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Bipolar Disorder and its Treatment1
Bipolar Disorder and its Treatment
A Research Paper
Johnny Stinson
Surry Community College
Psychology 281
Professor Deborah Patrick
April 27, 2011
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Bipolar Disorder and its Treatment
Bipolar disorder, known as manic-depressive disorder in the past, is a debilitating mood
disorder which causes extreme shifts in mood and energy, producing mood states called mania
and depression. These mood states are two extreme fluctuating poles one involving a low mood
of great sadness and low energy, and the other a state of elevated mood and energy. These states
occur in cycles that can vary from months to as short as one day in ultra-rapid cycling cases. The
states can also be experienced at the same time and are called mixed-episodes. The onset of the
disease appears around the ages of 15-25. The prevalence of bipolar disorder is around 2% of the
population in all sexes and races throughout the world.
One pole of the bipolar spectrum is called a depression episode. Depression is a state of
low mood, energy, and aversion to activities. These can affect a person’s behavior, feelings,
thoughts, and psychical well-being. A great feeling of sadness, hopelessness, anxiety,
worthlessness, restlessness, or guilt are present and can seem to be overwhelming for a person to
deal with. This can lead to suicidal thoughts and suicide attempts. Suicide is most likely to
happen during a depressive episode of a bipolar disorder and a patient should be under
supervision or care. Estimates of suicide in bipolar disorder range from 9% to as high as 60%,
with an average of 19% (Nathan, 205). People often experience cognitive impairments; such as
difficulty concentrating, or making decisions. Psychical symptoms include changes in weight,
excessive sleeping, fatigue, loss of energy, insomnia, aches, pains or digestive problems that can
be resistant to treatment. Loss of interest in previously enjoyed activities can also occur, the most
noticeable one being sex. In severe cases, a patient may become psychotic and “lose contact with
reality”, having delusions and hallucinations. This condition is called severe bipolar depression
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with psychotic features. A depressive episode can last from two weeks to over six months if not
treated. Depression is associated with changes and imbalances in chemical substances in the
brain, known as neurotransmitters. The neurotransmitters involved appear to be serotonin,
norepinephrine, and dopamine. Serotonin regulates many bodily functions including sleep,
aggression, sexual behavior, and mood. A decrease in the production and concentration of
serotonin cause disruptions in these functions and can lead to depression. Norepinephrine is used
by our bodies to help recognize and respond to stressful situations. It has been suggested that
people prone to depression may have norepinephrinergic systems that don’t handle the effects of
stress very efficiently. Dopamine helps regulate and control our drive to seek rewards and allows
us to feel a sense of pleasure. Low dopamine levels may explain why it is hard to find pleasure in
normally pleasurable things or activities while in a depression.
The other pole of the bipolar disorder spectrum is called mania. Mania is a mood state
that involves an unusual elevated or irritable mood, arousal, and energy levels. It could be
considered to be the opposite of depression, which is why they are each called polar opposites of
each other and together are called bipolar disorder. Mania varies in its intensity, from mild
mania known as hypomania to severe mania with psychotic features including, delusions of
grandeur, paranoia or suspiciousness, aggression, and hallucinations. In a hypomanic mood state,
a patient experiences an elated or irritable mood with a substantial increase in energy, lack of
need for sleep, floods of ideas and a desire and drive for success. They do not experience
psychotic symptoms such as delusions of grandiosity, and are able to function normally. They
become very outgoing, exhibiting pressured speech which is rapid speech that can go on tangents
that make it hard for a listener to understand. They can also becoming more competitive,
productive and creative. It is thought that many creative people throughout history have
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Bipolar Disorder and its Treatment4
exhibited states of hypomania and some even credit their work towards it. In a full blown manic
episode is very debilitating and a person is not able to function properly without intervention.
According to the DSM -IV (APA Diagnostic and Statistical Manual), a manic episode is “a
period of seven or more days (or any period if admission to hospital is required) of unusually and
continuously effusive and open elated or irritable mood … causing obvious difficulties at work
or in social relationships and activities, or (b) requires admission to hospital to protect the person
or others, or (c) the person is suffering psychosis.” They will exhibit the same features as a
hypomanic episode, but the intensity will be increased and cause the person to lose contact with
reality. They will be exhibiting psychotic features that will cause dysfunction and cause the
person to believe strange things and may cause them to act in dangerous ways.
There also exists a third mood state called a mixed state also known as a dysphoric manic
episode. This is a condition where symptoms of mania and depression occur simultaneously such
as difficulty sleeping, change in appetite, agitation, and suicidal thinking. The most common
form, called depressive mania, is characterized by hyperactivity and psychomotor anxiety, global
insomnia, combined with depressive thinking, weeping and emotional disruptions, and often-
delusional guilt feelings, all of which can be in various combinations. Severe depression or
agitation in this state can also be accompanied by symptoms of psychosis. These symptoms
include delusions and hallucinations. Studies show that only 40 percent of people who have both
manic symptoms and a sufficient number of depressive symptoms are diagnosed as being in a
mixed depressive and manic state. Studies have also shown that suicidal thoughts are increased
in people with mixed episodes.
The two different varieties of bipolar disorder are known as bipolar I, bipolar II. Bipolar I
disorder is a mood disorder that is characterized by at least one manic or mixed episode with
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Bipolar Disorder and its Treatment5
episodes of hypomania followed by states of depression. Bipolar I seems to affect both men
and women equally, according to the DSM-IV. Type II bipolar disorders consist of a
combination of major depressive episodes accompanied by at least one hypomanic episode.
There tends to be periods of normal functioning between these episodes. Many type II bipolar
patients are diagnosed and treated as if they were unipolar (only having depressive episodes)
patients, because they only report to the doctor about their depressions, as their hypomanic
episodes do not impair their functioning as drastically. The DSM indicates that women are more
likely than men to suffer from bipolar II.
People diagnosed with bipolar disorder commonly are diagnosed with other disorders,
known as comorbidity. Comorbitiy is defined as “a presence of one or more disorders (or
diseases) in addition to a primary disease or disorder, or the effect of such additional disorders or
diseases.” In a National Comorbidity Survey it was found that most (95%) of the respondents
with bipolar disorder met the criteria for 3 or more lifetime psychiatric disorders. (Sagman) The
most common comorbid disorders that occur along side bipolar disorder are anxiety disorders,
substance abuse disorders, and ADHD and personality disorders. With bipolar disorder, anxiety
disorder rates appear to exceed those in the general population.
Bipolar disorder is a biologically based disorder with multiple psychological components.
Among psychiatric disorders, bipolar disorder has been long considered one in which genetics
play a key role, as bipolar disorder tends to run in families. Researchers have been studying the
specific genes which they believe might play an important role. One of the more recent
discoveries was made in 2003 by a group of American and Canadian researchers, who
discovered that a mutation in the gene GRK3 is a possible cause of up to ten percent of the cases
of bipolar disorder worldwide. This gene is directly associated with a kinase enzyme involved in
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dopamine metabolism, meaning that a possible target has been found for new drugs that could
help to treat bipolar disorder more effectively.
There is no cure for bipolar disorder, but the disorder can be managed with a regiment of
psychiatric medicines depending on the severity. These regimens include anti-psychotics such as
lithium, mood stabilizers such as certain anticonvulsants, and antidepressants such as Prozac.
Each patient will have a different reaction to each group of medicines, so it takes time to get the
right doses and combination that work. Medication is the foundation of bipolar disorder
treatment. Taking mood stabilizer medication can help minimize the highs and lows of bipolar
disorder and keep symptoms under control. Periods of depression are often treated by taking
antidepressants. However, these antidepressants carry an increased risk of mania, especially if
not taken with a mood stabilizer. Anti-psychotics are used to treat and prevent mania and
hypomania. It is very important to stay on the medicine regimen, when mania onsets the patient
is often unaware that they need to continue to take their medication.
Therapy is also very beneficial to a person with bipolar disorder, as it causes many
distressing experiences that, if left unresolved, can actually turn into a negative feedback loop.
An example of this would be negative thoughts of self worth feeding into a depression making it
worse. Working with a professional you can also work on repairing any damage that you may
have caused between your relationships with others. Social rhythm therapy can also help you get
into a routine sleep schedule, an exercise regimen, and learning how to minimize stress with
behavioral therapy.
Social support from family and friends also greatly benefits someone with bipolar
disorder. Bipolar disorder can be a very hard thing to go through and having a strong support
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system in place can change your motivation and outlook. Support groups are also a great source
of help, they introduce you to people who are experiencing the same things you are and you can
share your experiences and learn from others.
By using a holistic approach to bipolar treatment a person can attain control over their
bipolar disorder, rather than it being in control of them. They can go on to have a normal
functional life as long as they stay medicated. They might even teach us something someday.
References
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Colom, F., & Vieta, E. (2006). Psychoeducation manual for bipolar disorde . Cambridge, UK:
Cambridge University Press.
Frances, A., Pincus, H. A., & First, M. B. (1994). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington: American Psychiatric Association.
Ketter, T. A. (2010). Handbook of diagnosis and treatment of bipolar disorders . Washington,
DC: American Psychiatric Pub..
Nathan, P. E., Gorman, J. M., & Salkind, N. J. (1999). Treating mental disorders: a guide to
what works. New York: Oxford University Press.
Sagman, D., & Tohen, M. (2009, March 23). Comorbidity in Bipolar Disorder The Complexity
of Diagnosis and Treatment. Psychiatric Times. Retrieved April 28, 2011, from
http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1391541
Tohen, M. (1999). Comorbidity in affective disorders . New York: M. Dekker.
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