Bipolar disorder, also called manic-depressive disorder refers to psychiatric condition that entails varied mood swings whereby an individual experiences episodes of intense mood swings.
These mood swings are different from the normal mood swings because they are so intense such that they interfere with normal body functioning ((Maj, Akiskal and López-Ibor, 2002, p. 6). The episodes involved here range from extreme levels of mania to the extreme lows of depression. As a result, there is a budge in energy, behavior, and thinking affecting an individual negatively.
Causes
Until now, there has not been any established cause of bipolar disorder. However, researches indicate that this disorder may result from imbalances in neurotransmitters, brain chemicals that if not balanced throws mood-regulating mechanisms off balance leading to mood swings.
There have been speculations that this condition maybe genetically inherited which acts as a predisposing factor. Generally, these causes are believed to be of genetic, biochemical and environmental nature (Maj, Akiskal and López-Ibor, 2002, p. 520). There is a strong link between bipolar disorder and depression. Substance abuse may also lead to this condition.
Signs and Symptoms
Signs and symptoms of this disorder vary in different situations in terms of frequency, severity, and pattern. This disorder occurs in four phases each with characteristic signs. The four phases, which also qualify as types are; mania, hypomania, depression and mixed episodes ((Maj, Akiskal and López-Ibor, 2002, p. 522).
During the mania phase, individuals have increased energy levels accompanied by euphoria and creativity. Individuals experiencing this phase are hyperactive, extroverted and they rarely sleep. They dream big and think that they are invincible. However, despite these feelings of greatness, this phase gets out of control easily. Individuals may become unrealistic, unable to concentrate and this often leads to delusions and hallucinations.
Hypomania, which is a less form of mania as the name suggests, does not get to the extremes of mania. Though individuals experience similar symptoms as those of mania, they do not lose touch with reality and they are almost normal. This is the transition stage between mania and depression and it can progress either way.
The depression phase is marked by hopelessness, sadness, tiredness, irritation coupled with mental and physical lethargy. Additionally, individuals may experience insomnia, loss of appetite. Combination of these conditions leads to feelings of hopelessness and at times is suicidal.
The mixed episode phase entails a mixture of depression, mania, and hypomania feelings. This mixture is the greatest predisposing factor of suicide amongst bipolar mania victims.
Diagnosis and Assessment
Diagnosis includes a doctor taking medical history of the patient including existence of the same in the family history. There is also physical examination to rule out other conditions like AIDS, epilepsy, multiple sclerosis and diabetes among others. These conditions produce symptoms similar to those of bipolar disorder.
In absence of any other disease, an individual can be diagnosed with bipolar disorder. However, given the complexity of the condition, it may be very difficult to diagnose an individual with bipolar disorder and it may take well over 10 years before doing a complete diagnosis (Cassano, Dell’Osso and Frank, 1999, p. 320). Getting early diagnosis reduces the aforementioned risk of suicide among others like divorce and truancy.
Control
While there are no known clear-cut prevention methods, susceptible individuals can be trained to notice early signs of mood swing episodes. After detecting any early sign, it is advisable to seek medical advice to prevent escalation of the condition leading to either mania or depression.
Individuals should continue taking medicines to full dosage even after their moods have stabilized to prevent unnecessary recurrence. Victims should not expect treatment to fix all their problems; contrary, they should live healthy lifestyles that support sanity of mind and well-being. Avoid antidepressants for they have been known to lead to depression and mania.
Treatment
Bipolar disorder treatment is highly recommended. Research indicates that treating primary episodes, which prevents progression to mania or depression, is one of the greatest goals an individual can achieve. Treatment involves administration of lithium and lamictal to stabilize mood (Cassano, Dell’Osso and Frank, 1999, p. 321).
Additionally, psychotherapy comes in handy in overcoming stress, depression, mania and mixed episodes. Counseling helps largely especially when individuals have lost touch with reality and is over ambitious. Currently researchers are working on acupuncture to introduce it as an alternative treatment of bipolar condition.
Conclusion
Bipolar disorder is a psychiatric disorder that entails varied episodes of mood swings. There are four main phases of this condition and they include; mania, hypomania, depression, and mixed episode phase. Mania is the extreme whereby one is excited while depression is the other extreme whereby one slumps into apathy and may lead to suicide. Hypomania is the transition point between mania and depression while mixed episode phase entails conditions of all other phases.
The most important thing that an individual can do is to live lifestyles that support sound mindfulness. Bipolar disorder is a condition of the brain and as long as an individual can practice sanity and remain in touch with reality then the challenge of this disorder becomes surmountable.
Reference List
Cassano, B., Dell’Osso, L., & Frank, E. (1999). The Bipolar Spectrum: A Clinical Reality In Search Of Diagnostic Criteria and an Assessment Methodology. Journal Of Affective Disorders 54(6): 319-328.
Maj, M., Akiskal, H., & López-Ibor, J. (2002). Bipolar Disorder. West Sussex: John and Wiley Sons. Web.
Bipolar disorder and schizophrenia are psychiatric disorders that affect youths especially in the adolescent stage. Although the two disorders have different classification, they have similar causative agents, signs and symptoms, which can lead to misdiagnosis. However, a severe schizophrenia disorder may be similar to bipolar disorder especially when the victims experience mental disturbances.
Bipolar disorder
This psychiatry disorder alters the patient’s perception of normal occurrences hence increasing their temperamental levels. The cause is either through familial characteristics (genetic), psychological or environmental issues. Genetically, an alteration in the serotonin, dopamine and glutamate genes may be the cause of the disease.
However, due to inveterate inconsistent in clinical research on the condition, the real genes that affect the motor neurons in the brain are yet to be established.
Alternatively, an individual with peculiar genes may be susceptible to the disorder (Serretti and Mandelli 743). The peculiar genes occur due to mutations especially in children born to old parents. Psychologically, “an alteration and dysfunction in the brain regions like globus pallidus, prefrontal cortex and the hypothalamus in the pituitary axis elevates stress” (Koehler 5).
The organelle mitochondrion is the cause of high-energy production leading to stress. Additionally, psychic trauma incurred during childhood eventually lead to stress. Awful ordeals like rape, fights amongst parents and frequent corporal punishment may lead to bipolar disorder especially in adulthood. Therefore, the close interactions of genetic, psychological and environmental factors lead to severe cases of bipolar disorder.
Symptoms
A series of mood changes accompanies bipolar disorder hence altering the normal behavior of an individual. Often, one sign leads to the other; for instance, depression may lead to mania then hypomania and finally a combination of the first signs. The depression stage manifests itself through insomnia, anger, loneliness coupled with unhappiness and eventually a feeling of guilty. Hallucinatory episodes and painful feeling may lead to temptation of committing suicide.
Due to dysfunction of the mitochondria, high energy levels lead to mania. Similarly, insomnia is frequent. Victims decide to abuse drugs and become alcoholic as a way to curb the disorder hence reduces the depression levels. Hypomania is not severe in that the patient appears normal and may deny being in depression.
Psychiatrists are usually unable to diagnose a patient at this stage. However, individuals have a decrease in memory levels hence poor recalling abilities. Surprisingly, this stage can be unnoticed, which makes the victim to have severe disorder.
A combination of the mania and depression can lead to severe cases of insomnia, drug abuse, alcoholism and eventually death due to suicide. Although psychiatrists find it hard to diagnose bipolar disorder, clear observation of the signs and behavioral changes are used. American Psychological Association (APA) says that, both the clinical officer and close relatives who experience the patients’ ordeals help in the diagnosis (355). The treatment is through psychological therapy and use of drugs like anticonvulsants and mood stabilization drugs.
Schizophrenia
This mental disorder alters the emotion of the individuals’ hence normal thinking. The main causes of schizophrenia are either environmental, genetic, neural dysfunction or psychological trauma. Genetically, a familial history contributes to the occurrence of schizophrenia. Additionally, possessions of certain genes cause the disorder. Researchers associate some proteins to the disorder, scientist link zinc and histone proteins genes to schizophrenia.
Various environmental factors lead to schizophrenia disorder in some individuals. Motherhood before and after birth predispose the infant to the disorder. Eating disorders and other infection predisposed to the infant during infancy may cause mental dysfunction after birth. Individuals who grow up in abuse relationships also may incur the disorder. Some factors like drug abuse due to peer pressure and lack of good parentage may be among the causes.
The use of hard drugs like cannabis and cocaine alters an individual normal thinking hence emotional perception. Most of these drugs lead to overdependence altering the functions of the neurons specifically in the brain region. Hallucinatory episodes, unclear communication, antisocial behavior are among the common signs.
Due to mood swings and unhappiness filled with anger, patients may attempt suicide to stop their suffering. Fortunately, schizophrenia has treatment, which includes psychological therapy, social therapy and use of drugs. Clozapine, perphanazine, quetiapine and risperidone among others medically curb the disorder.
Similarities and differences between schizophrenia and bipolar
The two disorders affect the mental ability of the individual. They have similar causative agents and symptomatic stages. Both disorders alter the normal behavior of an individual. Psychological and brain dysfunction are the main causes of the disorders. Similarly, environmental issues like drug abuse, physical abuse and poor parental are among the causes.
Additionally, genetic factors like familial factors and hereditary of defective genes contribute to the disorders. The two disorders have similar symptoms a fact that gives psychiatrist tough time to diagnose the disorders and eventually may lead to misdiagnosis. Both symptoms manifest through hallucinations, insomnia and depression, which aggravates the patients ability to indulge in hard drugs. Sever cases of both disorders end up in suicidal cases from the victims.
After keen observation, both medical intervention and psychotherapy curb the disorders. The main obstacle in that makes patient not seek medical intervention is social stigma because relatives and neighbors perceive the patients as mad people. Parents of the victims hide indoors their children to curb shame that comes with the disease.
Differences
There is administration of different drugs to patients with these disorders. However, the drugs used in schizophrenia have severe side effects, which may even lead to the death of the individual. Similarly, depending on the stage of schizophrenia a small percentage of patients mount resistance to the drugs. However, Bipolar disorder treatment has less cases of resistance mainly because the drugs used aim at inhibiting the function of aggravating genes like serotonin and dopamine.
McGlashan observes that, “sometimes, schizophrenia disorder may present in form of bipolar hence leading to difficulty in medications” (143). Therefore, in such a case, there is double diagnosis but treatment becomes a challenge due the use of different drugs. Sadly, some patients decide to forego any form of treatment and this culminates to death.
Conclusion
In summary, bipolar and schizophrenia affect mental hence emotions of the individuals. Therefore, they are mental disorders, which may be fatal if untreated. Environmental, genetic, familial and psychological factors are the main causes of the diseases. The similarities in the factors causing the disorders and eventual symptoms pose a challenge to medical practitioner during diagnosis.
However, the medical interventions are through combination of both administration of drugs and psychological therapy. Sometimes, schizophrenia patients end up dying due to inability to respond to drugs hence one of the medical challenges. Finally, parental genes whether defective or not predispose their children to schizophrenia and bipolar. Therefore, there is need of gene therapy especially when the disorder is hereditary.
Works Cited
APA. Diagnostic and statistical manual of mental disorders: USA Washington, DC: American Psychiatric Publishing, 2000.
Koehler, Brian. “Bipolar Disorder, Stress, and the HP Axis.”The International Society for The Psychological Treatment of Schizophrenia and Other Psychoses, 2005. Web.
McGlashan, Thomas. “Testing DSM-III symptom criteria for schizotypal and borderline Personality disorders.” Journal ofArchives of General Psychiatry, 1987. Web.
Serretti, Alessandro, and Mandelli, Luigi. “The genetics of bipolar disorder: genome ‘hot regions,’ genes, new potential candidates and future directions.” Molecular Psychiatry 13.8 (2008): 742–71.
The other name for bipolar disorder is Manic-depressive illness. This disease specifically causes the patient to experience extra ordinary changes in mood, strength, levels of concentration, and the ability to execute daily tasks (Kato, 2007). Unless the disease has been diagnosed, it is difficult to identify the symptoms.
Therefore, the infected person is constantly in conflicts with the people who interact with him/her. For instance, such persons can barely be in a stable relationship for a considerable period. Moreover, they seem to be in a habit of engaging in intense arguments at their places of work. This is probably because they cannot fully concentrate on what they are doing at a particular time.
Symptoms
Bipolar disorder is common in persons under the age of 25 years. However, there are situations that have been reported involving patients who are in their sun set years and others who are considered too young to contract this condition such as children below the age of ten years (Miklowitz, 2008).
Bipolar disorder is considered a long-term condition that often begins gradually because it can take up to 10 years before the symptoms are visible. Usually, symptoms are only uncovered through diagnosis. This implies that bipolar disorder falls into the category of diseases such as diabetes and heart condition, which need to be managed throughout the affected person’s lifetime (Serretti & Mandelli, 2008).
Bipolar patients experience irregular mood swings that range between exaggerated amusement and sadness (Srivastava & Ketter, 2010). This means that the patient can be extremely happy in one minute and the next minute the person looks dull. Such people are easily irritated and hence, should be handled with a lot of care and understanding.
These mood swings are not influenced by the events that are going on in their surroundings because their sadness or joy cannot be linked to anything. For instance, under normal circumstances, people laugh because something funny has been done or said, but to bipolar patients, joy and sadness alternate without a justifiable reason (Miklowitz, 2008).
Likewise, persons suffering from bipolar disorder tend to speak very fast during conversations like there is a matter of urgency. When they embark on making a statement, they hardly finish putting their point across because they encounter numerous distractions in their minds that cause them to divert from the topic of discussion (Kieseppa et al., 2004).
At the end of their conversations, there are so many half-complete stories. Moreover, they have a habit of setting unrealistic goals. This is caused by their thought of having unique abilities and hence they feel they can achieve goals that are deemed unachievable. This overconfidence causes them to handle more tasks beyond their capacity, such as assuming more roles at a go (Kato, 2007).
Furthermore, bipolar patients experience lack of sleep probably because they work for long hours. Nonetheless, they sleep for few hours due to the restlessness that keeps them up all night. Besides, they loose interest in activities that they previously enjoyed and in most occasions, they seem to be carried away due to their low level of concentration.
They are quite forgetful and hence tend to have varied opinion or fail to stick to an agreement’s terms due to their poor memory (Miklowitz, 2008). For instance, the infected person can schedule a meeting and later fail to avail him/herself without a good reason.
Effects of Bipolar Disorder
If a person suffering from bipolar is not diagnosed and the illness persists for a long time, the effects worsen with time. According to Miklowitz (2008), “The behavioral and emotional experiences of the person with bipolar disorder affect everyone – the patient’s parents, spouse, siblings, and children” (p. 5).
A bipolar individual is prone to getting into fights and arguments with friends and relatives including their spouse. In the end, their family ties are disintegrated. Similarly, their employers are hardly satisfied with their performance because they make avoidable mistakes, which may lead to dismissals.
This turn of events makes them to resort to abusing substances such as alcohol and other related drugs (Lam, Wright, & Smith, 2004). They abuse drugs in an attempt to divert their attention. They also experience hallucinations. Furthermore, patients who suffer from this condition are known to have thoughts of ending their own lives and hence, they are likely to commit suicide.
Other Diseases That Co-Exist With Bipolar
Bipolar disorder can go for a long time without being noticed because it exhibits symptoms common to related conditions. These illnesses include post-traumatic stress disorder (PTSD), social Phobia and attention deficit hyperactivity disorder (ADHD). Lack of concentration and restlessness are very common in these diseases and hence one may be confused for the other. When this happens, the medical expert ends up prescribing treatment for the wrong ailment and thus the symptoms persist (Srivastava & Ketter, 2010).
Additionally, bipolar patients are prone to contracting thyroid illness, migraine headaches, heart disorders, diabetes and obesity. It is therefore advisable for patients to consult the doctor if their treatment is not making any positive progress. This will cause the doctor to carry out a thorough diagnosis that could probably unveil other underlying illnesses that could be hindering the effective treatment of bipolar (Miklowitz, 2008).
Risk Factors for Bipolar
There is no exact cause of bipolar disorder. However, several issues have been identified as major contributors to contracting the ailment. The generic background of an individual has been sighted as the major contributing factor. This implies that bipolar disorder is a hereditary ailment because it can be passed on from parents to their children (Mansell & Pedley, 2008).
People who hail from family backgrounds that have had a history of being affected by this disease are more likely to contract the ailment than their counterparts whose families have never had any brain disorder related to bipolar. Twins are also prone to contracting bipolar, but in most cases, its only one child among the pair that tests positive to bipolar diagnosis. This does not mean that the other child will also contract bipolar disease because each of them exists as an independent entity (Serretti & Mandelli, 2010).
Diagnosis of Bipolar
Unlike other illnesses, bipolar cannot be detected through evaluation of blood samples or brain screening. However, these tests can be carried out to unearth other underlying illnesses that could hinder effective treatment of bipolar. The condition is therefore best diagnosed through physical observation coupled with thorough interrogation of the patient (Miklowitz, 2008).
Psychiatrists are in a much better position to handle conditions like bipolar due to their expertise. The medical health practitioner should seek to obtain adequate information regarding the patient’s family history regarding bipolar disorder. If the condition of the patient does not favor interrogation, the practitioner should consult a close relative to the affected person such as brothers, sisters and spouse such as wife or husband. Previous medical records can also be referred to while probing the health history of the patient (Kieseppa et al., 2004).
Treatment of Bipolar
Bipolar is not curable, but it is manageable. People who stick to the prescribed medication are able to regulate mood swings and hence lead healthy productive lives (Serretti & Mandelli, 2008). It is important to note that bipolar is a condition that keeps on recurring and hence the patient has to be on medication for the rest of his/her life.
The medicine for treating bipolar is usually prescribed by licensed medical experts; it cannot be purchased without written prescription. Among the drugs that are used to treat bipolar include Lithium, Valproic acid, Anticonvulsant lamotrigine, Neurontin, and Topamax (Miklowitz, 2008).
Besides medication, bipolar can be treated through psychotherapy. In this form of treatment, the patient is offered emotional support through regular conversations. The patient is helped to stop his/her destructive habits by being made to understand the consequences of his/her actions. Alternatively, the therapy can take place at the family level where the family members counsel one of their own. However, Miklowitz (2008) argue that:
A close working relationship between the bipolar patient and his or her family members can not only address the multiple psychological problems that emerge in the context of this disorder, but can also facilitate the patient’s willingness to follow a prescribed medication regimen. (p. 6)
Similarly, people suffering from bipolar can undergo collective counseling on the effects of bipolar disorder. Moreover, psycho-education is reserved for people who suffer from bipolar disorder. The training empowers them to be in a position to manage this lifetime condition, and seek medical attention while there is still enough time. This reduces the impact of the disease on the patients (Kato, 2007).
References
Kato, T. (2007). Molecular genetics of bipolar disorder and depression. Psychiatry and Clinical Neurosciences, 61(1), 3-19.
Kieseppa, T., et al. (2004). High concordance of bipolar I disorder in a nationwide sample of twins. American Journal of Psychiatry, 161(10), 1814-1821.
Lam, D., Wright, K., & Smith, N. (2004). Dysfunctional assumptions in bipolar disorder. Journal of Affective Disorders, 79(1-3), 193-199.
Mansell, W. & Pedley, R. (2008). The ascent into mania: A review of psychological processes associated with the development of manic symptoms. Clinical Psychology Review, 28(3), 494-520.
Miklowitz, D.J. (2008). Bipolar disorder: A family-focused treatment approach (2nd ed.). New York, NY: Guilford Press.
Serretti, A. & Mandelli, L. (2008). The genetics of bipolar disorder: Genome ‘hot regions,’ genes, new potential candidates and future directions. Molecular Psychiatry, 13(8), 742-771.
Srivastava, S. & Ketter, T. A. (2010). The link between bipolar disorders and creativity: Evidence from personality and temperament studies. Current Psychiatry Reports, 12(6), 522-530.
Bipolar disorder is a mental condition that alters brain functioning of the patients. In a study carried out in Washington, researchers tried to find out prevalence of treated bipolar disorder in the region. It was carried out in a Health Maintenance Organization (HMO). This essay summarizes the study, which focused on mental health issues.
Method of Study
A group of 294,284 patients who had been treated by HMO health care providers, and others, who had registered as health maintenance organization members, formed the basis of the study. Automated data was used to find out the total number of patients who had been treated for bipolar disorder between 1995 and 1996.
Computerized diagnosis of outpatient and inpatient visits and use of mood stabilizers was used to identify individuals who showed signs of bipolar disorder. A review of outpatient records was later conducted randomly in order to confirm validity of the procedure used to identify patients with bipolar disorder (Simon & Katon, 1998).
Results
The study showed that prevalence of treated bipolar disorder was at 42 percent. It was discovered that rates of treated bipolar disorder were higher in women, young people and families that were HMO members. In addition, women who were enrolled in individual plans that were part of HMO and Basic Health Plan programs for poor families exhibited higher rates of treated bipolar prevalence.
The total number of patients who were treated for bipolar disorder was 1,236. Out of this number, at least 93 percent had visited specialized mental health institutions. On the other hand, 86 percent had been given medication to stabilize their moods. The percentage that was treated with antidepressants, benzodiazepine or antipsychotic was small.
Importance of the Study
The study was important because bipolar disorder was a common mental condition that affected many people. It was therefore crucial to find out its prevalence since it affected a large number of women immediately they gave birth, something that exposed them to other illnesses. Despite the fact that a lot of work was required in order to manage individuals diagnosed with bipolar disorder, it was important to recognize it early enough in order to administer medication.
The study was also important because it made it possible for patients who had been treated for bipolar disorder to be identified. The condition affected a large number of people, but some of them did not consider treatment, hence they did not seek medical attention in good time.
In addition, the study made it possible for health care providers to evaluate the kind of treatment patients who had visited mental health institutions received. This was important because different medications were essential when bipolar disorder patients exhibited certain symptoms.
Limitations of the Study
The first limitation that made the study difficult was lack of accurate records for patients who had been diagnosed with bipolar disorder. This was due to the fact that some of them had not visited mental health institutions. As a result, health care providers could not get their actual numbers. The second limitation was risk of data loss because computerized systems were used to carry out the study.
Conclusions
After the study was conducted, it was concluded that the rate of bipolar treated prevalence in the HMO population was higher compared with the one that had been recorded for prepaid health schemes. However, large population surveys gave a lower estimate. Many patients who were treated received medication for mood stabilization and special services related to mental health.
Reference
Simon, G., & Katon, W. (1998). The treated prevalence of bipolar disorder in a large staff-model HMO.
Within patient reporting recent suicidal thoughts and past suicidal attempts, do you feel starting her on Lithium is appropriate at this PHP level of care and setting?
The case of this patient is complex and requires certain evaluations. On the one hand, Lithium seems to be an appropriate decision for treating this 31-year-old woman who is diagnosed with alcohol use disorder, bipolar II disorder, and generalized anxiety disorder (GAD). Lithium was proven one of the best suicide preventing options for long-term treatment (Lewitzka et al., 20115). Compared to placebo, lithium can be a part of monotherapy or pharmacotherapy along with antidepressants (Kessing et al., 2018). There is no definite answer to the question of how lithium helps patients. Still, the possibility to reduce the risks of suicides among people is the achieved outcome that makes physicians and psychiatrists choose this medication.
On the other hand, it is necessary to admit that in addition to the already mentioned mental health complications, the patient suffers from multiple suicidal thoughts and attempts during the last ten years with only two psychiatric hospitalizations. The level of her participation in patient hospitalization programs remains zero. Lithium, as well as other medications, is characterized by toxicity and overdose in case it is not observed by a professional practitioner.
The use of this medication can be lethal for some patients. Therefore, it is recommended to change traditional treatment (if this one is chosen) to treatment under thorough observations in a clinical setting. The patient is the mother of three children. She may not memorize things and forget to take medications or hide them to protect her children. Her treatment should be safe for her and her family. Therefore, Lithium can be appropriate at this PHP level of care only in case the level and the setting are changed for the next two weeks.
With history of bipolar and presenting depressed mood, would you consider starting this patient on Lamictal at this point in place of Lexapro?
Modern patients are free to choose treatment methods that can be offered in hospital settings. Lithium and Lexapro are the drugs that are frequently recommended for patients with bipolar disorders, suicidal thoughts, and depressed mood. In this case, the patient possesses the characteristics of all these mental health problems and has to deal with them in order to be a good mother and a socially responsible person. However, there is also the way of treatment that includes Lamictal, also known as Lamotrigine. The investigation by Terao, Ishida, Kimura, Yarita, and Hara (2017) shows that Lamotrigine is effective for patients with bipolar II disorder.
This drug helps to reduce the frequency and severity of mood changes in bipolar disorder patients. However, Lexapro is defined as an antidepressant with few adverse effects compared to other selective serotonin reuptake inhibitors (SSRIs).
The comparison of Lamictal and Lexapro shows that both drugs are approved by the FDA. Both of them aim at treating the cases of depression and anxiety. However, Lamictal is defined as the drug to treat bipolar disorders. Therefore, regarding the fact that the patient does not have allergies and does have a family history of schizophrenia, it seems to be rational to use Lamictal in place of Lexapro. The main positive effect of Lexapro is the possibility to reduce bipolar recurrence. In this case, the patient reports several suicidal thoughts and past diagnoses of GAP and alcohol use disorder. She asks to help her because she cannot stop drinking on her own. It is not enough to stop acute bipolar disorder at this moment. The goal is to make sure that the same cases do not occur in the future.
References
Kessing, L. V., Bauer, M., Nolen, W. A., Severus, E., Goodwin, G. M., & Geddes, J. (2018). Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: A systematic review of evidence from observational studies. Bipolar Disorders, 20(5), 419-431. Web.
Lewitzka, U., Jabs, B., Fülle, M., Holthoff, V., Juckel, G., Uhl, I.,… Bauer, M. (2015). Does lithium reduce acute suicidal ideation and behavior? A protocol for a randomized, placebo-controlled multicenter trial of lithium plus treatment as usual (TAU) in patients with suicidal major depressive episode. BMC Psychiatry, 15(1), 117-130. Web.
Terao, T., Ishida, A., Kimura, T., Yarita, M., & Hara, T. (2017). Preventive effects of Lamotrigine in bipolar II versus bipolar I disorder. The Journal of Clinical Psychiatry, 78(8), 1000-1005. Web.
Bipolar disorder (BD) is a mental disorder marked by a change in manic and depressive states, mixed states, and the alternation of euphoria and depression, which is also known as manic-depressive illness. Mood swings in patients with BD are more serious than those people encounter every day. In contrast to the normal change of mood, with their increases and decreases, which are inherent in any person, the symptoms of BD can lead to serious consequences (Cerimele, Chwastiak, Chan, Harrison, & Unützer, 2013). They can affect the quality of work and personal life and even cause thoughts about suicide. The alternations of mood are accompanied by significant changes in energy and behavior. The course of BD consists of the periods of the excited and passive states that are called mania and depression respectively. As for progress, the evidence shows that the disease may lead to more depressions, turn to a rapid-cycling manner, or result in functional recovery.
The symptoms of mania or manic episodes are increased energy and anxiety, euphoric mood, increased irritability, distractibility, inability to concentrate, inadequate assessment of the situation, drug abuse, especially cocaine, alcohol, and insomnia medications, and provocative, intrusive, or aggressive behaviors (Mondimore, 2014). A manic episode is diagnosed if a manic state accompanied by three or more symptoms lasts for most of the day, almost every day, and during a week or longer. The progression of the disease refers to depression or depressive episodes, during which patients tend to ponder over their behaviors and experience a sense of guilt. The key symptoms of depression include a prolonged state of sadness and anxiety, hopelessness and pessimism, the loss of interest in activities that the sick person previously enjoyed, low energy, concentration problems, difficulties in remembering or making decisions (Mondimore, 2014). Changes in appetite, chronic pain, or other persistent symptoms that are not the result of a physical illness or injury, and thoughts about death or suicide may be noted. A depressive episode is diagnosed if five or more symptoms frequently appear for two or more weeks on an everyday basis.
The recent epidemiological studies revealed the greatest prevalence of BD in the age group from 18 to 24 years, and without sex differences (Rowland & Marwaha, 2018). The appearance of the given disease at a later age, as a rule, is a consequence of traumatic brain injury, a stroke, et cetera. Rowland and Marwaha (2018) also mention that the lifetime prevalence of the bipolar disorder is 2.4 percent, while it may vary in various countries, depending on age, ethnicity, and other factors. The higher socioeconomic status and creativity are associated with lower risks of developing the disease.
Theory
Neurons have special ways to communicate with each other, the so-called projections of axons and dendrites. The gap between them composes the synaptic cleft, where the interaction of neurons occurs. Neurotransmitters are synthesized in the cells and delivered to the end of the axon – to the presynaptic membrane (Harrison, Geddes, & Tunbridge, 2018). Under the impact of electrical impulses, they enter the synaptic cleft and activate the receptors of the next neuron. This explains the core of neurotransmitters and receptors theories that will be used to understand the biological nature of BD in an in-depth manner. The pivotal biological cause of BD is the chemical imbalance expressed in a disruption in the production and synthesis of dopamine and serotonin neurotransmitters. At the chemical level, the disparity of neurotransmitters in the brain, namely, a reduced level of serotonin and noradrenaline and an increased rate of dopamine should be noted.
Dopamine, a neurotransmitter responsible for mood, shows an increased transmission at the time of the manic phase. It can be assumed that a rise in the level of dopamine causes a reduction in the secondary homeostatic regulation of the main systems and receptors, which, in turn, promotes an increase in the quantity of G-protein coupled receptors (Ashok et al., 2017). Furthermore, a decrease in dopamine transmission for the period of depression occurs. The depression period ends with the rise of homeostatic regulation, and the cycle is then repeated. It was found that two more types of neurotransmitters can cause severe changes in mood, such as gamma‐aminobutyric acid (GABA) and glutamate. In people with bipolar disorder, GABA is found in higher concentrations, and the disease leads to a decrease in GABA-beta receptors (Brady et al., 2013). The levels of glutamate significantly increase in the left dorsolateral prefrontal cortex during the manic phase of bipolar disorder and normalize after the end of the phase.
Dopamine receptor stimulants, also known as agonists, duplicate the effects of natural dopamine. They bind to the D2 and D3 receptors in the nigrostriatal dopaminergic pathway, which extends from the substantia nigra to the basal ganglia and the striatum (Ashok et al., 2017). A new generation of drugs that stimulate D1 receptors is under development. Dopamine receptor agonists are expected to counteract apathy and blunting cognitive abilities, while antagonists should be reduced in the course of the treatment.
Norepinephrine is a neurotransmitter that acts as an energy promoter, which is also used while making quick decisions. It is activated under stress and in extreme situations, causing a surge of energy, reducing the feeling of fear yet increasing the level of aggression (Harrison et al., 2018). The SLC6A2 gene encodes a norepinephrine transporter protein by providing norepinephrine’s reuptake in the presynaptic membrane. The latter determines how long norepinephrine will act in the human body after he or she successfully handled a dangerous situation. When the neuron is functioning normally, it releases norepinephrine into the synaptic cleft, the space between two neurons. Noradrenaline binds to the α1–, α2– and β1– receptors on the postsynaptic membrane – the neuron membrane on the other side of the synapse (Harrison et al., 2018). This binding is transmitted to the cell, which activates certain genes that regulate the activity of proteins, which, in turn, determine all the activity of a neuron. Alpha-2 agonists of Norepinephrine cause the sedating impact, and its antagonists are used as tricyclic antidepressants, antipsychotics, and beta-blockers.
Serotonin is a neurotransmitter that not only brings positive emotions but also reduces susceptibility to negative ones. It provides support to related neurotransmitters, including norepinephrine and dopamine. Serotonin is released into the synaptic cleft in the same way as norepinephrine. For serotonin, there are 17 different types of receptors, which emphasize its importance as a neurotransmitter. Also, it improves the accuracy of the transmission of active signals in the brain and assists in concentrating. The monoamine oxidase A enzyme (MAOA) is responsible for the deactivation of monoamines, neurotransmitters with one amino group, which includes adrenaline, norepinephrine, serotonin, histamine, and dopamine. The better the MAOA gene works, the faster the stressful situation is neutralized, and the faster a person becomes able to make informed decisions. Some agonists of serotonin provide an antidepressant-like effect (5-HT 2B) likewise such antagonists as 5-HT2C and 5-HT3A.
The evidence shows that the brain of patients with bipolar disorder is different from that of a healthy person. The severity of these changes is still unknown, but they can shed light on the causes of this disease. For example, neurotransmitters that control mood can play an important role in the development of the bipolar disorder. The increase in the level of GABA seems to be caused by a disorder at the early stages, as well as a violation of cell migration, the formation of normal detachment, and stratification of brain structures, usually belonging to the cerebral cortex (Kim, Santos, Gage, & Marchetto, 2017). The thinning of the cortex was revealed in patients compared with the control group, with the greatest deficiency observed in the areas responsible for inhibition and motivation, namely, the frontal and temporal areas.
Treatment
According to research results, patients with bipolar disorder undergoing treatment are at risk of developing mania, hypomania, or a rapidly circulating form of the disease (Mondimore, 2014). To protect patients with BD from such consequences, it is necessary to use mood-stabilizing drugs, either in combination with antidepressants or separately. Currently, lithium and valproate are considered the most common mood-stabilizing drugs. Nevertheless, experiments are continuing to assess the effectiveness of the use of new drugs compared to the existing ones (Geddes & Miklowitz, 2013). The treatment options are mood stabilizers that help in eliminating rapid emotional changes, antidepressants, and antipsychotic drugs that are prescribed together with mood stabilizers with vivid symptoms during the manic phase if a patient has a loss of contact with reality.
Risperidone (Risperdal) is an antipsychotic medication that selectively blocks 5-HT2-serotonergic, D2-dopaminergic, and alpha1-adrenergic receptors. It also interacts to a lesser extent with alpha2-adrenergic and histamine H1-receptors in the central nervous system. Risperidone has poorly expressed an affinity for 5-HT1A-, 5-HT1C-, 5-HT1D-serotonergic, and D1-dopaminergic receptors as well as haloperidol sensitive sites of sigma binding (Geddes & Miklowitz, 2013). The given medication cannot interact with m-cholinergic and beta2-adrenergic receptors. It has antipsychotic, sedative, antiemetic, and hypothermic effects that occur due to the blockade of the D2-dopaminergic receptors of the mesolimbic and mesocortical systems. The sedative action is a consequence of blockade of adrenoreceptors of the reticular formation of the brain stem, and hypothermic impact is caused by the blockade of the dopamine receptors of the hypothalamus. Risperidone is known to suppress delirium and hallucinations as well as reduce the feeling of fear and aggressiveness.
The absorption of Risperidone is quick and complete, while food does not affect the fullness and speed of absorption. Risperidone Tmax is one hour 1 h, 9-hydroxyrisperidone – three hours with high activity of CYP2D6 isoenzyme and 17 hours with low activity (Geddes & Miklowitz, 2013). Risperidone plasma concentration is proportional to the dose of the drug; the equilibrium concentration of the medication in most patients is achieved within one day. Risperidone is rapidly distributed in the body, penetrating the central nervous system and breast milk – the volume of distribution 1-2 liters/kg. The half-life of risperidone is three hours, and it is excreted by the kidneys in the form of the pharmacologically active fraction and the intestine. The complete elimination may be prolonged up to 20 hours, depending on a patient’s health condition.
Contraindications include hypersensitivity, lactation period, and children’s age up to 15 years since efficiency and safety have not been established to this category of patients. The side effects may be determined by a patient’s overall conditions, sensitivity to the drug, and other factors. The central nervous system presents the most of the side effects: insomnia, anxiety, headache, drowsiness, fatigue, dizziness, blurred vision, extrapyramidal symptoms, mania or hypomania, stroke, and neuroleptic malignant syndrome (Geddes & Miklowitz, 2013). At the same time, constipation, dyspepsia, vomiting, abdominal pain, hypo-salivation or hypersalivation, orthostatic hypotension, reflex tachycardia, priapism, erectile dysfunction, and urinary incontinence may be enumerated among the most common issues. As for the interactions, the given medication reduces the effect of levodopa and other dopamine agonists. Phenothiazines, tricyclic antidepressants, fluoxetine, and beta-blockers may increase plasma risperidone concentrations. Nonadherence to Risperidone creates additional risks, which should be clarified to patients immediately to make them aware of their condition and receive informed consent to continue the treatment.
A new antipsychotic medication, Cariprazine is currently undergoing clinical trials for indications for the treatment of the bipolar disorder. The drug provided by Gedeon Richter and jointly developed with Forest Laboratories and Mitsubishi Tanabe Pharma refers to piperazine/piperidine derivatives (Citrome, 2013). Cariprazine has partial D2 and D3 receptor agonist, which explains its positive impact on patients with BD. The molecules of the medication act, on the one hand, as a partial agonist of the dopamine receptors D3, D2L, and D2S, as well as the serotonin receptor 5-HT1A, on the other hand, as an antagonist of the serotonin receptors 5-HT2B and 5-HT2A. The D2 and D3 receptors are important targets since their excessive stimulation is implicated (Citrome, 2013). The increased selectivity of Cariprazine to D3 receptor reduces side effects, especially extrapyramidal symptoms that are frequent with the administration of other neuroleptics, and is also reflected in the form of positive pro-cognitive manifestations.
Although it is emphasized that second-generation antipsychotics have advantages compared to traditional drugs for the relief of negative symptoms, this difference was largely due to the dynamics of secondary negative symptoms (Severus et al., 2014). Cariprazine, which has a high affinity for D3 receptors, was designed to create a new antipsychotic drug that has therapeutic activity against negative symptoms and cognitive impairment in patients with BD. The results of preclinical studies show that the drug has a certain pro-cognitive and anti-anhedonic efficacy (Citrome, 2013). Thus, Cariprazine contributes to mitigating impaired working memory, attention, and recognition ability.
The given medication is captivated from the gastrointestinal tract, achieving a peak concentration within 3-4 hours after ingestion. With prolonged use, it accumulates in the plasma, but in the dose range of 1-18 mg, its concentration in the blood increases in proportion to the dose taken (Citrome, 2013). The half-life of Cariprazine is approximately six days, and the route of elimination is urine. After Cariprazine absorption behaves as a lipophilic antipsychotic, it is widely distributed in the tissues. In rat studies, its brain concentration was eight times higher than the plasma concentration. Metabolism of the drug occurs in the liver with the participation of cytochrome P450 CYP3A4 and, to a lesser extent, 2D6. Since the drug was not fully tested, it is ethical to avoid its prescription to children and adolescents whose central nervous system is especially vulnerable to negative impacts.
The side effects of Cariprazine include extrapyramidal symptoms, headache, dizziness, constipation, nausea, vomiting, diarrhea, blurred vision, hyperthermia, drowsiness, and insomnia. An increase in the level of prolactin and prolongation of the QT interval in the trials did not reach clinical significance. A noticeable increase in weight was observed in a significantly smaller number of patients than when receiving risperidone, although this figure was higher than when taking a placebo (Citrome, 2013). With the prolonged use, a potentially clinically significant weight gain was detected in a third of patients during the studies. However, there is no sufficient experience of its use for the treatment of cognitive disorders in a long-term period.
Lithium (Eskalith, Lithobid) is a mood-stabilizing drug that is often used to stabilize a patient’s mood. Severus et al. (2014) state that it helps to control the symptoms of acute mania and effectively prevents the recurrence of periods of mania and depression. The pharmacological action contains antipsychotic, normothermic, and sedative effects. Lithium blocks sodium channels in neurons and muscle cells and causes a shift of intraneuronal catecholamine metabolism. It is fully absorbed in the gastrointestinal tract, and the T max is 6–12 hours (Severus et al., 2014). The half-life period increases from 1-3 days after the first dose to 2-4 days after one year of regular intake. Lithium penetrates through the placental barrier and into breast milk, and its elimination occurs through urine. In terms of the exceptional treatment conditions and the ethical implications for high-risks, care providers should especially alert due to the toxicity of Lithium.
The common side effects include weight gain and digestive problems. The drug can also affect one’s thyroid and kidneys – periodic blood tests are needed to monitor the condition of the mentioned organs. Lithium is a category D drug, which indicates that it should be avoided during pregnancy, if possible. However, in some cases, the benefits may outweigh the potential risks. Contraindications also involve hypersensitivity, severe surgery, cardiovascular diseases, epilepsy, and Parkinsonism due to the neurotoxic effect of lithium (Severus et al., 2014). Leukemia in history and dehydration increases the risk of lithium toxicity. As for interaction, when carbamazepine is combined with Lithium, the risk of neurotoxic effects increases. Metronidazole, fluoxetine, diuretics, NSAIDs, and ACE inhibitors slow down kidney removal of Li + and increase its toxic effects. Lithium tends to reduce the pressure of norepinephrine and increase or prolong the blockade of neuromuscular transmission when combined with besylate atracurium or pancuronium bromide.
Conclusion
To conclude, the main theory associated with the BD is the imbalance of neurotransmitters and receptors, which is understood as a low level of serotonin and noradrenalin and a high rate of dopamine. Such an imbalance leads to the fact that the improper interaction of neurons in the human body impacts a patient’s behaviors and overall well-being. The key advantage of the discussed theory is its precise attention to biological issues that accompany the disease, while its disadvantage lies in the failure to clarify gaps existing in the literature. There are a lot of side effects and contraindications that set the direction for future research in the field of neurotransmitters theory – the search for the most relevant treatment option with a minimum of side effects. Thus, the risk-benefits perspectives should be assigned a top priority both for drug prescription and research studies.
References
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.
Brady Jr, R. O., McCarthy, J. M., Prescot, A. P., Jensen, J. E., Cooper, A. J., Cohen, B. M.,… Öngür, D. (2013). Brain gamma‐aminobutyric acid (GABA) abnormalities in bipolar disorder. Bipolar Disorders, 15(4), 434-439.
Cerimele, J. M., Chwastiak, L. A., Chan, Y. F., Harrison, D. A., & Unützer, J. (2013). The presentation, recognition and management of bipolar depression in primary care. Journal of General Internal Medicine, 28(12), 1648-1656.
Citrome, L. (2013). Cariprazine in bipolar disorder: Clinical efficacy, tolerability, and place in therapy. Advances in Therapy, 30(2), 102-113.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682.
Harrison, P. J., Geddes, J. R., & Tunbridge, E. M. (2018). The emerging neurobiology of bipolar disorder. Trends in Neurosciences, 41(1), 18-30.
Kim, Y., Santos, R., Gage, F. H., & Marchetto, M. C. (2017). Molecular mechanisms of bipolar disorder: Progress made and future challenges. Frontiers in Cellular Neuroscience, 11(30), 1-15.
Mondimore, F. M. (2014). Bipolar disorder: A guide for patients and families (3rd ed.). Baltimore, MD: Johns Hopkins University Press.
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269.
Severus, E., Taylor, M. J., Sauer, C., Pfennig, A., Ritter, P., Bauer, M., & Geddes, J. R. (2014). Lithium for prevention of mood episodes in bipolar disorders: Systematic review and meta-analysis. International Journal of Bipolar Disorders, 2(1), 15-32.
Various social factors impact the development of psychological disorders. This is substantiated by Aldinger and Schulze (2016) because the authors state that the environment and genetics of an individual with bipolar determine the development of this condition. The most significant components are traumatic life events and social support. In this case, BH suffers from manic episodes due to bipolar and to ensure proper treatment one should consider all the components that affect BH.
Firstly, Reinares et al. (2016) state that “there are significant associations between poor family functioning and clinical variables of severity,” which may worsen of episodes that this patient has in recent times (p. 66). From the patient’s history, it can be concluded that BH can receive family support only from her mother, while she thinks that her father is a celebrity. It is unclear whether ethical or cultural issues had a significant effect on this patient. Therefore, the lack of support from family members may have facilitated the patient’s psychosis mania.
The issue of autonomy during the treatment of abnormal behavior is complicated. This case demonstrates an excellent application of patient-centered care because at first, BH did not want to take medication that would reduce her psychosis symptoms. However, the medical professional in question explained the issue using references connected to energy, which were familiar to BH. Through this, the autonomy of choice was maintained through proper explanation and adherence to the wishes of BH.
In similar cases, it is necessary to evaluate the risk that the patient may impose on others while considering his or her preferences. Schizophrenia and psychosis can severely impair one’s perception of reality, and thus at times, the autonomy has to be sacrificed.
References
Aldinger, F., & Schulze, T. (2016). Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry and Clinical Neurosciences, 71(1), 6-17. Web.
Reinares, M., Bonnín, C. M., Hidalgo-Mazzei, D., Colom, F., Solé, B., Jiménez, E., … Vieta, E. (2016). Family functioning in bipolar disorder: Characteristics, congruity between patients and relatives, and clinical correlates. Psychiatry Research, 245, 66-73. Web.
Psychological health of a human has shown to largely depend on the environment. In the majority of the cases, however, a number of psychological disorders “result from a combination of environmental and biological influences, including genetics” (Kalat, 2007, p. 451). Not all the psychological disorders can be treated, though modern clinical psychology succeeds in dealing with a number of illnesses which were impossible to cure earlier.
One of such illnesses is bipolar disorder which belongs to the group of major depressive disorders (this group includes bipolar I disorder and bipolar II disorder). Such disorders are characterized by certain common features: “The person has feelings of failure, worthlessness, and total despair. Suffering is intense, and the person may become extremely subdued, withdrawn, or intensely suicidal” (Coon & Mitterer, 2008, p. 477).
Analyzing the case of Virginia Wolf (who suffered from bipolar disorder) using the psychodynamic approach shows that a wide range of biological, psychological and social factors contributed into the development of her disease; this case study perfectly explains the need for adaptation in the field of clinical psychology because it shows how modern methods of treating bipolar disorders could have saved human lives several centuries ago.
First of all, it is worth considering Virginia Wolf’s case in more detail. The subject exhibited the signs of bipolar disorder already in the childhood. Her family members described her behavior as “lapses into insanity” (Meyer, Chapman, & Weaver, 2009, p. 124). The first serious breakdown occurred when the girl was around 13. The breakdown was followed by deep depression that was treated only by outdoor exercises. Shortly after this depression, the subject started suffering from repeated headaches, nervousness and irritation. This was accompanied by the escalation into a manic state with the feeling of guilt about one of her family members.
Rest was the only treatment even after these symptoms. In the subsequent years, the subject occasionally experienced lapses into insanity: “During one episode she talked rapidly for several days without stopping, after which she fell into stupor” (Meyer et al., 2009, p. 126). At this, Virginia memorized most of what was happening with her during such episodes. Soon the episodes became more frequent; they were characterized by panic attacks, constant feeling of fear and auditory hallucinations. Eventually, Virginia Wolf committed a suicide, at this, being conscious of what she was doing.
Further analysis of this case study using psychodynamic approach to clinical psychology seems the most appropriate. Discussing biological factors of this particular case is especially beneficial from this approach because it presupposes that “early experiences and relationships, such as relationship between children and their parents, play a critical and enduring role in psychological development and adult behavior” (Plante, 2005, p. 117).
Important relationships in Virginia’s case were not only with her parents, but with other family members as well. The subject did not have predisposition to bipolar disorder (her father’s wife had repeated mental problems, but she and the girl were not related). This is why predisposing experience was the most contributing into the development of her disease. First of all, it was stressful experience and losses which were numerous in case with Virginia. The girl lost her mother, older sister, father, and another sister in quite short periods of times. Besides, it was namely after the death of her first sister that her first breakdown occurred. Secondly, the girl was sexually abused by her half-brothers since the age of five. Lastly, Virginia was subjected to other traumas and stressful experiences throughout her adolescence.
These included unhappy love experience above all (first the girl fell in love with her female cousin and then an older woman friend; moreover, later, her fiancée broke down the engagement because of his homosexuality). These also served as additional psychological stressors that deteriorated the girl’s psychological health and only aggravated what seemed to be a mere nervous breakdown that occurred after the death of her first sister. Nevertheless, biological factors were the most contributing because unhappy love experiences were the only psychological factors that affected the development of Virginia’s bipolar disorder.
Furthermore, social factors also seem interesting to consider. Virginia as a girl rarely lacked social support and, even as the disease progressed, she was surrounded by loving friends one of which married her. However, there was still one significant social factor which Virginia was exposed to from the childhood. First, this was a social restriction imposed on her by the society: females in those times were not allowed to get education and, though Virginia had a desire to learn, she never attended school. Second, and the most important, seeing her desire to study, Virginia’s father stopped controlling the books that the girl read when she was in her teens (the age in which children are open to negative influences most of all).
Though the case study does not specify which literature the girl read, it may be suggested that her father’s “large library” (Meyer et al., 2009, p. 125) could contain literature that could damage the girl’s back then unstable psychological health. Therefore, all these biological, psychological, and social factors had a significant influence on Virginia’s developing bipolar disorder.
Finally, the last important thing to discuss with regards to this case study is the need for adaptation in the field of clinical psychology. The matter is that Virginia Wolf lived some time prior to the emergence of treatment from her disorder. At present, lithium is quite effective in treating major depressive disorders and, in those times, if applied correctly and timely, it could have helped Virginia. This shows that time is one of the most important factors for the need for adaptation.
The approaches to treating psychological disorders change as the society develops and, perhaps, one day even more effective treatment for bipolar disorders will be found (lithium has many side effects avoiding which is impossible). Thus, this case study perfectly explains the need for adaptation in clinical psychology.
In conclusion, the analysis of Virginia Wolf’s bipolar disorder using psychodynamic approach allowed sorting out biological, psychological and social factors that influenced the development of her disorder. It was discovered that Virginia did not have predisposition to this mental illness; it was a range of such biological factors as stressful experience, losses, sexual abuse, as well as additional psychological stressors, social limitations, and lack of restraint in terms of literature the girl read, that resulted in her disease that developed throughout her life. The fact that Virginia was “treated” with outdoor exercises and rest allows evaluating the need for adaptation in the field of clinical psychology that now easily copes with such illnesses as bipolar disorder.
Reference List
Coon, D. & Mitterer, J.O. (2008). Introduction to psychology: Gateways to mind and behavior. Mason: Cengage Learning.
VS: BP 132/85, HR 72, Respirations 16, Pulse Ox 96%
Chief Complaint: “I feel the flight of ideas and hypermaniacal episodes”
HPI: A 34-year-old patient complains about concentration and depression. He has recently impulsively quit his job and has not been sleeping for the last several days. JS denies alcohol and illicit drug abuse, yet confirms smoking a pack of cigarettes per day. The patient admits that he becomes angry and aggressive, which he regrets afterward. He suggests that he has depression and claims to feel worthlessness and critically increased fatigue, which occurred 2 months ago.
Past Psychiatric History: The patient was diagnosed with major depression in 2017 after his wife’s death in the car accident and anxiety disorder in 2013 after losing his job. JS takes Celexa 30 mg per day. No suicidal attempts are reported.
Hx of Violence to others: No incidents.
Previous Treatment:
IOP: 0
PHP: 0
Previous psychiatric hospitalizations: 0
Trauma History: Psychological trauma caused by the death of the wife and dismissal.
Family Psychiatric History: the older brother has anxiety disorder diagnosed at the age of 18.
Background and Social History:
Place of Birth: South Carolina
Father: Deceased, SC
Mother: Deceased, MO
Sibling: 1
Social: Communicates with friends once a week and visits the brother’s family once a month.
Profession: Manager
Education: College
Marital: Widower
Children: 1
Spiritual: Christian
Alcohol: 2 bottles of beer on weekends
Legal HX: None
Developmental: none
Med/Surgical HX: N/A
Medications: Celexa 30 mg PO daily
Labs: the functional MRI (fMRI) shows increased neuronal activity, WNL including Na+ and thyroid levels is normal.
Mental Status Exam: Normal speech, cooperative, anxious, disoriented to some extent, depressed, tends to avoid eye contact, proves psychosis, responds to questions adequately, mood swings, increases in energy, and depressing thoughts.
Primary Psychiatric Diagnoses:
Bipolar II disorder; DSM: 296.89
Generalized anxiety disorder; DSM: 300.02
Major depression; DSM 296.32
Interventions (Plan):
Bipolar disorder and depression – Lithium 300mg PO BID and Celexa 30 mg PO daily;
Anxiety disorder – Xanax 0,5 mg PO per day and Lamotrigine 25 mg PO daily;
As a 34-year-old patient-facing severe depression, JS has been showing a fast decline in the number of social interactions and developing symptoms such as pessimism, and hopelessness. Therefore, the patient requires stabilizers of mood (Timoleptics). Lithium has to be administered to the patient starting at 600 mg/L. The specified dosage should be reduced to 300 mg/L as the patient begins to recover.
Thus, possible side effects can be avoided (Malhi, Tanious, Das, Coulston, & Berk, 2013). Besides, the administration of SSRIs such as Celexa will be required to strengthen the inhibitory effect of endogenous GABA (Farinde, 2013). SSRIs and monitoring checks are required to ensure that the patient’s condition does not aggravate. The patient has had mood swings, which is typical for a bipolar disorder (Malhi et al., 2013). Therefore, Lithium should be seen as the key measure for addressing the specified symptoms (Tränkner, Sander, & Schönknecht, 2013). Xanax and Lamotrigine, in turn, should be used as the means of addressing the development of the anxiety disorder in the patient.
The case under analysis shows that sociocultural and socioeconomic factors play a crucial role in diagnosing disease and locating the available treatment options, as well as developing and implementing a particular intervention plan. Particularly, it is crucial to create a socially welcoming environment in which the patient will feel inclined to communicate and participate in interactions with community members. With the help of the specified measure, the process of recovery will occur at a faster pace. Particularly, family involvement should become a crucial part of the therapy, with family members and friends assisting the patient in addressing the disorder.
The following questions may be formulated to contribute to the discussion of the case:
How will improving health outcomes of the patient affect the dosage of the prescribed medication, considering side effects and combinations?
What are the issues that should be taken into account while changing medical treatment for this patient?
Answers to the Questions
Question 1: Answer
When considering the administration of the prescribed drugs to the patient, one should keep in mind that there is a strong probability of the patient developing side effects in case the dosage of Lithium remains the same throughout the recovery process. Therefore, it is strongly recommended to reduce the dose of the medication administered to the patient as the latter shows the signs of health improvement.
Otherwise, the side effects may include nausea, vomiting, loss of appetite, and drowsiness. While seemingly mild, the specified outcomes may aggravate to the point where a patient’s death will ensue (Malhi et al., 2013). Therefore, a drop in the dosage of Lithium during the recovery phase is recommended. Particularly, in the acute control phase, 600 mg/day is required, whereas the transfer to the long-term control will imply a shift to 300 mg/day.
Question 2: Answer
During the treatment process, the transfer from using Lamotrigine to applying Celexa in combination with Xanax may become necessary. In the specified scenario, one must keep in mind that, when used together with Celexa, Xanax has a strong sedative effect, which means that the patient may develop drowsiness. Therefore, the identified outcomes must be taken into consideration when shifting from the use of Lamotrigine to Celexa.
The stimulation of benzodiazepine receptors that can be found in the allosteric center of the postsynaptic GABA receptors will have a positive effect on the patient’s current state of health. Besides, the shift toward social interactions should occur at the later stage of the recovery. Therefore, potential communication issues need to be identified and prevented respectively. Thus, a smooth transition to the realm of social interactions and communication within the community will be facilitated.
References
Farinde, A. (2013). Bipolar disorder: A brief examination of lithium therapy. Journal of Basic and Clinical Pharmacy, 4(4), 93-94.
Malhi, G. S., Tanious, M., Das, P., Coulston, C. M., & Berk, M. (2013). Potential mechanisms of action of lithium in bipolar disorder. CNS Drugs, 27(2), 135-153.
Tränkner, A., Sander, C., & Schönknecht, P. (2013). A critical review of the recent literature and selected therapy guidelines since 2006 on the use of lamotrigine in bipolar disorder. Neuropsychiatric Disease and Treatment, 9, 101-111.
It is crucial to diagnose a psychiatric disorder accurately to assign a treatment that would help improve a patient’s condition. The task is especially challenging for children and adolescents as their symptoms can be difficult to distinguish from other diseases. Typically, schizophrenia onsets between the ages of 14 to 35, however, most people are diagnosed before they turn 25 years old (Stevens, Prince, Prager, & Stern, 2014). Thus, it is essential to examine the state of a young person carefully before providing medication from schizophrenia, to identify the disorder in its early stages.
Diagnosing Schizophrenia
Diagnosing children and adolescents for schizophrenia is a complex task, as the symptoms can indicate other disorders. Firstly, children typically experience a more significant number of hallucinations that can be connected to schizophrenia than adults. However, it should be noted that according to Stevens et al. (2014) “psychotic symptoms do not necessarily portend the future development of schizophrenia” (p.5). Thus, the psychotic symptoms present in children and adolescents do not always progress into severe disorders.
Both children and adolescents with schizophrenia have indicators of behavior that are more psychotic. For instance, “thought disorder, negative symptomatology (apathy, social isolation), and impulsive aggression” can suggest that a person has schizophrenia and not a bipolar disease (p. 5). The treatment requires choosing an appropriate medication and dose and waiting for an improvement in the child’s condition. Thus, young children may experience symptoms similar to those of schizophrenia, but those may not develop further when they become adolescents.
It is acknowledged by the researchers that the symptoms (such as hallucinations) indicate the possibility of bipolar disease and not schizophrenia. According to Stevens et al. (2014), the case is valid for both children and adolescents. It is essential to distinguish whether a child or an adolescent has a psychiatric or psychotic condition. Argyelan et al. (2014) argue that there is a connection between the two diseases, as “schizophrenia and bipolar disorder share aspects of phenomenology and neurobiology and thus may represent a continuum of disease” (p. 100).
Moreover, the authors conclude that both represent an issue of disconnection in the brain. Thus, when a young person experiences mania and depression, the focus should be directed at treating bipolar disorder. Therefore, it is essential to recognize the difference between the two conditions, as although they have similar nature and symptoms, the treatments and outcomes vary.
Self-harming behavior
Children and adolescents with psychiatric diagnoses often participate in self-harm activities, specifically in self-cutting. According to Hawton et al. (2015), the action occurs repeatedly and often is associated with suicidal intents. The issue is prevalent in children older than 12 and happens more frequently with females aged 12 to 15 years. This can be connected to “depression in young adolescent females, and alcohol consumption and engagement in sexual activity in both genders” (Hawton et al., 2015, p. 6). The research suggests that males are more inclined to self-harm activities in adolescent years.
Psychiatric and physiological factors, among others, contribute to the prevalence of self-harm in children and young people. In particular, depression, anxiety, eating disorders, and attention deficit are often associated with self-harm. Currently, no detailed research with a significant number of subjects would suggest an effective intervention directed at solving the problem (Hawton et al., 2015). Thus, self-cutting is associated with a variety of physiatrists and physiological conditions. Females after the age of 15 may cease to participate in the behavior.
References
Argyelan, M., Ikuta, T., DeRosse, P., Braga, R. J., Burdick, K. E., John, M., … Szeszko, P. R. (2014). Resting-state fMRI connectivity impairment in schizophrenia and bipolar disorder. Schizophrenia Bulletin, 40(1), 100-110. Web.
Hawton, K., Witt, K. G., Salisbury, T. L., Arensman, E., Gunnell, D., Townsend, E., … Hazell, P. (2015). Interventions for self-harm in children and adolescents. Cochrane Database of Systematic Reviews, 12, 1-105. Web.
Stevens, J. R., Prince, J.B., Prager, L.M., Stern, T. A. (2014). Psychotic disorders in children and adolescents: A primer on contemporary evaluation and management. The Primary Care Companion for CNS Disorders, 16(2), 1-99. Web.