Bipolar disorder is believed to originate as far back as Early Greek and Roman periods. Lithium salts were used in bath waters to calm people during that time. In the 17th Century, both Robert Burton and Theophilus Bonet, identified the link between mania and melancholy.
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The first documented case of bipolar disorder was done in the 19th Century by the French psychiatrist, Jean-Pierre Falret. An article was written describing circular insanity which details people switching through severe depression and manic excitement. (2018, Krans, Cherney). Since then, the highly investigated neurological disease has been pursued. The first time the term bipolar disorder appeared was in the 1980 third edition of American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). Bipolar disorder is now highly researched with ongoing information towards identification of symptoms, related symptoms and associated disorders, causes, diagnosis, and treatment.
The Bipolar (two poles) disorder, previously called manic depression, has been determined as a neurological disorder in which the person shifts dramatically between the opposite differences of mania and depression. A created mental illness affecting a person’s moods, energy, activity levels, and everyday life such as decision-making processes, tasks, sleep, and perspectives on reality. Mania is excitement, delusions, and euphoria while depression is severe sadness, despondency, and dejection. Mood swings can shift between highs and lows in a matter of minutes and the person can become very agreeable to very unreasonable.
There are four types of bipolar disorders with varying severities and may have related disorders associated. The first type is Bipolar I disorder with manic episodes lasting a minimum of seven days, requiring hospitalization, following with severe depression, and creating a break from reality or psychosis and dangerous episodes of hallucinations or delusions, matching the person’s intense moods. The second type is Bipolar II disorder with a pattern of hypomanic and depressive episodes for longer periods, occurring a minimum of two years but without a manic episode and can cause a significant impairment in the person’s life. The third type of bipolar disorder is called Cyclothymia, having numerous periods of hypomania and depressive symptoms for at least two years with one year occurring during the childhood or adolescence years. The fourth is other specified and unspecified bipolar and related disorders which are defined by not matching any of the other three symptoms. These can be induced by certain drugs or alcohol or due to a medical condition, such as Cushing’s disease, multiple sclerosis or stroke (Mayo, 2016). Symptoms can occur with a chemical change to the body such as hormone imbalance through pregnancy or menopause or seasonal changes in the environment.
The symptoms of mania and hypomania have the same symptoms but different types of episodes with mania being more serious with noticeable problems in the person’s life including work, school, social activities, and relationships. An episode comprises of three or more of the following characteristics which include abnormally upbeat, jumpy, or wired, increased activity, energy, agitation, irritable, or touchy, exaggerated sense of well-being and self-confidence or euphoria, decreased need for sleep, unusual talkativeness about various subjects, racing thoughts, distractibility, and poor decision-making such as spending sprees, sexual risks, or impulsive investments (Mayo, 2016).
The symptoms of a depressive episodes reflect a noticeable difficulty in functioning with everyday life such as work, school, social activities, and relationships. An episode would consist of five or more of the following characteristics which include a depressed mood such as feeling sad, down, hopeless, tearful or irritability, feeling worried or empty, loss of interest or no pleasure in almost all activities, significant weight loss without dieting, weight gain, or an increase or decrease in appetite, either insomnia or excessive sleeping, restlessness or loss of energy, tired or slowed down, decreased activity levels, feelings of worthlessness or excessive or inappropriate guilt, decreased ability to concentrate, think, or indecisiveness, forgetting things often, and think about death or the idea of suicide with either planning or attempting (Mayo, 2016).
Related disorders can have similar indications to bipolar disorders. These illnesses can make diagnosing bipolar disorder difficult or may be underlying disorders associated with the mental illness. Other disorders include anxiety disorder, attention deficit hyperactivity disorder (ADHD), substance abuse disorders, eating disorders, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PSTD), borderline personality disorder, or schizophrenia. People with bipolar disorder are also at a higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses (NIMH, 2016).
Diagnosis should include a physical exam and lab tests to identify any potential medical problems, and a psychiatric exam to evaluate thoughts, feelings, behavior patterns, and personal perspectives. Diagnosing children and teenagers with bipolar disorder includes the same criteria used for adults but often have different patterns and may not fit into the diagnosis categories (2016, Mayo). Sometimes family members or close friends will be requested to fill out surveys to help provide information. Mood charting sleep patterns, or eating journals may also be applicable in helping to diagnose and provide the right treatments. A mental health physician or psychiatrist may compare symptoms with the criteria in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Exact causes are unknown but many aspects contribute including genetics, stress, and biological structure and function of the brain. Genetics increase the chances of acquiring the disorder when there is a history of the illness in a parent or sibling. Physical changes in the brain such as average size or activation happening are being identified as a contributing factor. According to the National Alliance of Mental Illness (NAMI), the average age of onset is about 25 years old but can occur in teens, or more commonly in childhood and affect men and women equally with 2.6% of the U.S. population diagnosed and nearly 83% are classified as severe (2017).
Bipolar disorder is a life-long ailment and will require various medical and therapy treatments. Finding the correct treatment and therapy can allow the person diagnosed with bipolar disorder the ability to live a long, fulfilling, successful life while the treatment plan is followed through. Treatments may be directed by team including a psychiatrist, medical doctors, social workers, psychiatric nurse, and family members. Medications that help treat the symptoms comprise of mood stabilizers controlling manic or hypomanic episodes, antipsychotics which control depression or mania, antidepressants which address depression, antidepressant-antipsychotic which works as a depression management and as a mood stabilizer, or anti-anxiety which helps with anxiety and improves sleep. The right medication is critical in finding what will be beneficial. Patients must be consist with following the regiment of taking the medication and reporting any side effects immediately or stopping the medication suddenly leading to rebounding or worsening of the bipolar disorder (NIMH, 2016). Psychotherapy is usually done in conjunction with medication involving individuals, families, or group settings. Talk therapy is effective by offering support, education, and guidance to both the person with bipolar disorder and the family and friends involved. Cognitive behavioral psychotherapy (CBT) educates in identifying unhealthy, negative beliefs, behaviors, and triggers with replacement, positive ones helping to develop manage stress strategies and develop coping mechanisms. Family-focused therapy provides techniques in communication and family support by gearing towards sticking to a treatment plan and identifying warning signs and mood swings. Interpersonal and social rhythm therapy (IPSRT) focuses on consistent routines, providing stabilization of daily rhythms including sleeping, eating, productive and destressing activities. Psychoeducation gives information on the bipolar disorder, understanding the symptoms and causes, learning to identify issues, create plans for prevention of relapse, teach support techniques, and the ability for consistency in the treatment plan. Another treatment option is electroconvulsive therapy (ECT) giving relief for severe bipolar disorders who are not able to recover through other treatments by sending an electrical current through the brain to trigger a brief seizure causing a change in the brain chemistry, reversing certain symptoms of the mental illness. Some short term side effects of the treatment are confusion, disorientation, and memory loss and can be used for women who are pregnant to prevent the side effects from risky medications or high risk suicide patients. Sleep medications can be helpful for insomnia and natural supplements maybe advantageous but very little research is available and doctors should be informed of them. A Life Chart can document mood symptoms, sleep patterns, and life events, helping doctors and patients track and treat the disorder effectively (NIMH, 2016). People diagnosed with bipolar disorder can develop lifestyle approaches such as eliminating alcohol and recreational drugs, creating healthy relationships with positive influences, developing healthy routines including eating, sleeping, exercise, and monitor salt intake with lithium, and check over-the-counter medications and supplements and reactions with prescriptions. People with bipolar disorder should not stop taking prescriptions of skip therapy sessions, need to be open and honest with health-care providers, and stay focused on goals, join support groups, find healthy hobbies and recreational activities, and learn relaxation techniques and stress management.
Bipolar disorder has been in existence for centuries and doctors are continuing to find solutions. Bipolar disorder is not curable but is treatable and causes are still unknown. Medical professionals need to be cautious in treating the correct condition and not the mirror symptoms of other disorders. People with bipolar disorder need to be educated and make decisions for lifestyle changes in order to lead to healthy lives. Various treatments and therapies are available and families need to find ways to continue support.
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