Category: Bipolar Disorder

Introduction: Profiling a Famous Person

Who is the celebrity you will be diagnosing? The celebrity I will be diagnosing is Demi Lovato. Demi Lovato was born on August 20, 1992, to Patrick Lovato and Dianna De La Garza in Albuquerque, New Mexico. Sadly, her father, Patrick, died of cancer, but she has followed in the footsteps of her mother by becoming an actress. Demi’s mother, Dianna, in addition to being an actress, is also a producer, while Demi herself is also a singer as well as an actress. Despite being diagnosed with bipolar disorder, Demi has managed to accomplish so much at such a young age and uses her platform to raise awareness of mental illness and what you can do to get help or what you can do to help others in need.

Body

Provide a description of the symptoms this individual is demonstrating

For instance, if you write, “Fred is demonstrating signs of depression, as evidenced by his feelings of worthlessness,” you must provide an example from Fred’s life history. For example, “Fred demonstrates the symptom of worthlessness, as evidenced by his constant self-degrading remarks. An example of this would be Fred’s self-description of himself as a “loser with no life purpose.”

Bipolar disorder includes a disruptive and intense experience of a manic episode. During a manic episode, the individual may experience unusually high levels of euphoria, which is the feeling state of an abnormally positive mood. “For years, people said I was depressed, and I actually didn’t know myself why I was so upset and why I would have these episodes of mania – what I now know is mania,” Demi says.

Please list the DSM V Criteria for this disorder

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy must last at least one week, and the symptoms must be present most of the day, nearly every day, or for any duration if hospitalization is necessary. During the period of mood disturbance and increased energy or activity, three or more of the following symptoms are present to a significant degree, four if the mood is only irritable, and represent a noticeable change from usual behavior: inflated self-esteem or grandiosity, decreased need for sleep, for example, the client feels rested after, say, only 3 hours of sleep, the more talkative mood than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, distractibility, for example, attention is too easily drawn to unimportant or irrelevant external stimuli, as reported or observed, increase in goal-directed activity either socially, at work or school, or sexually or psychomotor agitation, excessive engagement in activities that have high potential for painful consequences such as unrestrained buying sprees, sexual indiscretions, or foolish business investments. This episode must represent a clearly observable change in functioning but not be severe enough to require hospitalization to prevent harm to self or others.

Which criteria does your character meet? How?

Here, you will combine your answer in question 2 with DSM V diagnostic criteria. If you are unsure the individual meets a particular criteria, please write three questions you would ask to clarify. For example, if you are unsure Fred has insomnia (for the Major Depression Diagnosis), you will write: Insomnia (provisional), and the clarifying question: “I would ask Fred, how have you been sleeping.

During manic periods, Demi says she’d stay up until 5 a.m. and write seven songs in one night, showing both a decreased need for sleep and an increase in goal-directed activity. “Sometimes I felt invincible, and it was these moments when my mind would go all over the place,” she says, showing the flight of ideas and subjective experience that thoughts are racing. Not knowing what was behind her behavior led to addiction. ‘When you don’t know what’s happening, why you’re feeling certain ways, and you don’t have the answers yet, people tend to self-medicate, which is exactly what I did,’ she says. ‘Now I know that when I focus on my treatment plan with my team and my support system, I’m able to not only maintain a healthy mind, but I’m able to maintain my sobriety.’

Please research two different theories on the causes of the disorder (bio-psycho-social)

First, both genetic and environmental factors can create vulnerability to bipolar disorder. As a result, the causes vary from person to person. While the disorder can run in families, no one has definitively identified specific genes that create a risk for developing the condition. There is some evidence that advanced paternal age at conception can increase the possibility of new genetic mutations that underlie vulnerability. Imaging studies have suggested that there may be differences in the structure and function of certain brain areas, but no differences have been consistently found. Second, Life events, including various types of childhood trauma, are thought to play a role in bipolar disorder, as in other conditions. Researchers do know that once bipolar disorder occurs, life events can precipitate its recurrence. Incidents of interpersonal difficulty and abuse are most commonly associated with triggering the disorder.

Please describe the specific treatments and medications that are used for the disorder

The traditional treatment for bipolar disorder is lithium carbonate, referred to as lithium, a naturally occurring salt found in small amounts in drinking water that, when used medically, replaces sodium in the body. Clinicians advise people who have frequent manic episodes, two or more a year, to remain on lithium continuously as a preventive measure. The drawback is that even though lithium is a natural substance in the body, it can have side effects. These include mild central nervous system disturbances, gastrointestinal upsets, and more serious cardiac effects.

As a consequence, people who experience manic episodes may be reluctant or even unwilling to take lithium continuously. One of the major ways Demi maintains her mental health and sobriety is by working out for an hour to an hour and a half every day. “I actually exercise as much as possible because there’s something that it does—it just helps,” she says, explaining that she enjoys a mix of circuit training, cycling, and hiking. “I used to meditate every day, as well. I don’t do that as often anymore because I feel like exercise is kind of a form of meditation for me—what it does to me spiritually and physically.”

Please list the prevalence (i.e., age, culture, family patterns) of this disorder

Bipolar disorder has a lifetime prevalence rate of 3.9% in the U.S. population and a 12-month prevalence of 2.6%. Of those diagnosed with bipolar disorder in a given year, nearly 83% have cases classified as severe. At least half of all cases begin before a person reaches the age of 25. Approximately 60% of all individuals with bipolar disorder can live symptom-free if they receive adequate treatment. This means a large percentage continue to experience symptoms. According to one estimate, over the course of a 5-year period, people with bipolar disorder feel that their mood is normal only about half the time.

Conclusion

List some interesting facts about this disorder. (i.e., are there other famous people with the disorder?) Of all psychological disorders, bipolar disorder is the most likely to occur in people who also have problems with substance abuse. People with both bipolar and substance use disorders have an earlier onset of bipolar disorder, more frequent episodes, and a higher risk of developing anxiety and stress-related disorders, aggressive behavior, problems with the law, and risk of suicide.

References

1. Demi Lovato. (n.d.). About. Retrieved from https://www.demilovato.com/about
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3. Demi Lovato: Dancing with the Devil. (2021). [Documentary]. Directed by Michael D. Ratner. YouTube Originals.

Introduction

Due to related symptoms, mental disorders are often confused with other disorders. Educating yourself about mental disorder differences can increase your chances of distinguishing between the many disorders. “A mental disorder is a behavioral or mental pattern that causes significant personal functioning distress or impairment” (2018. April). Bipolar disorder, also known as manic-depressive disorder and Schizophrenia, is two examples of mental disorders. They are usually misdiagnosed because they have similar features.

What is Bipolar Disorder

Bipolar disorder is traditionally a mental disorder described in ‘insanity’ scenes. (2018, April). Some symptoms can include happiness, distractibility, fracturing, and gaudy. People often show great energy and move, think, and speak quickly. They rest barely anything, but they don’t seem to be sleepless. For example, they may also hallucinate or dream of things that are false or not present. They may be suspicious of people around them who they believe may hurt them. During a hyper scene, some probably hear voices or see things. The bipolar problem often involves acute burdensome scenes (2018, April). Bipolar-confused individuals experience scenes of extreme feelings. These have three main different types of scenes: Hyper scenes are seasons of increased movement and vitality.

A hyper scene can make you feel incredibly happy or sad. Hypomanic scenes are like hyper scenes but less vivid. Bipolar I is the most severe form of the condition. Bipolar I patients experience at least one manic episode with bipolar disease, and most people will also have depressive episodes or at least some depressive episodes. Episodes are defined as symptoms that affect a person for at least one week every day. The manic episodes are experienced in bipolar one but are often extreme for people with bipolar disorder. Bipolar II is usually diagnosed after at least one major depressive episode and at least one hypomania episode. The bipolar II highs are not as high as the bipolar I highs. (2018, April)

Symptoms of Bipolar disorder

Bipolar disorder may exist in several types. Mania or hypomania and depression can be included. Symptoms can cause unpredictable changes in mood and behavior, leading to severe distress and life problems. Both a manic episode and a hypomanic episode produce three or more of these symptoms: Unusually upbeat, panicky, or wired; increased activity, energy, or irritation; exaggerated sense of well-being and self-confidence; reduced need for sleep; unusual talkative, racing thoughts; Distractibility, Poor decision making (2018, April).

What is Schizophrenia?

Schizophrenia is a serious brain disorder that distorts a person’s way of thinking, acting, expressing emotions, perceiving, and relating to others. People with Schizophrenia, the most chronic and disabled of the most serious mental illnesses, have problems working in society, at work, at school, and in relationships. Schizophrenia can scare and withdraw its patient. It is a life-long disease that cannot be cured but can be treated properly. Schizophrenia is not a split or multiple personality, contrary to popular belief. Schizophrenia is a psychosis, a type of mental illness in which a person can’t tell what is real. (2017, Jan,11)

Symptoms of Schizophrenia

People with Schizophrenia may have several symptoms involving changes in functioning, thinking, perception, behavior, and personality, and they may display different kinds of behavior at different times. It is a long-term mental illness that can show its first signs in men in their late teens or early 20s, while in women, it tends to be in their early 20s and 30s. The period when symptoms first start to arise and before the onset of full psychosis is called the prodromal period. It can last days, weeks, or even years. Sometimes, it can be difficult to recognize because there is usually no specific trigger. A prodrome accompanied by what can be perceived as behavioral changes, especially in teens. This includes a change in grades, social withdrawal, trouble concentrating, temper flares, or difficulty sleeping. The most common symptoms of Schizophrenia can be grouped into several categories, including positive syamptoms, cognitive symptoms, and negative symptoms(n.d).

Bipolar and Schizophrenia compared

Blood tests for bipolar disorder or Schizophrenia are not available. Your physician will conduct a physical and mental evaluation instead. You will be simply asked about any immediate family history of mental health problems, illnesses, and symptoms during the examination. Treatment for bipolar disorder or Schizophrenia includes medication and treatment. Both for bipolar disorder and Schizophrenia, psychotherapy may include Having to learn about mood swings and how to better them by educating family members about the illness so that they can be that that that that that that supportive and help to overcome episodes that help you improve relationships with friends and colleagues who learn to manage their days to avoid possible triggers, such as lack of sleep or stress.

The schizophrenia treatment method involves antipsychotics and psychotherapy. Some of the most common antipsychotics used to treat Schizophrenia are risperidone, aripiprazole, haloperidol, paliperidone, ziprasidone, and olanzapine. A schizophrenic episode can also be experienced and never another. If you’ve only experienced one episode, you may find an organized specialty care program called Recovery After an Initial Schizophrenia Episode (RAISE) helpful. This program offers Family schooling in psychotherapy medicines and supporting work or education.

Symptoms of bipolar disorder and Schizophrenia can often be successfully managed with medication and treatment. The inclusion of a support system increases your risk of handling your symptoms successfully. Family, friends, and people at work can be included in a support system. You have an increased suicide risk if you have either bipolar disorder or Schizophrenia. If you do have suicidal thoughts, see your physician. So, they also can improve outcomes. Treatment centers can help decrease the risk of suicide. To once again reduce your risk, you could also avoid alcohol and drugs.

Conclusion

Due to similar symptoms, mental disorders are often misdiagnosed. Educating yourself about mental disorder differences can increase your chances of distinguishing between the many disorders. A mental disorder is a behavioral or mental pattern that causes significant personal functioning distress or impairment. Bipolar disorder, also known as manic-depressive disorder and Schizophrenia, is two examples of mental disorders. They are usually misdiagnosed because they have similar features.

References

1. National Institute of Mental Health. (2018, April). Mental Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/mental-disorders/index.shtml
2. National Institute of Mental Health. (2018, April). Bipolar Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
3. National Institute of Mental Health. (2017, Jan 11). Schizophrenia. Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Introduction

How many people do you know that have a mental disorder? Well, 60 million people are affected by this illness. I will be talking about the disorder, symptoms, causes/cures, and the effect it has on the person dealing with this illness.

Body

Point 1 What is bipolar disorder?

• Bipolar disorder is an illness that causes huge mood swings
• You can go from feeling hopeless and depressed to feeling like you run the world
• Mood swings can affect sleep, energy, judgment, behavior, and the ability to think clearly

Point 2- symptoms

• Bipolar I is a kind of bipolar disorder. At least one manic episode has occurred, maybe preceded or followed by significant depressive episodes. Mania can sometimes lead to a disconnection from reality (psychosis).
• Bipolar II is a kind of bipolar disorder. You’ve experienced at least one severe depressive episode and at least one depressive episode but no manic episode.

Cyclothymic disorder is a kind of cyclothymia. You’ve experienced frequent times of hypomania symptoms and periods of depressed symptoms for at least two years or one year in children and teens (though less severe than major depression).

Other kinds. Bipolar and associated illnesses, for example, might be caused by particular medications or alcohol or by a medical condition such as Cushing’s syndrome, multiple sclerosis, or stroke.

Both a manic and a hypomanic episode include three or more of these symptoms:

• Abnormally upbeat, jumpy, or wired;
• increased activity, energy, or agitation;
• exaggerated sense of well-being and self-confidence (euphoria);
• decreased need for sleep;
• unusual talkativeness, Racing thoughts, Distractibility, Poor decision-making, for example, going on buying sprees.

Point 3- Causes and cures

Causes-biological distinctions Bipolar illness patients’ brains appear to be changing physically. The importance of these alterations is currently unknown, although they may eventually aid in the identification of causes.

Genetics. People with bipolar disorder are more likely to have a first-degree family with the illness, such as a sibling or parent. Researchers are looking for genes that may have a role in the development of bipolar illness.

Cures-Treatment normally lasts a lifetime and usually consists of a mix of drugs and psychotherapy. There are some medications that can be taken as well.

Conclusion

Bipolar disorder is an illness that is not talked about that much, but many people struggle with this disease.

References

1. Bowden, C., & Singh, V. (2006). Bipolar disorders: Treatment options and patient satisfaction. Neuropsychiatric Disease and Treatment, 2(2), 149–153. https://doi.org/10.2147/nedt.2006.2.2.149
2. Carlson, P. J., Merlock, M. C., & Suppes, T. (2004). Adjunctive stimulant use in patients with bipolar disorder: Treatment of residual depression and sedation. Bipolar Disorders, 6(5), 416–420. https://doi.org/10.1111/j.1399-5618.2004.00132.x
3. Dumont, C. M., Sheridan, L. M., Besancon, E. K., Blattner, M., Lopes, F., Kassem, L., & McMahon, F. J. (2020). Validity of the Mood Disorder Questionnaire (MDQ) as a screening tool for bipolar spectrum disorders in anabaptist populations. Journal of Psychiatric Research, 123, 159–163. https://doi.org/10.1016/j.jpsychires.2020.01.011

Bipolar Disorder as Presented in Silver Linings Playbook

Bipolar Disorder is a serious mental illness that affects approximately 5.7 million adult Americans. It is so serious in fact, that on average, it results in a 9.2-year reduction in expected life span, and as many as one in five patients with bipolar disorder completes suicide (DBSA, 2009). Bipolar Disorder is complex, and patients often suffer from a broad spectrum of symptoms. Treatment for bipolar disorder often requires medication, therapy and even inpatient psychiatric hospitalization. To fully understand and treat bipolar disorder, we must consider the neurochemistry behind the illness. Psychiatric disorders have long since been a topic in movies, one example in particular is Silver Linings Playbook which portrays a man (Bradley Cooper) who was recently diagnosed with Bipolar Disorder and his struggle to get his life back on track.

The main character in Silver Linings Playbook is Pat Jr., a young man who has just been released from an inpatient psychiatric hospital where he was diagnosed with Bipolar Disorder. “Bipolar disorder is a mood disorder characterized by the presence of at least one manic episode. A manic episode is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week that includes symptoms such as inflated self-esteem, impulsive behavior, increased rate of speech, and decreased need for sleep” (Lebeau, 2013). In the beginning of the movie, Pat Jr. has a very severe manic episode in which he violently attacks his wife’s lover when he finds the pair together in the shower. This leads to his being hospitalized in a psychiatric unit for eight months. Pat is released from the hospital into the care of his parents. Not long after he is discharged, he meets Tiffany, a complicated girl with her own issues who offers to help him get back in his estranged wife’s good graces. The two develop a unique bond that ultimately ends in a romantic relationship. Pat decides not to take the medication prescribed to him that is meant to manage his bipolar symptoms. “People experiencing bipolar disorder may believe they have special powers, go without sleep, talk incessantly, act recklessly and experience racing thoughts and irritability” (Haslam, 2020). Throughout the movie, we see several examples of these behaviors in Pat. One classic scene from the movie where his bipolar tendencies are clearly noted is when rather than sleeping, he stays up to finish Ernest Hemmingway’s A Farewell to Arms. When he gets upset that there isn’t a happy ending, he throws the book through the window and storms into his parents’ bedroom where he wakes them up ranting about the ending of the novel.

“There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes” (Smith, 2020). In a manic episode people tend to experience heightened energy, creativity and euphoria. We see this throughout most of the movie with Pat Jr. His energy level is palatable. His speech is pressured, he paces constantly, he seems like he is driven by a motor. He is obsessed with trying to win his estranged wife back and fails to understand that his goal is unrealistic, as she has taken out a restraining order against him. “Hypomania is a less severe form of mania. In a hypomanic state, you’ll likely feel euphoric, energetic, and productive, but will still be able to carry on with your day-to-day life without losing touch with reality. To others, it may seem as if you’re merely in an unusually good mood” (Smith, 2020). We see this when Pat goes to the school he used to work at in order to get his old job back. He is overly cheerful and optimistic about getting his life back on track. He doesn’t seem to realize how unrealistic his expectations are given the circumstances. Pat Jr. cycles between mania and hypomania throughout most of the movie. Pat’s obsession with “silver linings,” reuniting with his estranged wife, and his tumultuous relationship with Tiffany are all examples of his hypomanic states. The movie does not show Pat in Depressive episodes quite as much. A depressive episode is not the same as regular depression. Although a depressive episode and regular depression share some similarities, certain symptoms are more prevalent in bipolar depression. For example, a bipolar depressive episode is more likely to involve irritability, guilt, mood swings and restlessness. Some symptoms are moving and speaking slowly, excessive sleeping and weight gain. People with Bipolar are also more likely to experience major problems with work and social functioning. They are also more prone to psychotic depression, a condition where you lose contact with reality (Smith, 2020). “A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide” (Smith, 2020). We see Pat exhibit signs of agitation, anxiety and racing thoughts. In another scene where Pat wakes his parents up in the middle of the night, he is frantically looking for his wedding video. He accuses his mother of hiding the video in order to protect him. Pat is yelling, swearing and tearing the house apart to find the video, and is clearly distraught. In fact, he is so escalated that he accidently hits his mother and must be restrained by his father; ultimately the police respond.

DSM-5 Criteria and Presentation

Bipolar Disorder is a mood disorder characterized by extreme highs and lows. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Bipolar disorder “is a category that includes three different conditions – bipolar I, bipolar II, and cyclothymic disorder:

• Bipolar I disorder is a manic-depressive disorder that can exist both with and without psychotic episodes
• Bipolar II disorder consists of depressive and manic episodes which alternate and are typically less severe and do not inhibit function
• Cyclothymic disorder is a cyclic disorder that causes brief episodes of hypomania and depression” (Truschel & Montero, 2019)

Pat Jr. fits the criteria for a diagnosis of Bipolar I with psychotic episodes. When Pat caught his wife with her lover, their wedding song “My Cherie Amour,” happened to be playing. Every time Pat hears this song thereafter it triggers a psychotic episode and he even becomes aggressive at times. There is a scene where Pat hears this song playing in the waiting room of his therapist’s office and it triggers him to have an emotional outburst. In another scene, he is in front of a theater and is having an argument with Tiffany. After becoming emotionally triggered he begins to hear this song playing, although it appears that he is having a psychotic break and that it is not in fact actually playing. In the very beginning of the movie, Pat explains to his therapist that not long before he assaulted his wife’s lover, he had called the police to report that his wife and the lover had been embezzling money from the local high school where she worked. Pat admits that this too was a delusion.

Brain Based Explanation of Bipolar Disorder

The exact cause of Bipolar Disorder is still not completely understood. However, doctors and scientists have discovered a lot about the disorder over the last few years by studying the brain. “The neurotransmitters that are suspected to be involved in bipolar disorder include dopamine, norepinephrine, serotonin, GABA (gamma-aminobutyrate), glutamate, and acetylcholine” (Nemade, 1995). These chemicals appear to be unbalanced in people with bipolar disorder. Studies have shown that GABA is lower in the blood and spinal fluid, whereas oxytocin is higher in those with a bipolar diagnosis. “However, the role of these findings to overall brain functioning is not yet understood. Whether the presence, absence, or change in these chemicals is a cause or outcome of bipolar disorder remains to be determined. The importance of neurochemicals in creating bipolar disease cannot be denied” (Nemade, 1995). It would make sense that dopamine levels are lower, since dopamine is responsible for regulating pleasure and emotional reward. Serotonin levels being low would contribute to disturbances in “sleep, wakefulness, eating, sexual activity, impulsivity, learning, and memory” (Bhandari, 2019) that is oftentimes associated with bipolar disorder. It is also believed that “As a biological disorder, it may lie dormant and be activated on its own, or it may be triggered by external factors such as psychological stress and social circumstances” (Bressert, 2020).

Recent studies using Computerized Axial Tomography (CAT) and Magnetic Resonance Imaging (MRI) scans showed “enlarged ventricle spaces (spaces which carry cerebrospinal fluid through and around the brain) in those with a bipolar diagnosis. Larger ventricles indicate less brain tissue is present as a whole within the brain and suggests that either deterioration has occurred, or that bipolar brains develop differently than normal brain controls” (American Addiction Centers, 2015). Researchers also noted that in the brain of people with bipolar disorder there was an abnormal amount of “small, white areas in the brain known as ‘white matter hyperintensities’. White matter is partly responsible for transmitting messages to other areas of the brain. It was noted that people with these “hyperintensities” are three times more likely to have bipolar disorder. These brain scans also showed that there was a reduction of glial cells in patients with bipolar. These cells are what insulate neurons, allowing them to communicate more efficiently (American Addiction Centers, 2015). Because of the hyperintensities and reduction of glial cells and the effects this has on communication within the brain, it is possible that it contributes to the symptoms of bipolar disorder.

Reality vs. Portrayal in the Movie

In my opinion, Silver Linings Playbook is a mostly accurate portrayal of what it is like to live with Bipolar Disorder. Although it may seem that certain aspects are exaggerated for a cinematic effect, I feel as though that is because people living with bipolar disorder are prone to such extreme behavior. Of course, it is still a major motion picture, and thus needs to captivate the audience. I believe it is for this reason that no depressive episodes were portrayed. Mania and psychotic episodes are far more captivating to watch than someone in the throes of a depressive episode. I found that all of the characters in the movie all feel very real and relatable and were well-developed. I also like that the movie shows the struggle with adhering to treatment as well as patients’ reluctance to take medication. Not all real-life cases have such an optimistic outcome, however Silver Linings Playbook shows that treatment for bipolar disorder can be effective.

As one movie critic who himself suffers from Bipolar Disorder said, “There are job losses, broken relationships, unlimited optimism, anger, and a feeling that no one understands you. But he doesn’t even understand himself. He thinks he is the only sane person around. He is in complete denial yet goes along with treatment just to get along with others. The obsession with his estranged wife drives him. Everything he does is to make himself look desirable to her. Then there is the hair trigger and the propensity toward violence which ultimately put him into the hospital. He has the belief that he sees with much more clarity than anyone else. There is also the hatred of medications and the belief that he doesn’t need them. Yet, there is hope” (IMBD, 2012).

Treatment Options

Luckily, there are very effective methods of treating Bipolar Disorder. Medication is often necessary in mitigating the symptoms of the disorder. Most often prescribed are mood stabilizers, antipsychotics, antidepressants and anxiety medications. Psychotherapy is also vital in successfully dealing with bipolar disorder. Some helpful types of therapy include Interpersonal and social rhythm therapy (IPSRT), Cognitive Behavioral Therapy (CBT), Psychoeducation, and family focused therapy (Mayoclinic, 2018). Another less common treatment method is electroconvulsive therapy (ECT). “Electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don’t get better with medications, can’t take antidepressants for health reasons such as pregnancy or are at high risk of suicide” (Mayoclinic, 2018).

Bipolar Disorder is a complex mood disorder that if left untreated can cause significant challenges in a person’s life. The extreme shifts in mood can make everyday life incredibly challenging. Because of studies done on physiological causes of Bipolar Disorder, doctors are now able to better treat the symptoms with a variety of medication as well as other treatment options. Bipolar Disorder is a fairly common diagnosis, in fact 1 out of every 100 people will be diagnosed with it at some point in their life (DBSA, 2009) therefore it is important that we have an accurate understanding of the disorder.

References

1. American Addiction Centers. (2015). Brain Imaging and Bipolar Disorder. Retrieved from https://www.mentalhelp.net/bipolar/brain-imaging/
2. Bhandari, S. (2019, March 18). Bipolar Disorder Causes & Risk Factors. Retrieved from https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-causes#1
3. Bressert, S. (2020, January 14). Causes of Bipolar Disorder. Retrieved from https://psychcentral.com/bipolar/bipolar-disorder-causes/
4. Haslam, N. (2020, March 2). Romcom’s silver lining is its portrayal of mental illness. Retrieved from http://theconversation.com/romcoms-silver-lining-is-its-portrayal-of-mental-illness-11715
5. LeBeau, R. (2013, January 26). ‘Silver Linings Playbook’ Makes a Hit Film Out of a Risky Concept: A Romantic Comedy about the Mentally Ill. Retrieved from https://www.psychologyinaction.org/psychology-in-action-1/2013/01/26/silver-linings-playbook-makes-a-hit-film-out-of-a-risky-concept-a-romantic-comedy-about-the-mentally-ill
6. Mayoclinic. (2018, January 31). Bipolar disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961
7. Nemade, R. (1995). Neurochemistry and Endocrinology in Bipolar Disorder. Retrieved from https://www.gracepointwellness.org/4-bipolar-disorder/article/11204-neurochemistry-and-endocrinology-in-bipolar-disorder
8. Silver Linings Playbook. (2012, December 29). Retrieved from https://www.imdb.com/title/tt1045658/reviews
9. Smith, M. (2020, February 17). Bipolar Disorder Signs and Symptoms. Retrieved from https://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-signs-and-symptoms.htm
10. Truschel, J., & Montero, H. A. (2019, November 29). Bipolar Definition and DSM-5 Diagnostic Criteria. Retrieved from https://www.psycom.net/bipolar-definition-dsm-5/

Introduction to Topic

Writing this bipolar disorder essay example, I will delve into the intricate ways in which positive and negative emotions, along with various personality traits, exert their influence on the daily life of an individual dealing with bipolar disorder. Another name for Bipolar Disorder is that it is a Manic-Depressive Illness. This illness is a type of brain disorder that influences many abnormal changes and or switches that affect moods, any sorts of activity levels, energy, and any power to do everyday tasks. Manic episodes are short or long periods of unrestricted euphoria, elevated self-esteem, high levels of lavish optimism, and being very skittish. There are many different stages to Bipolar Disorder that can cause for the amount that the disorder effects in a person. It can also be a leading cause to Depression. Bipolar Disorder affects roughly 2.6% (5.7 million) of the U.S population starting from the ages of 18 and going up (National Institute of Mental Health). Bipolar Disorder is life long, yet symptoms can be reduced to a minimum with medication and therapy.

Introduction to Paper

In this paper, I will answer how positive and negative emotions as well as personality traits affect a bipolar person in their day to day life, as well as seeing how they interact with others around them. This paper will bring up how having social interactions with people are healthy, how the disorder itself can result in social dysfunction.

Research of Bipolar Disorder

Owen, Gooding, Dempsey, & Jones (2016) had found evidence that led to the social aid that can help relapse rates, operation and other several clinical outcomes in many patrons that have the disorder. The way it was programmed, was that there were semi-constructed qualitative interviews that had included 20 different people that had the disorder (Owen, Gooding, Dempsey, & Jones, 2016). The questions on the survey had been designed in a certain way to evoke all the effects of any social interactions, the path of the disorder, as well as the impact that the disorder itself had caused (Owen, Gooding, Dempsey, & Jones, 2016). The results were pretty promising it had captured that any empathy and or understanding from another person made it much easier with helping cope with having the disorder (Owen, Gooding, Dempsey, & Jones, 2016). Many things can cause a break, such as losing any social support, or losing anything that has greater importance can signify a downfall (Owen, Gooding, Dempsey, & Jones, 2016).

Castanho et al. (2008) revealed a showcased set of 25 patients with bipolar disorder types that had been evaluated compared to a set of 31 healthy patrons who had been coordinated in many categories. Patients that had bipolar disorder had much lower IHS scores in all areas that reside in conversational skills such as having self-confidence and opening up to any new people and social situations (Castanho et al., (2008). The end conclusion was that this behavior was more than likely to have a obstructive impact on the amount of social functioning and on the overall quality of life (Castanho et al., (2008).

Sparding, Pålsson, Joas, Hansen, & Landén (2017) did a study on 110 patients that had bipolar disorder 1 had been interviewed, 85 with bipolar 2, and 86 regular people all had their personality assessed, by using the Swedish Universities Scales of Personality (SSP), to see what made them all different (Sparding, Pålsson, Joas, Hansen, & Landén (2017). These patients were followed for two years to see the changes that their brain went through as they got older (Sparding, Pålsson, Joas, Hansen, & Landén (2017). They assessed all the impacts of Neuroticism, Aggressiveness, and Disinhibition on the illness (Sparding, Pålsson, Joas, Hansen, & Landén (2017). These results showed how each type of disorder had impacted each person differently (Sparding, Pålsson, Joas, Hansen, & Landén (2017).

Alloy, Bender, Wagner, Whitehouse, Abramson, Hogan, Michael, Louisa, & Harmon-Jones (2009) found that Bipolar Disorder and Substance Use Disorder happen to show very big similarity and co-occurence (Alloy et al., 2009). The reason for this is because there are very great personality vulnerabilities in both disorders (Alloy et al., 2009). They had tested whether the High Behavioral Approach System (BAS) sensitivity or impulsiveness were linked to having shared personality passiveness in bipolar disorder in addition to any substance use problems and their coinciding in a study of 132 patrons on the bipolar scale and 153 controlled people (Alloy et al., 2009). The patrons with bipolar disorder had much higher and similar rates of a lifetime Substance Use Disorder problems during the follow-up visit (Alloy et al., 2009).

Johnson, Carver, & Tharp (2017) found that people who have Bipolar Disorder are more likely to commit suicide than someone who doesn’t have the disorder. One hundred and thirty-three patrons diagnosed with Bipolar I Disorder and one hundred and ten control with absolutely no mood disorder or psychotic disorder had completed a self-report on the measures of emotion negative and positive scales as well as multiple interviews concerning things such as lifetime suicidality (Johnson, Carver, & Tharp 2017). A history of suicide ideas and attempts, also including self-harm were more commonly known and seen in the bipolar disorder group as that compared to with the control group (Johnson, Carver, & Tharp 2017). These findings also extensive research on the importance of all emotion-triggered impulsivity to a bigger broad range of key outcomes within bipolar disorder itself (Johnson, Carver, & Tharp 2017).

Two Theories on Bipolar Disorder

There are two theories that match the topic of the paper are two articles. “Psychological Behaviorism Theory of Bipolar Disorder” and “Living the Life You Want Following a Diagnosis of Bipolar Disorder: A Grounded Theory Approach” both showcase how having Bipolar Disorder can change your life. The “Psychological Behaviorism Theory of Bipolar Disorder” gives a theory on how Bipolar Disorder can provide a very big integrative developmental approach that is being established on behavioral principles (Riedel, Elaine, & Kopetskie (2001). It will take everything that you already know (the base principles) and it will add to it to make it a more complex thing, that will help people with Bipolar Disorder greatly (Riedel, Elaine, & Kopetskie (2001). The other theory that comes from the article, “Living the Life You Want Following a Diagnosis of Bipolar Disorder: A Grounded Theory Approach” manifests how even though being diagnosed with being bipolar can be very severe and lifelong, there are many ways that a person can still live the life that they want without having to change anything due to the disorder (Warwick, Tai, & Mansell 2019). This study involved all the ways of recovery and stuck to them with the patients to see if constantly helping them would even help them at all (Warwick, Tai, & Mansell 2019). Many of the patients said that it did help and that they hadn’t felt depressed, or anything else (Warwick, Tai, & Mansell 2019).

Conclusion on Bipolar Disorder and How It Affects People

Overall, Bipolar Disorder can mess with many things. It affects the way that you live your life, the way that you interact with the people around you, and it affects your brain and mental health. Living with this disorder isn’t meant to be taken lightly as it can be detrimental to the human body, and the brain. People that have bipolar disorder have to live with not being able to do everything that they want to do, and being able to communicate properly with others. They also need to deal with the monsters that live inside their head, as they can’t fight the episodes of depression that they do receive.

Introduction

Bipolar disorder is a highly complex condition which is less than fully understood but believed to stem from numerous genetic, developmental, and physiologic factors (Sigitova, Fišar, Hroudová, Cikánková, & Raboch, 2017). Bipolar disorder is not a single diagnosis but an umbrella term that encompasses Bipolar I, Bipolar II, cyclothymic disorder and hypomania (Sadock, Sadock, & Ruiz, 2016). This paper will focus on bipolar I disorder. In order to meet the criteria of bipolar I disorder, a patient must demonstrate three or more of the following characteristics: inflated self-esteem or grandiosity, reduced sleep needs, more talkative than usual or pressured speech, flight of ideas or racing thoughts, easily distracted, increased goal-directed activities and excessive participation in high-risk pleasurable activities.

The mood disturbance must be significant enough to impair the person’s ability to function in activities of daily living or be considered harmful to self or others. The episode may not be attributed to any other psychiatric or medical condition (Severus & Bauer, 2013). These characteristics along with the corresponding neural pathways and structural brain changes found in bipolar disorder as well as medical and psychosocial treatment options for the disorder will be explored in this paper.

Neural Pathways in Bipolar Disorder

The three primary monoamine neurotransmitters (NTs), serotonin, dopamine and norepinephrine, are all believed to be contributors to bipolar disorder, although there are a number of others which may also play a role including brain derived neuortrophic factor (BDNF). The primary NTs are discussed here. Serotonin, believed to be responsible for sleep, energy and eating patterns, is initially synthesized by the precursor tryptophan, an amino acid, and stored in vesicles in the presynaptic neuron. Norepinephrine (NE), responsible for behavior and stress, is synthesized from the precursor amino acid tyrosine and stored the same way in vesicles in the presynaptic neuron (S. M. S. Stahl, 2013). Both NTs are released into the post-synaptic space, trigger the appropriate receptors (5-HT for serotonin and alpha-1 and beta receptors for NE). Both are also concurrently reabsorbed by synapses SERT and NET. As both serotonin and norepinephrine are believed to also be regulated by MAO-A–it breaks both SERT and NET into inactive metabolites–it is hypothesized that increased levels of MAO-A essentially take serotonin and norepinephrine out of circulation, perhaps explaining one of the malfunctions in bipolar disorder (Sigitova et al., 2017). The manifestations of this imbalance are believed to result in an inability of the brain to regulate mood, emotion, sleep, memory and executive processes but the precise mechanisms are unknown (Grande, Berk, Birmaher, & Vieta, 2016). An additional hypothesis proposes that varying levels of dopamine, crucial in emotion and pleasure, also contribute to bipolar disorder due to disruption in dopamine transporters (Sigitova et al., 2017). Dopamine is synthesized by the amino acid tyrosine via the active transport system. Within dopamine containing neurons, tyrosine is converted to dopamine. At the same time, “tyrosine hydroxylase catalyze the addition of a hydroxyl group to the meta position of tyrosine, yielding L-dopa,” (Ayano, 2016, p.2) a precursor to dopamine, norepinephrine and serotonin. Tyrosine not only acts on L-dopa but also other amino acids, including tryptophan, potentially explaining how manipulation of dopamine through medication also impacts serotonin and norepinephrine (Ayano, 2016). Dopamine suppression is implicated in depression (Ayano, 2016), and it is theorized that elevated levels of dopamine have the effect of mania (Ashok et al., 2017) potentially resulting in bipolar disorder.

In terms of structural changes, significant structural brain changes are not found consistently in bipolar disorder (Bootsman et al., 2016)⁠. However there is a theory that “neurotrophic molecules, such as brain-derived neurotrophic factor, have a vital role in signaling pathways of dendritic sprouting and neural plasticity. Dendritic spine loss has been noted in post-mortem brain tissue of patients with bipolar disorder.”(Grande et al., 2016) It is postulated that this loss potentiates the disrupted neural communication pathways but may not demonstrate physical changes on MRI.

Pharmacologic Treatment

Upon confirmation of bipolar I disorder, the first step in treatment is typically pharmacologic as bipolar disorder is typically diagnosed during a period of mania. Depending on the severity of the initial manic episode, hospitalization for stabilization may be determined to be necessary. According to Citrome, quetiapine mono-therapy or lurasidone with lithium or valproate as adjunctive are first line therapy (2014). Efficacy seems to be comparable with both. The exact method of lithium action is unknown, but it is believed to both support serotonin, norepinephrine and dopamine and one study found higher hippocampal volumes in patients with higher lithium volumes. This is believed to be neuroprotective in patients with bipolar disorder.

Quetiapine and lurasidone both: (a) block serotonin 2A receptors, resulting in enhanced dopamine release improving cognition and (b) act as a partial agonist at the 5HT1A receptor site which may help stabilize mood (S. M. Stahl, 2017). Following stabilization with medication, non-pharmacologic adjunctive therapies should be explored along with clinical follow-up with the patient every 1-2 weeks to ensure stability is indicated. Extensive education to patient, family and close friends is also indicated at this treatment point.

Non-Pharmacologic Treatment Options

In addition to pharmacologic treatment, cognitive behavioral therapy (CBT), social rhythm therapy, or lifestyle therapy should be considered. CBT has been proven effective in impacting the negative-feedback loop of self-talk as well as altering the neural pathways (amygdala and hippocampus) which reinforce and “remember” this new positive pathway. CBT would likely be of benefit in the areas of insomnia, stress reduction, anxiety and interpersonal relationships. It has proven effective in relapse prevention and should be offered to patients under medication management for BD (Shah, Grover, & Rao, 2017).

Electroconvulsive therapy (ECT) has been found to increase gray matter volume as well as hippocampal volume in the brain and is considered a third line treatment option for patients who do not tolerate or achieve good response to medication and psychotherapy alone (Dukart et al., 2014). This treatment would require a support system as the treatment requires multiple trips to the treating office and the patient is not permitted to drive home following treatment.

Finally, one might consider complementary therapies such as omega-3 fatty acids, S-adenosylmethionine (SAM-e), N-acetyl cysteine (NAC), and inositol These supplements have promising results in the treatment of bi-polar disorder with few known or documented side effects. They are active in reducing inflammation, improving catecholamine function and have a role glutathione production–all of which have been implicated in bipolar disorder (Strakowski, 2014).

Other Considerations and Follow-up Care

Patients diagnosed with bipolar disorder require multiple layers of support from both the healthcare team as well as from a social support network. Initial stabilization is essential and requires pharmacologic therapy. In the first week following any type of medication initiation, close follow-up is indicated to evaluate both side effects of medication withdrawal as well as to monitor closely any return of manic symptoms. Consideration of a patient’s insurance coverage as well as his or her ability to maintain follow-up appointments is critical when considering choice of medications as many will require ongoing monitoring of lab values (Grande et al., 2016). In the same way, socioeconomic status will impact alternative treatment options as complementary and alternative therapies such as supplements are rarely paid for by insurance. While insurance is increasingly covering ECT and TMS, there may still be significant economic burden with co-pays. Assessing a patient’s ability to monitor his or her own mood through a tool may be helpful in highlighting any early, subtle changes and is a low-cost monitoring tool. Clinic follow-up every two to three weeks though the initial transition is indicated with further spacing of visits to every three months if stable. If the patient has transportation issues, connecting by phone or video may also be an option. Medicare has, in recent years, relaxed requirements for reimbursement of tele-health services (“Telehealth Insurance Coverage,” n.d.). Annual blood work and full examination is indicated to monitor any metabolic changes as well. As the clinician considers individual or group therapy options, insurance coverage for treatment will play a role as will personal finances. Many will find the co-pays or transportation requirements prohibitive. Most communities of modest size will offer some type of reduced cost or sliding-scale group therapy option. Hospital systems are often a great resource for free or low cost support programs.

Finally, consideration of a patient’s other health conditions should also play a role in determining a care plan. A person with co-existing substance abuse disorder or chronic pain conditions, for example, would require greater support (Miller et al., 2013). Someone with profound physical disabilities will also require a higher level of home and social support as well as assistance with transportation to and from appointments. The care for a patient with the diagnosis of bipolar I disorder is ongoing and complex and will be impacted by the individual’s medical status, socioeconomic background and social support team and is expected to be a lifelong journey.

References

1. Ashok, A. H., Marques, T. R., Jauhar, S., Nour, M. M., Goodwin, G. M., Young, A. H., & Howes, O. D. (2017). The dopamine hypothesis of bipolar affective disorder: The state of the art and implications for treatment. Molecular Psychiatry, 22(5), 666–679. https://doi.org/10.1038/mp.2017.16
2. Dukart, J., Regen, F., Kherif, F., Colla, M., Bajbouj, M., Heuser, I., … Draganski, B. (2014). Electroconvulsive therapy-induced brain plasticity determines therapeutic outcome in mood disorders. Proceedings of the National Academy of Sciences, 111(3), 1156–1161. https://doi.org/ 10.1073/pnas.1321399111
3. Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561– 1572. https://doi.org/10.1016/S0140-6736(15)00241-X
4. Miller, C. J., Abraham, K. M., Bajor, L. A., Lai, Z., Kim, H. M., Nord, K. M., … Kilbourne, A. M. (2013). Quality of life among patients with bipolar disorder in primary care versus community mental health settings. Journal of Affective Disorders, 146(1), 100–105. https://doi.org/10.1016/j.jad.2012.08.045
5. Moreno-Ramos, O. A., Lattig, M. C., & González Barrios, A. F. (2013). Modeling of the hypothalamic- pituitary-adrenal axis-mediated interaction between the serotonin regulation pathway and the stress response using a Boolean approximation: A novel study of depression. Theoretical Biology and Medical Modeling, 10(1), 59. https://doi.org/10.1186/1742-4682-10-59
6. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2016). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry. (11th ed.).
7. Severus, E., & Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5. International Journal of Bipolar Disorders, 1(1), 14. https://doi.org/10.1186/2194-7511-1-14
8. Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian Journal of Psychiatry, 59(Suppl 1), S51–S66. https://doi.org/10.4103/0019- 5545.196974
9. Sigitova, E., Fišar, Z., Hroudová, J., Cikánková, T., & Raboch, J. (2017). Biological hypotheses and biomarkers of bipolar disorder. Psychiatry and Clinical Neurosciences, 71(2), 77–103. https:// doi.org/10.1111/pcn.12476
10. Stahl, S. M. (2017). Stahl’s Essential Psychopharmacology Prescriber’s Guide (6th ed.). San Diego, California: Cambridge University Press.
11. Stahl, S. M. S. (2013). Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Application (4th ed.). Cambridge University Press.
12. Strakowski, S. (2014). Bipolar Disorder: Bipolar Disorder. Retrieved from http://ebookcentral.proquest.com/lib/unh/detail.action?docID=1712401
13. Telehealth Insurance Coverage. (n.d.). Retrieved September 19, 2019, from https://www.medicare.gov/coverage/telehealth

Introduction

In any given year, one in five people in Canada will experience a mental health problem or illness, and about one percent of Canadians will experience Bipolar Disorder. (Mental Health Commission of Canada, 2013) Bipolar 1 Disorder formerly known as “manic depressive” disorder is characterized by one manic episode, which is usually followed by a major depressive episode but not always. “A person experiencing a manic episode often has feelings of self importance, elation, talkativeness, coupled with the characteristics of irritability, impulsiveness, and a decreased need for sleep”. (Raber, 2012) Sometimes a person may experience both manic and depressive episodes at the same time, those are called mixed episodes. Someone experiencing a mixed episode may feel extremely energized while at the same time feeling sad, agitated, they may have changes in appetite as well as reoccurring suicidal thoughts. This paper will explore Bipolar 1 Disorder such as manic episodes, depressive episodes, mixed episodes, along with the recommended treatment.

Bipolar 1 Disorder

Bipolar 1 Disorder once known as “manic depressive disorder” is a mental disorder and a “bio-chemical condition that results in an imbalance of neurotransmitters in the brain.” (Government of Canada, 2009) People who suffer from Bipolar 1 disorder have periods of significant elevated moods which is known as manic episodes, and periods of “sad or hopeless” moods known as depressive episodes. “Sometimes a mood episode includes symptoms of both mania and depression, this is called a mixed episode.” (Bipolar Disorder, 2016) Psychotherapy and medications such as mood stabilizers and antipsychotics are most commonly used for treatment. To treat bipolar, some psychotherapy treatments may be used such as Cognitive Behavioural Therapy (CBT), family-focused therapy, or interpersonal and social rhythm therapy. (Bipolar Disorder, 2016)

Manic Episodes

A person who suffers from Bipolar 1 Disorder can have periods of elevated moods, known as mania. Mania can bring on an intense feeling of energy and the person may feel “wired” or “jumpy”. Someone experiencing mania may have an “exaggerated sense of well-being and self confidence”. (Bipolar Disorder, n.d.) Some criteria for manic episodes according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text Revision) (DSM-IV-TR) would be “inflated self-esteem or grandiosity, a decrease need for sleep, they may be more talkative then usual, their thoughts could be racing and they can seem very distracted, they may also have an increased involvement of goal-directed activity, and excessive involvement in pleasurable activities that have a high potential for painful consequences.” (Reiser & Thompson, 2005)

Bipolar symptoms in children and adolescents are different then those experienced by an adult. Within this age group manic episodes, may show more psychotic symptoms which can sometimes lead to being misdiagnosed with schizophrenia. Also, dysphoric mania is common in adolescents and is characterized by irritability and anger instead of elation. (Basile & Cataldo, 2012) Certain people with Bipolar Disorder experience a less severe type of mania called hypomania. During a hypomanic episode a person may feel good, be very productive, and seem to be functioning well. “But friends and family may recognize the mood swings as possible signs of bipolar disorder.” (Bipolar Disorder, 2012) Hypomania can develop into severe mania or depression if not properly treated. (Bipolar Disorder, 2012)

Treatment

There are many different treatment options for someone who is experiencing a manic episode, certain medications may work while others may not. “Lithium plus an atypical antipsychotic lorazepam (Ativan) is indicated. For cases presenting with nonresponse to lithium, dysphoric mania, or rapid cycling, valproate is recommended.” (Reiser & Thompson, 2005) “Lithium was the first mood stabilizer approved by the U.S Food and Drug administration (FDA) for the treatment of mania and the prevention of both manic and depressive episodes”. (Raber, 2012) Lithium should not be used for mixed episodes, as well it can take up to ten days to start working within the bloodstream, so it is often paired with “neuroleptics and/or benzodiazepines” for a more immediate relief of manic episode. (Raber, 2012)

Depressive Episodes

Some criteria for a diagnosis of a major depressive episode according to the DSM-IV-TR would be a “depressed mood, markedly diminished interest or pleasure in all, or almost all activities, weight loss when not dieting, insomnia or hypersomnia, fatigue or loss of energy, feelings of worthless or excessive inappropriate guilt, diminished ability to think or concentrate and reoccurring thoughts of death.” (Reiser & Thompson, 2005) Manic and depressive episodes may last from days to months, and “run the spectrum from mild to severe.” (Basile & Davidson, 2015) A Bipolar depressive episode may be harder to distinguish from a major depressive episode. People who experience bipolar depression tend to have very low energy, their mental and physical processes may slow down, and have more profound fatigue. “An example would be hypersomnia, a sleep disorder marked by a need for excessive sleep, or sleepiness when awake.” (Basile & Davidson, 2015)

“Suicide is a major complication with Bipolar Disorder and is a result of the duration of the depressive episode. The longer the depressive episode lasts, the higher chance of suicidal tendencies to appear. Alcoholics and patience with other chronic medical diseases are particularly prone to planning and implementing a suicide attempt.” (Basile & Odle, 2016) Research has shown that there are four groups that are most likely to plan and carry out a suicide attempt and those are, individuals who are overwhelmed by life problems. In this group suicide is related to aggression and impulsive behaviours and not major depressive episodes. Individuals that attempt to control others. Individuals that are very ill with other medical health issues. And individuals with other types of psychotic illness, paranoia, and delusions. (Basile & Odle, 2016)

Treatment

“Antidepressants are sometimes used to treat symptoms of depression in Bipolar Disorder.” (Bipolar disorder, 2016) Some antidepressants that may be used to treat depression in Bipolar are: Fluoxetine sometimes known as Prozac, Paroxetine also known as Paxil, Sertraline or Zoloft and Bupropion or sometimes known as Wellbutrin. Doctors recommend taking mood stabilizers along with antidepressants to prevent switching to mania or develop rapid cycling. There are also side effects from taking antidepressants and side effects may include headache, nausea, agitation as well, antidepressants may cause sexual health problems in both men and women. (Bipolar, 2016)

Mixed Episodes

“During a mixed state you may feel very agitated, have trouble sleeping, experience major changes in appetite, and have suicidal thoughts. People in a mixed state may feel very sad or hopeless while at the same time feeling very energized”. (Bipolar Disorder, 2016) Valproate is one of the few drugs available that has proven to treat rapid cycling bipolar and mixed episodes. It is prescribed by its self or with carbamazepine and or lithium. The combination of depression, energy, and agitation makes someone experiencing a mixed episode at a higher risk for suicide. (Canadian Mental Health Association, 2013)

Rapid Cycling

“Rapid cycling occurs in up to twenty percent of bipolar individuals. In rapid cycling, at least four manic and depressive mood swings must occur within twelve months. In some cases of ultra-rapid cycling, the individual may bounce manic and depressive states several times within twenty-four-hour period.” (Basile & Cataldo, 2012) Rapid cycling is very severe as it can impair your ability to function as well as lower your quality of life. “Rapid cycling seems to be more common in people who have their first bipolar episode at a younger age.” More women are affected by Rapid Cycling then men. (Bipolar Disorder, 2012)

Psychotic Symptoms and Psychosis

Major episodes of depression or mania can also include symptoms of psychosis. “Psychotic symptoms include visual or auditory hallucinations and delusions. Psychotic symptoms in bipolar tend to reflect the current extreme mood episode.” (Basile & Davidson, 2015) When a person is experiencing a manic episode, some psychotic symptoms may include grandiosity, the belief of having special powers or extreme wealth or power. During a depressive episode, psychotic symptoms may include paranoia, fears of being poisoned or attacked, or belief that one has committed a crime. Because of these symptoms sometimes bipolar is misdiagnosed as schizophrenia. (Basile & Davidson, 2015)

“Psychosis is defined as the loss of contact with reality, during which time a person can not tell the difference between what is real and what is imagined.” (Purse, 2019) “During a period of psychosis, a person’s thoughts and perceptions are disturbed. Other symptoms include incoherent or nonsense speech, and behaviour that is inappropriate for the situation.” (Psychotic Disorders, 2016) Psychosis is usually accompanied by severe mania but can also come with depression, and include symptoms of delusions, and hallucinations. (Purse, 2019) During a psychotic episode, atypical antipsychotics may be used to treat psychotic symptoms and acute mania and contribute in stabilizing the mood. (Basile & Cataldo, 2012)

Psychotherapy

“When done in combination with medication, psychotherapy can be an effective treatment for bipolar disorder”. (Bipolar, 2016) Psychotherapy provides education, support as well as guidance to people suffering with the disorder. Some psychotherapy treatments would include Cognitive Behavioural Therapy (CBT), which can help individuals learn how to change harmful or negative behaviour and thought patterns. Family focused therapy which involves family members, it helps improve communication with family members, it also helps families learn coping strategies such as “recognizing new episodes early” (Bipolar, 2016) so they can help. Interpersonal and social rhythm therapy which helps individuals improve their personal relationships along with “managing their daily routines”.

Following a regular daily schedule, and a good sleep schedule, can help prevent manic episodes. Psychoeducation teaches people about their illness and treatment. It can help individuals recognize signs that an episode is coming on early and get treatment “before a full-blown episode occurs”. (Bipolar, 2016) Sometimes medication and psychotherapy may not work, when that happens Electroconvulsive Therapy (ECT) may be used. ECT formerly known as “shock therapy” had a bad reputation at one time but has improved in recent years. Electroconvulsive therapy can provide relief for a person with Bipolar disorder who has tried other medications that have not worked. ECT is a highly effective treatment for major depressive, manic and mixed episodes, but it “not used as a first-line treatment”. (Bipolar, 2016)

Causes

The source of Bipolar Disorder has not yet been identified clearly, but research shows genetic and environmental factors seem to be involved when it comes to triggering episodes. “Bipolar tends to run in families, some research has suggested that people with certain genes are more likely to develop Bipolar disorder than others.” (Bipolar Disorder, 2012) Children who has a parent with Bipolar Disorder is at a greater risk for developing the disease. Many studies show “possible genetic connections to the predisposition of bipolar disorder.” (Basile & Cataldo, 2012) A study done in Sweden that was reported in 2009, showed that bipolar disorder and schizophrenia seem to “share similar genetic causes.” (Basile & Cataldo, 2012)

Substance abuse is common in people with Bipolar Disorder, but it is still unknown to why. “It seems people with bipolar disorder may try to treat their symptoms with drugs and alcohol. However, substance abuse may trigger or prolong bipolar symptoms, and problems with controlling behavior associated with mania can lead to a person drinking to much.” (Bipolar Disorder, 2012)

Sometimes manic and depressive episodes coincide with seasonal changes for people with bipolar. During winter and fall, depressive episodes are more common and during the summer and spring months manic episodes seem to be more probable. “These individuals might be diagnosed with seasonal affective disorder (SAD).” (FordMartin & Davidson, 2014)

Conclusion

This paper explored the symptoms of Bipolar 1 Disorder such as mania, depression, and mixed episodes. It also looked at the causes of Bipolar Disorder, psychotic symptoms, and treatments such as medications and psychotherapy. Manic episodes include feeling of euphoria and high energy, the person may act very erratically and talk very fast. Depressive episodes include feeling of sad and hopelessness, the person may have feelings of guilt and may feel worthless. They may be very tired and have reoccurring thoughts of death. And a mixed episode is when someone experiences symptoms of both mania and depression at the same time. They may feel sad and hopeless at the same time feeling very energized. Someone with Bipolar Disorder may also have psychotic symptoms where they loose touch with reality. Because of these complex symptoms, Bipolar Disorder can sometimes be misdiagnosed as schizophrenia. There is no cure for Bipolar Disorder, but it can be effectively treated overtime. When Bipolar Disorder is properly treated, people can gain back control of their lives, and live a much healthier life.

Introduction

From the summit to the abyss. From the trance of passion and madness to the abyss of depression. From recklessness and impulsivity to indifference. These are the extreme cases attributed to bipolar disorder (or: Bipolar disorder, formerly called Manic Depressive Psychosis), a psychiatric disease characterized by an imbalanced mood. The Journal., Bipolar disorder is also known as ‘bipolar disorder’ when extreme manic behavior is one side of the disorder, while severe depression forms the other. Extreme mood changes in manic-depressive illness can last for weeks or even a few months, causing disruptions in the management of normal life in people who suffer from it, also affecting the family and the circle of close friends. Recent research into the subject suggests that bipolar disorder carries many symptoms, which is why many people with the disorder are undiagnosed. In general, manic-depressive disorder worsens if not treated. The proportion of people who commit suicide due to bipolar disorder is high. However, with proper and effective treatment, life can be managed normally, enjoyable and productive, despite the presence of bipolar disorder. Symptoms of bipolar disorder are generally characterized by a change in behavioral patterns when you feel the peak of mania (or mania) or when you feel that you have reached the perihelion (depression). Initial signs and symptoms can range from very mild to very severe and very serious. There may also be periods of life during which there is no effect of this disorder.

Signs and symptoms

Signs and symptoms that may appear at perihelion (depression) in bipolar disorder can include: Sorrow, Despair and lack of hope, Suicidal thoughts or suicidal behavior, feeling guilty, Sleep disorders, Appetite disorder, Exhaustion, Lack of attention to daily events, Problems in focus, Anxiety and nervousness and, Chronic pain without visible cause.

Causes of bipolar

• Genetic factors. Family history of the disease increase the probability of occurrence.
• Biological traits
• Brain-chemical imbalances. The difference in the level of neurotransmitter may lead to bipolar disorder such as serotonin, norepinephrine and serotonin.

Symptoms of mani appear in high level of norepinephrine, but depression occurs in low level of it .

• Hormonal problems
• Change in the level of hormone
• Environmental factors
• Emotional stress.

Types of bipolar disorder

Bipolar disorder (bipolar disorder / two-way disorder) can be divided into two main types: Type I bipolar disorder: If the patient has in the past, for at least one period, experienced mania, whether or not it includes a previous period of depression. Also, Type II bipolar disorder: If the patient has suffered in the past, for at least one period, from depression and for at least one period of mild mania (Hypomania). In a symptom, a manic episode is similar to a typical manic episode, but its symptoms are more moderate, lasting only a few days, and not as dangerous. Moreover, In a manic-depressive episode, the patient may feel exhilarating, with certain anxiety and changes in his or her daily functioning, but in general, he or she can continue to live normally, without having to lie in the hospital. In type II manic depression, depression periods are significantly longer than in mild mania. In addition, Cyclothymia: Cyclothymia is a mild type of bipolar disorder. Circulatory disorder involves mood swings and swings at a great pace and speed, but peak and perigee moments are not as serious as bipolar disorder at its peak.

Treatment

Drug therapy

• Lithium carbonate is the most used drug to treat long-term episodes of depression and mania or hypomania. The duration of treatment is about 6 months.
• Anticonvulsants drugs are used to treat mania episodes.
• Antipsychotics drugs are used in sever condition such as Aripiprazole, olanzapine and risperidone.
• Psychological treatment
• Psychotherapy helps in reduce the symptoms.
• Cognitive behavioral therapy (CBT), family has a role in reducing the relapse.

Prevention

there is no method to prevent the disease but early diagnosis is important and good management with suitable drugs that help to decrease the symptoms and the episode

Conclusion

To sum up, some people with bipolar disorder remain at risk of recurrent and frequent bipolar disorder. This definition applies to at least four mood swings within twelve months. These mood swings occur quickly, sometimes by a few hours. When talking about a mixed situation of bipolar disorder, the symptoms of both mania and depression appear simultaneously, in parallel and in parallel. Very severe depressive episodes can lead, in particular, to general psychosis (psychosis) or even absolute separation from reality. Symptoms of absolute bipolar disorder may include hearing sounds or seeing things that do not exist (hallucination) and a strong and true belief in things that are not true (illusions – deception, visual or sensory – Illusion )

“The great hope of society is in individual character “ (Channing) According to the dictionary, “Individualism” is a social theory that advocates the liberty, rights, or independence of an action of an a specific person.(Dictionary) Individualism is being your own person and making your own choices that set you apart from the world. I did research on the individuality of a specific mental illness. I was curious how much of the world is made up of people who suffer from bipolar disorder, since it is something that affects me directly, and how much it affects our roles in society. I predict that it effects every aspect of our lives and that it may be hereditary or caused by trauma. I predict that it is more common to have mental illnesses than I realize.

One of the studies that I found stated that people who suffer from early childhood trauma are more prone to grow up with some form of psychiatric disorder. (Hatva, 2010) Trauma can cause bipolar symptoms to flair. Bipolar disorder is distinguished by crippling occurrences of hopelessness and higher elevated moods (mania or hypomania). For most sick people, depressive signs and symptoms are more widespread than the elevation of moods or jumbled symptoms, and therefore have been announced in a person of a specific kind research to force or inflict a much larger heavy load on affected specific people, caregivers, and society.(Miller et al. 2014)

Through research, I have found out that Bipolar disorder affects around 5.7 million adult Americans, or approximately 2.6% of the United States citizens 18 years of age and up on a yearly basis. (National Institute of Mental Health) The illness can begin as early as childhood or as late as your 40’s, though it typically has a median of age 25. Bipolar disorder can be found in people of all age, race, and nationality. (5)

According to the National Institute of Mental health, “Bipolar disorder is the sixth leading disability in the world.” That number was much higher than I had originally anticipated. Children whose parents are affected by bipolar disorder are more likely to have it themselves. Though it is hereditary, that is not the sole way that it can happen. Bipolar disorder can be hard to live with due to the erratic emotions flowing through. It can be hard for someone with bipolar disorder to maintain a job and function in society in the same way that someone without the disease can. Around one in five people with bipolar disorder commits suicide. (5) According to my phycologist, bipolar disorder can be hard to diagnose.

Though bipolar is treatable, there is no cure. Bipolar disorder is made up of Mania or hypomania and depression. There are two types of bipolar disorder. Bipolar disorder type 1 consists of Mania, whereas type two experiences hypo-mania. Signs of mania can include promiscuity, extreme highs, addiction, increase in energy levels, money spending issues, and much more. Signs of depression include fatigue, sadness, emptiness, anxiety, suicidal thoughts and more.(6)

From what I have found, my analysis was correct. Bipolar disorder can be hard in society. More people commit suicide that have the disorder than I had realized. I feel that with treatment and possible medication, people who suffer from bipolar disorder can lead a somewhat normal life. I fear that the depressive part of bipolar disorder is just as dangerous as the manic side of bipolar.

I was diagnosed with bipolar disorder when I was in the fifth grade. I was put on a mood stabilizer in order to help control the mood swings which has helped me tremendously. Most people do not know that I have bipolar disorder unless I tell them so. Growing up with bipolar disorder, I had to understand that my emotions are simply higher than the average person’s. It was really rough to try to learn to separate my feelings from casual discussions.

Having bipolar disorder not only effects those who have bipolar disorder, but it also directly effects those who love an individual that has bipolar disorder. It effects my family because they have to witness the struggles with the disability to concentrate on simple tasks. They also have to witness the pain that I go through when I lose someone I love, since my emotions have a higher scale than the average person. Though there is a lot that makes having bipolar disorder challenging, it is not all bad. Having bipolar disorder also makes the good emotions that much stronger. I am able to love deeper than the average person due to the hypo-mania that I experience. Hypo-mania is like being in a room filled with cute little puppies while eating an ice cream cone with chocolate sprinkles.

References

1. William Ellery Channing from: https://www.brainyquote.com/quotes/william_ellery_channing_378661
2. www.Dictionary.com/browse/individualism
3. Hatva, E. (2010, February 1). Childhood Trauma and Depression. Retrieved February 18, 2019, from https://www.psychologicalscience.org/observer/childhood-trauma-and-depression
4. Miller, S., Dell’Osso, B., & Ketter, T. (2014, December). The prevalence and burden of Bipolar Depression. Retrieved from https://doi-org.libproxy.lamar.edu/10.1016/S0165-0327(14)70003-5
5. Bipolar Disorder Statistics – Depression and Bipolar Support Alliance. (n.d.). from https://secure2.convio.net/dabsa/site/SPageServer/?pagename=education_statistics_bipolar_disorder
6. Mental Health America from: http://www.mentalhealthamerica.net/conditions/bipolar-disorder

According to the DSM-5 book to get a diagnosis of bipolar I disorder individuals must have all of the diagnostic features.. The onset age is said to be 18 years old when diagnosing bipolar I disorder. Individuals that re separated, divorced or widowed individuals also have a higher rate of bipolar disorder. Family history is also one of the strongest and consistent risk factors. Individuals with adult relatives that have bipolar disorder have a higher increase as well. (American Psychiatric Association. 2013) Treatment options include medications, day treatment programs and hospitalization if individuals are feeling suicidal.

“A developmental approach to dimensional expression of psychopathology in childhood and adolescent offspring of parents with bipolar disorder” is an article that examines the functioning and symptoms of the development of bipolar disorder in child and adolescent offspring of parents with bipolar disorder. This was considered the first study to explore psychopathology, functionality and symptom dimensions. The study consisted of 90 offspring from 54 families with at one parent with bipolar disorder. In order for the parents to participate in the study they had to meet the criteria for bipolar I disorder. All of the diagnostic assessments given were performed by child and adolescent psychiatrists. (Moron-Nozaleda, Diaz-Caneja, Rodriguez-Toscano, Arango, Castro-Fornieles & Moreno, 2017) The Children’s Global Assessment scale was used to assess the psychosocial functioning. The Premorbid Adjustment Scale was used in the study to assess social and scholastic ability during childhood and adolescence.

In the findings of this study, they found that there was a higher prevalence in anxiety and disruptive behavior disorders. Rates were also higher in depression and bipolar disorder. There were some psychosocial risk factors listed throughout the study, some included effects on the development of psychopathology in genetically at risk youth. With given effects, there can be an impact of family dysfunction, social risk, and trauma. Many limitations were listed throughout the study as well, the symptom dimensions weren’t able to be tracked of a cross-sectional assessment was used. Another limitation of this study included was how the participants were recruited, they weren’t all recruited in the same wat so the section could have been bias. One of the last limitations included in this study was the size of the samples, they could have limited the ability to get the significant differences in the developmental elements. Early subsyndromal psychopathology may design prevention and early intervention programs for the high risk population. (Moron-Nozaleda, Diaz-Caneja, Rodriguez-Toscano, Arango, Castro-Fornieles & Moreno, 2017)

According to Zimmerman. (2019), research has shown that bipolar disorder and borderline personality disorder are both serious public health issues. Both disorders experience some of the same similarities which include impaired functioning, high rate of psychiatric services and substance abuse disorders and suicidality. Research shows that bipolar disorder and borderline personality can be easy to get confused when diagnosing which can lead to an overlap in diagnostic frequency. Researchers reported that individuals with bipolar disorder with borderline personality disorder had more mood episodes an earlier onset of bipolar disorder and a higher rate of suicidality. Researchers also found individuals to have a higher prevalence in substance abuse as well. The methods to improve diagnostic assessment and services project (MIDAS) project was done by Zimmerman where he was examining clinical experiences with individuals with bipolar and borderline personality disorder because both disorders had a higher risk for suicide and marked impairment. (Zimmerman, 2019).

He compared the family history and clinical characteristics of groups of individuals. The MIDAS showed some risk factors, which including that borderpolar individuals had the most psychopathology in their first-degree relatives. Borderpolar has a higher risk of episodes of depression, and more anger than bipolar disorder. (Zimmerman 2019) The results of the MIDAS project report that individuals with both bipolar disorder and borderline personality disorder are more ill than individuals with just one of the disorders. Zimmerman states that throughout the past decade there has been an effort to improve the acknowledgment of bipolar disorder. There has been a lot of different screening assessments and scales that have been developed for screening bipolar disorder. In the study it was reported that no research has explored the potential treatments for patients with both diagnoses. Individuals with both of these diagnoses represent groups of individuals experiencing severe psychosocial morbidity suicidal and mostly likely unemployed. Zimmerman has suggested that there should be more efforts when identifying better effective ways when treating individuals with these diagnoses. (Zimmerman 2019)

In the article “Weight changes associated with antiepileptic mood stabilizers in the treatment of bipolar disorder” examines the management of body weight changes during the use of stabilizers in bipolar disorder. The researchers have performed a systematic literature search of Embase, which they only collected information regarding prevention, treatment and monitoring of weight changes in nonlithium stabilizers. (Grootens, Hartong, Doornhos, Bakker, Hadjuthy & Ruhe 2018) Four psychiatrists, a pharmacist, a physician assitant and two others, they were all working with individuals with bipolar disorder of all ages. Some mood stabilizers showed an association with weight gain and some showed low risk of weight gain. In the study, researchers suggested to have a more “proactive” approach when finding the choice of mood stabilizers in the treatment of bipolar disorder. They also suggest that weight monitoring should be considered earlier. (Grootens, Hartong, Doornhos, Bakker, Hadjuthy & Ruhe 2018)

There were also some limitations throughout the study, one included the systematic research on weight monitoring straegies were not present. The evidence shown in the study for strategies to prevent weight change was very limited as well. Weight gain can have a major impact on individual’s lives so it is vital to find better effective ways to help individuals keep their weight under control. Throughout all of these studies each had different purposes. Each study has shown how bipolar disorder effects individuals daily whether it be physically or psychologically. (Grootens, Hartong, Doornhos, Bakker, Hadjuthy & Ruhe 2018)

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA
2. Grootens, K. P., Meijer, A., Hartong, E. G., Doornbos, B., Bakker, P. R., Al Hadithy, A., Ruhe, H. G. (2018). Weight changes associated with antiepileptic mood stabilizers in the treatment of bipolar disorder. European Journal of Clinical Pharmacology, 74(11), 1485–1489.
3. Morón-Nozaleda, M., Díaz-Caneja, C., Rodríguez-Toscano, E., Arango, C., Castro-Fornieles, J., de la Serna, E., … Moreno, D. (2017). A developmental approach to dimensional expression of psychopathology in child and adolescent offspring of parents with bipolar disorder. European Child & Adolescent Psychiatry, 26(10), 1165–1175.
4. Zimmerman, M. (2019). Borderpolar: Patients with Borderline Personality Disorder and Bipolar Disorder. Psychiatric Times, 36(12), 17–18.