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Bipolar disorder

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Overview of bipolar disorder

Bipolar disorder, also known as bipolar affective disorder or manic-depressive illness, is a chronic, recurrent illness associated with tremendous societal costs: increased healthcare costs, loss of productivity, lower quality of life and suicide.1,2

It is a category of mood disorders and is the most common severe persistent illness.

This condition is characterized by:

  • Periods of deep, prolonged and profound depression.
  • Mania (medical condition characterized by extremely elevated mood, energy and unusual thought patterns).

These episodes of depression and mania are separated by normal mood. In some persons, a condition called rapid cycling occurs, where depression and mania rapidly alternate (more than four episodes of mood swings in a year).

Manic-depressive illness was coined by Emil Kraepelin a German scientist  in the late 19th century (1856–1926).3 Distress, disruption, and high suicidal rate are associated with this condition.4

Bipolar disorder is classified into the following types:

1. Bipolar I: This is known as classic manic-depression and is characterized by depression alternating with episodes of mania, leading to severe impairment of function.

2. Bipolar II: This is a milder disorder consisting of depression alternating with periods of hypomania. Hypomania is a less severe form of mania that does not lead to major impairment of function.

3. Cyclothymic disorder: This condition is characterized by oscillating moods.

Occurence of bipolar disorder in different groups

This disorder affects all age groups and is prevalent in about 1% of the population.5 Studies reveal that prevalence is highest in the age group of 18–24 years. The incidence of bipolar disorder is seen to be high in first-degree relatives of persons with this disorder. A study revealed a 13% risk of bipolar disorder among offspring of persons with the disorder.6

Even children can be affected by this disorder. In children, this condition is referred to as pediatric bipolar disorder. For many, the first symptoms are seen in their early twenties. The behavioral pattern of this disorder is different in teens and children. This condition also affects late life and needs to be elucidated.

Signs and Symptoms of bipolar disorder

A person with bipolar disorder shows episodes or severe mood swings of mania and depression. The intensity of bipolar symptoms varies from mild-to-severe.

Signs and symptoms of maniac phase of bipolar disorder include:

  • Racing speech and thoughts
  • High energy
  • Decreased need for sleep
  • Elevated mood and exaggerated optimism
  • Increased physical and mental activity
  • Excessive irritability, aggressive behavior and impatience
  • Poor judgment
  • Reckless behavior, like excessive spending, making rash decisions and erratic driving
  • Difficulty concentrating
  • Inflated sense of self-importance
  • Drug abuse

Signs and symptoms of depressive phase include:

  • Sadness
  • Hopelessness
  • Suicidal thoughts or behavior
  • Anxiety
  • Guilt
  • Sleep problems
  • Appetite problems
  • Fatigue
  • Loss of interest in daily activities
  • Problems concentrating
  • Irritability
  • Chronic pain without a known cause

Causes of bipolar disorder

Bipolar disorder has a number of causes contributing to it.

Some of them are as follows:

Genetics

Bipolar disorder has a major genetic component. Evidences show that first-degree relatives of people with bipolar disorder are more likely to suffer from this illness. Offspring of a parent with bipolar disorder have a 50% chance developing this illness. A genome-wide study found that 10 genes of small effect was associated with bipolar disorder.7

A recent study by Tsuang et al. indicated a genetic link between schizophrenia and bipolar disorder.8

Biochemical

Abnormalities in biochemical pathways contribute to this condition. Blood pressure reducing drugs like reserpine decrease the production of catecholamine (a group of amines that have important physiological effects as neurotransmitters and hormones, and include epinephrine, norepinephrine and dopamine) from nerve terminals causing both mania and depression.

Drugs like cocaine act on neurotransmitter system causing mania. Hormonal imbalance and response to stress also contributes to this illness. Tricyclic antidepressants can trigger mania.9

Environmental

Environmental factors may play a role in bipolar disorder. Death in the family, separation of parents, changes during puberty, external stressors due to nature of work are some of the factors contributing to it.

Diagnosis of bipolar disorder

Bipolar disorder is difficult to detect. For some people, it may take 10 years or more to be diagnosed because of its dual nature. Bipolar disorder shares many signs and symptoms of other psychiatric illnesses such as anxiety disorders and schizophrenia, thereby complicating the diagnosis.

There are no laboratory tests to detect this disorder. However, an assessment is done, which involves gathering information about the patient’s history and a thorough physical examination is conducted to exclude the presence of any medical illness.

A questionnaire is conducted called Mood Disorder Questionnaire or MDQ. This MDQ is a checklist that helps a doctor to identify bipolar related symptoms.10

Diagnosis of bipolar disorder involves the following:

Psychiatric History

Details of the current and past symptoms of the patient and of immediate family members and relatives should be evaluated. Bipolar disorder is derived from a combination of genetic factors and life experiences. Therefore, it is easy to rule out, if there is a family history of depression or bipolar disorder.

Complete Medical History and Physical Exam

This is conducted to rule out any form of physical illnesses that may be producing or mimicking the symptoms of bipolar disorder. AIDS, a brain tumor or head injury, diabetes, epilepsy, lupus, multiple sclerosis, a salt imbalance or thyroid disorder can produce bipolar-like symptoms.

It is also important to know whether the patient suffers from mania or hypomania. When only symptoms of depression are present, it is known as unipolar depression. Many people with bipolar disorder do not know that they are suffering from it. Some do not get treated because they are ashamed of what they feel, while others are incorrectly diagnosed with other illnesses, such as depression, anxiety or schizophrenia. Without appropriate treatment, the disorder could become more difficult to treat.

Category-Based Diagnosis

Bipolar I:  In this condition, the patient shows mixed episodes of depression and mania.

Bipolar II: In this condition, the patient shows hypomanic episodes and at least one major depressive episode.

Cyclothymia:  This involves the presence or history of hypomanic episodes intermingled with depression episodes.

Treatment of bipolar disorder

Treatment can stabilize a person’s moods and helps the person to manage and control symptoms, as there is no cure for bipolar disorder. Treatment varies from person to person. Following are the various therapeutic options.

Treatment of bipolar disorder

Prevention of bipolar disorder

Bipolar disorder cannot be prevented but can be controlled with proper medication. Medication should be taken for life.

Following are some guidelines to prevent depressive or manic mood episodes.

  • Eating a balanced diet
  • Exercising
  • Avoiding excessive travel
  • Maintaining approximately equal hours of sleep
  • Avoiding alcohol and illegal drugs
  • Reducing stress at work and home

Living with bipolar disorder

Living with bipolar disorder is like living with any other chronic medical condition like diabetes and hypertension. It can be kept under control with proper medications, education and support from family and friends. Working closely with experts and taking guidance also helps.

References

1.Goodwin FK. Rationale for long-term treatment of bipolar disorder and evidence for long-term lithium treatment. J Clin Psychiatry. 2002: 63(Suppl 10): 5–12.

2.Calabrese JR, Shelton MD. Long term treatment of bipolar disorder with lamotrigine. J Clin Psychiatry. 2002: 63(Suppl 10): 18–22.

3.Available at : http://www.kraepelin.org/. Accessed on: 24 March, 2008

4.Osby U, Brandt L, Correia N. Excess mortality in bipolar and unipolar disorder in Sweden. Arch GenPsychiatr. 2001; 58 (9): 844–850.

5.Soldani, Sullivan PF, Pedersen NL, et al. Mania in the Swedish Twin Registry: Criterion validity and prevalence. Aus NZ Psychiatr. 2005; 39(4): 235–243. 

6.Griswold KS, Pessar LF. Management of bipolar disorder. Am Assoc Fam Phy. 2000; 62(6) : 1343–1358.

7.Baum AE, Akula N, Cabanero M, et al. A genome-wide association study implicates diacylglycerol kinase eta (DGKH) and several other genes in the etiology of bipolar disorder. Mol Psychiatry. 2007.

8.Tsuang MT, Taylor L, Faraone SV. An overview of the genetics of psychotic mood disorders. J Psychiatr Res. 2004; 38(1): 3–15.

9.Lepping P, Menkes DB. Abuse of dosulepin to induce mania. Addiction. 2007; 102(7): 1166–1167.

10.Hirschfeld R, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: The mood disorder questionnaire. Am J Psychiatr. 2000; 157: 1873–1875.

Written by: healthplus24.com team

Date last updated: December 24, 2014