12/08/2020
BIPOLAR DISORDER :
1. INTRODUCTION
Bipolar disorder is a mental illness that could make an individual feel happy and feel angry in an instant. In other words, it extremely changes a person’s mood at an immediate pace from low to high and high to low. Individuals with bipolar disorder tend to feel depressed at their low state and feel mania at the high state. Sometimes, they can feel both and the moods are mixed. This mental illness case has been increasing rapidly throughout the years in around 5 million people who are still suffering this and possibly still increasing till these days. Also, until today some of them just can not be cured. Mostly, a person who is in their late teens or in their early adult years are the ones that are generally diagnosed with bipolar disorder but it could also occur in children too. Usually, bipolar diagnoses are more likely to be received by woman rather than men but yet this reason still remains unclear as it could not be proven by researchers.
Bipolar disorder is one of the most highly investigated neurological disorders. As it is a mental illness that has been affected by people in a large number and most of them have severe cases. On the other hand, not many pupils are able to receive high-quality treatment for the disorder due to a lack of education, social stigma, and funding issues. Which they are known to receive a minimally adequate treatment. Researchers have tried their best to figure out the the causes of bipolar disorder but since it is a complex illness. Therefore, they are still doing research until these days ever since ancient times. How did it all actually began?
2. BACKGROUND
It all started in the 1st century in Greece. A physician named Aretaeus of Cappadocia had begun to process the detailed symptoms in the medical field. He has written down notes with the links between manic and depression as it has started before in the definition of bipolar disorder. “Manic” and “depressive” are modern-day terms that were called modern-day and “melancholia” by the Greeks and Romans back in those days. Lithium Salts are used in baths to calm manic people and made the depressive people lift their spirits. This was discovered by the Greeks and Roman as well and the treatment has become a common treatment by today to treat people with bipolar.
This mental illness was cited as an inspiration for the great artists during the Greek philosopher Aristotle days. People around the globe during this time who are diagnosed with bipolar of any other mental condition are generally executed. As time goes by, the study medicine has evolved a lot and in some perception from the strict religious stated that these people were possessed by demons and shall be put to death.
In the 17th century, “The Anatomy of Melancholy” a book by Robert Burton which issued about treating melancholy using music and dance. The book also issued about depression and the full effects of depression on the society. It also expanded deeply about the symptoms and treatment for clinical depression or major depressive disorder, the modern-day terms. After that century, a physician and a medical writer, Theophilus Bonet published “Sepuchretum”. It is a text that consists of 3000 autopsies from his experience. In this step is was substancial as mania and depression are considered as separated disorders.
Later on, in the 19th century. Jean-Pierre Falret has published an article which he called it “La Folie Circulaire” in 1851. The title translates to the circular insanity. The abstract of the article is it issues about people switching through manic excitement and severe depression. This article is considered as the first documented diagnosis of bipolar disorder.
What about today’s condition of bipolar disorder among pupils? How are the medical researchers are progressing with the research on the bipolar disorder? In the late 20th century, the “bipolar” term signifies the polar opposites of mania a depression. It firstly appeared, in the American Psychiatric Association (APA) and Diagnostics and Statistical Manual of Mental Disorder (DSM) in its third revision in 1980. The term mania is used in the revision to avoid calling the patients “maniacs”. Now, DSM-5 is the leading manual for mental health professionals. The manual contains the diagnostics and treatment guidelines that help doctors to manage the diagnosed bipolar patients and other mental conditions. The concept of spectrum was developed to target specific difficulties with more precise medications. Stahl lists the four major mood disorders as follows :
• Manic episode
• Major depressive episode
• Hypomanic episode
• Mixed episode
Today’s bipolar disorder has come to an understanding to us that it has evolved since ancient times. Educations and treatments that we’re created in the past century alone have been greatly advanced especially with the high technology that has been used to prolong the research. Many medication and treatment has helped many patients to cope with their condition and manage their bipolar symptoms. However, there is still much work to be done because many of the other patients arent’t getting the treatment they needed to lead a better quality of life.
There are three types of bipolar disorder. All of it involves clear changes in mood, energy, and activity levels. The moods could change from being extremely irritable or energized (know as manic episodes) to be very down or sad or in a hopeless period (known as depressive episodes). The less severe manic periods are called hypomanic episodes.
Bipolar I Disorder – These manic episodes last at least 7 days or by manic symptoms which are so severe. Therefore, the person needs immediate hospital care. Commonly, depressive episodes will appear as well, which will last at least 2 weeks. Patients are also possible to have depressive symptoms and manic symptoms simultaneously.
Bipolar II Disorder – it is a pattern by periods of hypomanic episodes as well as depressive episodes but it is not a full-blown manic episodes that are typical like Bipolar I Disorder.
Cyclothymic Disorder – this is also known as cyclothymia. This is defined by periods of hypomaniac symptoms as well as periods if depressive symptoms which will last for at least 2 years (1 year in children and adolescents). However, the symptoms does not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
In certain cases, not all symptoms will be a match with the three categories that will be experienced by that person. This refers to “other specified and unspecified bipolar and related disorders”. In addition, bipolar disorder are mostly diagnosed during early adulthood or late adolescene. It could also appear in children too. Besides that, it could also appear during a woman’s pregnancy or after giving birth. This mental illness will be needing a lifeling treatment and a prescribed treatment in order to help manage and improve their quality of life.
There are many signs and symptoms for a person who is having a mental disorder. We must know these signs so we are able to help out others especially our loved ones on coping with their life while having a mental illness. Bipolar patients tend to have periods of unusual intense emotions. For example, irregular sleep patterns and activity lessens. Uncharacteristic behaviour such as recognizing their likely harmful or undesireable effects. These periods may be able to last for a day, few weeks, or several days.
There are two types episodes. As it has been mentioned before, whichare called the “maniac episodes” and the “depressive episodes”. The patients who are experiencing the “ manic apisodes” would feel ‘up’, ’high’, ‘irritable’ or can be touchy as well. They would also feel jumpy or wired. They will feel the loss of appetite and they tend to talk rapidly about varieties of things. They feel like their thoughts are always racing and they think they can do lots of things at once. On the other hand, they would also do risky things that potrays a poor judgement. In example, eat and drink excessively, spend or give away a lot of money, or have reckless s*x. Lastly, they would feel as if they are talented, powerful or important in an unusual way.
The symptoms for “depressive episodes” are they feel sad, down, useless, hopeless and worthless. These bipolar patients with this type of episodes they will have trouble sleeping, or will experience imsomnia, they would either wake up too early or having too much sleep. They would also feel mentally drained. As a result, they would feel very slow, the feeling where they have nothing to do or say plus they will easily forget on what to do. Depressive bipolar patients would also have trouble concentrating and difficulties to make a decision which makes them feel unable to to do simple task. They would also feel minimal interest in most activities and also the inability to experience pleasure (anhedonia). Lastly, they would seldomly had a thought about death or suicidal thoughts.
Sympstoms of a child’s manic episode caused by bipolar disorder can include acting very silly and feeling overly happy, fast and rapidly changing subjects, having trouble focusing or concentrating, doing risky things or experimenting with risky behaviours, having a very short temper that leads quickly to outbursts of anger, having trouble sleeping and not feeling tired after sleep loss.
Symptoms of a child’s depressive episode caused by bipolar disorder can include moping around or acting very sad, sleeping too much or too little, having little energy for normal activities or showing no signs of interest in anything, complaining about not feeling well, including having frequent headaches or stomachaches, experiencing feelings of worthlessness or guilt, eating too little or too much, thinking about death and possibly su***de.
In some rare cases, there are several patients that will experience both episodes. This refers to a term called mixed features. These types of patients would feel sad, empty, hopeless and feel exaggeratingly energized simultaneously. A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar disorder (Bipolar II) experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.
In order for bipolar patients to be properly manage their life, they will be needing proper treatment and specific diagnosis. Talking with a doctor or other licensed health care provider is the fundamental step. The health care provider can complete a physical exam and order necessary medical tests to rule out other conditions. A mental healthcare will be conducted by the healthcare or provide a referral to a trained mental health care providers, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar patients. Lifetime history, experiences, and, in some cases, family history and as symptoms are the factors that are used by the health care provider trainees for their diagnosis. Diagnosis in youth is particularly important as well.
Diagnosing bipolar disorder in children is controversial. This is largely because children don’t always display the same bipolar disorder symptoms as adults. Their moods and behaviours may also not follow the standards doctors use to diagnose the disorder in adults. Many bipolar disorder symptoms that occur in children also overlap with symptoms from a range of other disorders that can occur in children, such as attention deficit hyperactivity disorder (ADHD).
However, in the last few decades, doctors and mental health proffesionals have come to recognize the condition in children. A diagnosis can help children get treatment, but reaching a diagnosis may take many weeks or months. Your child may need to seek special care from a professional trained to treat children with mental health issues. Like adults, children with bipolar disorder experience episodes of elevated mood. They can appear very happy and show signs of excitable behaviour. These periods are then followed by depression. While all children experience mood changes, changes caused by bipolar disorder are very pronounced. They’re also usually more extreme than a child’s typical change in mood.
There are several risk factors that could lead to bipolar mental disorder. As a start, brain structure and functioning. Some research indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder. Acknowledging about these differences may help scientists understand bipolar disorder and assuring which treatements will be the foremost. Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene can cause the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.
Other than that, your brain. Your brain structure may impact your risk for the disease. Abnormalities in the structure or functions of your brain may increase your risk. Environmental factors. It’s not just what’s in your body that can make you more likely to develop bipolar disorder. Outside factors may contribute, too.
These factors can be include :
• Extreme stress
• Traumatic experiences
• Physical illness
Each of these factors may influence who develops bipolar disorder. What’s more likely,is that a combination of factors contributes to the development of the disease. Bipolar disorder can be passed from parent to child. Research has identified a strong genetic link in people with the disorder. If you have a relative with the disorder, your chances of also developing it are four to six times higher than people without a family history of the condition. However, this doesn’t mean that everyone with relatives who have the disorder will develop it. In addition, not everyone with bipolar disorder has a family history of the disease. Still, genetics seem to play a considerable role in the incidence of bipolar disorder.
Throughout the years, scientists have been searching for a conclusion and a proper treatment to treat bipolar disorder. Sadly, there’s still no answer on how to cure it but they have provided an alternative. It may not surely cured the person but it helps them to manage throughout their daily lives. Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotheraphy, also called “talk theraphy”.
Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms. Other than that, the pharmaceutical company has also managed to make drugs prescribed to help out the treatment for the mental illness. Certain medications can help manage symptoms of bipolar disorder. Some people may need to try several different medications and work with their health care provider before finding medications that work best.
Medication generally used to treat bipolar disorder include mood stabilizers and second generation antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.
Even before consuming the drugs or medication, patients should be precaution and have a discussion with their health taker to ensure that the medications would not give a negative side effects to them. They should also report any oddly side effects urgently to their health taker so an initiative could be done to avoid furthermore damage to themselves. The health taker may need to change the doser or the types of medication. The medication for bipolar should be taken consistently as how it has been prescribed even though the patient is feeling well. Avoid stopping a medication without talking to a health care provider first. An abrupt stopping a medication may lead to a “rebound” or it could worsen the bipolar disorder symptoms.
Another way of treating bipolar disorder is by psychotheraphy. In other terms, it is called the “talk theraphy”. This way can be an effective part of the treatment plan for people with bipolar disorder. Psychotheraphy is a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviours. It provides support, education, and guidance to people with bipolar disorder and their families. Treatment may include therapies such as cognitive behavioral theraphy (CBT) and psychoeducation, which are used to treat a variety of conditions.
Treatement may also include newer therapies designed specifically for the treatement of bipolar disorder, including interpersonal and social rhythm theraphy (IPSRT) and family-focused theraphy. This determines whether intensive psychotherapeutic intervention at the early stages of bipolar disorder which could possibly prevent or put a limit on its full-blown onset as it is an important area of ongoing research.
There are also other types of medication given to these bipolar patients to manage their symptoms. Such as a electroconvulsive theraphy. It is a theraphy to stimulate the brain to make the patients feel relieved from several of the symptoms. By using the modern ECT, a person usually goes through several treatment sessions over several weeks. ECT is delivered under general anesthesia and is safe. It can be effective in treating severe depressive and manic episodes, which occur most often when medication and psychotheraphy are not effective or are not safe for a particular patient. ECT can also be effective when a rapid response is needed, as in the case of su***de risk or catatonia in other terms it is known as a state of unresponsiveness.
Another way of treatment is by using Transcranial Magnetic Stimulation (TMS) . TMS is a new approach to stimulate the brain by using the magnetic waves. It is delivered to an awake patient most days for 1 month. Research shows that TMS is helpful for many people with various subtypes of depression, but its role in the treatment of bipolar disorder Is still under study.
Besides, paying treatment that cost an arm and a leg for the specialized treatments, there are other alternative of treatements to use. As we all know by exercise or involve ourselves in sports it enables us to relieve ourselves and it allow us to express our feelings by moving physically. For example, regular aerobic exercise, such as jogging, brisk walking, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for the heart and brain. There is also some evidence that anaerobic exercise such as weightlifting, yoga, and pilates can be helpful. Patients should check with their health care provider before they start a new exercise regimen:
Another way is by keeping a life chart : even with proper treatment, mood changes could occur. Treatment is more effective when a patient and health care provider work together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life event can help patients and health care providers track and treat bipolar disorder over time. Patients can easily share data collected via smartphone apps including self-reports, self-ratings, and activity data with their health care providers and theraphists.
3. SCOPE
Bipolar disorder cases has been increasing throughout the years. Scientist and researches have been trying to figure out on how to create and provide a proper treatment and a specific type of medication for the patient to use. Bipolar disorder is a mental disease that these patients have an extreme changes in their mood. They could feel ‘up’, ’high’, ‘happy’, energergized and overly joyful. This term is known as the manic episodes. They could also feel sad, hopeless, worthless, and down. This term is known to be the depressive episodes. However, the bipolar patients could be diagnosed with both episodes. They could feel the manic episodes and the depressive episodes simultaneously but this is a rare case. The few symptoms in the manic episodes is that the patients would feel like their head is racing and the tend to have loss in their appetite. On the other hand, the depressive episodes the bipolar patients would feel as if theyre sleep deprived or have too much sleep. Since the world has evolved and technology has been upgraded. Researches have been provind services, treatmens, medication for the bipolar patients but not managed to fully understand the disease itself.
4. CONCLUSION
I. First example case study
Sarah is 42 years old married woman who has a long history of both depressive and hypomanic episodes. Across the years she has been variable diagnoses as having major depression, borderline personality disorder, and most recently, bipolar disorder. Review of symptoms indicates that she indeed have multiple episodes of depression beginning in her late teend but that clear hypomanic apisodes later emerged. Her elevated interpersonal conflict, hyper-s*xuality and alcohol use during her hypomanic episodes led to the provisional borderline diagnosis, but in the context of her full history, bipolar disorder appears the best diagnosis. Sarah notes that she is not currently in a relationship and that she feels alienated from her family. He has ben taking mood stabilizers for the last year, but continues to have low level symptoms of depression. In the past, she has gone off her medication multiple times, but at present she says she is “tired of being in trouble all the time” and wants to try individual psychotheraphy.
SYMPTOMS : alcohol use, depression, elevted mood, impulsivity, mania / hypomania, mood cycles, risky behaviors
II. Second example of case study
Gary is a 19 year old who withdrew from college after experiencing a manic episode during which he was brought to the attention of the Campus Police (“I took the responsibility to pull multiple fire alarms in my dorm to ensure that they worked, given the life or death nature of fires”). He had changed his major from engineering to philosophy and increasingly had reduced his sleep, spending long hours engaging his friends in onversations about the nature of reality. He had been convinced about the importance of his idea, stating frequently that he was more learned and advanced than all his professors. He told others that he was on the verge of revoulutionizing his new field, and he grew increasingly irritable and intolerant of any who disagreed with him. He also increased a number of high-risk behaviors drinking and engaging in s*xual relations in a way that was unlike his previous history. At the present time, he has returned home and his been placed on a mood stabilizer (after a period of time on an antipsychotic), and his psychiatrist is requesting adjunctive psychotheraphy for his bipolar disorder. The patient’s parents are somewhat shocked by the diagnosis, but they acknowledge that Gary had early problems with anxiety during pre-adolescence, followed by some periods of with drawal and depression during his adolescene. His parents are eager to be involved in treatment, if appropriate.
SYMPTOMS : alcohol use, depression, elevated mood, impulsivity, mania / hypomania, mood cycles, risky behaviors.
In conclusion, bipolar disorder is a mental disease that we should not take it lightly. As there are many others who suffers it around us. We should take cautious to those who are dealing with it. As it is quite a daunting disorder to control. Therefore, with the suitable treatment and medication. There would be always be chances to be able to have a great life in the long run. Eventhough by having such disease. Bipolar disorder is seldomly neglected or be ignored when it comes to research as it is known not to be major issue like depression or schizophrenia. In the fields of nosology, epidemiology, and molecular genetics, there were recent advances that shows the researches have managed to partially figured out about the complexity of the bipolar disorder issue. By any chance in the up coming years, scientists are able to comprehend the issue and ables to them to provide and create the precise also specific treatment and medication for the bipolar patients.
