Psychological Disorder Analysis: A Case of Bipolar Disorder

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The questions which we should ask her to complete her profile and learn more about her illness, feelings and background are:

Are you often sad, down, blue, or teary?
Do you have interest in a hobby and look forward to enjoyable activities?
Are you able to have fun or joy?
Do you have friends?
Do you have a good relationship with your family?
Are you employed?
Tell me something about your childhood and past life.
Were you ever diagnosed with any physical ailments?
Were you ever hospitalized for any psychiatric reasons?
Are you taking any medication?
Are you married? If yes, do you have any children? If no, are you currently involved in a romantic relationship?

After enquiring her about her symptoms and feelings, her complete profile is as follows:

Marla is a 42-year-old Hispanic female who comes to the mental health clinic complaining of trouble sleeping, feeling “jumpy all of the time,” and an inability to concentrate. These symptoms are causing problems for her at work, where she is an accountant. She says that her symptoms started three weeks back when she became very sad as her company lost an important contract. She stopped talking to anyone and cried most of the time when she was alone. Then after a week she noticed that she could not concentrate on her work. She had racing thoughts in her mind and she kept on thinking about different files she reviewed in the past week. She felt that she has excessive energy and started reviewing ten files simultaneously but could not complete even a single one of them. Her friends also pointed out that she was talking excessively and disturbing them all the time.

According to Marla, she feels on top of the world currently and feels good about the energy she has. These days she has been out of the work most of the time and has been shopping excessively. She had similar episode a year back when she spent all her savings on the new car and house and went bankrupt. Those symptoms resolved in a week and she did not consult any doctor for that. Since then she occasionally has low mood and feelings of guilt and hopelessness and has never completely recovered. She has lost interest in her daily activities and does not enjoy life anymore. She has no hobbies and spends most of her free time thinking about her wrong deeds and gloomy future. This has also affected her personal relationships with her family and friends as she no longer spends time with them.

Her husband died 3 years back and since then she alone is taking care of her three children. There is no one else to support them. Her childhood and development was unremarkable. She has pleasant memories about her childhood but recalls that one of her uncles had similar symptoms and was a known case of mental illness but she is unaware of the diagnosis.

According to her, she feels there is something wrong in her attitude and behavior but she is not sure if she has a mental illness and whether it will improve with treatment or not.

Based on the symptoms, we can diagnose Marala with bipolar disorder. Bipolar disorder is characterized by episodes of mania and depression. It affects more than 1% of adult population of America (Faces of Abnormal Psychology Interactive). The patient suffering from bipolar disorder has extremes of mood swings.

The manic episode is characterized by elation or irritability, excessive activity and self-important ideas. The patients are easily distractible and leave their tasks incomplete. Their sleep is decreased and they are full of energy all the time and eat excessively at times. There is also pressure of speech and flight of ideas. Patients become extravagant and make reckless decisions. In severe cases, delusions (delusions of grandiosity, delusions of persecution, etc) and hallucinations may be present. Insight is usually absent.

The other extreme of bipolar disorder is depression. Depression is characterized by low mood, depressive thinking and physical or biological symptoms. Patients usually complain of low mood, frequent crying spells, lack of energy and loss of interest in daily activities. There is also lack of concentration in work and psychomotor retardation. Patients have pessimistic thinking about future and also have feelings of guilt, hopelessness and helplessness. The physical symptoms include sleep disturbance, loss of weight and appetite, constipation, loss of libido and amenorrhea. Depressed patients also have frequent suicidal ideations and many even attempt suicide. In severe depression, psychotic symptoms like delusions and hallucinations may be present.

According to DSM-IV criteria, the diagnosis of bipolar disorder can be made after a single episode of mania lasting for at least a week, causing social and functional impairment and the symptoms are not caused by any medical condition or substance induced disorder.

There is no single cause of bipolar disorders. It is interplay of various factors including genetic factors, personality, predisposing and precipitating environmental causes and physical factors.

Nowadays, several models are used for explanation and treatment of abnormal thinking and functioning. These include biological model (physical processes like neuroanatomy and neurotransmitters affect behavior), psychodynamic model (repressed emotions and past experiences lead to abnormal behavior), behavioral model (outside behavior and reactions are responsible for abnormal behavior), cognitive model (emphasizes on the way of thinking which leads to abnormal behavior), human-existential model (choices and values play a role in human behavior) and socio-cultural model (society and culture affect human behavior).

Biological model of abnormality

This is a dominant model in our society today. It takes a medical perspective and is based on the assumption that abnormal behavior and functioning is an illness which has biological causes and is brought about by malfunctioning of parts of the human body, especially brain (Comer, 2005). In other words, behavior becomes abnormal because something has gone wrong with the brain.

Brain is made up of billions of neurons and glial cells and they maintain different body functions. Abnormalities of these brain cells in different parts of the brain can lead to various abnormalities. For e.g. loss of neurons in the basal ganglia can lead to Huntington’s disease (abnormal body movements, thinking and behavior).

Similarly, there are numerous neurotransmitters in the brain which are responsible for transmission of impulses from one neuron to another. Neurons in different areas of brain have specific neurotransmitters. Therefore, lack of different neurotransmitters affects different areas of brain and leads to distinct abnormalities. Dopaminergic hyperactivity leads to schizophrenia whereas decreased levels of GABA have been associated with anxiety disorders. Decreased activity of both serotonin and norepinephrine plays a causative role in depression. Neuronal activity is also controlled by hormonal levels in the body. For e.g. high cortisol levels can cause anxiety, bipolar disorders and schizophrenia.

Many familial and twin studies have shown that individuals have a genetic predisposition for mental disorders like schizophrenia, bipolar disorder, anxiety disorder, etc. These mental disorders usually run in families but specific genes for these disorders have not yet been identified.

It has also been postulated that viral infections can cause abnormalities in brain structure and function which leads to abnormal behavior and functioning. It has been found that many mothers of schizophrenic children had a history of viral infection during their pregnancy. Viral agents responsible for causing anxiety and mood disorders have not been found but the research is ongoing.

Based on the biological model, different treatment modalities have been used for abnormal behavior and functioning. These include pharmacotherapy, electroconvulsive therapy (ECT) and psychosurgery (Comer, 2005). The drugs used for treatment usually maintain the balance of neurotransmitters. Antidepressants include selective serotonin reuptake inhibitors (SSRI’s), mono-amine oxidase inhibitors (MAOI’s) and tricyclic antidepressants (TCA’s). These antidepressants maintain adequate levels of serotonin and norepinephrine in the synaptic terminals. Mood stabilizers like lithium, valproic acid and carbamezapine are used for treatment of mania or bipolar disorder. The exact mechanism of action of these drugs by which they control mania is unknown. Anxiolytics like benzodiazepines are used in the treatment of different anxiety disorders.

ECT is mainly used as treatment of depression. During ECT, a current is passed through the electrodes and seizure activity is generated in the brain. After a few cycles of ECT, symptoms of patients get better.

Psychosurgery is mostly used as an experimental modality these days and involves brain surgery where connections between different parts of the brain are cut to improve abnormal behavior. This is only considered in cases which are refractory to treatment.

In a nutshell, according to the biological theory, bipolar disorder is a multifactorial disease involving genetic predisposition, disturbance in neurotransmitters and structural defects in the brain. This disease runs in families and monozygotic twins have a higher risk of developing bipolar disorder as compared to dizygotic twins. Mood stabilizers like lithium are the most effective treatment modalities available.

References

Comer. (2005). Fundamentals of abnormal psychology. New York: Worth.

Faces of Abnormal Psychology Interactive. (n.d.). Web.

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Psychological Disorder Analysis: A Case of Bipolar Disorder

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