Bipolar

 

Oluwafikayo Ojo Intro to Psychology Dr. Christine Hoskins August 3, 2014.  Bipolar Disorders

There has been much speculation as to whether people’s behavior could be explained by a diagnosis of bipolar. Approximately one to three percent of the world’s  population has been diagnosed with a bipolar disorder. (Merikangas, ?) Americans have a higher occurrence of over o ver four percent. (Merikangas, ?) Bipolar disorders do not discriminate between genders and is being more frequently diagnosed in children. This paper p aper will explain what bipolar disorders are and how they affect the individual’s ability to function. Bipolar Disorder, also known as manic depression, causes shifts in a person’s mood, energy, perception, and ability to function in a consistent day-to-day life. If untreated, it can cause a person to lose friends, jobs, money, and, in the worst cases, their life. Fortunately, there are treatment options and an d ways a person with a  bipolar disorder can manage their life with minimum episodes to maintain a good quality of life. There are four diagnostic bipolar disorders all differing in types, severity, and frequency of episodes. The four types of bipolar disorders are Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified. The disorders involve a history of Manic Episodes, Mix Episodes, or Hypomanic Episodes usually u sually accompanied by a history of Major Depressive Episodes. (DSM-V, 2013) These episodes have hav e certain criteria for diagnostic purposes that are defined in the DSM-V. The primary indicator of a Major Depressive Disorder is a period of two weeks in which the individual experiences either a depressed mood or a lack of interest in activities. The depressed

 

mood may be described by the individual as sad, hopeless, discouraged, or as an increased irritability. Children and adolescents particularly exhibit a more irritable mood. The individual may notice a lack of interest in hobbies or other such activities that they onc oncee enjoyed. The individual’s friends, family, family, or co-workers may notice that they are less sociable, are making excuses for not participating, or no longer enjoy outdoor activities. In addition to either of these two criteria, the individual must experience at least four more accompanying symptoms from a list of nine. The remaining symptoms for a Major Depressive Episode include changes in appetite; insomnia or hypersomnia nearly every day; da y; psychomotor agitation or retardation, fatigue or loss of energy nearly every ever y day; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; recurrent thoughts of death or suicide. The changes in appetite are typically represented by a loss of appetite resulting in weight loss. In an adult this is marked by a five percent change of weight in a one month period. In children, it is observed as not making expected weight gains. Psychomotor agitation is defined as excessive motor activity associated with a feeling of inner tension. The activity is usually non-productive and repetitious such as pacing, fidgeting, wringing of the hands, pulling of clothes, and inability to sit still. (DSM-IV, 2000) Psychomotor retardation is a visible generalized slowing of movements mov ements and speech. (DSM-IV, 2000) These physical actions must be severe enough to be observable by others to meet this criteria. The recurrent thoughts of death or suicide associated with Major Depressive Disorder include the individual’s individual’s belief  belief that others would be better off if the individual were dead, thoughts of committing suicide, or an actual plan of how ho w to commit suicide. The term bipolar was introduced in the 1950’s (Goodwin, (Go odwin, Jamison, 2007), however clinical observations of opposing mood occurrences in an individual have been noted and

 

documented since the first century. Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified all differ in the dominating mood episode and severity. Individuals with a bipolar disorder d isorder typically experience a shift in the  polarity of the episodes, especially as the illness progresses. progresses. A shift in polarity is defined as a clinical course in which a Major Depressive Episode evolves into a Manic Episode or Mixed Episode or vice versa. (DSM-IV, 2000, p.382) Hypomanic Episodes are on the same pole as Manic Episodes and Mixed Episodes.

Bipolar I Disorder is characterized by the occurrence of o f one or more Manic Episodes Ep isodes or Mixed Episodes. Most often an individual will also have the occurrence of one or more Major Depressive Episodes. Bipolar I Disorder is sub-classified according to the recurrence of episodes or if the episode is the first that the individual has experienced. The recurrence is indicated by either a shift in polarity or an interval of at least two months between episodes in which manic symptoms is not present. Recurrent Bipolar I Disorder can be specified according to the current, or most recent, episode experienced. The specifier “with Seasonal Pattern” only applies to Major Depressive Episodes that follow a pattern occurring during the same time period over at least a two t wo year observation, and without episodes occurring during the non-seasonal time period. Seasonal patterns are more commonly noticed in Bipolar II Disorder individuals Specifiers are used to indicate the current cu rrent or most recent clinical status of Bipolar II Disorder. The first specifier being either depressed or hypomanic. The remaining specifiers are similar to Bipolar I Disorder including the pattern of Rapid Cycling. C ycling. (DSM-IV, 2000, p.392-393)

 

  Cyclothymic Disorder is characterized by a chronic, fluctuating mood disturbance involving  periods of hypomanic symptoms and periods with depressive symptoms. The individual must have presented these symptoms for at least two years with no longer than a two month period  between mood disturbances. Children and adolescents need only to present these symptoms for one year to meet the criteria. The individual must not have experienced a Manic Episode, Mixed Episode, or a Major Depressive Episode during the initial two years. Cyclothymic Disorder usually begins in adolescence or early adulthood.

The hypomanic symptoms for an individual with Cyclothymic Disorder are not of the severity or duration to meet the criteria for a Hypomanic Episode. Episo de. This is also true for the depressive symptoms not meeting the criteria for a Major Depressive Episode. However, Howev er, after the initial two year period of Cyclothymic Disorder, if the individual experiences a Manic Episode the diagnosis changes to Cyclothymic and Bipolar I Disorder. If the individual experiences a Major Depressive Episode, the diagnosis, subsequently, changes to Cyclothymic C yclothymic Disorder and Bipolar II Disorder. There is a fifteen to fifty percent chance that the individual will develop either Bipolar I Disorder or Bipolar II Disorder. (DSM-IV, 2000, p.399) The exact cause of bipolar disorders is still undetermined, however, genetics seem to play a role in bipolar disorders. There is an elevated chance that an individual will be bipolar if they have a parent with bipolar. Bipolar I Disorder has the highest chance of inheritance at four to twenty-four percent in comparison to the general public, p ublic, and Bipolar II Disorder at a one to five  percent chance of inheritance in comparison to the general public. (DSM-IV, 2000, p.386).

 

Scientists are working to locate the genes that may be associated with various symptoms of  bipolar disorders. Bipolar disorder cannot be prevented but it can be controlled and managed through various methods. Mood stabilizers along with psychotherapy psychotherap y are the recommended course of treatment for individuals living with a bipolar disorder. Lithium acts as a mood stabilizer by controlling biochemical in the brain. There are other mood stabilizing drugs  prescribed if an individual does not respond to lithium. In many cases it may take a combination of drugs to manage symptoms. Psychotherapy P sychotherapy is the suggested clinical therapy for those with a  bipolar disorder. Psychotherapy can aid the individual in recognizing the triggers for the onset of an episode and can help reduce the severity of an episode. (nimh.nih.gov, 2010) Cognitive  behavioral therapy, family-focused therapy, and interpersonal and social rhythm therapy are, specifically, beneficial therapies. Children, especially, experience the onset of episodes as a result of social anxieties. Interpersonal and social rhythm therapy teaches the th e individual tools on how to improve their relationships to reduce those anxieties. (nimh.nih.gov, 2010). Environmental factors contribute to the triggering of an episode. Periods P eriods of high stress or sleep deprivation due to excessive travel or work wo rk demands can trigger episodes. These are factors that individual can anticipate and manage. mana ge. Most individuals become extremely aware of the factors that act as their triggers and learn to control the onset with time management or simply being aware of their limitations. Some individuals may find it necessary to restrict caffeine or or carbohydrates in their diet to avoid the highs and lows. (mental-health-today.com/bp)

The average age of bipolar disorder presenting is twenty years old. (DSM-IV, 2000,  p.386, 394) There are tests that can be given to present the individual with a self-reporting checklist of general mood changes, changes in cognitive ability, or behavioral changes. These

 

tests do not meet the criteria for a diagnosis. A psychiatrist ps ychiatrist reviews the test and determines the  best course of action to determine a diagnosis. Without meeting with a clinician and determining a course of treatment, the individual’s bipolar disorder diso rder will progressively worsen. Bipolar Disorders with a Rapid Cycling pattern have a poorer prognosis. (DSM-IV, 2000, p.386 p.386)) An individual experiencing so many episodes in a year’s time would have difficulty maintaining employment, friendships, or school requirements. The same is true for individuals that do not seek treatment or exhibit signs of substance abuse. (mental-health-today.com/bp). Bipolar can be extr emely emely disruptive in an individual’s life. The symptoms can cause an individual to have failed marriages, accrue great financial debt, and suffer occupational o ccupational losses due to inconsistent  performance. However, after the initial diagnosis and beginning a treatment plan an individual with bipolar disorder can live a normal life with minimal symptomatic disruptions. Psychotherapy, self-managing triggers, and drug treatments are the key ke y to living a normal life.

 

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,

Fourth Edition, Text Revision. Washington, DC, American Psychiatric P sychiatric Association, 2000.

Goodwin, F., & Jamison, K.R. (2007). Manic-Depressive Manic-Dep ressive Illness: Bipolar Disorders and

Recurrrent Depression, 2nd Edition. New York: Oxford University Press

U.S. Department of Health and Human Services, (2010). National Institute of Mental Health:

Transforming the Understanding and Treatment of Mental Illness Through Research. Bipolar

Disorder. Retrieved from http://www.nimh.nih.gov/health/publications/bipolar-disorder/ http://www.nimh.nih.gov/health/publications/bipolar-disorder/

complete-index.shtml

Patty E. Fleener M.S.W. Mental Health Today. Toda y. Bipolar Disorder. Retrieved from http://

www.mental-health-today.com/bp/art.htm