Psychology
OUTLINE
- Introduction
- An overview of the main points involving Bipolar Disorder will be discussed
- Description of Bipolar Disorder
- Etiology or cause of the disorder
- DSM-IV-TR or DSM-5 symptom criteria of Bipolar Disorder
- Disorder Statistics
- Prevalence or the number of people who display Bipolar Disorder in the total population at any given time
- The number of cases or incidence of Bipolar Disorder appearing during a specific period
- Other relevant facts pertaining to Bipolar Disorder
- Treatments for Bipolar Disorder
- The type of therapeutic approach including cognitive-behavioral or interpersonal therapy, which is considered as the best practice for treating the condition.
- Discuss the medications that could be used as a treatment.
- How Bipolar Disorder causes an impact on different populations consisting of two different groups of individuals
- Women and men
- Ethnic or racial minorities
- Description of client symptoms
- Description of treatment for the symptoms
- Conclusion
Introduction
This paper will present an overview of the Bipolar Disorder (BD), which is also known as manic-depressive illness. There will be a presentation on how the episodic recurrent pathological mood disturbance can range from extreme elation or mania to severe depression. At the same time, the etiology or cause of the disorder shall be explained in detail, as well as the DSM-IV-TR or DSM-5 symptom criteria of the disorder. There will be discussion of the current statistics and figures of the prevalence of the symptoms on certain groups of people who display Bipolar Disorder in the total population at any given time. The number of cases or incidence of the disorder shall be shown based on other relevant facts pertaining to Bipolar Disorder. The treatments for Bipolar Disorder using the therapeutic approach including cognitive-behavioral or interpersonal therapy will be discussed to determine the best practice for treating the disorder. Aside from this, the medications and proper treatment of the disorder will be provided. To illustrate the disorder more clearly, there will be a sample of two different populations groups of individuals including women/men and ethnic/racial minorities who have shown tendencies leading to bipolar disorder. A case example will be presented including the early symptoms of the disorder and how to treat these symptoms. Finally, the paper will present the conclusion of the findings and the description of treatment for the symptoms of the disorder.
Description of Bipolar Disorder
Pinto and Schub (2013) stated that Bipolar disorder or “BD” is also called manic depressive illness. This disorder is a chronic psychiatric disorder characterized by recurrent, alternating episodes of depression and mania. A person who is diagnosed with “BD” experiences irritable mood or behavior that is excessively elevated (Pinto and Schub, 2013). BD can result in severe functional impairment that affects relationships and performance in work and school, and is associated with a high risk for suicide. Although the BD condition is treatable, majority of the patients have been shown to have experienced relapses frequently that lead to a poor quality of life. BD has been classified as BD I, which includes recurrent manic episodes or mixed manic/depressive episodes, and BD II, which includes recurrent depressive episodes that alternate with hypomania including less severe mania episodes (Pinto and Schub, 2013).
The patients with BD usually experience subsequent manic or depressive episodes. Some of them can also experience hypomanic and mixed episodes, including a lower threshold of mood labiality during the episodes (Miller, 2006, p.369). On the other hand, the patients with BD II have a history of only hypomania and major depressive episodes. Episodes of mania and depression usually last for 1 week or more. Patients who experience 4 or more episodes in a year are characterized as having rapid-cycling BD. In some patients the episodes and swing modes are not clearly delimitated which makes diagnosis difficult. Most episodes of bipolar depression are often misdiagnosed as major depression and in some cases it can take years for BD to be accurately diagnosed. Substance abuse is extremely frequent among patients with BD, who also may have other comorbid personality disorders; attention deficit hyperactivity disorder (ADHD) should be ruled out in children and adolescents, or treated if it is comorbid (Pinto and Schub, 2013).
Etiology or cause of the disorder
Miller (2006, p. 368) stated that bipolar disorder is a lifelong mood disorder that is characterized by recurrent manic or hypomanic and depressive episodes. Such condition can interfered with cognition and behavior, the can cause a significant impact on relationships with family, friends and employers. The most common symptoms exhibited during the manic episodes pressured speech, hyperverbosity, physical hyperactivity and agitation, decreased need for sleep, hypersexuality and/or extravagance.
Bipolar Disorder is commonly accompanied by disturbances in thinking and behavior that tend to manifest psychotic features through delusions and hallucinations (Craddock and Sklar, 2013). However, the diagnostic tests of people whose bipolar disorder phenotype has been defined solely on the basis of clinical features. There are clinical subtypes that have been divided into three: 1.) bipolar disorder type I or those who experience full manic episodes; 2.) bipolar disorder type II or those who do not experience full manic episodes and only milder hypomanic episodes; and 3.) bipolar type schizoaffective disorder. The third type is a form of recurrent mood and psychotic illness where in the manic episodes goes along with schizophrenia-like psychotic symptoms (Craddock and Sklar, 2013). Based on recent studies, there are several individuals who have experienced depression, however only mild or short-lived hypomanic episodes fail to comply with the threshold criteria for a diagnosis of bipolar disorder type I or II. At this instance, these individuals are diagnosed to suffer from unipolar depression (Craddock and Sklar, 2013).
DSM-IV-TR or DSM-5 symptom criteria for Bipolar Disorder
Based on the report of Angst (2013), the primary lines of the DSM-5 definition of major depressive episodes (MDE), which are similar to the diagnoses for bipolar I and bipolar II disorders are the same to those disorders under DSM-IV. Further, there is the presence of five of nine diagnostic symptoms that lasted for at least two (2) weeks and the change from earlier functioning. This had made it possible to identify the depressive disorders and bipolar disorders with mixed features. On the other hand, the definitions of both manic and hypomanic episodes have been undergone radical revisions that shall bear a major impact on the two bipolar diagnoses. According to Angst (2013), the main changes are composed of three criteria which are: First is the problematic change that deal with the gate questions, or known as criterion A; Second, the welcome reduction in the number of exclusion criteria; and Lastly, the dynamic effort to operate the bipolar syndromes that had been previously joined under the National Occupational Standards or NOS heading (Angst, 2013).
With regard to the gate questions covering mania and hypomania, bipolar disorder has the same diagnoses for disorders falling under the DSM-IV category and same symptoms are required. In the case of criterion A, the presence of one of the two mood symptoms such as elation/euphoric and irritable mood should appear. While in the case of DSM-5, the mood change should be associated with the persistently increased activity or energy levels of the patient (Angst, 2013).
Bipolar Disorder Statistics
Based on recent reports, in the United States, the estimated lifetime prevalence of BD is 1–1.6 percent. BD I affects men and women in equal numbers; BD II affects more women than men. Women experience rapid cycling more often than men. Mean age of symptom onset is 21 years, but BD can occur at any age. Women are more likely to seek treatment than men. BD
accounted for 26 percent of primary diagnoses among adolescents discharged from inpatient psychiatric care in the U.S. in 2004. Among patients with BD I who are treated with lithium, 50–60% gain control of their symptoms; in 7 percent of these patients, symptoms do not recur (Pinto and Schub, 2013). Based on the report of Miller (2006, p. 368), there is an estimate of 1.2 percent of the adult population in the United States, that is composed of 2.3 Million of Americans who suffer from Bipolar I disorder. On the other hand, those who experience Bipolar II disorder and cyclothymic disorder have increased to an estimate of 5 percent of the general population. Further, the lifetime prevalence of BD based on race and ethnicity for BD I and BD II shall be divided as follows: Caucasian is 0.8 percent and 0.4 percent, African American 1.0 percent and 0.6 percent, and Hispanic 0.7 percent and 0.5 percent (Miller, 2006, p.368). Studies have shown that there is no gender difference that has been shown in BD I, although BD II disorder is more prevalent among the female population. BD has been ranked as the sixth disorder in the top causes of disability for individuals who ages range from 15 to 44 years.
Signs and Symptoms of BD
Pinto and Schub (2013) state that manic symptoms include racing thoughts, poor judgment, risk-taking behavior such as drug use, reckless driving, promiscuity, distractibility, decreased need for sleep, psychomotor agitation, and pressured speech. Depressive symptoms include sadness, anxiety, guilt, hopelessness, sleep and appetite disturbances, fatigue, lack of interest in previously pleasurable activities, restlessness, irritability, poor concentration, and suicidal ideation (Pinto and Schub, 2013). BD carries psychotic symptoms which may be characterized by hallucinations and delusions. For those children and adolescents have been diagnosed of BD, some of the symptoms include truancy, difficulty with peer relationships, poor grades, unexplained crying, social isolation, destructive outbursts, running away from home, and sneaking out at night (Pinto and Schub, 2013).
Treatments for Bipolar Disorder
The treatment for bipolar disorder shall include mood stabilizers in all phases of the treatment including mania, depression and rapid cycling (Miller, 2006, p.371). These have been identified as short-term and long-term therapy. In case of the monotherapy, it comprises of lithium or valproic acid as the first line of choice for both the acute treatment and of the prevention of mania. In the event that the monotherapy will not be successful, regardless of the medication used, it has been recommended by the experts that these agents can be used in combination. For the second line of mood stabilizers, carbamazepine and lamotrigine shall be recommended for treatment. However, the atypical antipsychotic medications such as olanzapine and risperidone shall be considered as first-line agents to treat psychotic depression and also treats mania. In case of mild depression, it can be treated using mood stabilizer monotherapy. However, for the more severe depression of the patient, an antidepressant and a mood stabilizer can be used for starters. According to the study of Miller (2006, p. 371), buproprion and venlafaxine shall be considered as first-line depressants, provided it is indicated within the six (6) months of remission. In the event that the mania or depression is rapidly occurring, the mood stabilizer therapy such as the valproic acid can be initially administered to the patient.
Aside from the adherence to the medication regimen as part of treatment of bipolar disorder, some experts recommended that simply good listening techniques and sensitivity to the illness of the patient are effective treatments (Miller, 2006). Some of the effective management of BD shall include collaborative therapeutic approach including cognitive-behavioral or interpersonal therapy, which can be considered as the best practice for treating the condition. Psychoeducation and psychotherapy are crucial components to the collaborative practice model for BD. This shall include the knowledge of the illness on the part of the provider, knowledge on behalf of the patient and the timely decisions made between the provider and the patient in medication and adjunctive therapy treatment management (Miller, 2006, p.371).
The Effects of Bipolar Disorder on different populations
Based on the special report of Brown University Psychopharmacology (2004), although men and women develop bipolar illness in equal numbers, women are more prone to rapid cycling and displaying depressive characteristics. This type of disorder usually starts in adolescence or early part of adulthood, which places many women at risk for episodes during the reproductive years. The biggest challenge to providing effective treatment for bipolar women during pregnancy and post-partum depression is that the clinicians and consumers’ medication can harm the fetus (Brown University Psychopharmacology, 2004).
Based on the study of Vaskinn, et al, (2007) on the effect of gender on emotion perception bipolar disorder shall that women showed more depressive episodes and rapid cycling compared to men. This resulted to a speculation that emotion perception is more affected in women with bipolar disorder, than it is with men with bipolar disorder.
Based on the report of Carliner et al. (2014), the effect of serious mental illness (SMI) such as bipolar disorder among ethnic or racial minorities showed that compared to general population estimates, there was evidence that showed that they experience additive risk that can lead to more serious illnesses such as cardiovascular disease. However, the future studies on this condition must be able to include longitudinal assessment, stratification by gender, subgroup analyses to make clarifications on the mechanisms that may lead to potentially elevated risk of the potential effects of bipolar disorder (Carliner et al., 2014).
Description of client symptoms
One classic example of a subject who is suffering from Bipolar Disorder I is Susie. The patient is a female, who is 20 years of age, and a sophomore in a small Midwestern college. Susie has been having problems sleeping for the past five days and spent most of her time in an increased state of hyperactivity. She regards her behavior as “out of control” that is characterized by odd and extravagant ideas that are being mistaken for sexual tone. This can be illustrated when she declared to her friends that she did have menstruation for that month since she was a member of the third sex. She explained to her friends that she considered herself as a “superwoman” who does not have to engage in sexual intercourse and can still conceive a child (Cooper, 2011).
Description of treatment for the symptoms
Based on the characteristics of Susie, she is suffering from bipolar disorder I which may affect her mood, cause changes in her behavior and compromise her relationship with family and friends. The ups and downs in her behavior are very distracting that do not ensure a productive and normal life. Anti-depressant pills such as olanzapine and aripiprazole are her medical prescriptions that will serve as antidepressants that will treat the symptoms of severe mania, psychosis, or a mixed episode. Susie can take antidepressants that will serve as mood stabilizers to prevent the risk of experiencing mania or hypomania that may result to a rapid cycle (Cooper, 2011).
Conclusion
Although the cause of BD is unknown, there are multiple factors that are believed to contribute, including genetic, biochemical such as neurotransmitter levels; neurophysiological effects such as changes in regions of the brain that regulate emotional responses and environmental factors such as external stressors (Pinto and Schub, 2013). The patients with BD present alternate episodes of mood disturbance that range from depression to manic or hypomanic episodes that vary in severity and duration. Manic episodes include several characteristics such as hyperactivity, irritable mood, euphoric behavior, lack of sleep, and a sense of extravagance, as the patient engages in delusions and fantasies about his/her abilities and achievements. Manic episodes also show recklessness, impulsiveness and poor judgment. When a manic episode takes place, the patient engages in risky behaviors and irresponsible endeavors without taking into account the possible consequences the actions. This can also be manifested when the patient overspends and goes beyond his or her budget, or entering extramarital relationships (Pinto and Schub, 2013).
It bears to stress that the pathogenesis of bipolar disorder cannot be easily comprehended by many. However, there are some compelling pieces of evidence which point to the substantial genetic contribution to risk, as well as the availability of research devices which make it possible for early detection of susceptibility genes for common familial disorders. With these information, the field of psychiatry is given the unprecedented opportunity to for the identification of the biological systems surrounding the disorder (Craddock and Sklar, 2013). It is also recommended that the future tests should include testing a person for the presence of a schizophrenia-associated or other serious mental illness that carries a number variant that is known to aggravate the risk of congenital heart disease, and will be useful in targeting cardiac investigation. This is intended to bring overall benefits for the patient's health care and quality of life (Craddock and Sklar, 2013).
References
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Angst, J. (2013). Bipolar disorders in DSM-5: strengths, problems and perspectives. International Journal of Bipolar Disorders 2013, 1:12 doi:10.1186/2194-7511-1-12.
Carliner H, Collins, P.Y, Cabassa, L.J., McNallen, A., Joestl, S.S., and Lewis-Fernandez, R. (2014). Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: a critical literature review. Compr Psychiatry. 2014 Feb; 55(2):233-47. doi: 10.1016/j.comppsych.2013.09.009.
Cooper, T. (2011). The Case Study of Susie: Bipolar I Disorder. Criminology and Justice. Web. Retrieved on February 5, 2014, from
http://criminologyjust.blogspot.com/2011/08/case-study-of-susie-bipolar-i-disorder.html.
Craddock, N., & Sklar, P. (2013). Genetics of bipolar disorder. The Lancet, 381(9878), 1654-62. doi:http://dx.doi.org/10.1016/S0140-6736(13)60855-7
Miller, K. (2006). Bipolar disorder: etiology, diagnosis, and management. Journal Of The American Academy Of Nurse Practitioners,18(8), 368-373. doi:10.1111/j.1745-7599.2006.00148.x .
Pinto, S, and T Schub (2013).Bipolar Disorder. CINAHL Plus with Full Text, EBSCOhost . Retrieved on February 3, 2014.
Special Report: Women & Psychopharmacology Managing bipolar disorder in pregnant women. (2004). Brown University Psychopharmacology Update, 15(6), 1-5.
Vaskinn, A. A., Sundet, K. K., Friis, S. S., Simonsen, C. C., Birkenaes, A. B., Engh, J. A., & Andreassen, O. A. (2007). The effect of gender on emotion perception in schizophrenia and bipolar disorder. Acta Psychiatrica Scandinavica, 116(4), 263-270. doi:10.1111/j.1600-0447.2007.00991.x.
