Bipolar Disorder - Incurable Psychic Disease Associated with Adverse Health Complications - Essay Example

BIPOLAR DISORDER by + Introduction Bipolar disorder (BD) is a debilitating, chronic mental illness that is characterized by rapid mood changes and usually affects adolescents and young adults. The typical clinical presentation includes alternating episodes of mania with hyperactivity, euphoria, and behavioral disinhibition and depression with loss of motivation and severe apathy. In this paper, I will highlight the key clinical features of the disease as well as describe the available diagnostic tools and provide the analysis of the current treatment options. Causal Factors Bipolar disorder is a multifactorial disease, and its causes vary between individuals. Genetic factors are considered to be the leading contributor to the disease, accounting for up to 80% of the risk of having the illness. The heritability index was calculated to be around 0.7 (Edvardsen 2008). Despite having been restricted to a relatively low number of samples, twin studies have revealed a considerable genetic component, together with a clear environmental impact. Extensive studies over the last years have consistently estimated the concordance rate for bipolar I disorder to be around 5% in fraternal twins, in comparison to over 40% in identical twins (Barnett & Smoller 2009). Studies have also identified certain physiological processes underlying the bipolar disorder. For instance, by means of magnetic resonance imaging researchers have noted the differences in the volume and density of various brain zones between the healthy individuals and patients with BD. Specifically, the analysis of structural MRI findings provided evidence of the increased volume of the pale body and lateral ventricles (Arnone et al 2009). Simultaneously, functional MRI scans indicated the impaired coordination between the limbic corpus amygdaloideum and prefrontal region (Srakowski et al 2012). According to another theory, when genetically predisposed people are exposed to stress, their stress threshold at which behavioral changes happen lowers. After a number of such exposures, the episodes may start spontaneously. In support of the theory, Alloy and Bender (2011) report of the correlation between stressful situations and malfunction of the hypothalamic-pituitary-adrenal axis. Stress factors cause hypothalamic hyperactivation, which may eventually result in disease. Some researchers imply the major contribution of the environmental factors to the development of bipolar disorder. Evidence suggests that broken interpersonal relationships and hurtful early-life events may increase the risk of onsets and induce the recurrences of bipolar mood episodes. Thus, Blietzke revealed that nearly 50% of adults diagnosed with the disease could recall a traumatic experience in childhood (2011).  Epidemiology Bipolar disorder is the sixth most common cause of disability worldwide with over 250,000 registered cases in the UK. According to Schmitt (2014), a lifetime prevalence of the disease equals to 3% in the general population. The epidemiological survey held in the UK in 2011 indicated that up to 22% of patients with depression may suffer from a misdiagnosed BD (Smith et al. 2011). Bipolar disorder affects men and women with the same frequency. The incidence is also relatively equal across different ethnic groups and cultures. In 2000, the World Health Organization conducted a study that showed a very similar incidence rate of bipolar disorder across the globe. Thus, prevalence per 100,000 individuals varied between 422 in South Asia to 481 in Africa for men and from 450 in Europe to 492 in Australia for women (Blietzke 2012). Nevertheless, the severity of symptoms may be significantly different in various parts of the world. For instance, disability develops sooner in patients from the developing countries where the health care availability and affordability are poorer. Typically, the first symptoms present between 14 and 30 years of age, although the disease may also affect children or debut in the late adulthood. Clinical Presentation Patients with bipolar disorder suffer from alternating episodes of extreme emotional highs and lows. Every mood episode displays a distinct deviation from the individual’s normal behavior. Overly excited and ecstatic states are known as manic episodes while extremely melancholic and frustrated states are called depressive episodes. Mixed states combine symptoms of mania and depression. Persons with BD may also be irritable and aggressive during a mood episode. Symptoms of BD include changes of both mood and behavior. Therefore, typical mood changes during a manic episode involve long periods of euphoria and hyperirritability while behavioral alterations include accelerated speech, inconsistency between the expressed ideas, eagerness to start new projects, hyperactivity, reduced need of sleep, exaggerated self-esteem and impulsiveness. Depressive episodes manifest with prolonged periods of sadness, hopelessness and apathy; patients feel tired, lose appetite and experience difficulties focusing on things and making decisions. In some cases, patients think of or even attempt to commit suicide (Mayo Clinic Staff 2015). Bipolar disorder is frequently associated with a range of somatic diseases, such as diabetes, ischaemic heart disease, or pneumonia. Over 60 percent of people with BP also suffer from another brain disorder, most often - from anxiety disorder or impulse control disorders. Diagnosis Clinical presentation is a principal criterion of diagnosing bipolar disorder. Physicians distinguish four main forms of the disease: 1. Bipolar I Disorder is characterized with manic or mixed episodes lasting for the minimum of seven days, or by a state of mania that is so intense that needs to be cured immediately. Depressive episodes may occur as well. 2. Patients with Bipolar II Disorder suffer from series of depressive episodes. Full-blown manic episodes are not common for this type of BD. 3. The diagnosis of Bipolar Disorder Not Otherwise Specified is usually set when the symptoms of BD are identifiable but do not fit into any of the first two types. 4. Typical features of Cyclothymia include episodes of mild depression and hypomania for no less than 2 years. However, clinical presentation is not severe enough to meet the diagnostic threshold of any of the above-mentioned forms of BD (National Institute of Mental Health 2015). Apart from the interview, physical examination and basic lab tests, magnetic resonance imaging of the brain may be performed. Although the diagnosis of BD cannot be verified through MRI scans, brain imaging may help in identifying some other factors that may initiate behavioral and mood changes, such as tumor or stroke. Analysis of the Clinical Guidelines Despite the vast array of available effective medications and a well-developed theoretical framework, the major issue with the guidelines for the treatment of BD is that they have to be constantly updated and that the evidence base grounds primarily on reports of monotherapy trials that barely reflect the approach to management in a hospital setting. Therefore, four evidence-based management guidelines for BD were reviewed to determine the optimal pattern of action. The guidelines included those developed by the British Association for Psychopharmacology, International Society for Bipolar Disorders, Canadian Network for Mood and Anxiety Treatments and those proposed by the Australian group of researchers. Each of them has been reported to bring successful clinical results (Connolli 2011). Having utilized all of the protocols, it is possible to distinguish several most efficient recommendations that are generally agreed and backed with strong clinical evidence: 1. Atypical antipsychotics, lithium, or divalproex should be the first-choice option in treatment of patients with identified maniac episodes; 2. Mixed episodes are most effectively cured with atypical antipsychotics or divalproex; 3. Quetiapine, lamotrigine, or a combination of fluoxetine and alanzapine are the treatment of choice for bipolar depression; 4. All individuals with BD should undergo psychoeducation. Unfortunately, BD is an incurable illness, and even with the strict compliance to the recommendations the complete recovery is not possible. However, a combination of psychotherapy and medicamentous treatment may significantly improve the quality of life of such patients. Moreover, carefully following the treatment plan and avoiding drugs and alcohol, patients may prevent the relapse (Connolli 2011). Importance of Communication Good communication skills are crucial while taking care of patients with BD. Constructive communication helps to establish the atmosphere of trust between the patient and the care provider and minimizes the risk of evoking hostile behavior. Some of the recommendations include active listening, mutual problem solving, calmly expressing opinions about the patient’s behavior, praising for positive changes, and reaching compromises (Mayo Clinic Staff 2015). Health care providers who deal with BD patients are supposed to display a high level of expertise. Not only is professional approach crucial when finding the key to the patient, but also for personal security reasons. Due to the drastic mood changes, the incorrect manner of a carer may provoke immediate aggression. Furthermore, health care professionals play a principal role in teaching family members how to communicate with the diseased. Impact on the Daily Life Patients with BD experience substantial deterioration of functional condition. Due to the swift mood changes and episodes of uncontrollable behavior, they may lose employment. Furthermore, BD is a common cause of divorce. Taking care of patients with BD is a burden for the family members, and their aggressive, sometimes dangerous behavior often leads to the family separations. In 2009, AstraZeneca conducted a survey in order to examine how BD affects the daily lives of individuals. It was revealed that the patients’ greatest worry was that their symptoms will influence their families, relationships, and job. Specifically, almost 90% of those questioned said they have abandoned social involvement because of depression. Moreover, 73% of persons with BD complained that depressive symptoms reduced their capability to handle housework while 60% confessed they were unable to complete job assignments (Nauert 2009). Conclusion Bipolar disorder is an incurable psychic disease that is associated with a number of adverse health complications. Usually, the disease affects young individuals. The primary focus of treatment should be aimed at safety and include a combination of psychotherapy and antipsychotic drugs. If managed properly, the relapse of BD symptoms may be delayed significantly and the patient enjoy a normal quality of life. Reference List Arnone, D, Cavanagh, J, & Gerber, D 2009, "Magnetic resonance imaging studies in bipolardisorder and schizophrenia: Meta-analysis", The British Journal of Psychiatry, vol. 95,no. 3, pp. 194–201. Barnett, JH & Smoller JW 2009, "The genetics of bipolar disorder", Neuroscience, vol. 164, no.1, pp. 331–43. Bender, RE & Alloy LB 2011, "Life stress and kindling in bipolar disorder: review of theevidence and integration with emerging biopsychosocial theories", Clin Psychol Rev, vol. 31 no. 3, pp. 383–98. Brietzke, E 2012. "Impact of childhood stress on psychopathology", Rev Bras Psiquiatr vol. 4,no. 4, pp. 480–8. Connolli, K 2011, “The Clinical management of bipolar disorder: a review of evidence-based guidelines”, Primary Care Companion, vol. 13, no. 4, pp. 89-93. Edvardsen, J 2008, "Heritability of bipolar spectrum disorders. Unity or heterogeneity?", Journal of Affective Disorders, vol. 106, no. 3, pp. 229–240. Mayo Clinic Staff 2015, Bipolar disorder, viewed 15 May 2015 http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/complications/con-20027544 National Institute of Mental Health 2015, Bipolar disorder, viewed 15 May 2015 http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part_145405 Nauert, R 2009, “Bipolar disorder affects daily life”, PsychCentral, viewed 15 May 2015 http://psychcentral.com/news/2009/04/20/bipolar-disorder-affects-daily-life/5419.html Schmitt, A 2014, "The impact of environmental factors in severe psychiatricdisorders", Frontiers in Neuroscience, v. 8, no. 19. Smith, DJ, Griffiths, E & Kelly, M 2011, “Unrecognised bipolar disorder in primary care patients with depression”, British Journal of Psychiatry vol. 199, no. 7, pp. 49-56. http://psychcentral.com/news/2009/04/20/bipolar-disorder-affects-daily-life/5419.html Strakowski SM, Almeida J, & Blumberg HP 2012, "The functional neuroanatomy of bipolardisorder: A consensus model". Bipolar Disorders, vol. 14, no. 4, pp. 313-325. Read More