Bi polar

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bi polar

Bipolar Disorder 1
Bipolar Disorder

The event of bipolar disorder has been a mystery since the 16th century. Records have
shown that this problem can appear in almost anyone. It is clear that in our social world
many people live with bipolar disorder. Regardless of the number of people suffering from
the disease, we are still waiting for an explanation regarding the causes and cure. One
fact of which we are aware, is that bipolar disorder severely undermines its' victims
ability to obtain and maintain social and occupational success. Bipolar disorder has such
devastating symptoms, that it is important we remain determined in searching for
explanations of its causes and treatment.

Bipolar disorder affects approximately one percent of the population in the United States.
Bipolar disorder involves feelings of mania and depression. Which is where individuals
with manic episodes experience a period of depression. The depression episodes are
characterized by a persistent sadness, almost inability to move, hopelessness, and
disturbances in appetite, sleep, in concentration, and driving. The manic episodes are
characterized by elevated or irritable mood, increased energy, decreased need for sleep,
poor judgment and insight, and often reckless or irresponsible behavior (Hollandsworth,
Jr. 1990 ). As the National Depressive and Manic Depressive Association (MDMDA) have
demonstrated, bipolar disorder can create substantial developmental delays, marital and
family disruptions, occupational setbacks, and financial disasters. In addition, bipolar
states and psychotic states are misdiagnosed as schizophrenia, but a closer look at speech
patterns can help distinguish between the two (Lish, 1994).

The beginning of Bipolar disorder usually occurs between the ages of 20 and 30. A typical
bipolar patient may experience eight to ten episodes in their lifetime. However, those who
have larger cases may experience more episodes of mania and depression closer and more
frequent, without a period of remission (DSM III-R). The three stages of mania begin with
hypomania, in which patients report that they are energetic, extroverted and assertive
(Hirschfeld, 1995). Hypomania then progresses into mania and the transition is marked by
loss of judgment (Hirschfeld, 1995). Lastly, the third stage of

Bipolar Disorder 2

mania is evident when the patient experiences delusions with often-paranoid themes. Speech
is generally rapid and hyperactive behavior is apparent, and 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 at 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 unhappy; yet, they exhibit the energy associated
with mania. Rapid cycling mania is also a presentation of bipolar disorder. Mania may be
present with four or more distinct episodes within a 12-month period. However, there is
now evidence to suggest that sometimes rapid cycling may be a brief demonstration of the
bipolar disorder. This form of the disease exhibits more episodes of mania and depression
than bipolar.

There are medications that can be prescribed, that can help control the disease, and let
people affected lead normal lives. Lithium has been the primary treatment of bipolar
disorder since its introduction in the 1960's. Its main function is to stabilize the
cycling characteristic of bipolar disorder. In four controlled studies by F. K. Goodwin
and K. R. Jamison, the overall response rate for bipolar subjects treated with Lithium was
78% (1990). Lithium is also the primary drug used for long- term maintenance of bipolar
disorder. In a majority of bipolar patients, it lessens the duration, frequency, and
severity of the episodes of both mania and depression. Unfortunately, as many as 40% of
bipolar patients are either unresponsive to lithium or cannot tolerate the side effects.
Some of the side effects include thirst, weight gain, nausea, diarrhea, and edema.
Patients who are unresponsive to lithium treatment are often those who experience
dysphoric mania, mixed states, or rapid cycling bipolar disorder.

Another problem associated with lithium is the fact the long-term lithium treatment has
been associated with decreased thyroid functioning in patients with bipolar disorder.
Preliminary evidence also suggest that hypothyroidism may actually lead to rapid cycling
(Bauer et al., 1990). Pregnant women experience another problem associated with the

Bipolar Disorder 3

use of lithium. Its use during pregnancy has been associated with birth defects,
particularly Ebstein's anomaly. Based on current data, the risk of a child with Ebstein's
anomaly being born to a mother who took lithium during her first trimester of pregnancy is
approximately 1 in 8,000, or 2.5 times that of the general population (Jacobson et al.,
1992).

There are other effective treatments for bipolar disorder that are used in cases where he
patients cannot tolerate lithium or have been unresponsive to it in the past. The American
Psychiatric Association's guidelines suggest the next line of treatment to be
Anticonvulsant drugs such as valproate and carbamazepine. These drugs are useful a
antimanic agents, especially in those patients with mixed states. Both of these
medications can be used in combination with lithium or in combination with each other.
Valproate is especially helpful for patients who are lithium noncompliant, experience
rapid cycling, or have comorbid alcohol or drug abuse.

Neuroleptics such as haloperidol or chlorpromazine have also been used to help stabilize
manic patients who are highly agitated or psychotic. Use of these drugs is often necessary
because the response to them is rapid, but there are risks involved in their use. Because
of the often-severe side effects, Benzodiazepines are often used in their place.
Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms of
rapid control of agitation and excitement, without the severe side effects.

Antidepressants such as the selective serotonin reuptake inhibitors (SSRI's) fluovamine
and amitriptyline have also been used by some doctors; as treatment for bipolar disorder.
A double-blind study by M. Gasperini, F. Gatti, L. Bellini, R.Anniverno, and E. Smeraldi
showed that fluvoxamine and amitriptyline are highly effective treatments for bipolar
patients experiencing depressive episodes (1992). This study is controversial however,
because conflicting research shows that SSRI's and other antidepressants can actually
precipitate manic episodes. Most doctors can see the usefulness of antidepressants when
used in conjunction with mood stabilizing medications such as lithium.


Bipolar Disorder 4

In addition to the mentioned medical treatments of bipolar disorder, there are several
other options available to bipolar patients. One study compared the response to light
therapy of bipolar patients with that of unipolar patients. Patients were free of
psychotropic and hypnotic medications for at least one month before treatment. Bipolar
patients in this study showed an average of 90.3% improvement in their depressive
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