Bipolar Disorder: Diagnostics and Treatment - Research Paper Example

? Bipolar Disorder Bipolar disorder is a mental illness involves maniac and depressive episodes in a patient.Similar to other mental disorders, the disease is under diagnosed and the symptoms maybe both confusing and devastating to an individual who is not aware of the disorder. The paper explores the classification of bipolar and the diagnostic criteria according to DSM V. In addition, it analyzes the different empirically proven therapeutic methods for bipolar disorder. Bipolar Disorder Introduction Bipolar disorder (maniac depressive disorder) is a psychiatric disorder that is accompanied by spontaneous mood swings that can involve outbreaks of depression and others of high mania (Godwin & Jamison, 2007). The disorder is persistent and can be severe in some patients. The disease can be classified into three categories which include bipolar I, bipolar II and cyclothymia. These three classes possess their own unique clinical presentations, which is also essential when considering the pharmaceutical as well as psychological therapeutic approach. The exact pathophysiology of bipolar disorders has not yet been established, however, some studies have linked some genetic factors to the development of this condition (Godwin & Jamison, 2007). The paper will illustrate the characteristics of bipolar disorders according to the DSM-IV criteria and further illustrate the studies that have been carried out in determining the etiological factors and pathophysiology of the disorder. Primary Characteristics and related features of Bipolar using DSM V The Diagnostic and Statistical Manual of Mental Disorders is one of the key tools utilized in the diagnosis of psychiatric disorders. According to this criteria there are 2 main types of bipolar which include bipolar I or II. A third type which was mentioned above is cyclothymia which is can be defined as a recurrent, chronic mild form of bipolar disease. This disease shows less prominent signs of both type I and II bipolar. This disorder typically oscillates between dysthymia and hypomania. If the patient has a depressive or maniac episode he or she id not diagnosed with cyclothymia. The DSM V classifies this disorder separately (Rush & Thase, 2002). According to the DSM-V criteria, bipolar I has been characterized as the occurrence of one or more episodes of mania or at times mixed episodes. On the other hand, the main presentation of bipolar II is at least one episode of hypomania. The disorder is also characterized by one or more episodes of depression (Rush & Thase, 2002). Bipolar I disorder can be diagnosed with a single maniac episode. In this situation, the patient is found to have no previous depressive episodes and 1 maniac episode. This single episode of mania is superimposed by delusional disorder or schizophrenia and is also not distinctly accounted for by schizoaffective disorder. Recurrence is referred to as deviation in polarity from a depressive state or the patient going for two months without experiencing maniac symptoms. This type of mania can be classified as moderate, mild or severe and can present with or without any signs of psychotic features. In addition, it can also present with postpartum onset or catatonic features. Bipolar II was characterized by the History or presence of 1 or more major episodes of depression (Rush & Thase, 2002). It also presences with 1one or more episodes characterized by hypomaniac state. The patient also does not have any history of mixed or maniac episode. These symptoms are not better accouted for or superimposed by schizophrenia, delusional or schizoaffective disorder. The psychiatrist must indicate whether the patient has a depressive or hypomanic episode. The symptoms of both type I and II bipolar disorders have adverse impacts on the occupational, social or everyday functioning of a patient (Rush & Thase, 2002). Research supported causal theories of Bipolar Disorder. As mentioned above, there have been several factors that have been linked with the development of bipolar disorders which include biochemical, psychodynamic, environmental and genetic factors. Caudno et al carried out researches in London utilizing the Maudsley Twin Register. They found that a genetic liability and risk factor similarity is noticeable in schizoaffective, maniac disorders as well as schizophrenia. This study also illustrated an independent genetic psychosis liability which was present in both schizophrenia and mood disorders. This aspect had also been previously suggested by Berrrettini (Miklowitz, 2010). Other gene related studies have also showed that individuals who are affected with bipolar disorder have a decreased rate of expression in oligodendrocyte-mylein genes. In addition, the patients also presented with an abnormal amount of white matter within various regions of the cerebral cortex. Kendler and Smoller also discovered in their research that approximately 25% of genetic variation was responsible for the development of mental illnesses (Miklowitz, 2010). Seifuddin et al., also conducted a review on genome wide gene expression in patients suffering from bipolar disorder (Lam et al., 2010). The study was carried out using a mega analysis of previous research that was done utilizing prostmortem neurological tissue. Data was obtained from several studies and it was standardized and processed. This data was later combined and with studies on the following sections of the brain: random, hippocampus and the prefrontal cortex. The results from the study showed that 382 genes were significantly altered in the patients suggesting that genes have a role to play in the development of the condition (Lam et al., 2010). Theories also suggest that environmental factors play a role in the development of bipolar disorder. Studies by the International Mental Health Research Organization on monozygotic twins illustrate that the development of bipolar disorder in twins was only prevalent in 65% of the patients (Miklowitz, 2010). Therefore, since these individuals share identical genetic similarity they should be 100% prevalence in twins. This suggests that there are certain epigenetic factors that play a role in the development of the disorder and the pathogenesis is not solely dependent on genetic factors. Empirically supported treatment options and their relative effectiveness for the disorder There have been several treatment plans that have been innovated and in cooperated in the treatment of bipolar. Hollon and Ponniah carried out an analysis on psychological therapies utilized to treat mood disorders in adults (Hollon & Ponnish, 2010). The study reviewed different therapy trials in order to determine those that were empirically supported and were capable of reducing symptoms and preventing recurrence and relapse. Treatment options that were empirically supported in the study included dynamic psychotherapy which was used for treating the depressive episode in BP patients. These have been found to have similarities with psychodynamic interpersonal psychotherapy (Miklowitz, 2010). Other forms of psychotherapy that have been analyzed include psychoeducation, cognitive behavior therapy, interpersonal and social rhythm therapy and family focused therapy. Psychoeducation and its implications on bipolar were first studied by Perry et al., who carried these studies over approximately 12 psychoeducation lessons (Hollon & Ponnish, 2010). Perry et al., assessed the adherence to medication and the impediment of relapse. The patients that were assessed were on mood stabilizers and were provided psychoeducation as an addition to their treatment. The patients who were provided these education sessions were found to an 18% risk of manic relapse whereas those who did not receive these educational lessons had a 46% chance of relapse (Hollon & Ponnish, 2010). In addition these patients also had a lower risk of developing relapses in their depressive state as they had a risk of 31% whilst those who did not receive the additional therapy had a 48% risk. Psychoeducation also showed that over a longer period of time the chances of relapse are further reduced (Hollon & Ponnish, 2010). Cognitive Behavioral Therapy involves assisting the patient in identifying the relations between the thoughts, emotions and behaviors which are significant with bipolar disease. The patients in this therapy are taught to improve their way of coping with Bipolar and which exercises are useful in restructuring cognitive functions (Keck & McElroy, 2009). Patients who were receiving maintenance pharmacotherapy were given CBT sessions which concluded that CBT was helpful in reducing the risk of hospitalization and improved adherence. Patients who were given therapy had a hospitalization rate of 21% and those who did not had a rate of 57%. Cochran et al., concluded that this therapeutic intervention was useful in the treatment of bipolar patients (Keck & McElroy, 2009). Family Focused Therapy is intended to reduce the risk of relapse by enhancing a patient’s social support system and reducing the inappropriate expression of negative emotions by family members or other individuals who live in the vicinity of the patient. These have been found by several researches to enhance the relapse and hospitalization rates among patients suffering from mood disorders. There have been few researches that have been created on this subject. These have however indicated that the reduction in risk of relapse is limited whereas there is a significant decrease in the chances of hospitalization with the percentages being 60% and 12% in patients who participated in therapy and those who didn’t respectively (Keck & McElroy, 2009). The fourth therapeutic intervention that will be discussed is Interpersonal and Social Rhythm Therapy which places emphasis on assisting bipolar patients in adopting regular daily rhythms and to treat interpersonal skills. A study that was conducted to illustrate the benefits of this intervention showed that it was less helpful than other interventions (Hollon & Ponnish, 2010). Other studies have shown that adding this type of therapy to patients who are in stable condition during pharmacological therapy may worsen the symptoms. Only one positive outcome has been noticed in patients after this therapy (Hollon & Ponnish, 2010). Current newspaper or magazine article All the rage A patient describes her condition nine years ago, which was characterized with constant mood swings and contemplation of suicide. She remained with this condition until she was shaken by her thoughts of driving off the Golden Gates Bridge. After this experience she called a psychiatrist and was diagnosed with bipolar II and states that the diagnosis was a relief as it was a way of explaining so many things in her life that made no sense at a certain point (Waldman, 2012). After the diagnosis she was able to take several steps in improving her live and wrote a book within a period of six months. However, this patient’s problem was not resolved with the diagnosis as she embarked on a hard journey of medications some of which were ineffective and were accompanied with several side effects such as weight gain and loss of libido. These events led the patient to conduct constant research on the internet about her condition and the most effective drugs that were available at the moment. During her long journey of treatment she was diagnosed with PMS which is a mood disorder and is experienced by approximately 80% of women ovulating (Waldman, 2012). The story shared by this woman is indicative of the experiences faced by bipolar patients every day. Before diagnosis the symptoms of bipolar disease are very confusing and can be difficult for uneducated patients. Therefore, diagnosis is the first step towards the problems associated with bipolar. The patient also explains the experience she has with medications and how they are often accompanied with numerous side effects. Part of this problem is that the etiology of this disorder is not fully understood and the cognitive function of the brain still remains a mystery in some aspects that are associated with bipolar disorder (Waldman, 2012). The information is quite accurate as the patient appears to have done a substantial amount of research on her disorder. She also focuses on additional therapy that was discussed above during her menstrual cycle. In this phase Serotonin Selective Reuptake Inhibitors, which she was taking, are in effective. Therefore, she utilizes approaches of Cognitive Behavioral Therapy. This therapy enables a patient to understand her disease more efficiently and adapt the appropriate response mechanisms to prevent recurrence of depressive or maniac episode (Waldman, 2012). Bipolar relationship with depression and mania Bipolar is related mental illness that is associated with depressive and manic episodes. These are the defining characteristics of the disorder and enable the psychiatrist to state if the patient has bipolar type I or II (Lam et al., 2010). Depression and mania also assist in determining the mode of treatment for the patients as bipolar patients with mania episodes are given tranquilizers whilst those who have depressive states are treated with anti depressants (Lam et al., 2010). Conclusion Bipolar disorder is a condition which is associated with mood disturbances. It is characterized by maniac and depressive episodes depending on the type of disorder. The etiological factors of bipolar are not yet fully understood, however, genetic and environmental factors are have been closely linked to the development of the disease. Patients suffering from bipolar are often given pharmacological treatment accompanied by additional therapeutic interventions such as psychoeducation, cognitive behavior therapy, interpersonal and social rhythm therapy and family focused therapy. Treatment still remains a challenge however; management of the disease is possible. Patients and the people around them should be dedicated towards the prescribed treatment plan as the pharmacotherapy alone is not enough to appropriately manage the condition. References Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: bipolar disorders and recurrent depression (Vol. 1). Oxford University Press. Hollon, S. D., & Ponniah, K. (2010). A review of empirically supported psychological therapies for mood disorders in adults. Depression and anxiety,27(10), 891-932. Keck, P., & McElroy, S. (2009). Treatment of bipolar disorder. In The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition. American Psychiatric Publishing, Inc. Lam, D. H., Jones, S. H., & Hayward, P. (2010). Cognitive therapy for bipolar disorder: A therapist's guide to concepts, methods and practice (Vol. 101). Wiley. com. Miklowitz, D. J. (2010). Bipolar disorder: A family-focused treatment approach. Guilford Press. Rush, A. J., & Thase, M. E. (2002). Psychotherapies for depressive disorders: a review. Evidence and Experience in Psychiatry, 1, 161-206. Waldman, A., (2012). All the Rage. New York Times. Retrieved from http://www.nytimes.com/2012/02/19/t-magazine/womens-fashion/all the-rage.html?pagewanted=2 Read More