Mood Swings of Bipolar Disorder - Essay Example

?Bipolar Disorder As the suggests, bipolar disorder (BD) is a condition in which a person experiences conditions of a of mind, which are literally at opposite ends of the normal mental spectrum. Typically, it comprises of a manic phase, which is euphoric, delusional, filled with excitement and an elevated mood, which could be instantly followed by a bout of depression, anxiety, irritability and sadness. The transition from one to the other could be within a matter of minutes, which, in layman terms is called ‘mood swings’. Clinically, bipolar disorder can be categorized under 3 types: Type I BD is defined by a minimum of 1 lifetime manic episode, which is accompanied with euphoric mood elevations Type II BD is defined by significantly less severe manic episodes, with bouts of acute depression. Type III, commonly called Cyclothymia, is a less severe form of this condition. The person undergoes cycles of mild mania and/or depression. At times, when undetected, it could progress to either the type I or II variant. Bipolar disorder is a chronic illness and it significantly affects the lifestyle of the patient on a social and professional basis, and quite often impairs their cognitive functioning. Depression is the phase of BD that represents the greatest challenge in management of the disorder. Undetected or prolonged depression and delirium is a frequent cause of suicide, and thus it is imperative that this condition be dealt with sensitively. The depression: mania ratio in bipolar disorder is 1:3, which tells us that the patient spends more time in an all-time low (Galvez, Thommi, & Ghaemi, 2011) . Heredity and Statistics: The possibility of inheriting BD from a previously diagnosed parent is 86-90% and studies over the past 11 years have shown that 9% of unipolar depressive patients were diagnosed as having BD. The suicide rate in these patients is almost 17 times higher, as compared to the general healthy adult population (Rapoport, Basselin, Kim, & Rao, 2009). In addition to being a social burden, BD has equal implications on personal finances and world economy. Within the USA itself, the treatment regimen spans from $12000 for a single episode of this syndrome, to a whopping $62K for patients who have to be aggressively managed with drugs and other therapy. Typically, symptoms of BD appear by the average age of 22 years, but are recognized and diagnosed with a lag period of almost 10 years. Even after commencement of therapy, the subject may remain symptomatic for a significant period of time, which makes it essential to continually monitor and adjust the treatment protocol (Nivoli et al., 2011). It has been reported that more than 66% of patients have a minimum of one close relative that has been diagnosed with either unipolar or bipolar depression, thus linking it to heredity (Nivoli et al., 2011). Characteristics and symptoms of people with Bipolar Disorder: Symptoms of varying degrees and intensities can be observed in this syndrome. The most common observation in Type I BD is extreme mood fluctuations. The highs include excitement, overly enthusiastic behavior, boundless energy, megalomaniac tendencies, generous thoughts and a surge in confidence levels. The lows that one typically experiences are prolonged periods of depression, irritability, sleep deprivation and a general feeling of loneliness, often accompanied by phases of crying for trivial or no apparent reasons. It is very common to have feelings of being incomplete, inadequate and worthless, which eventually culminates into thoughts and ideas of suicide. The hallmark of this disorder is the frequent cycling between the high and lows, namely the mania and depression, by virtue of which this disorder is detected. Social Challenges: Needless to mention, social stigma is commonly encountered by people, who are aware and informed that they are suffering from this syndrome. Such subjects consciously modify their behavior, in order to reduce the instances of being rejected or discriminated. In the mild to moderate symptoms in Type II BD, functional, cognitive and occupational impediment have been observed, although the extent of depression is not as pronounced as in the other variants of BD. Depression episodes may limit social interaction, as the subjects tend to keep to themselves (Vazquez et al., 2011). Management of BD: Monotherapy is not the preferred mode of treatment in bipolar disorder, as over a period of time, the efficacy of a single drug in reducing the symptoms is lost. It thus becomes necessary to resort to a treatment regimen using combination therapy. An important factor to keep in mind while prescribing a treatment regimen is the issue of non-compliance, due to the nature of the disorder. A constant monitoring of the drug intake and behavioral patterns and changed should be carefully recorded. The principle of cognition and behavior is based on the process of neurotransmission. Neurotransmitters are chemical moieties, which are synthesized and released, each of which plays a specific role in the body. The glutamatergic, cholinergic, dopaminergic and seratonergic neurotransmitters exist at certain concentrations, and a disturbance in any one of these will result in an alteration of mental make up. These agents in turn, are responsible for the release of hormone-like chemicals termed as second messengers. In the realm of bipolar disorder, arachidonic acid (AA) is the second messenger, which is of importance. A surge in the AA cascade amounts to behavioral changes. Currently, the categories of drugs in use are the mood stabilizers, anti-psychotics, anti-depressants and SSRIs (secondary serotonin reuptake inhibitors) (Nivoli et al., 2011) (Thase & Sachs, 2000). The mood stabilizers commonly employed are Lithium, Sodium valproate- Valproic acid (either singly or in a 1:1 molar combination), and carbamezepines. An anticonvulsant such as a barbituric acid may also be added to the medication. Antidepressants, which exert their effects by preventing the uptake of norepinephrine, are termed as SSRIs, and drugs in this category such as Lamotrigine and Fluoxetine are of immense use and are indicated frequently. These agents are used to delay the appearance of changing mood states. Mood stabilizers typically reduce the levels of AA in the body and thus restore behavioral patterns. Some of these drugs are prescribed to switch over from depression to mania, as the latter is better treated, and the suicidal tendencies in a subject are minimized (Thase & Sachs, 2000). Side effects: Although these agents play a very useful role in controlling the symptoms and prevention in frequent recurrences in mood variations, they do have their share of adverse effects. Lithium, for example, over a period of time is found to produce delirium, loss of motor coordination, confusion, and an alteration in circadian rhythms. Similarly, there have been reported cases of the hepatotoxic and pancreatotoxic effects of Valproic acid, and the nephrotoxic and neurotoxic effects of carbamazepine. Hence, the treatment options should be carefully weighed keeping in mind the existing condition of the subject (Skjelstad, Malt, & Holte, 2010). Other treatment approaches: The non-drug based treatment could be broadly divided as somatic and non-somatic methods. The somatic method includes techniques such as sleep deprivation, electroconvulsive or shock therapy, and phototherapy. It is believed that these treatment models affect the brain function directly or indirectly and produce a betterment of symptoms. Phototherapy is of use in patients who have seasonal attacks in the depressive, low-sunlight months of the fall and winter. Exposure to full intensity white lights for a period of 2 hours a day is found to be a good substitute to pharmacotherapy in a number of subjects (Thase & Sachs, 2000). Support groups: Since BD is globally prevalent, practically every nation or country has a good support system for patients suffering from it, or for their family members, to better understand and cope with the situation. These support groups are similar to the popularly known AA (alcoholics anonymous). Frequent workshops are held, where the role of medications and steps to maintain a neutral mood are discussed. There are workshops on spirituality, which has worked wonders for very many patients, due to the calming nature of therapy, and intense concentration on a spiritual subject. Exercises such as Yoga are also offered by some groups, which help in gaining control over one’s concentration and focus, thus reducing the frequencies of BD. Some such support groups in the US and Canada are (http://www.nami.org, 2011): National Alliance for the mentally ill (NAMI) Depression and Bipolar Support Alliance National Mental Health Association Mood Disorders Association of Manitoba World Fellowship of Schizophrenia and Allied Disorders Medicaid: Medicaid, in many states in the USA, provides various health services to the youth and adults with mental conditions. This is much superior to the support offered by private insurance firms, as the latter provides assistance to an emergency situation or a one time outpatient medical care. On the contrary, Medicaid offers significant support in recovery and rehabilitation, apart from the emergency medical services. The Accountable Care Organizations (ACO) is a subset of Medicaid, which aims at providing a more integrated and coordinated care to patients living with multiple mental conditions. The National Institute of Health (NIH) received a grant of $10.4 billion from the recovery act, for use in the year 2009-2010 by the National Institute of Mental Health (NIMH) (http://www.nimh.nih.gov). Conclusions: Irritability, sleeplessness, and bouts of mania followed by spans of depression are common indicators of bipolar disorder. Genetics and heredity plays a major role in bipolar disorder, but a quick diagnosis and prompt commencement of therapy could help the patient lead a comfortable life with a stable mental condition. The right dose titration of therapeutic agents have reduced the mood alteration patterns in subjects with as frequent as 3-4 cycles of mania and depression, to just 1-2, spread over a period of months. Constant supervision and care is essential, as the condition may relapse after a prolonged asymptomatic period. Enrolment with support groups helps not only the subject with the ailment, but also the family members, who get more insight on the disorder and pointers which assist in diagnosing an episode. References: Galvez, J. F., Thommi, S., & Ghaemi, S. N. (2011). Positive aspects of mental illness: a review in bipolar disorder. [Review]. J Affect Disord, 128(3), 185-190. doi: 10.1016/j.jad.2010.03.017 http://www.nami.org. (2011). National Alliance of Mental Health http://www.nimh.nih.gov. National Institute of Health. NIMH Information on the American Recovery and Reinvestment Act of 2009. Nivoli, A. M., Colom, F., Murru, A., Pacchiarotti, I., Castro-Loli, P., Gonzalez-Pinto, A., . . . Vieta, E. (2011). New treatment guidelines for acute bipolar depression: a systematic review. [Research Support, Non-U.S. Gov't Review]. J Affect Disord, 129(1-3), 14-26. doi: 10.1016/j.jad.2010.05.018 Rapoport, S. I., Basselin, M., Kim, H. W., & Rao, J. S. (2009). Bipolar disorder and mechanisms of action of mood stabilizers. [Research Support, N.I.H., Intramural Review]. Brain Res Rev, 61(2), 185-209. doi: 10.1016/j.brainresrev.2009.06.003 Skjelstad, D. V., Malt, U. F., & Holte, A. (2010). Symptoms and signs of the initial prodrome of bipolar disorder: a systematic review. [Research Support, Non-U.S. Gov't Review]. J Affect Disord, 126(1-2), 1-13. doi: 10.1016/j.jad.2009.10.003 Thase, M. E., & Sachs, G. S. (2000). Bipolar depression: pharmacotherapy and related therapeutic strategies. [Research Support, U.S. Gov't, P.H.S. Review]. Biol Psychiatry, 48(6), 558-572. Vazquez, G. H., Kapczinski, F., Magalhaes, P. V., Cordoba, R., Lopez Jaramillo, C., Rosa, A. R., . . . Tohen, M. (2011). Stigma and functioning in patients with bipolar disorder. [Research Support, Non-U.S. Gov't]. J Affect Disord, 130(1-2), 323-327. doi: 10.1016/j.jad.2010.10.012 Read More