Bipolar Disorder and its Treatment

People who suffer from bipolar disorder have moderate to severe mood disorders, alternating between states of depression and states of elation. People who are in a state of depression will experience insurmountable despair and be unable to sustain normal relationships and function to their full capacity, and may experience hallucinations and delusions. Mania is a psychological condition where a person is euphoric and extremely energized, and appears to be self-centered with a diminished need for rest and food. People who have bipolar disorder experience lengthy periods of depression, as well as shorter-lived experiences of mania and hypomania.

The primary sign of bipolar disorder is the occurrence of at least one hypomanic or manic episode. The frequency and character of bipolar symptoms, rather than mimicking mild to moderate depressive or hypomanic states, can vary between episodes.

For patients affected by this disorder, it represents an intense disruption to their personal lives and spoils relationships. This pattern of behavior can destabilize partnerships and contribute to job loss. It is essential to recognize the signs of the disease early on so that it can be better managed. It is essential to be mindful that bipolar disorder does not concentrate solely on the mood of an individual; these temper swings and altered mental states have significant psychological and emotional implications. An appraisal of the cognitive implications and treatments for bipolar disorder is also attempted in this section. The breadth of the interactions and associations among different brain areas makes it plausible that bipolar disorder is both metabolic and functional.

Definition and Symptoms

Bipolar disorder is a mental illness that stops people from properly regulating their moods. A person who argues is completely separate from the ordinary fluctuations of mood because of every age, behaving out of mania and depression (or more in between) on a periodic basis. Most importantly, bipolar disorder affects mood in excessive emotional states or cycles of lows and highs that influence energy, activity, judgment, and behavior. Those fluctuations in gain or intensity mimic age problems but may remain mystified due to an absence of understanding of the disorder. It may take up to 10 years after the first signs of bipolar disorder before anyone has diagnosed or treated the problem. Bipolar disorder can seem to be a variety of disorders, and remedies are based on the predominance and severity of symptoms. However, experts agree that all four symptomatic categories are present in a few individuals. Manic, hypomanic, and depressive episodes are categorized by signs or symptoms related to subjective, emotional, and cognitive capabilities. Characteristically, these characteristics occur in the mood already existing between a manic and a depressive episode. The type of mood alteration is important because numerous individuals may lapse, especially during the initial treatment period, into a hypomanic state or directly into a depressive episode in an illness that is described as eventually leading to a collapse of the heart of the enterprise. New mixing techniques occur within manic or depressive states. Awareness of periodic mood changes is an essential issue in bipolar diagnosis and is one key reason for the interest in this context. Media reports commonly highlight these happenings, thus registering some descriptions. Dictionary definitions all provide pointers to be of use in these discussions.

Types of Bipolar Disorder

Bipolar disorders are distinguished according to the nature of the process. These are explained below:

• Bipolar I: The primary difference is that mania is more pronounced in this category, even though it is often followed by recurrent depressive episodes.
• Bipolar II: The primary difference in this category is that mania is relative, in which hypomanic episodes are more pronounced and depressive episodes are more severe or exist.
• Cyclothymic Disorder: This is a distinct and chronically stable mood, but it does not match the full criteria of mania or depression. Accordingly, cyclothymic disorder includes subclinical symptoms or individual depressive and hypomanic episodes. The lower intensity of these disorders can often be much milder than those discussed in other episodes, particularly in bipolar I disorders. Bipolar disorder is a schematic disorder of the syndrome, and in fact, manic-depressive disorder is an illness of the syndrome. Correct determination and naming of classes is important in patients' treatment planning and treatment assessment. The importance of a name in a bipolar disorder, including the whole of the disease, underscores the complex nature of the co-syndromal disorders. Correct determination of the syndrome and naming is as important as diagnosis. The correct diagnosis is essential, as the ungoverned may make patients and their families lose losses and avoid treatment adherence in many cases.

Causes and Risk Factors

Bipolar disorder is a complex multifactorial disorder whose etiology is a combination of diverse genetic and environmental influences. Indeed, the heritability has been estimated to be between 70% and 80%, suggesting a greater role of genetic than environmental factors. However, contemporary studies highlight that genetic risk factors may make individuals more vulnerable to environmental stress. Therefore, about 20% of bipolar disorder diagnoses occur in the absence of a family history of this disorder, and between 60% and 68% of monozygotic twins show concordance for the disorder, indicating the importance of environmental risk factors in the expression of the disorder. In association with the answer to the question "what causes bipolar disorder?", an understanding of "risk factors" is necessary. Risk factors include any situation, occupation, environment, personal attribute, or trait that increases the probability of developing a medical or psychiatric disorder. Knowledge of risk factors is an important step in developing programs to prevent the disorder. They may be specific to causal pathways or be more simply associated with the outcomes and can precipitate or exacerbate bipolar disorder. The period with the highest risk for onset of the disorder is emerging adulthood, late adolescence, and the beginning of the third decade of life. There is a tendency for a subsiding risk of onset in the 60s, but with consistent occurrence of new-onset bipolar disorders throughout most of the adult years. Research has shown that almost half of cases have their onset in adolescence or early adulthood when precipitating events very commonly occur. The age of onset varies between the subtypes. Bipolar I has an average age of onset younger than bipolar II or cyclothymia. Three categories of risk factors have been proposed to explain the onset of mood disorders: stress, trauma, major life changes; genetic risk factors; and developmental changes. Racialism appears to be associated with age of onset. Ethnically mixed individuals are at higher risk of earlier age of onset than those who are solely one ethnic group.

Genetic Factors

Evidence for a genetic predisposition to the development of bipolar disorder has been compelling. Adoption studies have demonstrated that the biological children of parents with bipolar disorder are at a 3-33 fold greater risk of developing bipolar disorder than are the adoptive children of these parents. In an adoption study of 144 reared-apart offspring, 6.6% of the biological offspring of parents with bipolar disorder developed bipolar disorder, whereas 0.2% of the adoptive offspring of parents with bipolar disorder developed bipolar disorder. Consistent with this evidence, findings in family studies indicate that both first-degree and second-degree relatives of patients with bipolar disorder share an increased general vulnerability to mood disorders, with depression being the predominant manifestation in the family. Indeed, family histories of mania may predict an increased familial loading for unipolar as well as bipolar disorder. These and other findings have suggested that a general liability to mood dysregulation is heritable, and that it is not only the genetic vulnerability that is familial but the range of phenotypic expression as well. Among the various proposed models, statistical intensity in male relatives signifies a male-specific genetic vulnerability.

Carriers of specific alleles have been shown to be at increased risk of developing bipolar disorder. Surrogate cis-acting transcriptional regulatory elements affect the expression of at least two genes not usually associated with bipolar disorder: 1. GRK3. This gene encodes a protein that functions as a negative regulator of certain signaling pathways in the cell, including at least two neurotransmitter receptors; inhibiting GRK3 might amplify signaling within these pathways; and 2. GSK3B. This gene encodes an important signaling molecule that participates in many molecular events in the cell. It is a target of drugs used to treat the manic states of bipolar illness, and a likely target for the development of new therapeutic agents. Carriers of the risk alleles for each of these markers are at higher risk for developing bipolar disorder. However, the overall effect of these variants on susceptibility in bipolar disorder is small; consequently, a complex, multi-factorial mode of inheritance is suggested. No genes responsible for the appearance of classic mania-overactivity, racing thoughts, delusions as well as depression have been reported. It is likely that a characteristic endophenotype will be necessary to localize new loci with a primary effect in mania. Clinician-scientists now have the following model: the genes for bipolar disorder interact with the environment. The disorder defines an endophenotype that reflects an interaction between genes and the environment. It is likely that such an endophenotype will include several of the affected genes.

Environmental Triggers

Substantial evidence suggests that a range of life events, especially those involving significant relationship changes or marked interpersonal rejection, are of etiological significance as triggers for the first onset of bipolar disorder. This is also the case for the first onset of depression, although it is less clear whether postmortem diagnoses of bipolar disorder show the same protection from early negative life events as is seen for schizophrenia. Other life events implicated as triggers include persevering financial difficulties in the run-up to an episode and the loss of a parent before the age of 11, especially for females with a positive family history, who are at 15 times the risk of suicide compared to female controls. It is also suggested that effects are mediated through the neurodevelopmental sensitizing mechanisms discussed above.

Traumatic experiences are likely to be of particular importance, with almost half of all bipolar patients reporting a history of abuse; two-thirds have a positive family history. This exposure is significantly associated with the number of complex, severe episodes, rapid cycling, and mixed affective states; its presence also decreases the age at onset of the illness. More generally, the abuse of what have been termed attachment patterns can give rise to temperamental excesses of excitable flight into hypomanic fantasy as a psychological counterbalance for feelings of insecure attention and demand from others. However, in the majority of cases, genetic factors will also be necessary if a truly psychotic mania or manic-delusional depression is to eventually emerge. A much higher frequency of major failure or loss, including deaths of children or partners, is experienced in the year prior to the onset of a manic episode; the actual season of admission is also suggestive of an important environmental effect in spring. Sleep represents a further major trigger, with those vulnerable to bipolar disorder showing season-related reductions in slow-wave sleep, and the aftermath of any sleep deprivation, including jet lag effects, presenting as an important precipitant of a first episode. The same stress kindling model applies, such that sleep disruption may precede any initial onset of episodes, and perhaps also any depressive relapse. It may then also progress from the relatively mild effects of a changed season to mania itself.

Diagnosis and Assessment

Bipolar disorder is a serious mental health condition. It is essential not to diagnose it wrongly as some other mental health conditions. The better we are at evaluating, the better our treatment can be. To identify a health condition, doctors generally use a book called the DSM-5. It recognizes when someone has a health condition called bipolar disorder. In interviewing sessions, our doctors spend some time discussing their life and mood. They also ask about past and present illnesses. Our doctors use questions from the General Behavior Inventory 16 adult versions.

We use this questionnaire of the exact same material in a personal setting as well. Some important reasons that bipolar disorder is frequently misdiagnosed include: 1. Many mental health diagnoses list strong emotions as symptoms 2. Not seeing manic episodes 3. Diagnoses that are short or not reported 4. Not having a clear history. Parents, partners, kids, and other important persons in someone's life typically take part in assessments. They usually do an event chart. Young people often assist in grades. We use assessment tests to help understand the history of a person and the problems that occurred. In a few tests, events can build up over a week, and some tests can help to determine the right drugs to handle the problem.

Diagnostic Criteria

It is with the diagnostic criteria that the DSM-5 specifies which aspects a person’s condition must present in order for them to be considered as having bipolar disorder. The first issue it addresses is the various types of symptoms or episodes that a person needs to present to be diagnosed correctly.

Manic or hypomanic episode: To be diagnosed with bipolar disorder, the person must have experienced a manic or hypomanic episode at some point in their lives. For a diagnosis of bipolar I disorder, the person must have had a manic episode, which must be either present at the time or be in the past. A depressive episode is not a requirement for a diagnosis of manic or hypomanic episodes.

Depressive episode: The second requirement for a bipolar disorder diagnosis is a depressive episode. In the context of bipolar II disorder, the person’s depressive episode is positioned in, around, or after a hypomanic episode.

The third requirement is the duration of the person’s symptoms in a depressive or manic/hypomanic episode. To be diagnosed with bipolar disorder, the person must have had their symptoms for a minimum of two weeks in a hypomanic episode and one or more weeks in a manic episode. To help diagnose bipolar disorder and work out which type you have, it is crucial for healthcare professionals to rule out other potential causes of your symptoms and to assess whether or not your symptoms are instead due to another mental health disorder. This rule ensures that the diagnosis and your mental health treatment are as accurate as possible.

Assessment Tools

When diagnosing potential BD patients, experts apply a wide variety of assessment tools in order to attain an accumulation of data to establish if the patients should be diagnosed with BD, as well as which subtype they have, measure the number and characteristics of their mood episodes, and evaluate the severity of their current mood swings, as well as their interepisodic functioning and symptoms. A central, but not exhaustive, list of tools that are most commonly used is as follows. For diagnostic purposes: SCID, MINI, IPDE. For mood symptom severity: MADRS, HDRS, BDI, YMRS, CARS-M, CARS-F, HCL-32. For the quantification of episode number and rapid cycling: life-charting and the DSM-5 criteria.

The tools partly overlap; however, combining as many as possible in clinical practice and research increases the chances that a comprehensive BD diagnosis can be made. A comparison of the data from the different assessment methods will also assist clinicians or researchers in choosing who should benefit from treatment adjustments, either by taking a more critical stance on how to manage potentially troubling side effects or by adding other therapeutic elements adjusting to the unique characteristics of the patient’s overall presentation. For spontaneously reported depressive symptoms, the HAM-D and the MADRS are frequently used patient self-reported scales that measure symptom intensity. For depression and mania, three self-report questionnaires commonly used are the Beck Depression Inventory, the Mood Disorder Questionnaire, the Internal State Scale, and the Altman Self-Rating Mania Scale. Administering the HAM-D should always be done by clinicians in practice as well as implemented in a trial setting. The biggest differences between the scales are their clinical difficulties of usage and whether the self-identification of current symptoms opposes or confirms the clinician's identification. Administering several observer, e.g., clinician rater-completed scales to evaluate a patient’s current mood level also facilitates the detection and confirmation of the symptoms. Administering one or several different scales during treatment will also help in identifying who a responder or non-responder is, as well as assist in the evaluation of the efficacy of the treatments for the current mood episode.

Treatment Approaches

Management of the illness is complex and involved. There are several approaches that can be used to manage the illness, reduce the symptoms, and alleviate distress at different times. As everyone’s experiences of having and living with a mental health problem are different, the approach taken for each person will need to be unique. Treatments can be adapted to support someone with bipolar disorder through specific life stages or events they may be currently experiencing, or that will help plan for the future to reduce the likelihood of a recurrence. Seeking support is an important first step towards recovery. Bipolar disorder is associated with low self-esteem, isolation, and sometimes poor mental and physical health. It is important, when seeking help and support, to build a team of people around you who will support your physical, psychological, spiritual, and emotional health needs.

Not everyone with bipolar disorder couples medication treatment with psychotherapy; medication is often referred to as the 'first-line treatment.' Many people with bipolar disorder will also benefit from 'well-being advice,' which can be an activity that helps people to help themselves. Exercise is one way in which movement can make a difference to mood by improving depressive symptoms. Psychological therapists, like life coaches and people with a special interest in advising on aspects such as nutrition, may also offer well-being advice. The best treatment is one that is tailored to the specific individual experiencing such feelings. The best position to offer such treatment is the primary care team from your GP, who will have specialist organizations locally to consult with.

It is now recognized that a wide variety of interventions may be helpful for people with a bipolar disorder diagnosis. These can involve a combination of medical and non-medical approaches. There is no drug that works like a 'magic bullet.' Support for mental and physical health, as well as social support, is likely to be an important part of preventing extended periods of physical, mental, or social breakdown. Brain science, genetics, and wider social sciences make clear the need for treatments that are more 'personalized' to the social, psychological, and underlying mechanisms in individual situations. Long-term treatment plans and their meetings can take into account someone’s hope for the future, the beliefs and values they hold, their personal social and cultural fears, and protect their dignity and worth. Different treatment approaches, such as medication, can be coordinated by psychologists, psychiatrists, GPs, and practice-based pharmacists. Physical health nurses can be involved to support lifestyle changes, which can also make a difference for people with a diagnosis. For some, psychological therapists, such as counselors, coaches, or others, can also offer approaches especially tailored to the individual.

Pharmacological Interventions

The treatment of BD, when not contraindicated or refused, must foremost include the use of medications. Psychopharmacological interventions for BD include a range of medications, with notable disparate mechanisms of action. Existing treatments for BD are classifiable into mood stabilizers, antipsychotics, including both the first and second generations, and antidepressants, including the use of TCAs and SSRIs. The efficacy of such medications in defining the symptoms of mania, including psychosis, is mostly rooted in their capacity to manipulate dopaminergic and noradrenergic transmission, enhancing gamma-aminobutyric acid along with other mechanisms of transmission. The establishment of dosage ranges for BD exists in the body of literature, along with evidence on benefits and side effects. The prescriber is required to maintain a regular assessment of side effect occurrence and severity, and modify dosages accordingly. Again, patient-prescriber communication, in all steps, is crucial. The overall challenging aspect of the pharmacological treatment for BD, on one side, lies within the so-called 'trial and error' of using or switching a medication in the absence of established biomarkers currently available and, on the other side, the potential for more or less nonadherence to medication that is required to be taken for long periods.

Many existing treatments in BD can treat mania acutely, in conjunction with other interventions. The treatment evidence tends to involve medicines that are used for this, rather than mood stabilizers necessarily. A range of mood stabilizers have been demonstrated in either reducing or stabilizing symptoms of mania. The dissemination of reasons for the continued administration of mood stabilizers or antipsychotics post-manic phase has hardly been researched. Also, it is uncertain whether some of the potential consequences of maintaining treatment, such as weight gain or metabolic syndrome, are not of concern after acute presentation is less pronounced. Finally, incorporating a lifetime of exposure to these agents into any result remains a challenge, because the time frames evidence provides span from weeks to a few years. In short, the currently available evidence does support repeat presentation of BD. The way we might wish to treat symptoms that are outside of the time-dependent manic or depressive poles of the illness might differ from when such is not the case. It lacks clarity.

Psychotherapy and Counseling

Psychotherapy or counseling can help patients with bipolar disorder lead healthier, more satisfying lives and engage more fully in treatment. The skills learned in various kinds of psychotherapy can help make a person with the disorder feel better, relate better to others, and behave in ways that support their goals. Although medication can relieve many of the symptoms that accompany bipolar disorder, it is less effective in helping patients adjust to receiving a lifelong psychiatric diagnosis and cope with the social impact of living with a mood disorder. For these reasons, psychotherapy can be added to medication. Several forms of therapy are effective. One of the most practical choices is often cognitive behavioral therapy, which can be adapted or refined to help patients with different forms of the disorder.

Interpersonal and social rhythm therapy is a form of therapy developed specifically for bipolar disorder. It focuses on helping individuals regulate their daily routines to improve bipolar symptoms. Psychotherapy, or "talk" therapy, can help individuals with bipolar disorder, as well as provide support, education, and guidance. Therapy can help improve mood, increase activity, and allow the individual to question and change negative, pessimistic thoughts. Relationship counseling can provide support for people who are dealing with the pressures of caring for a loved one with bipolar disorder. It can provide information about the family members' role in treatment, express feelings about the way family members interact, and help the person with bipolar disorder express feelings and fears about their condition. A trusted therapeutic alliance between a patient and their mental healthcare provider is key to successful treatment of the disorder. The patient must have confidence that their provider listens to their concerns, outlines the pros and cons of different hard choices, and explains the basis of their own views and advice. Patients with bipolar disorder need to involve themselves actively in treatments and have a part in developing treatment plans. Families can play a key supportive role. Often, cooperation in treatment can ease the burden of the caretaker. Given the often significant familial and social disruptions of bipolar disorder, family education and support are essential. Systematic early interventions can prevent mood problems before they become severe. Effective interventions provide support and guidance to families. Families often find it helpful to employ professionals who help families become more efficient communicators, learn effective problem-solving methods, and express feelings between family members.

Lifestyle Management

Lifestyle management strategies can help with bipolar disorder. With bipolar disorder, and the day-to-day instability it brings, a stable routine can bring some relief. This doesn’t mean you should never try new things or change things in your life, but in general, it is best to try to keep a regular routine as a way of managing your illness. Everyone’s illness is different, but the sections below outline the main lifestyle changes that are likely to be useful for you.

During manic phases, some people may need less sleep or have sleep problems. In a depressive phase, you may feel that you want to sleep more. This can sometimes make sleep problems even worse, so it is important to find ways to try to improve sleep. Some good sleep hygiene tips include keeping to a regular routine, establishing a pre-sleep routine, and avoiding substances that can interfere with sleep. Around 30 minutes to an hour before bedtime, it can be helpful to do some relaxing activities, such as reading, taking a warm bath, or relaxing with music.

Exercise can help you feel better and stay well. Even engaging in a little regular exercise – half an hour a day, preferably outside – can help to regulate your moods and improve your feelings of well-being. You don’t need to do a long walk or to be really physical. All that matters is getting out and about and doing something you enjoy.

Our mood can also be affected by the food we eat. Sugary or fatty foods and drinks can make people feel better temporarily, but it does not help to stabilize their mood in the long term. For some people, managing their sugar levels can be particularly helpful in managing their mood. It is important, therefore, to have a balanced diet and drink plenty of water. To get all the nutrients you need, food and drink you consume can form the basis of your healthy diet, such as fruit and vegetables, whole grain carbs, lean protein, nuts and seeds, low-sugar and low-fat substances, and no processed food. Always consult your GP if you have any drastic changes to your diet or any physical health problems.

Many people with bipolar disorder make a personalized mental health and lifestyle plan that includes some of these lifestyle changes. They think about these changes when they’re well and find ways to include them in their lives.

Sleep Hygiene

The importance of regularity in daily life (in eating, sleeping, and waking times) for people with bipolar disorder has been emphasized. The 'social zeitgeber' hypothesis of bipolar disorder suggests that irregular rhythms may trigger or exacerbate mood symptoms. However, it remains uncertain whether disturbed sleep directly triggers changes in mood or whether disturbed sleep and mood changes are symptoms of an underlying pathology. There has not been enough research into successful sleep interventions to make firm recommendations for what actually helps. That said, regularity of sleep remains an important goal.

It follows from the above that if disturbed sleep can trigger a mood episode, regular and undisturbed sleep will aid in keeping mood stable. A regular time for bed and for waking is most important, but regular times for meals are also helpful. The following is recommended to improve sleep for someone with bipolar disorder: - If sleep patterns are disturbed, make an agreement with the health provider about what changes to sleep are likely to be helpful. - Establish a routine for going to bed and getting up; it’s easiest if it can be the same every day, even on weekends. The routine should involve allowing 8-9 hours for sleep and not using the bed for activities other than sexual intercourse and sleep. It may be a good idea to establish a pre-sleep ritual. - Try to sleep in a dark room rather than with nightlights. - The room should also be cool, not too hot or too cold. - Get some exercise during the day; daily light exercise, especially in the morning, can be very helpful in improving nighttime sleep.

Exercise and Nutrition

There is a known link between our bodies and our mental health, with regular exercise and a healthy diet proven to be highly effective at enhancing our mood and reducing anxiety. Regular physical activity has been shown to be effective in managing the symptoms of depression and could be effective for those with bipolar disorder as an adjuvant therapy. Any form of exercise can be beneficial, from swimming, riding a bike, going for a walk to lifting weights in the gym, as all forms can stimulate the release of endorphins in the brain, which are our bodies' natural feel-good chemicals. Endorphins act as analgesics, diminishing the perception of pain, and as sedatives. They are manufactured in your brain, spinal cord, and many other parts of your body. Nutritious food and regular meals can also play a key role in maintaining mood stability.

There are several lifestyle and dietary factors to consider to help improve symptoms and work synergistically with psychiatric care. Following a healthy daily routine will help those with bipolar disorder to remain well by managing their symptoms. The right balance of nutrients, which are either unknown or are believed to have a role in the regulation of mood and anxiety, includes omega-3 fatty acids, which are important for brain function and are found in oily fish; complex carbohydrates; omega-3s; and protein, which all release serotonin, the feel-good hormone found in whole grain rice, pasta or bread, fruits and vegetables, meat, fish and eggs, dairy, and plant-based proteins. It is possible to manage some symptoms of bipolar disorder through lifestyle changes. It can be difficult for someone to commit to activating themselves through exercise and consciously break the link between physical and mental well-being. They might be able to understand it, but doing it daily as a routine and schedule can be a block. They might feel that once they start to engage in tomorrow or another day, what healthy eating or physical activity could improve.

The individual might also grapple with the long-term benefit in exchange for an activity that they might not enjoy due to being in a depressive episode. Indeed, those who have children with demanding jobs are less likely to be able to engage in it. It can also be hard for those with underlying health problems as a result of their mental health issues that could restrict their activity. Management and signing up for traditional sports in the sense of support often become a barrier for people with a mental illness. Not to mention, the social anxiety from those with previous trauma could be a considerable factor. They often seek security and feel self-conscious about their appearance. The gym can be a possible place, but it was not until self-confidence and their mental health improved. All these factors must be taken into consideration, and any exercise options must be individual-led.

Did you like this example?

548

23