Bipolar Affective Disorder Introduction Bipolar disorder is commonly known as maniac-depressive disorder, it is a neurological condition that is responsible for alteration in mood, daily tasks, level of energy as well as involvement in any activity. The condition is dissimilar to the routine mood swings. Such altered mood directly influences personal relationship, job prospects, performance at personal or professional front and induce the feeling of committing suicide. However, if recognized at an early stage the condition can be treated completely and the individual attains normal routine. The condition could be observed in teen age, adolescence or early adulthood. In many cases the symptom onsets before the age of 25 years (Kessler et al, 2005), but it remains undiagnosed till the problem takes the form of disorder. Management of the condition is crucial and is a long-term process where co-operation of the associated individuals play a significant role. Symptoms of Bipolar Disorder Individuals suffering from bipolar disorder display severe emotional condition which is termed as "mood episodes", encompassing either too thrilled or overjoyed which is called the maniac episode; or the individuals remain in the phase of discouraging thoughts or gloom this phase is termed as the depressive episode. Individuals also witness a mixed stage where phase of mania as well as depression co-exist. Individuals with bipolar disorder may become bad-tempered or dangerous during their mood episode. These symptoms directly influence daily activities such as the energy levels, behaviour of the person, trouble in proper sleep, restlessness. With time the condition becomes severe and the person have longer duration of unbalanced frame of mind as compared to the distinct phases of depression or mania (Web. Bipolar Disorder). Individuals displaying terrible phases of mood swing and almost every day or remain in such altered mindset for two to three weeks is likely to suffer with bipolar disorder. The symptoms can be categorized as- A. Manic episode or mania encompasses- a. mood swing- this is the extreme phase where the individual is either over joyful, in very high spirit or display very extrovert nature. On the other hand, this phase also displays other aspect where the individual remain ill-tempered, disconcerted, jumpy feeling may also be seen (Web. Bipolar Disorder). b. behaviour alterations- the individual gets diverted without difficulty, can jump from one thought to another or many thoughts could be presented simultaneously. The individual starts taking at a faster pace, restlessness is also displayed during this phase and the individual may not sleep appropriately. During this phase some sort of hyperactivity is also observed where the individual may show over enthusiasm in taking new assignments and jobs due to impractical conviction in one's skills. This phase also display unusual behaviour such as participating in high-risk task, may show extravagance temperament, getting diverted towards pleasurable things and perform impetuous investments (Web. Bipolar Disorder). B. Depressive episode of depression encompasses a. mood swing- during this phase the individual has the feeling of being empty and remains depressed. The individual do not show any interest in activities which were once providing pleasure (Web. Bipolar Disorder). b. behaviour alterations- the normal pace of work becomes slow, the individual is not able to concentrate on things and a habit of forgetfulness could be observed. Individuals during this phase may face difficulty in remembering and recollecting from the memory and therefore finds intricacy in taking any decision rather they remain restless and irritable. Changes could also be observed in eating as well as sleeping habits. Suicidal thoughts often ponder in mind and in severe condition a person may attempt to commit suicide (Web. Bipolar Disorder). Bipolar disorder constitute two phases or poles, BPI, or classic manic-depression. BPII is considered to be placid disorder with alternating phases of depression and hypomania. Hypomania is considered gentle form of mania where the individual does not display the symptoms of psychosis that may otherwise lead to social or professional predicament. Such individuals do not necessitate any emergency concern. Individuals belonging to this phase may be progressive and maintain better state of mind. Lack of medical attention may turn the situation towards severe mania or depression. Under severe conditions the individual may complain of delusion or hallucinations as well as psychotic symptoms. Psychotic symptoms for the individual with manic episode inculcate varied thoughts such as being very famous and affluent or in certain cases the person may have the sense of some unbelievable powers. On the other hand, psychotic symptoms with depressive episode may induce the feeling of being bankrupt or they behave as though they have committed an offence. At this stage diagnosis may be confused with schizophrenia (Web. Bipolar Disorder). Causes Bipolar disorder displays a wide range of conditions which are responsible for the onset of the neurological condition. Namely three categories of causes have been reported- Genetic- Genetic linkage studies highlight the fact that bipolar condition runs in families. According to the initial studies carried out in 1969 by Reich et al, indicate that various chromosomal regions display inconsistent results. Later it was established that certain chromosomal locations are responsible for the carrying traits of bipolar disorder. Genes responsible for the synthesis of serotonin, dopamine and glutamate are transmitted together with other genes but the advanced age of parents, directly indicating more exposure to mutagenic agents and augmentation in genetic mutation is likely to be responsible for the enhanced chances of bipolar disorder in the progeny (Frans, 2008). Physiological factors encompass abnormal morphological or physiological aspects of the brain (Kempton et al, 2008; Arnone et al, 2008). Stress in life may induce abnormality in hypothalamic-pituitary-adrenal axis (HPA axis), indicating that stress and early life pressure directly influence the hypothalamus mediated functioning (Koehler, 2005). Environmental factors- are responsible for the psychosocial responses. Various environmental factors are known to bring many genetic variations called mutations which may hamper not only social predisposition of the individual but also brings mood swings which has direct correlation with the development of bipolar disorder (Alloy et al, 2005). Childhood abuse and post traumatic stress disorder has direct impact on the brain which results in development of the bipolar condition (Leverich et al, 2006; Mueser et al, 1998). Adults with bipolar disorder are reported to have stressful and abusive childhood (Miklowitz & Chang, 2008). Various studies have been carried out across the globe to highlight the fact that environment and genetics during the childhood carries lasting implications in the life of the child and in preventing the development of neurological conditions. Diagnosis Bipolar disorder is not associated with any kind of fever or other related infectious symptoms of physiological origin. The condition could not be examined by means of blood test or any kind of scans to establish the disease diagnosis. Diagnosis of bipolar disease is based on self reported abnormal behavior or as per the observation of the family members, are providers, friends of those who are associated with the individual since long time as they can observe and notice the changes in the behavior of the individual. Later psychiatrist or psychologist or physician or any social worker or nursing staff could analyze the symptoms of bipolar disorder. It is imperative for the clinicians or psychiatrist to understand the symptoms carefully and then take the history of the patient as well as the immediate family for the prevalence of any kind of mental disorder. It is essential to consider family's level of education as well as family atmosphere, economic condition of the family is also imperative. For the diagnosis of bipolar disorder the criteria considered is based on American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. At present DSM-IV-TR is considered while DSM V is going to be available in 2013 (Perugi, 2006). Children or adolescence could be monitored by the family members and adults while adults suffering with bipolar disorder seek medical attention when they experience phase of severe depression, condition of mania or hypomania which may result in poor prognosis of the condition. Epidemiology In United States bipolar disorder has the prevalence range of 1- 1.6%. BPI has prevalence of 1.0%, BPII has the prevalence reported as 1.1% while subthreshold prevalence of 2.4-4.7% (Calabrese, 2008). International statistics display the prevalence of bipolar disorder as 0.3-1.5%. Personal survey of around 61,000 adults in 11 nations keeping the norms according to the World Mental Health of World Health Organization Composite International Diagnostic Interview, brings down the facts as- for BPI the prevalence rate was 0.6%, for BPII the prevalence rate was 0.4% while for bipolar disorder subthreshold was recorded as 1.4% and bipolar spectrum as 2.4%. (Merikangas, 2011). Indicating the prevalence of bipolar disorder worldwide. The prevalence of bipolar spectrum is quite high as compared to the actual condition. Gender-difference in prevalence of bipolar disorder in a community Lifetime prevalence estimates for BPI was reported as 0.6% for males as compared to 0.3% in females. However the mean age or prevalence was reported as 29.5 years. However, the first identification was reported at the age of 22 years as an average with male average age for onset was 22.3 years while for women the age of onset was 21.2 years. Of this the manic phase was reported as 22 years on an average with 22.5 years in males and 21.4 years in females. The depressive phase was reported to have 23.4 years as an average age with 24.1 years for males and 22.5 years for females. Further, the study also highlights that 22.7 % of the cases of BPI reported their onset with depressive episode while 77.3% of the cases reported the onset with the manic episode. Both the episodes of bipolar disorder was reported in 64.1% of the cases. Of the total number of cases studied 55.9% never thought of seeking medical help and only 13.2% were hospitalized for psychiatric care. During the course of survey only 7.1% of the individuals were on treatment while suicide attempt was reported in 8.1% of the men and 5.4% of women. Cases have been reported where intermittent major depression episodes were observed and gradually these individuals were reported to develop bipolar disorder at the age of 50 years, highlighting the fact that these individuals have family history of bipolar disorder (Ketter, 2010). Another study highlight the gender differences in the onset of bipolar disorder in England by Kennedy et al, (2005), highlight the fact that there is a correlation between gender and age of onset of first episode of mania. Males are reported to have and early onset as compared to the females. Moreover, males with antisocial behaviour during the childhood leads to the early onset of the bipolar disease, which is attributed to the abnormal neurodevelopment which eventually leads to early onset of bipolar disorder. In males, the onset of bipolar disorder incidence are reported more during the early life as compared to the later stages of life. Moreover, women seek medical help later than the males. Other related factors which are responsible for the prevalence in males may be contributed by social deprivation or substance abuse (Kennedy, et al, 2005). Prognosis Bipolar condition is often misunderstood with other psychosis especially with schizophrenia, and therefore bipolar disorder may be misdiagnosed, if the condition is treated with care then good prognosis could be attained. If untreated then the bipolar condition could turn out to be devastating. Post treatment with medication the individual may lead a normal life and may display the episodes of near normal to normal performance. Evidence from one of the recent studies carried out by Miklowitz, (2012), suggests that in almost 50% of the reported bipolar disorder cases, the condition commences at an early stages of life, either during childhood days or during the adolescence stage and this has emerged as one of the reasons of poor prognosis of the condition and this is attributed by the comorbid substance abuse of any kind. Clinical trial with psycho-education of the family was performed and this resulted as an efficient add-on to medication. Psycho-education of the family enables one to stabilize the signs of bipolar disorder. Thus family focused treatment (FFT) in terms of behavioral family treatments by means of psychotherapeutics has helped in bipolar disorder prognosis. According to Tohen et al, (2003), hospitalization of bipolar cases resulted in syndromal recovery in 50% of the cases after six weeks while in two years it was 98%. Relapses may occur and mood swings may alter but gradually with psychotherapy and family intervention the condition could be taken care of. Such an approach not only enhances the patients confidence but also the coping mechanism together with eliminating comorbid factors. Mortality is also reported in bipolar disorder because of the suicidal ideation. Reports reveal that one in every three cases of bipolar disorder is known to have made an attempt to commit suicide or have gained success in the same (Novick, 2010). Normally people do not attempt to commit suicide unless some serious matter has occurred but individuals with bipolar disorder have the tendency of attempting or committing suicide. Comorbid factors attributing to bipolar disorder Substance abuse or substance use disorders (SUDs) are found to be associated with bipolar disorder and therefore SUD must be prevented or delayed in cases with bipolar disorder. These comorbid factors are alcohol, drug abuse, substance abuse, dependence or disorder. According to the study carried out by Goldstein & Bukstein, (2010), demonstrate that onset of bipolar disorder at young age presents elevated risk of SUD when compared with onset of bipolar disorder at adult stage. Study report that prevalence of SUD increases at adolescence stage which is linked with various factors including teenage pregnancy, academic failures, legal issues, family issues, separation of parents etc. 55-83% youth cases of bipolar onset pave the way for SUD, it is therefore imperative to prevent the incidence. Education, counselling and family intervention could prevent these comorbid factors from proliferation (Goldstein & Bukstein, 2010; Strakowski et al, 1998; Krishnan, 2005). Treatment of Bipolar Disorder Bipolar disorder does not hold any appropriate treatment but the mood oscillations could be minimized by following the proper treatment of the symptoms. The procedure is true for milder to severe form of the condition (Sachs & Thase, 2000; Huxley et al, 2000). As bipolar disorder is a condition which has lifelong implications it is essential to follow the treatment for the longer duration to gain control over the situation. A combined therapy of medication with psychotherapy is essential in order to prevent the relapse of the condition. Medications- response to medicines vary from person to person and therefore hit and trial method is adopted for the treatment procedure. It is essential to keep a record of daily activities called 'daily life chart' of bipolar patient encompassing mood swing, sleep behavior, interaction with people and day-to-day activities must be maintained. This aids in finding out the improvement or occurrence of side-effects due to medications. Medications include- Mood stabilizing medicines- this should be taken for years. these medicines include lithium and other anticonvulsants are given in case of bipolar disease to stabilize mood. Lithium is gradually introduced and maintained at plasma concentration between 0.5-0.8 mEq/L. Such treatment lengthens the interval between cycles of mood swings: episodes of mania as well as depression are attenuated, if not totally prevented. Bipolar disorder is the most common and definite indication of lithium. Risks and benefits of prolonged lithium therapy are to be weighted in individual cases. Patients have been maintained on lithium therapy for over a decade. Most cases relapse when lithium is discontinued. Withdrawal when attempted should be gradual over months. Approximately 50% patients of mania and bipolar disorder (especially rapidly cycling cases) show incomplete or poor response to lithium. Many do not tolerate it or are at special risk of toxicity (Tripathi, 2008). Alternative to lithium include- 1. Carbamazepine (CBZ)- the medicine is found to prolong remission in bipolar disorder. Its efficiency in mania and bipolar disorder has not been confirmed and is rated almost equal to lithium. Patients who relapse on lithium therapy or those prone to rapid cycling of mood state do better on combined lithium + CBZ treatment (Tripathi, 2008). 2. Sodium valproate- reduction in manic relapses is noted when valproate is used in bipolar disorder. It is now a first line treatment of acute mania in which high dose valproate acts faster. It is useful for those who do not respond to lithium or are unable to tolerate it. Patients with rapid cycling pattern may particularly benefit from valproate therapy. A combination of lithium and valproate may succeed in cases resistant to monotherapy (Tripathi, 2008). 3. Lamotrigine- an anticonvulsant is now used to treat bipolar disorder particularly in rapidly cycling bipolar depression (Tripathi, 2008). 4. Topiramate- useful as adjunctive therapy of bipolar disorder (Tripathi, 2008). 5. Atypical antipsychotics- such as olanzapine is also approved for maintenance therapy of bipolar disorder as it carries a low risk of inducing extrapyramidal side effects or agranulocytosis, it is increasingly used as an alternative to lithium for prophylaxis of cyclic mood swings (Tripathi, 2008). Antidepressant medications such as Fluoxetine is used to treat symptoms of depression in bipolar disorder (Tripathi, 2008). Interventions Psychotherapy- the psychological impact is given to the patient by talk therapy to counsel the individual and also the associated people. This involves behaviour therapy to enhance cognitive behavior of the individual, family-focused therapy (FFT), interpersonal and social rhythm therapy to eliminate restlessness and sleep schedules, psycho education to stick to the regimen (Miklowitz, 2007). Electroconvulsive therapy- under severe condition when medication as well as psychotherapy does not work, electroconvulsive therapy is given to the patient. It is also known as 'shock therapy'. The process involves a brief anaesthesia and muscle relaxant and the shock lasts from 30-90 seconds and individual recover in 5-15 minutes (Pandya et al, 2007). Other interventions include sleep medications to induce sleep and eliminate restlessness in bipolar patients. 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