Bipolar Disorder

Abstract

Bipolar disorder is a brain disorder that causes unusual shifts in a person's mood, energy and ability to function. It is also known as manic-depressive illness. The symptoms of bipolar disorder are severe and very different from the normal ups and downs that everyone goes through. It is the third most common mood disorder after major depression and dysthymic disorder. It affects about 1% of adults during their lifetime. The symptoms of bipolar disorder typically begin during adolescence or early adulthood, continuing to recur throughout life. Men and women are equally likely to develop this disabling illness. The consequences of the illness can be devastating, including marital break-ups, unemployment, alcohol and drug abuse. Bipolar illness is often complicated by co-occurring alcohol or substance abuse. Without effective treatment, bipolar illness leads to suicide in nearly twenty percent of cases. There are effective treatments available that greatly reduce the suffering caused by bipolar disorder, and can usually prevent its devastating complications. Unfortunately, bipolar disorder is often not recognized by the patient, relatives, friends, or even physicians. This causes people with bipolar disorder to suffer needlessly without proper treatment, for years or even decades. In addition, many patients do not respond to at least one drug, and many show no response to several. This means that combination treatment is often the rule. A combination of different drugs with different methods of action can be more effective without increasing the risk of side effects. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life. When treated properly, people with this illness can lead full and productive lives.

There are several causes as to why a person has bipolar disorder. In many cases, it is believed to be inherited, and tends to run in families (Cilag, 2005). More than two-thirds of people with manic-depressive illness have at least one close relative with the disorder, or with major depression (Cilag, 2005). Genetic factors are important, and it is likely that susceptibility to the illness is related to several genes (Cilag, 2005). "However, the specific genes involved have not yet been conclusively identified" (Cilag, 2005). "Once this is achieved it is hoped that it will be possible to better treatments and prevention strategies aimed at the underlying illness process" (Cilag, 2005).

"It may be that the development of bipolar disorder is due to a process of sensitisation (kindling)" (Cilag, 2005). This idea suggests that the first episodes of illness are triggered by stressful life events, but that each episode of illness causes changes in the brain which making the next episode more likely, and eventually episodes will occur spontaneously (Cilag, 2005). "This process was first describes as an explanation for epilepsy, and may explain why certain antiepileptic drugs are also effective in the treatment of bipolar disorder" (Cilag, 2005).

Another explanation for this illness involves neurotransmitters. They are the molecules that enable the transmission of nerve impulses from one nerve to the next. It is thought that faulty nerve transmission may be one cause of bipolar disorder, it is possible that these molecules are involved (Cilag, 2005). Examples include dopamine, serotonin (5-HT; 5-hydroxytryptamine), acetylcholine, GABA and glutamate (Cilag, 2005).

Bipolar disorder causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between (Cilag, 2005). Severe changes in energy and behavior go along with these changes in mood. These periods of "highs" and "lows" are called episodes of mania and depression (Cilag, 2005).

Signs and symptoms of mania (or a manic episode) may include increased energy, activity, and restlessness, excessively "high", overly good, euphoric mood, extreme irritability, racing thoughts and talking very fast, jumping from one idea to another, distractibility, unable to concentrate well, little sleep is needed, unrealistic beliefs in one's abilities and powers, poor judgement, spending sprees, a lasting period of behavior that is different from the usual, abuse of drugs, particularly cocaine, alcohol, and sleeping medications, provocative, intrusive, or aggressive behavior, and denial that anything is wrong (Goodwin, 2006). A manic episode is diagnosed when elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer (Goodwin, 2006). If the mood is irritable, four additional symptoms must be present (Goodwin, 2006).

Signs and symptoms of depression (or a depressive episode) include lasting sad, anxious, or empty mood, feelings of hopelessness or pessimism, feelings of guilt, worthlessness, or helplessness, loss interest or pleasure in activities once enjoyed, including sex, decreased energy, a feeling of fatigue or being "slowed down", difficulty concentrating, remembering, making decisions, restlessness or irritability, sleeping too much, or inability to sleep, change in appetite and/or unintended weight loss or gain, chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury, thoughts of death or suicide, or suicide attempts (Goodwin, 2006). A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer (Goodwin, 2006).

Hypomania is a mild to moderate level of mania (Goodwin, 2006). It may feel good to the person who experiences it and quite often is associated with good functioning and enhanced productivity. Family and friends may learn to recognize the mood swings as possible bipolar disorder; however, the person may deny that anything is wrong. Untreated, or without proper treatment, hypomania can become severe mania in some people or it can revert into depression (Goodwin, 2006). .

In some cases, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms) (Goodwin, 2006). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts) (Goodwin, 2006). The psychotic symptoms in bipolar disorder have the tendency to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is president or has special powers, may occur during