Bipolar Disease
Description:
What is unipolar illness? When the
mood is just depressed. This is far more common than bipolar illness.
What
is bipolar disease? Bipolar disorders (manic-depressive illness) are marked by
periods of manic, greatly elated moods or excited states as well as by periods
of depression. Although the manic-depressive psychosis may alternate from one of
its phases to the other, one or the other phase is usually dominant for a while.
Depression is more often dominant than mania. Manic-depressive patients often
recover spontaneously for periods of time, but relapses are fairly common. Most
often this disease is genetic. Bipolar is a severe mental disorder. There are 2
types of the bipolar diseases: Bipolar 1 & bipolar 2.
Bipolar 1- person
experiences at least one, and usually many more, manic episodes, alternating
with episodes of major depression
Bipolar 2- the individual experiences
periods of hypomania alternating with episodes of major depression.
What is
cyclothymia? Similar to bipolar disorder since it is characterized by mood
swings from mania to depression. However, there are several important
differences between the two. A person with cyclothymia experiences symptoms of
hypomania but never a full-blown hypomanic episode. A person with cyclothymia is
never symptom-free for longer than two months.
The Affective Spectrum- Some
people who have bipolar disorder (manic depression) or unipolar disorder
(depression-only) have co-existing conditions such as migraines, attention
deficit disorder, fibromyalgia, eating disorders, etc
The following have
been identified (so far) as part of the medical spectrum, which may accompany
affective disorders:
· attention deficit disorder (ADD & ADHD)
·
body dysmorphic disorder
· cataplexy
· eating disorders (bulimia,
anorexia, binging)
· fibromyalgia (includes chronic fatigue)
·
impulse-control disorders
· irritable bowel syndrome
· kleptomania
·
migraine/severe headache
· narcolepsy
· intermittent explosive
disorder
· pathological gambling
· pyromania
· personality disorders
· post traumatic stress disorder
· substance abuse and addiction
(includes alcoholism)
· obsessive-compulsive disorder
· panic disorder
· Tourette's disorder
· anxiety disorders
· autism
Symptoms:
Mania-
Increased energy- Decreased Sleep, Little Fatigue, an
Increase in Activities, and Restlessness.
Speech disruptions- Rapid Speech
and Incoherent Speech
Impaired judgment- Lack of Insight, Inappropriate
Humor and Behavior, Impulsive Behavior, Financial Extravagance, and Grandiose
Thinking.
Changes in thought patterns- Irritability, Excitability,
Hostility, and Feelings of Exhilaration
Changes in Perception- Inflated
Self-Esteem, Hallucinations, Paranoia, and Increased Religious Activities
Depression- Changes in Activity- Decreased Energy, Fatigue, Lethargy,
Diminished Activity, Insomnia or Hypersomnia, Loss of Interest in Pleasurable
Activities, and Social Withdrawal
Physical Changes- Unexplained Aches and
Pains, Weight Loss or Gain, Decreased or Increased Appetite, and Psychomotor
Agitation or Retardation
Emotional Pain- Prolonged Sadness, Unexplained,
Uncontrollable Crying, Feelings of Guilt, Feelings of Worthlessness, Loss of
Self-Esteem, Despair, Hopelessness, and Helplessness
Difficult Moods-
Irritability, Anger, Worry/Anxiety, Pessimism, Indifference, and Self-Critical
Changes in Thought Patterns- Inability to Concentrate, Indecision, Problems with
Memory, Disorganized
Preoccupation with Death- Thoughts of Death, Suicidal
Ideation, Feeling Dead or Detached
Treatment:
Psychotherapy- psychotherapy is indicated to help the person deal with
the effects of the illness in his or her life, to work on coping with the
stresses that can trigger episodes, or to help individuals who have
psychological difficulties when their moods are stable. Family therapy can help
all family members learn about the illness and deal with it better as a family.
For Acute Mania- This may require hospitalization to protect the individual
or others from impulsiveness. Lithium is generally the drug used to stabilize
the person. The response to lithium usually takes a few days. If the individual
is experiencing psychotic symptoms, antipsychotics (e.g. haloperidol) are
usually given. Anticonvulsant drugs such as Carbamazepine (Tegretol) can also be
used.
For Acute Depression- Lithium can be given and is very effective.
Antidepressants may also be prescribed to the patient.
Cyclothymia- Therapy
is used in most cases. In severe cyclothymia, lithium will be prescribed.
In
general- Lithium is given and really decreases the manic and depressive attacks
in about 70% the patients. The person must be tested to monitor potential side
effects and to be certain the person is taking the medication.
To treat
acute episodes of mania and depression and to prevent relapse, doctors often use
medications.
Common Drugs:
Lamotrigine (Lamictal)- Mood Stabilizer /
Anticonvulsant
Lithium- Mood Stabilizer
Oxycarbazepine (Trileptal)- Mood
Stabilizer / Anticonvulsant
Topiramate (Topamax)- Mood Stabilizer /
Anticonvulsant
Venlafaxine (Effexor)- Antidepressant
Setraline (Zoloft)
Side Effects of the Medication:
Lithium- increased urination,
Nausea, increased thirst, muscle twitching, and weight gain.
Carbamazepine-
clumsiness or unsteadiness, dizziness, drowsiness, lightheadedness, and nausea
or vomiting.
Haloperidol- Blurred vision, changes in menstrual period,
constipation, dryness of mouth, swelling or pain in breasts (in females),
unusual secretion of milk, and weight gain.
Lamotrigine- Blurred or double
vision or other changes in vision; clumsiness or unsteadiness.
Oxycarbazepine- Mild sleepiness or fatigue; nausea, vomiting, or stomach
pain; tremor; dizziness; rash; diarrhea, constipation, or decreased appetite;
headache; or dry mouth
Topiramate- Breast pain in women; nausea; tremors
Venlafaxine- Abnormal dreams; anxiety or nervousness; chills; constipation;
diarrhea; dizziness; drowsiness; dryness of mouth; heartburn; increased
sweating; loss of appetite; nausea; stuffy or runny nose; stomach pain or gas;
tingling, burning, or prickly sensations; trembling or shaking; trouble in
sleeping; unusual tiredness or weakness; vomiting; weight loss
Sertraline
(Zoloft)- Decreased appetite or weight loss; diarrhea or loose stools;
dizziness; drowsiness; dryness of mouth; headache; increased sweating; nausea;
stomach or abdominal cramps, gas, or pain; tiredness or weakness; trembling or
shaking; trouble in sleeping
Facts About Bipolar Disorder and Suicide
· Approximately twenty percent of all patients with bipolar disorder have
their first episode during adolescence. Peak age of onset is between fifteen and
nineteen years.
· Most people suffering from bipolar disorder who attempt
suicide do so very soon after the onset of the disorder.
· Patients
suffering from depression and bipolar disorder are far more likely to take their
own lives than individuals in any other psychiatric or medical risk group.
Without effective treatment, bipolar disorder leads to suicide in nearly 20
percent of cases.
· The mortality rate for untreated bipolar patients is
higher than it is for most types of heart disease and many types of cancer.
· Among all those who die by suicide, more than two thirds suffered from a
depressive illness or bipolar disorder.
· Although more men than women
complete suicide in the general population (4:1), the gender rates for completed
suicide in those suffering from bipolar disorder are equal.
· Studies of
bipolar populations indicate that 25-50% of bipolar people attempt suicide at
least once.
· Studies indicate that most bipolar patients who die by suicide
try and communicate their suicidal ideas to others, most frequently through a
direct and specific statement of suicidal intent.
· There is strong
scientific evidence linking bipolar disorder, artistic creativity, and suicide.
More research is needed to determine which patients are most vulnerable to
suicide and which treatments effectively deal with the disorder without
hindering a person’s artistic performance and creativity.
· Treatments for
people with depressive disorder are successful in alleviating symptoms over 80%
of the time.
Key terms:
Hypomania- a mild degree of mania; often a
precursor to a full manic episode. Often it doesn’t require hospitalization
because it isn’t as severe as a manic episode.
Mania- an excited mood
characterized by mental and physical hyperactivity, disorganization of thoughts
and behavior.
Manic depression- was and earlier name used for bipolar
disease.
Cyclothymia- similar to bipolar disorder since it is
characterized by mood swings from mania to depression
Bipolar disorder-
Disorder in which an individual alternates between feelings of euphoria and
depression.
Manic-type reaction- a psychotic reaction characterized by
extreme elation, agitation, confusion, disorientation, and incoherence.
Depressive-type reaction- a response pattern in which a person is
overcome by feelings of failure, sinfulness, worthlessness, and despair.
Bibliography:
The Medical and Health Encyclopedia
Editor, Rich
J. Wagman, M.D.
J.G. Ferguson Publishing Company
http://bipolar.about.com
Psychology Today May/June 1997
Understanding Psychology
Richard A. Kasschau, PH.D.
McGraw-Hill