Bipolar Disorder

The phenomenon of bipolar affective disorder has been a mystery since the 16th century. Bipolar disorder or as the alternate names, manic depressive illness or affective bipolar disorder can be classified as a mood disorder characterized by mood swings from manis (exaggerated feeing of well-being) to depression. History has shown that this affliction can appear in almost anyone. Even the great painter Vincent Van Gogh is believed to have had bipolar disorder. It is clear that in our society many people live with bipolar disorder; however, despite the abundance of people suffering from the it, we are still waiting for definite explanations for the causes and cure. The one fact of which we are painfully aware is that bipolar disorder severely undermines its' victims ability to obtain and maintain social and occupational success. It is also believed that the lithium level is what causes these mood swings. Because bipolar disorder has such debilitating symptoms, it is imperative that we remain vigilant in the quest for explanations of its causes and treatment. A smorgasborg of symptoms that can be broken into manic and depressive episodes characterized by affective disorders.

The depressive episodes are characterized by intense feelings of sadness and despair that can become feelings of hopelessness and helplessness. Either the manic or the depressive episodes can predominate and produce few mood swings or the patters of mood swings my be cyclic. Some of the symptoms of a depressive episode include anhedonia, disturbances in sleep and appetite, psycomoter retardation, loss of energy, feelings of worthlessness, guilt, difficulty thinking, indecision, and recurrent thoughts of death and suicide (Hollandsworth, Jr. 1990 ). Some of the other symptoms that may occur in the depressive stage can be also fatigue that can last anywhere from weeks to months and a person may not be aware of why this is actually happening. Daytime sleepiness can also occur making it hard for a person with this illness to hold down any sort of a job for a length of time. Unintentional weightloss can make the doctor go in a different direction in this making it difficult for them in diagnosis because of all the possible symptoms that a person may exhibit. A person may also have some memory loss episodes or episodes of amnesia, going blank for a periods of time. They may not even be aware that they have a family to take care of their jobs.

The manic episodes are characterized by elevated or irratable mood, increased energy, decreased need for sleep, poor judgment and insight, and often reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). When a person is in the manic statge they may become agitated which makes them more talkative than usual or they feel pressured to keep talking, they also may wring their hands or fidget because they feel unsure of the situation that they are in and seem to have just extreme restlessness to them. They might appear to have put on quite a bit of weight and anger extremely easy.

Their erratic behavior can make it hard for their families to be around them. Eventually pushing their families aside and the diagnosis is harder to get because of the lack of support from others and their behavior is often so off. In this stage the sexual activity can be increased dramatically, making the patient seek other people to be with if they are not fulfilled in their relationship at home. This can lead to the disruption of the family unit. This disease is very serious and can affect anyone.

Bipolar disorder affects approximately one percent of the population (approximately three million people) in the United States. Bipolar Disorder can affect both males and females and involves episodes of mania and depression.. Bipolar disorder is diagnosed if an episode of mania occurs whether depression has been diagnosed or not (Goodwin, Guze, 1989, p 11). Individuals with manic episodes most commonly experience a period of depression. The rarest symptoms were periods of loss of all interest and retardation or agitation (Weisman, 1991). As the National Depressive and Manic Depressive Association (MDMDA) has demonstrated, bipolar disorder can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters,loss of jobs and millions of dollars in cost in society.As the patient ages or get older they report that the depressions are longer and increase in frequency. Many times bipolar states and psychotic states are misdiagnosed as schizophrenia. Especially if the family history exhibits schizophrenia or some other illness. Bipolar is most distinguished with families that have mental illness in their background and can occur most often in those settings than in any other, although it can affect anyone. Speech patterns help distinguish between the two disorders (Lish, 1994). The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years of age, with a second peak in the mid-forties for women. A typical bipolar patient may experience eight to ten episodes in their bipolar Disorder 3 lifetime. However, those who have rapid cycling may experience more episodes of mania and depression that succeed each other without a period of remission (DSM III-R). Rapid cycling means that their mood changes several times a day.

The three stages of mania begin with hypomania, in which patients report that they are energetic, extroverted and assertive (Hirschfeld,1995). The hypomania state has led observers to feel that bipolar patients are "addicted" to their mania. Hypomania progresses into mania and the transition is marked by loss of judgment (Hirschfeld, 1995).Often, euphoric grandiose characteristics are displayed, and paranoid or irritable characteristics begin to manifest. The third stage of mania is evident when the patient experiences delusions with often paranoid themes. Speech is generally rapid and hyperactive behavior manifests sometimes associated with violence (Hirschfeld, 1995).

When both manic and depressive symptoms occur at the same time it is called a mixed episode. Those afflicted are a special risk because there is a combination of hopelessness, agitation, and anxiety that makes them feel like they "could jump out of their skin"(Hirschfeld, 1995). Up to 50% of all patients with mania have a mixture of depressed moods. Patients report feeling dysphoric, depressed, and unhappy; yet, they exhibit the energy associated with mania. Rapid cycling mania is another presentation of bipolar disorder. Mania may be present with four or more distinct episodes within a 12 month period. There is now evidence to suggest that sometimes rapid cycling may be a transient manifestation of the bipolar disorder. This form of the disease exhibits more episodes of mania and depression than bipolar.

Lithium