Bipolar Disorder Major Issues - Research Paper Example

Bipolar Disorder Teacher               As one of the most prevalent psychological disorders in the world, bipolar disorderis more serious than it seems as it affects an estimated 27 million people. Research shows that contrary to the emotional basis of bipolar disorder, it has a neuroanatomical and developmental basis. Neuroimaging techniques have somehow proven that the tendency to develop bipolar disorder can be predicted even in childhood. Moreover, bipolar disorder is also suspected as a multi-systemic inflammatory disease that may actually trigger the same pathways as cardiovascular diseases, autoimmune disorders and even retroviral diseases. Thus, bipolar disorder is actually more serious than it seems. Bipolar Disorder Based on data from the World Health Organization, there are 27 million people in the world who are suffering from bipolar disorder, and that an estimated 25 to 50 percent of these individuals experience suicide attempts at least once and that 10 to 15 percent would even somehow completely perform the act of suicide (Serious Mental Illness, 2011). Twenty-seven million with as many as 50 percent with suicidal tendencies is indeed an overwhelming figure and is definitely a cause for alarm not only for medical institutions but also for governments. However, recent developments concerning bipolar disorder show us that it has a neuroanatomical basis and is actually a multi-system inflammatory disease. Definition, Nature and Etiology According to the National Institutes of Health, bipolar disorder, which is also known as manic depression or manic depressive illness, is a brain disorder characterized by unusual shifts in mood, activity levels, energy and the capacity do what one is supposed to do in a day (Bipolar Disorder, NIMH, 2014). Bipolar disorder is classified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, as a mood disorder which can be classified into four types that actually overlap each other when it comes to the symptoms. These types are the following: Bipolar I Disorder, which is characterized by predominantly manic symptoms; Bipolar II Disorder, which is dominated by depressive episodes; Bipolar Disorder Not Otherwise Specified, or BP-NOS, which has very few or very short manic or depressive symptoms; and Cyclothymia, or Cyclothymic Disorder, which is a long term attack of alternating weak episodes of mania and depression (Bipolar Disorder, NIMH, 2014). Nevertheless, despite the confusion among the various types of bipolar depression, its symptoms are generally very similar in all cases. According to data from the National Institutes of Health, bipolar disorders are made up of manic and depressive symptoms. Manic symptoms include one’s being easily distracted, restlessness resulting in an inability to sleep or racing thoughts, poor control of temper, poor judgment, lack of self control which is evident in binge eating and drinking habits. Moreover, there are also symptoms of excess, namely promiscuity and extravagance. The patient also possesses a hyperactive mood which translates as talkativeness, abnormally high energy or a very high self-esteem that somehow borders around fantasy and encourages false beliefs about the self. On the other hand, the depressive symptoms somehow include the exact opposite of the manic symptoms. The former includes a loss of appetite or overeating, feelings of guilt, an unexplained lack of energy or fatigue, loss of self-esteem and sense of pleasure, worthlessness or hopelessness, an inability to put oneself to sleep or an uncontrollable habit of oversleeping, an unexplained isolation of the self from friends and company, and probably the most dangerous of all – developing the tendency to encourage thoughts of death and suicide (Bipolar Disorder, NIMH, 2014). This last mentioned symptom but certainly not the least – thoughts of death and suicide – is the main reason why bipolar disorder must be treated. In fact, the early-onset bipolar disorder is commonly associated with high rates of attempted suicide (Bipolar Disorder, NIMH, 2014). The symptoms of bipolar disorder are actually more complex than those of other mental illnesses probably because one experiences alternating mania and depression. Moreover, both manic and depressive symptoms have their own sub-symptoms, each one masking the disease into something simpler than what it is. Serious complications that may develop from an untreated bipolar disorder include a much more pronounced substance abuse using alcohol or drugs, problems with work, finances and relationships, and suicidal behaviors and thoughts, and even the actual act of suicide (Bipolar Disorder, NIMH, 2014). Without proper treatment, it would be impossible for one to have these complications treated or prevented in case they occur. Nevertheless, effective treatment for bipolar disorder usually requires essential information on how the disease started or developed in the patient, and thus treatment for the disease is all about the elimination of the causes and predispositions of the patient. In fact, bipolar disorder is caused by a number of factors. However, the NIH emphasizes a genetic origin: the exact cause of bipolar disorder is so far unknown, but it almost always occurs in relatives of people with bipolar disorder. In fact, there is a similar network of genes implicated in both bipolar disorder and schizophrenia and other related disorders. Moreover, bipolar disorder seems to involve a similar feedback or uniformly recurring patterns of connectivity in the following parts of the brain: between the medial prefrontal cortex and the anterior insula, and between the medial prefrontal cortex and the ventral lateral prefrontal cortex (Bipolar Disorder, RCP, 2014). This means that bipolar disorder usually affects particular parts of the brain, and this implies that the disease is actually more complicated than it seems. Bipolar disorder may also be brought about by external emotional events that may disrupt the usual workings of the mind and may destroy or wound one’s self-esteem. These events may include life changes such as marriage, childbirth, divorce or death of a spouse. Other factors that may trigger bipolar disorder, especially its manic episodes, include the use of medications like steroids or antidepressants, periods of sleeplessness, and the use of recreational drugs (Bipolar Disorder, RCP, 2012). So far, these are the external practices that are rumored to help cause bipolar disorder. Thus, the occurrence of bipolar disorder somehow requires the synergistic combination of effects from the genetic or neuroanatomical connections and the external emotional causes. Neuroanatomical Issues in Bipolar Disorder Bipolar disorder actually affects definite areas of the brain. Based on the findings of a 2012 article entitled “The functional neuroanatomy of bipolar disorder: a consensus model,” one is most likely genetically predisposed towards bipolar disorder because the disease is mostly a manifestation of neuroanatomical problems in the emotional networks of the brain. The old school thought concerning bipolar disorder was that the disease is based on a malfunctioning of the emotional networks of the brain concerning simple emotions. Nevertheless, in addition to the fact that the part of the brain that controls emotions is not completely defined, there is no clear evidence that bipolar disorder is linked to these emotional networks, which are actually made up of two ventral prefrontal networks, ventromedial cortex. Therefore, based on the findings of the study, and based on the latest imaging techniques, the networks involved in the progression of the disease are actually different from the established emotional routes. Based on neuroimages of the brain, bipolar disorder is commonly associated with amygdala dysfunction, specifically excessive amygdala activation during mania (Strakowski et al., 2012). This actually means that bipolar disorder can be detected in the individual even just through neuroimaging techniques as specific regions of the brain are definitely associated with bipolar disorder. Bipolar disorder is mainly associated with the amygdala. Moreover, it is not only the amygdala that seems to be associated with bipolar disorder but a neuroanatomical problem with the ventral prefrontal regions, which actually include the ventrolateral and the orbitofrontal prefrontal cortex. In fact, abnormalities in the prefrontal regions of the brain somehow lead to the dysfunctional activity of the amygdala (Strakowski et al., 2012). If bipolar disorder occurs in or affects the amygdala, then it means that bipolar disorder is associated with the development of fear. Moreover, other findings based on neuroimaging techniques, specifically diffusion tensor imaging, suggest that bipolar disorder is also based on white matter abnormalities. These findings therefore suggest that bipolar disorder is more or less based on neuroanatomical causes. In fact the failure of the development of certain regions of the white matter may actually trigger bipolar disorder (Strakowski et al., 2012). This exact mapping of the brain, particularly the white matter, somehow makes people think that bipolar disorder indeed actually involves cognition or the system of knowing and remembering. Moreover, there has also been considerable evidence that bipolar disorder is based on the malfunctioning or failure of development of the anterior cingulated cortex (Strakowski et al., 2012). This further means that bipolar disorder may actually have a real anatomical basis and not necessarily an emotional basis just like previous claims on its etiology. Another evidence for the claim that bipolar disorder has neuroanatomical basis is the fact that it begins in late adolescence, and somehow it progresses in terms of the gravity of symptoms. Thus, this suggests that bipolar disorder is progressive (Strakowski et al., 2012). This somehow implies that just like any developmental disease, then bipolar disorder is one that progresses regardless of the emotional causes but perhaps because of the progressive malfunctioning or degeneration of certain parts of the cortices involved in the onset of the disease. Lastly, one more proof for the neuroanatomical nature of bipolar disorder is that its occurrence is consistent with the increase in the brain volumes in the parahippocampal and prefrontal cortices. In fact, according to authors and experts, the increased volume of the cortices somehow indicates failed pruning or faulty developmental processes that happened prior to the onset of the illness (Strakowski et al., 2012). The fact that such a thing happened before the onset of bipolar disease means that it is actually not caused by the disease but that they may have actually happened at the same time or that the neuroanatomical change even occurred before the bipolar disorder did. Bipolar Disorder as a Multi-System Inflammatory Disease Bipolar disorder is also a disease that is not solely limited to the mental aspect of an individual but also affects other systems of his body. In fact, studies have proven that the occurrence of bipolar disorder in an individual leads to an increase in cardiovascular risk. However, this is most commonly associated with the side effects of the various types of medications used in bipolar disorders. Based on medical research, Lithium can actually cause weight gain, impairments in glucose metabolism. Another medicine associated with bipolar disorder – valproic acid – may bring about insulin resistance and weight gain. In the same way, the anti-psychotic drugs used in bipolar disorder may also bring about an increased risk for diabetes, hyperlipidemia, and weight gain (Leboyer et al., 2012). Thus, bipolar disorder is actually dangerous and one reason for this is the side effects of the medicines used to alleviate and cure their conditions. Moreover, bipolar disorder is also thought of as something correlated with the incidence of atherosclerosis from the moment that the endothelium malfunctions, to plaque rupture and thrombosis. The explanation for this is that somehow bipolar disorder has a common inflammatory factor with cardiovascular diseases, thus making bipolar disorder a multi-systemic inflammatory disease which is similar to any cardiovascular disease (Leboyer et al., 2012). Thus, bipolar disorder is actually a disorder that somehow activates multiple pathways and thus may trigger other diseases like cardiovascular problems. Moreover, evidence also shows that bipolar disorder is associated with hypertension, diabetes and obesity (Leboyer et al., 2012). Such a connection may therefore imply that bipolar disorder may actually trigger or activate the same pathway of disease as these conditions, and so a possible treatment of bipolar disorder may also lead to the prevention or alleviation of these related diseases. Bipolar disorder has also been found out to be consistent with abnormalities concerning sleep/wake cycles and the circadian rhythms. Although this may be emotional in origin, somehow sleep disturbances occur even before the manifestations of the symptoms of bipolar disorder, thus it seems that the cause is rather more physiological than psychological in nature. Moreover, sleep loss and disturbances in the sleep/wake cycles are associated with diabetes, atherosclerosis, metabolic syndromes and obesity. Coronary events and other diseases like this seem to have a common inflammatory factor that includes bipolar disorder (Leboyer et al., 2012). This means that there is a big reason to believe that sleeping disturbances and bipolar disorder may actually be triggered by the same neurophysiological pathway and factor, and so they may be related in this way. Moreover, another factor that is repeatedly found in bipolar patients is the incidence of stressful events and episodes. Moreover, psychological stress can actually trigger any inflammatory response in the brain as it happens. Induced neuronal microdamage is therefore the most likely cause of bipolar disorder (Leboyer et al., 2012). Thus, when one is bipolar, one is certainly also depressed as well and one would naturally engage in psychologically challenging situations, and this may likely explain the psychological stress. Another phenomenon that is associated with bipolar disorder is the incidence of autoimmune disorders. For example, the manic episodes of bipolar disorder are somehow associated with thyroid failure and atrophic gastritis. Moreover, acute encephalitis also somehow occurs together with bipolar disorder. Aside from these, it is also a given that bipolar disorder is expected to occur together with multiple sclerosis, rheumatoid arthritis, psoriasis, ulcerative colitis and thyrotoxicosis (Leboyer et al., 2012). The fact that bipolar disorder is associated with various autoimmune disorders somehow leads to two conclusions: the possible elimination and treatment of bipolar disorder may lead to prevention of autoimmune disorders, and that the occurrence of autoimmune disorders may actually be dependent on the treatment of the bipolar disorder which may coexist with them in the same patient. Lastly, there is a scientific basis for the association of bipolar disorder with the activation of certain retroviruses in the body such as the Endogenous Retrovirus or HERVs. The activation of this retrovirus in the bodies of certain people leads to the production of neurotoxic substances as well as pro-inflammatory substances that may actually cause chronic inflammations in various parts of the body (Leboyer et al., 2012). The fact that bipolar disorder somehow correlates with the activation of certain retroviruses in the body even without a definite scientific basis somehow leads experts to believe that either bipolar disorder triggers the same inflammatory pathways as these particular retroviruses, or that bipolar disorder somehow weakens the immune system for these opportunistic viruses to be activated and to take advantage of the body’s weakened state. Either way, the presence of bipolar disorder is definitely a very certain trigger for the development of viral diseases. Moreover, bipolar disorder could even more likely trigger other diseases aside from retroviral ones. Conclusions Based on the findings of Strakowski et al. (2012) and based on evidence from neuroimaging techniques, bipolar disorder indeed has a probable neuroanatomical basis. This means that there is indeed a possibility that bipolar disorder has a genetic or congenital basis, which further means that one is predicted to have bipolar disorder later on in life. This means that bipolar disorder may not actually be due to mere emotional causes, and may in fact be largely due to a particular genetic or developmental predisposition. Thus, the only advantage here is that it may be detected and corrected early. Moreover, based on the findings of Leboyer et al. (2012), bipolar disorder may actually trigger the same inflammatory pathways as other diseases such as cardiovascular disorders, glucose metabolism disorders, hypertension, diabetes, obesity, autoimmune disorders, stress-related disorders, and even retroviral diseases. Thus, it seems that bipolar disorder is actually a multi-systemic inflammatory disease that may actually trigger a host of other diseases. The idea therefore is to find out more about such physiological connections between bipolar disorder and other diseases, for the purpose of preventive therapy. References Bipolar Disorder. (2014). Retrieved from the National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml Bipolar Disorder. (2014). Retrieved from the Royal College of Psychiatrists: http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/bipolardisorder.aspx Leboyer, M., Soreca, I., Scott, J., Frye, M., Henry, C., Tamouza, R. & Kupfer, D. J. (2012). Can bipolar disorder be viewed as a multi-system inflammatory disease? Journal of Affective Disorders, 141(1), 1-10. Serious Mental Illness: Symptoms, Treatment and Causes of Relapse. (2011). Retrieved Aug. 1, 2012 from the Keeping Care Complete: Psychiatrists’ perspectives on mental illness and wellness: An International Survey. Retrieved from the World Federation for Mental Health: http://wfmh.com/wp-content/uploads/2013/11/WFMH_GIAS_SMI_FactSheet.pdf Strakowski, S. M., Adler, C. M., Almeida, J., Altshuler, L. L., Blumberg, H. P., Chang, K. D., DelBello, M. P., Frangou, S., McIntosh, A., Phillips, M. L., Sussman, J. E. & Townsend, J. D. (2012). The functional neuroanatomy of bipolar disorder. Bipolar Disorder, 14(4), 1-15. Read More