Bipolar Disorder

 

Bipolar Disorder

 

Introduction

Bipolar disorder causes shifts in a person’s mood, energy, and ability to function. The symptoms of this disorder have the potential to damage relationships. This paper analyzes the case of Scott, a patient diagnosed with bipolar disorder. This paper presents an intensive investigation of bipolar disorder, its phases, signs and symptoms, diagnosis, treatments and medications.

 

Bipolar Disorder

Bipolar disorder is also known as manic-depressive disorder. This disorder is frequently marked by periods of inconsolable sadness and despair (major depression) alternating or intermixed with periods of extreme cheerfulness, energy, extravagance, and talkativeness that may suddenly turn into rage and hostility (mania). Usually the presence of one of the moods is followed by a period of the opposite mood ( 2000). Bipolar disorder, also commonly known as manic depression, is a brain disorder that causes shifts in a person’s mood, energy, and ability to function. The symptoms of bipolar disorder can result in damaged relationships, difficulty in working or going to school, and even suicide. Bipolar disorder can cause dramatic mood swings – from high and feeling on top of the world, or uncomfortably irritable, to sad and hopeless, often with periods of normal moods in between. The periods of highs and lows are called episodes of mania and depression.

 

Signs and Symptoms

Mania (Manic Episode)

• Increased energy, activity, and restlessness


• Excessive ‘high’, overly good, euphoric mood


• Extreme irritability


• Racing thought and talking very fast, jumping from one idea to another


• Distractibility


• Little sleep needed


• Unrealistic beliefs in one’s abilities and powers


• Poor judgment


• Spending sprees


• A lasting period of behavior that is different from usual


• Increased sexual drive


• Abuse of drugs


• Provocative, intrusive, or aggressive behavior ( 2007)

Depression (Depressive Episode)

• Lasting sad, anxious, or empty mood


• Feelings of hopelessness or pessimism


• Feelings of guilt, worthlessness, or helplessness


• Loss of interest or pleasure in activities once enjoyed, including sex


• Decreased energy, a feeling of fatigue or of being ‘slowed down’


• Difficulty concentrating, remembering, making decisions


• Restlessness or irritability


• Sleeping too much, or lack of 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


• Thought of death or suicide, or suicide attempts (National Institute of Mental Health, 2007)

 

Bipolar Disorder I

Bipolar disorder I is characterized by at least one manic episode, with or without major depressions (). People with bipolar episode type I experience at least one episode of mania – that is, an episode during which their mood ranges unpredictably from euphoric to irritable and is accompanied by hyperactivity, lack of need for sleep, impulsiveness, rapid thoughts and speech, poor follow through in tasks, poor judgment in business and personal arenas, poor insight (self-awareness of changes in attitude and behavior), delusions of wealth or power or victimization by conspiracies, and often, but not always, auditory hallucinations (2000). Patients with bipolar I disorder have had at least one episode of mania. Some patients have had previous depressive episodes, and most patients will have subsequent episodes that can be either manic or depressive. Hypomanic and mixed episodes can occur, as well as significant subthreshold mood lability between episodes ()

 

Bipolar Disorder II and Hypomania

Bipolar disorder II is characterized by at least one episode of hypomania and at least one episode of major depression (). People with bipolar II disorder show a similar pattern of a recurrent depression punctuated by occasional mood elevations, except that the mood elevation is milder and is described as hypomania. Individuals with hypomania tend to experience episodically expansive but controllable ‘highs’ and increased productivity while retaining reasonable insight and judgment. These ‘little highs’ may last only a few hours before a mood swing occurs and increasingly severe depressive symptoms set in (2000). Patients meeting criteria for bipolar II disorder have a history of major depressive episodes and hypomanic episodes only (). Hypomania is a mild to moderate level of mania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression (2007).

 

 

 

Cyclothymic Bipolar Disorder

Cyclothymic disorder may be diagnosed in those patients who have never experienced a manic, mixed, or major depressive episode but who experience numerous periods of depressive symptoms and numerous periods of hypomanic symptoms for at least 2 years, with no symptom-free period greater than 2 months (). While cyclothymic disorder is not as severe as either bipolar disorder II or I, the condition is more chronic. Hypomanic symptoms tend toward irritability as compared to the euphoric symptoms of bipolar II. The disorder lasts at least two years, with single episodes persisting for more than two months.

 

Scott’s Case

Scott is a 26-year old patient diagnosed with Bipolar Disorder – predominantly having manic phases 2 years ago. He is a plumber by trade and has been working full time for the last six months. He was admitted in the last 24 hours to an acute mental health inpatient unit. He reported that signs and symptoms such as little sleep, lack of appetite, and weight loss. In addition, he also exhibits grandiose or unrealistic beliefs on his abilities. His friend reveals that Scott has a tendency to be distracted owing to the fact that he was unable to complete a single job in two weeks despite commencing many. Other symptoms that Scott present are rapid speech and flight of ideas. Scott refuses to be hospitalized therefore he has a great tendency run away from the unit.

Studying the signs and symptoms that Scott exhibits, his medical records, and the supporting evidence/statements presented by his family and friends reveal that Scott’s condition is Bipolar I Disorder characterized by manic episode accompanied by lack of need for sleep, rapid thoughts and speech, poor follow through in tasks, poor judgment, grandiose and denial. These symptoms of mania are accompanied by Hypomania. With Hypomania the symptoms of mania are milder and of shorter duration (but they last at least four days). They do not affect social or work life as dramatically.

 

Goals of Scott’s Care and Treatment

Bipolar disorder is a recurrent disease. However, its course is unpredictable. The major goals of treatment are the following:

• To treat and reduce the severity of acute episodes of mania when they occur.


• To reduce the frequency of episodes.


• To avoid cycling from phase to another.


• To help the patient function as effectively as possible between episodes.

 

Scott’s case calls for a treatment that will control his acute manic episodes and a long-term maintenance treatment to reduce the frequency of episodes. The primary focused of Scott’s treatment is symptom control to allow a return to normal levels of psychosocial functioning.

 

Hospitalization

Many patients with bipolar I disorder are hospitalized at some point in the course of their illness. Because acute mania affects insight and judgment, individuals with mania are often hospitalized over their objections, which can be upsetting for both patients and their loved ones. However, most individuals with mania are grateful for the help they receive during the acute episode, even if it was given against their will at the time. Hospitalization should be considered under the following circumstances:

• When safety is in question due to suicidal, homicidal, or aggressive impulses or actions


• When severe distress or dysfunction requires round-the-clock care and support


• Where there is ongoing substance abuse, to prevent access to drugs


• When the patient has an unstable medical condition


• When close observation of the patient’s reaction to medication is required (www.psychguides.com)

At present, Scott is experiencing an acute manic episode, requiring hospitalization and close attention. However, long-term hospitalization is not necessary.

 

Therapeutic Interventions

Psychotherapy

Psychotherapy for bipolar disorder helps a person cope with life problems, come to terms with changes in self-image and life-goals, and understand the effects of the illness on significant relationships. As a treatment to relieve symptoms during acute episode, psychotherapy is much more likely to help with depression than with mania – during manic episode; patients may find it hard to listen to a therapist. Long-term psychotherapy may help prevent both mania and depression by reducing the stresses that trigger episodes and by increasing patients’ acceptance of the need for medication ().

 

Specific Psychotherapies for Bipolar Disorder

1. Psychoeducation

The purpose of psychoeducation is to educate patients about the illness and its treatment including types of treatment (especially pharmacology) and side effects in order to enhance understanding and compliance (2000). Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs ().

 

 

 

2. Family Therapy

The purpose of family therapy is to improve communication among family members, reducing interpersonal crisis and noncompliance ( 2000). Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person’s symptoms ().

3. Cognitive Behavioral Therapy (CBT)

CBT helps patients understand and change depressed negative cognitions (2000). CBT helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness ().

4. Interpersonal and Social Rhythm Therapy

Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes (National Institute of Mental Health).

 

Pharmacological Interventions

Mood stabilizing drugs are the mainstay for patients with bipolar. They are defined as drugs that are effective for acute episodes of mania and depression that can be used for maintenance. The currently available first-line mood stabilizers are lithium and valproate. Both drugs stimulate the release of the neurotransmitter glutamate, although they appear to work through different mechanisms. Other drugs may also be used. 

Lithium has been used for years for bipolar disorder. It remains the best drug for people with pure mania characterized by euphoria and pure depression. Valporoate is an anti-seizure agent that is effective for many patients with mania, rapid cycling, and mixed states, as well as for patients who are also substance abusers. Carbamazepine is usually the second anti-seizure medication of choice. Atypical Antipsychotics have mood stabilizing properties

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Ethical Considerations

The ethical consideration in drug therapy is that drugs remove responsibility for the patient. They put all the power into the hands of doctors and psychiatrists. Pharmacological drugs have serious and dangerous side effects. The biological model of mental disorders removes responsibility from the patient and places it on faulty functioning of the body. With respect to ethics, this means that no blame is attached to the individual, but on the negative side. It means that the patient is not empowered to help him/herself. All responsibility is taken away and placed in the hands of the health professional.

 

 

Conclusion

Bipolar disorder poses a great challenge to patients, their families and loved ones and to the health professionals as well. Bipolar disorder affects one’s life and can damage relationships. Bipolar disorder can be controlled. Patients together with their families need to work hand in hand with health professional in order to manage the disorder effectively. There are different drugs available that effectively control the symptoms of bipolar disorder. The key to successfully managing the disorder and effective patient function is early detection and treatment.

 

 

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