Bipolar Disorder (BPD) is a psychological disorder that affects the brain of over 60 million adults (WHO, 2018). It is characterized by two moods: mania and depression. These moods have been known to manifest themselves in various ways, from changes in attitude, to full blown manic episodes that include blackouts and irrational behavior. At this time, there is no official recorded physiological test for BPD. However, some psychologists have taken an interest in measuring lithium deficiency among patients. Doctors can also attempt to identify it by ruling out other serious neurological conditions while observing a patient’s behavior. Bipolar Disorder can be a burden, but can be treated effectively using cognitive behavioral therapy, in conjunction with pharmaceutical intervention.
Bipolar Disorder had been classically described by psychiatrists as occasional mood disturbances. What psychologists now know is that these mood disturbances are not always episodic, but can be a constant, everyday struggle (Soreca et al., 2009). Consider a pendulum, swinging back and forth from one side to another. This is a physical example of a patient dealing with the cycles of BPD. A patient can experience symptoms of mania: sleeplessness but with increased energy, extreme irritability, the irrational need to spend money, abnormally increased sexual desire (coupled with deviant sexual behavior), an abuse of drugs and alcohol, blackouts and loss of memory (BBF, 2018). This can last up to seven days, until the pendulum swings to the opposite side. This can lead to symptoms of depression: sadness and anxiety, fatigue and decreased energy, feelings of hopelessness, changes in appetite, and even thoughts of death or suicide (BBF, 2018). Patients with BPD toggle back and forth between these two moods in a constant cycle. The nature of these cycles has been categorized into three types of BPD: Bipolar Disorder I, for which a patient’s symptoms are so severe, he or she may end up causing themselves or others severe financial destruction or end up needing hospitalization; Bipolar Disorder II, for which a patient’s symptoms are more defined by shifts in mood, but not full blown episodes of mania or depression; Bipolar Disorder with Rapid Cycling, for which a patient may experience episodes more than four times a year (BBF, 2018).
Because psychologists are still trying to determine a physiological sign for BPD, it is difficult to pinpoint what the diathetic factors are. According to psychologist Datto, there are two major factors that could possibly contribute to the etiology of BPD: biological factors and environmental factors. Biologically, physical changes seem to occur in the brains of patients with BPD, although the reasons for this remain unclear. Genetically, BPD tends to appear in families with a history of the disorder, especially among first-degree relatives. Scientists have been able to show correlation between a patient’s genetics and family history (Datto et al., 2016). Hormonally, an imbalance has been shown to trigger the onset of BPD. Environmentally, an extreme amount of stress or a traumatic experience can often exacerbate symptoms of BPD or cause it to present itself if it has not already been diagnosed (Soreca et al., 2009).
Treatment for Bipolar Disorder is a multi-step process. Both medication and cognitive therapy go hand in hand to effectively control the symptoms of BPD, and make a patient’s life more comfortable. Pharmaceutically, Lithium, which has long been used as a mood stabilizer, has shown to be the most effective in treating a patient’s mania by altering the functions of neurons, as well as re-balancing hormones that cause manic behavior and/ or suicidal thoughts (Monteggia, 2017). According to psychologist Monteggia, BDNF, a protein that influences the degree to which neurons in the brain form connections with one another, tends to be lower in patients with bipolar disorder. Lithium treatment has been shown to increase these levels. Lithium does not have to be used long term, and a patient can eventually be weaned off, potentially being prescribed another long term medication once they have exhibited a balance in mood.
Of course, most medications come with side effects, and while there is much agreement in the psychiatric community as to the effectiveness of Lithium, patients who actually suffer from BPD do not often enjoy what’s been called the numb feeling they develop while taking it. In an on the record interview with Nathan Green, a current patient of Austin Lakes Hospital, who is receiving treatment for Bipolar Disorder I with rapid cycling in their outpatient program, he states, While being on Lithium has definitely calmed my erratic behavior, it has also made me feel completely emotionless. I no longer get sad or angry, but I also don’t really feel any joy. I don’t react to humorous things, I don’t really laugh or cry. I am just here. But after Green’s experience with an extreme manic episode, where he maxed out three of his wife’s credit cards, experienced a black out, and has now had to file for bankruptcy, he is more than willing to endure the side effects of what will hopefully be an effective treatment. I hit rock bottom, I let my family down, and the worst part is I don’t even remember doing most of it, he claims (Green, N. August 28, 2018).
Another facet of treatment is cognitive behavioral therapy. Bipolar Disorder patients have cognitive difficulties in everyday functionality such as memory, attention, and motivation (Goodwin et al., 2008). For patients such as Green, outpatient programs, like the one at Austin Lakes Hospital, offer individualized strategies for: communicating with family members and peers when the onset of a manic or depressive episodes may be occurring, problem solving in the event of stress or mania, sleep/wake cycle regulation, and task oriented goal setting. Learning to recognize and manage episodes of mania and depression can help a patient successfully function in everyday situations that they may have found previously impossible. It can also prevent dangerous behaviors from occurring during a severely manic episode. However, for these cognitive therapies to be effective, a patient has to be motivated enough to put these skills into practice, which can be difficult if the patient’s medications are ineffective, or if the patient does not have the will to get better.
Bipolar Disorder requires much more research and study before psychiatrists and psychologists can truly understand the influences and etiology of the disorder. In recent years, great strides have been made to treat BPD effectively in patients to help ease the difficulties of living life on an emotional pendulum. If those diagnosed with BPD continue to pair medical intervention with psychotherapy, reducing, or even eliminating, this disorder can be accomplished.
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