Differentiating the Cognitive Function Across Manic or Hypomanic in Bipolar Disorder - Research Proposal Example

Differentiating the Cognitive function across manic or hypomanic, depressed, and euthymic s in bipolar disorder s Abstract Bipolar disorder is one of the most interesting diseases in terms of analysis and scientific study as the reflection of its symptoms has a variable nature. Many scientists have long worked on the investigation of the states and reasons of the emergence of bipolar disorder. However, there are several states, which are typical for this disease and each of them are different in terms of expression. The aim of this work is to differentiate the cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. This paper addresses the main psychological reflections of bipolar disorder, determining the relationships between the performance and functioning of clinical features. The program of the differentiation of cognitive functions in bipolar disorder took place in one of the hospitals in Barcelona and included groups of people, who underwent special tests. The outcome of the experiment will reveal the levels of the group in terms of their compliance with the test. My prediction as for this test is that patients, who suffer from the depressed state will represent the lowest level of results. Introduction “Bipolar disorder, formerly known as manic depression, is a mental illness that affects as many as 10 million individuals in the United States alone. It is called bipolar disorder because there are 2 phases to the illness: an "up," or manic phase, and a "down," or depressive phase” (Torpy, J. M., 2009). Bipolar disorder is a mental illness that manifests itself in the form of affective states such as mania (or hypomania) and depression, reflecting sometimes the mixed symptoms, when the patient experiences rapid change of the states of mania and depression or faces them at the same time (for example, depression with taut, anxiety or euphoria with inhibition and so forth). These states are called episodes or phases of the disease. They often replace each other through the "light" intervals of mental health (intermissions), with little or no decrease in mental function, even in case of the longest episodes. During the period of intermissions the psychological state of the patient reaches the norm. Approximately 75% of the patients with bipolar disorder often suffer the other, similar mental disorders (for example, anxiety disorders). The most common are periodic (or intermittent) flow type affective psychosis. Relatively regular alternation of periods of illness (affective phases) and intermission is a characteristic feature of bipolar psychosis. Due to the fact, that bipolar disorder has a tendency to be inherited by other members of the family, scientists try to find the specific genes, which repeat from generation to generation and may increase the chances of disease. However, the problem arises not only due to the genetic factors. The study of monozygotic twins, having the same genetic structure shows that the occurrence of bipolar disorder is connected not only with the genes, but with other factors as well. If the cause of bipolar disorder was only in the genetic code, then in case of illness of one of the twins, the other one would also get sick. Consequently, if one of the twins suffers from bipolar disorder, the chance to acquire the same illness for the other twin is much higher than for other brothers and sisters. In addition it should be noted that the results of genetic studies suggest that the reason for bipolar disorder, as well as any other mental illness, is not resulted in one particular gene. Apparently, bipolar disorder is the result of joint action of many genes in combination with other individual, human and environmental factors. It is very difficult to detect these genes, as each of them makes a small contribution to the development of a predisposition to bipolar disorder. “Researchers from the United States, the United Kingdom, and Australia have linked variants in 2 genes with an increased risk of bipolar disorder. Both genes encode proteins that play roles in ion channels in nerve cells and affect the excitability of neurons” (Stephenson, J., 2008). The scientists hope that the recent introduction of the new research methodology will allow to solve this issue, which will lead to the development of more effective treatment for bipolar disorder. The difficulties in accurately assessing the prevalence of bipolar disorder are associated not only with the variety of criteria, but also with the inevitable subjectivity of this diagnosis in psychiatry. There are no great distinctions in the features which cause or predetermine the bipolar disorder. Men and women, as well as the representatives of different cultural and ethnic groups suffer from this illness equally. The possibility for acquiring "classic" bipolar disorder (at least one manic episode) is estimated at 2%. There are no accurate data on the incidence of bipolar disorder in child’s age, as the applicability of the criteria for the diagnosis in adults is limited. The overall prevalence of depression for grownups states 15 - 40%. Many scientific works emphasize that greater prevalence of affective disorders in adolescence period corresponds to a higher rate of suicides. The rate of the disease by age shows that the number of ill people who are from 22 to 44 states 46.5%. The causes and mechanisms of bipolar disorder are not revealed clearly, although in recent years the scientific studies provided the new data, primarily on the nature and the inheritance tendency of the disease and its neurochemistry. In addition, the study of the effects of antidepressants and other drugs at the level of the nerve cells led to the deeper understanding of the pathological processes of bipolar disorder. All these data allowed medicals to take a fresh look at the role of the development of the established violations of biogenic amines, as well as to study the endocrine changes, variations in water-salt metabolism, pathology of circadian rhythms, the influence of gender and age, constitutional features of the organism and so forth. Based on these data, the hypotheses describe not only the idea of the biological nature of the disease, but also provide the information on the role of the individual factors in the formation of the clinical features of bipolar disorder. The accumulation of data about the incidence in families of the patients, especially among monozygotic twins provided the establishment of the quantitative relationships of genetic and environmental factors in the development of bipolar disorder. The studies showed that the influence of genetic factors on the disease states 70%, while the environmental factors comprised only 30%. Some individuals possess the increased risk of developing the bipolar disorder. These people include, for example, a melancholy personality type, which is determined primarily by the accentuated focus on orderliness, persistence and responsibility. To the risk factors belong also the types of people, associated with emotional instability, which is expressed by the excessive affective reactions to the external causes, as well as spontaneous mood swings. On the other hand, the same group of risk comprises the category of people, suffering from the deficiency phenomena in any sphere of mental activity. Their main qualities are the insufficiency of emotions and personality conservatism. Their mental reactions are represented by rigidity, monotony and uniformity. In order to differentiate the cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder, one should understand the principles of its identification. The cognitive function involves a set of processes, procedures and methods of acquiring knowledge about the phenomena of bipolar disease. During the active phase of bipolar disorder, the cognitive function is not revealed in the proper way, because of its impairment. The researches, which compare the neuropsychological functioning with various clinical states, happen quite rare. The patients usually reveal the serious dysfunctions in such cognitive areas as education, attention, memory and so forth. The scientific studies discovered that the cognitive dysfunctions as the consequences of bipolar disorder remain beyond the stages of illness and can be chronic. However, there are no evidence of the existence of chronicity in the research of manic, depressed and euthymic state of the patients. The majority of researches, intended to compare the stages of the disease, are held without any differentiation of the patients according to gender, age or other characteristics. The aim of these researches is to find out which of the cognitive functions impairs in the period of bipolar disorder’s active phase or is maintained in the clinical remission. However, there are a lot of clinical factors, which influence the cognitive functions of people with bipolar disorder. During the research the patients expressed various models of neuropsychological activity, depending on their clinic state. The main task of the modern researchers is to determine the relationships between the neuropsychological functioning, functional outcome and clinical variables. Methods Substance abuse by patients with bipolar disorder does not appear to slow their recovery, but it may indicate that patients have a more rapid cycling form of the disease, according to a study funded by the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism (Kuehn, B. M., 2010).The program of identification of the bipolar disorder and its states was organized in one of the hospitals in Barcelona. The mental state of the patients was determined by the psychiatrists, who were responsible for the watching of the process of disease and its stages in terms of the program. The identification of disorders was held by means of DSM VI criteria, Mania Rating Scale and Hamilton Depression Scale. Thirty people, who participated in the experiment for the comparison with the bipolar disorder patients, included the hospital staff, men and women of different ages. All of them were properly examined for the existence of the relatives with the psychological deviations before the testing. The healthy and ill groups were not distinguished according to the gender, age, character features, education or any other differences. The clinical variables were gathered in terms of the protocol of the problem of bipolar disorder. The psychopathological assessment was held by means of using the scale of positive and negative syndromes (Spanish version). The assessment included such marking estimation scales as “good functioning” and “poor functioning”. The first type of assessment expressed the situation when the patients worked at a good level of functioning, while the second one expressed the disability of the patients to work properly or complete refusal from work. The scale of positive and negative syndrome was estimated by the General Assessment of Functioning, while the assessment of neuropsychological features was made by the professional psychologist who did not pay attention to the results of clinic researches. The choice of tests for the research was predetermined by the number of sources, provided the information for examination of bipolar disease. The experiment included the tests, which were widely-spread in the particular literature. All tests were held in the room with comfortable and quite atmosphere, according to the instructions. The time period of the tests was approximately 1,5 – 2 hours. The tests were represented by the following activities: checking of the executive functions (sorting out the cards, color association, animal-naming), attention scale (trail making test), educational and memory check (tasks on logical memory) and so forth. The four groups of participants (manic, hypomanic, depressed, euthymic and healthy) were compared according to the clinic and social characteristics. The results of the neuropsychological tests were measured with the help of the multivariate analysis of variance. The relationships between the test results were checked by Pearson’s correlation. The group variations between manic, hypomanic, depressed and euthymic objects were checked by ANOVA. ANOVA’s check did not reveal any significant differences in the variables of the patients in regard to the characteristics of gender, age, education and so forth. Variance multiple analysis identified the existence of cognitive dysfunctions of bipolar patients, despite their clinical state. The patients revealed bad work in the sphere of verbal memory. People with depression revealed the problems with the visual recall, comparing with the healthy ones. All groups of patients expressed the violation in color and cards association. Pearson check revealed that psychological functioning of bipolar patients was connected with the neuropsychological measures, but not with the clinical variables. No connection was stated between the social functioning of the patients and the duration of their disease. However, people with the chronic features of the illness made more mistakes and expressed the lower level of attentiveness. The number of suicides is connected with the measures of memory. The patients, who suffered from manic episodes, expressed the cognitive dysfunction in memory and verbal studies. These researches showed that memory and verbal study of the patients were damaged because of the development of bipolar disorder. The group with depressed patients also expressed bad level of writing, making many mistakes during the test. It was identified that the violation of the verbal learning and memory reduces the effectiveness of the medical treatment of the patients. Considering the results of the test, the lowest level revealed the group, which suffered from the manic episodes. The members of the group failed in dealing with even the simplest tasks, such as sorting of the cards, animal-naming, association game and so forth. The group revealed a high level of indifference as for the tasks of the test. They also had unsatisfied results in the answering questions, as their answers were characterized by the inconsecutiveness of the facts and the way of presenting information, missing words, sounds and so forth. During the writing test the members of the group revealed the high level of impatience in relation to the tasks, doing them not in order, but in a mess. Analyzing all these facts, we can definitely say that people, who suffered from manic episodes, revealed the lowest level in testing. Conclusion “Opportunities exist to extend the use of evidence-based interventions across a range of psychiatric disorders from the management of depression and anxiety disorders by primary care physicians to the care of bipolar disorder and schizophrenia by mental health specialists” (Olfson, M., 2013). The treatment of bipolar disorder is a complex task and requires a detailed understanding of psychopharmacology. Patients with bipolar disorder usually take many different drugs, which creates difficulties for the prevention of side effects. The efficiency of treatment of bipolar disorder depends essentially on the number of disease episodes. The treatment applied after the first manic episode is more effective than the treatment, which begins after several affective episodes. The treatment with lithium significantly reduces the incidence of suicides. It was confirmed by a meta-analysis of 48 randomized trials. Such a result is achieved due to the qualities of lithium to reduce the aggressiveness and impulsivity of the patient. However, in 2000, Europe was conducted an interesting study about the treatment patterns of bipolar disorder. It was found that lithium itself is almost never used in the therapy. In 75% of cases, lithium is only a part of the combined therapy. Only 8% of patients use lithium as monotherapy, but large percentage of patients does not use it at all. Lithium had a positive effect on approximately 30-45% of the patients. However, the effect of such treatment was achieved only in two weeks after its application. The vast majority of patients who had manic state possess a great percent of possibility that the disease would return. The returning episodes of the disease may pose a real threat to the life of the patients and lead to the lowering of the level of their social functioning. In this regard, it is imperative to conduct the preventive therapy for them. Summarizing the information which reveals the differentiation of the cognitive functions across manic or hypomanic, depressed, and euthymic states in bipolar disorder, one can notice that all areas of the disease are characterized by the deviations in the neuropsychological functions of the patients. The researches described in this work reveal that all patients, depending on the kind of their disease have dysfunctions in the sphere of verbal learning, mental activity, attention concentration and objects association. The following studies of bipolar disorder must be dedicated to the testing of the pharmacological treatment, aimed to reduce the impact of the disease on the patients’ proper functioning. References David J. Miklowitz, Michael J. Goldstein. 1997. Bipolar disorder: a family-focused treatment approach. New York: Guilford Press Evins, E., Cather, C. (2014). Maintenance Treatment With Varenicline for Smoking Cessation in Patients With Schizophrenia and Bipolar Disorder. 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London: Martin Dunitz ;Florence, Ky.: Distributed in the USA by Taylor & Francis Stephenson, J. (2008). Clues to Bipolar Disorder, 300 (No. 11) Torpy, J. M., Lynm, C. (2009). Bipolar Disorder. Journal of the American Medical Association, 301 (No. 5) Read More