Bipolar Disorder in Adults

Abstract

Bipolar disorder (BD) is one type of mood disorder recognized by the DSM-IV. There are three divisions of BD: bipolar I, bipolar II, and cyclothymia (also bipolar disorder not otherwise specified- rapid cycling bipolar disorder). BD is characterized by periods of mania with interruptions of depression. The different types of BD are characterized by different severities of depression and mania. BD is caused by a combination of factors including genetic factors, neurological factors, and environmental factors. BD effects 1 percent of the population (age 18 and over) in a given year. Typically the onset of BD is between late adolescence and early adulthood, though it often takes five years or more for a patient to get diagnosed. BD can develop during childhood and early adolescence, but it is rare. BD is equally prevalent in males and females excluding patients with rapid cycling BD. African Americans, compared to whites, are under diagnosed with BD; they often get diagnosed with schizophrenia instead. The outcomes of BD are suicide, disability, and long-term treatment. Treatments include mood stabilizers such as lithium, atypical antipsychotics such as Clazapine and benzodiazepines such as clonazepam.

Bipolar Disorder in Adults

Bipolar is a severe and recurrent condition that affects nearly 2 percent of the adult population in the United States (Sajatovic, Davies, & Hrouda, 2004). The World Health Organization defines it as one of the leading causes of disability throughout the world. It's known as a manic-depressive illness, a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. According to Thase (2005), depression is the most important facet of the illness. The classic form of the illness is called bipolar I, which involves recurrent episodes of mania and depression. According to NIMH, some people never develop severe mania but instead experience milder episodes of hypomania that alternate with depression, this is known as bipolar II.

On average, the onset of bipolar disorder is in late adolescence or early adulthood (NIMH, 2001), usually between the ages of 15 and 24 years (Muller-Oerlinghausen, et al., 2002). It usually takes between 5 and 10 years before treatment is obtained for bipolar disorder due to the fact that 50 percent of bipolar patients do not get diagnosed for at least five years (Muller-Oerlinghausen, et al.). Occasionally bipolar disorder can develop in early childhood or late adulthood (NIMH, 2001), but if the symptoms develop after the age of 60, the primary cause of the disorder is probably dues to medical issues (e.g., neoplasm, multiple sclerosis (neurological), Cushing's disease (endocrine) or systemic lupus erythematosus (inflammatory), among others) (Muller-Oerlinghausen, et al.).

Bipolar disorder occurs equally in males and females with the exception of rapid cycling bipolar disorder, which affects more women than men (rapid cycling occurs in 10-15 percent of patients with bipolar) (Muller-Oerlinghausen, et al., 2002). Bipolar disorder is more prevalent in people who are creative, have high intelligence, and are of upper socioeconomic status (Sherman, 2001; see also Muller-Oerlinghausen, et al.). Bipolar disorder is typically misdiagnosed in ethnic minorities. Kilbourne, Haas, Mulsant, Bauer, and Pincus (2004) report that African Americans are likely to receive a misdiagnosis of bipolar disorder; they are often diagnosed instead with schizophrenia. Lewinsohn, Klein, and Seeley (2000) found in their study that bipolar disorder had a lifetime prevalence of 1 percent in adolescence and 2 percent in young adulthood.

According to the National Institute of Mental Health (2001), there is no single, proven cause of bipolar disorder, but research strongly suggests that it is often an inherited problem related to a lack of stability in the transmission of nerve impulses in the brain. This instability of nerve transmissions causes people with bipolar disorder to be more vulnerable to emotional and physical stress. No single gene is the sole culprit that causes bipolar disorder.

Research that has been done on families and twins has shown a correlation between bipolar disorder and genetic factors (Muller-Oerlinghausen, et al., 2002). The National Institute of Mental Health (2001; see also Muller-Oerlinghausen, et al.) reports that studies done on identical twins demonstrate that bipolar is caused not only by genes, but by other factors as well. Genes may not have a large effect on the development of bipolar disorder because of the extensive variation of phenotypes in people with the disorder, suggesting that factors from a patient's environment and development may contribute to the development of bipolar disorder (Muller-Oerlinghausen, et al.). Studies show that the identical twin of someone who has bipolar disorder will not necessarily develop the disorder (NIMH). This finding demonstrates that genes are not the only cause of bipolar disorder (NIMH). If the etiology of bipolar disorder was purely genes the identical twin of the person who has the disorder would always develop bipolar (NIMH). On the other hand, research has shown that if one twin has bipolar disorder, the other twin has a better chance of developing the disorder than one of their other siblings (NIMH). Furthermore, even though research is fairly new, scientists believe that the inheritance of bipolar disorder is from a contribution of several genes and goes against Gregor Mendel's theory of genetics (Muller-Oerlinghausen, et al.).

Bipolar disorder is inherited because of a genetic vulnerability, which is passed down through family. There is evidence that suggests that, in order to develop bipolar disorder, there needs to be a genetic predisposition and also a stressor in the patient's environment. Once a patient develops bipolar disorder, their symptoms will occur even without the original stressor (Fawcett, Golden, & Rosenfeld, 2000).

It is generally accepted by scientists that bipolar disorder is not caused by one factor alone; instead, they agree that it is caused by a combination of many factors (National Institute of Mental Health [NIMH], 2001). The leading theories about the cause of bipolar disorder are neurological dysfunction (pathophysiology), genetic factors, and environmental factors. The National Institute of Mental Health reported that one cause of bipolar disorder might be that a bipolar patient's brain is different than that of a healthy person.

There are two neurological theories that date back to the 1970s. The first