Bipolar Disorder – National Institute of Mental Health

According to the National Institute of Health approximately 5.7 million adults in America are diagnosed with some form of Bipolar disorder every year, making up 2.6% of the population. At least 25% of patients diagnosed with Bipolar disorder will attempt to or will commit suicide in their lifetime (NIH, Jamison,2017). Bipolar disorder is a mental health illness that is classified by mood swings from deep depression to mania or hypomania. There are three main types of Bipolar disorder, all classified by how often the cycling of moods is experienced as well as the type of mania or depression experienced by the patient. Many patients who suffer from Bipolar also suffer from other mental health conditions such as anxiety or post traumatic stress disorder (Mayo Clinic, 2018). Because this disorder manifests itself in many ways it can be hard to identify and diagnose, often being confused with depression or in some cases schizophrenia. It has been found that a patient's family may exacerbate or trigger manic or depressive episodes, but family therapy and intervention can help stabilize the person with Bipolar (Miklowitz,2007). Studies show that diagnosing children with Bipolar disorder can be difficult because it can be confused with symptoms of other mental illnesses or trauma, but if untreated the consequences can be extremely severe and even deadly (Sutton,2013). Bipolar disorder occurs equally in men and women, and equally across all races and religions, but the type of bipolar disorder tends to vary among genders. People with relatives who have Bipolar are also much more likely to have the disorder themselves, with the likelihood increasing with the amount of relatives. Although Bipolar disorder can be difficult to pinpoint, once it has been diagnosed the patient has many treatment steps they can take, including individual and family therapy and medication.

The typical onset age of Bipolar disorder is 25 (National Institute of Mental Health, 2017), but it can present itself at any age, although it may be harder to diagnose and may be confused with other mental health illnesses. Bipolar disorder can only be diagnosed by a mental health professional and the type of Bipolar that is diagnosed is qualified by multiple criteria, such as the frequency of mood cycling, or whether the patient experiences mania or hypomania. Mania and hypomania are different in that mania can be more destructive and severe, and mania can also trigger a psychotic break, while hypomania tends to be less severe and cause less damage in the person's personal life and relationships (Mayo Clinic,2018). Some symptoms of mania and hypomania include: Racing thoughts, a lack of need for sleep, false sense of self-confidence, and impulsive or risky financial or sexual behaviors. Some symptoms of a major depressive episode include: Fatigue or energy loss, significant gain in sleep or insomnia, lack of enjoyment in activities that the patient used to enjoy, and feelings of immense sadness, hopelessness or lack of motivation (Mayo Clinic,2018). Bipolar I disorder is classified by one manic episode that is preceded by or followed by depressive or hypomanic episodes. Bipolar II is classified by one major depressive episode and one hypomanic episode, but does not necessarily include mania. A diagnosis for Cyclothymic disorder requires two years containing many hypomanic and depressive episodes (Mayo Clinic,2018).

Bipolar disorder is currently the sixth leading cause of disability in the world (NIH,2017) and it occurs equally across all socio-economic platforms, religions, and places in the world. Men and women are equally susceptible to bipolar disorder, but women are three times more likely to experience Bipolar in a rapid cycling form (NIH,2017). Women are also much more likely to experience the disorder with mainly depressive episodes than men. A major problem when it comes to diagnosing children with Bipolar disorder (although it affects approximately 750,000 children a year (Sutton,2013)), is that it doesn't seem to follow typical mood cycling patterns typically found in the disorder, because mania and depression tend to manifest differently in younger people. According to the Depression and Bipolar Support Alliance as many as 80% of children with Bipolar disorder are undiagnosed for up to ten years before receiving appropriate treatment. This difficulty in diagnosing stems from the fact that at such a young age, the child's behaviors may be confused for ADHD, Depressive disorders, or may be attributed to typical experiences of puberty. Having so many undiagnosed adolescents and children is dangerous and often causes problems in the patient's life. Children with undiagnosed Bipolar are at an increased risk of experiencing difficulty in academics, and are higher risk of having learning disabilities. Adolescents with undiagnosed Bipolar disorder are also 40-50% more likely to experience alcohol or drug abuse (Sutton,2013). They also tend to experience a much greater difficulty maintaining healthy friendships and relationships, even with family members.

Although as of right now there is no definitive cause of Bipolar disorder, multiple factors have been found to exacerbate it, or make it more likely. Currently it is believed that the disorder is partially caused by the malfunction of three brain chemicals: Serotonin, dopamine, and noradrenaline (Psych central, 2018). Bipolar has also been found to be a hereditary disease, with the likelihood increasing if one or both parents have the disorder. If one parent has Bipolar disorder the likelihood of the child having it spikes by 15%, and if both parents have it, the likelihood of the child developing the disorder is 40% greater (Mayo Clinic,2018). Environmental factors can als affect when the disorder begins to manifest itself outwardly. Traumatic events may trigger a depressive episode, and alcohol or drug use may trigger manic episodes or even psychotic breaks.

Family has also been shown to greatly affect the cycling of moods in a person with Bipolar Disorder. Research has implicated the role of psycho-social stressors, including high expressed emotion attitudes among family members, in the relapse- remission course of the disorder (Miklowitz,2007). In families where high expressed emotion attitudes are common, such as intense criticism, hostility, and/or emotional overinvolvement negative interactions tend to occur more often and may trigger Irritability in the person with Bipolar disorder, and may be linked to causing manic or hypomanic episodes, which in turn causes more high expressed-emotion interactions from the parent or family member (Miklowitz,2007). Family focused treatment has been shown to help resolve these high emotion-expressed situations, and also teaches parents and family of the person with Bipolar disorder how to recognize symptoms of an episode and how to act in ways that won't further trigger them. Some components of family focused treatment include psychoeducation, communication enhancement treatment, and problem-solving skills training.

Even though there's currently no cure for Bipolar, there are many treatments that can help maintain stability in someone with the disorder. Many people choose with Bipolar choose medications to stabilize their moods. Many psychiatrists recommend anti- convulsants (anti-seizure) medications such as Lithium or Topiramate, while others recommend anti- psychotics like Risperidone or Ziprasidone. Some choose to also undergo therapy that also acts as education about their disorder. Cognitive behavioral therapy, psychotherapy, and family therapy have all been shown to aid stabilization. Educating oneself about Bipolar disorder can also help stabilization because it teaches the patient how to recognize symptoms of mania or depression.

Summary

Bipolar disorder affects 2.6% of the American population, and is the sixth leading cause of disability in the world. It affects men, women, and all races and classes of people indiscriminately, as well as children. Bipolar disorder is often harder to diagnose in children, and can cause many problems for them in adolescence. There is no definitive cause of Bipolar disorder, but there are multiple factors that are suspected to be responsible; including hereditary genetics, neurotransmission failure and environmental factors including the family of the person with Bipolar disorder. Manic and depressive episodes can be triggered by high expressed-emotion families, but this can be counteracted through family therapy. There is no current cure for Bipolar, but through consistent therapy and the proper medication, people with the disorder can live relatively stable lives.

Discussion

I chose the topic of Bipolar disorder because not only do I find it to be interesting, I was diagnosed with mixed state Bipolar disorder six years ago. I always enjoying having reasons to educate myself on issues that affect my life on a day to day basis. The topic I chose was one of the options given, but It also relates to the course specifically because it is mentioned in chapter 15 under the unit about psychological disorders. Much of the information in this paper I was already aware considering I live with the disorder every day, but something interesting I learned about was high expressive-emotion families and how that can trigger mania. That was something I took note of because that cycle of criticism and interference from my parents leading to irritation on my part was something I could relate to. I think that family focused treatment could help me and my family understand my disorder better, so I will definitely keep that information with me moving forward.

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