Bipolar Disorder as a Possibly Treatable Illness

Bipolar disorder is a potentially treatable psychiatric illness that has substantial humanitarian and high social and economic impacts (Swann, A. C., 2006). It is a common, complex, and frequently severe mental health condition, characterized by progressive social and cognitive function disturbances and comorbid medical problems. Exemplifying a regular chronic disorder, it is marked by fluctuations in mood state and energy. It affects more than 1% of the world's population, regardless of nationality, ethnic origin, or socioeconomic status. Notably, bipolar disorder is among the leading causes of disability in young people (J. Alonso, M. Petukhova, G. Vilagut, et al.

, 2011), causing cognitive and functional impairments as well as elevated mortality rates, particularly through suicide. Psychiatric and medical comorbidities are common in affected individuals. The accurate diagnosis of bipolar disorder is challenging in medical practice, as the onset typically manifests as a depressive episode, closely resembling unipolar depression.

Bipolar disorder is characterized by the propensity to alternate between two contrasting 'poles' of elevated mood and depression, with a return to largely usual functioning in between these episodes. Periods of elevated mood are termed mania or hypomania, sharing common characteristic symptoms. Patients who have experienced an episode of mania are diagnosed as having Bipolar I disorder, whereas those with only hypomanic episodes are said to have Bipolar II disorder. For most patients with bipolar disorder, more of their lives are spent in a depressed mood than in periods of elevation, even for those with Bipolar I disorder. Furthermore, the illness usually first presents with a depressive episode, indicating that some young people with depressive episodes may later have hypo/manic episodes. It is crucial that the depressive episodes of bipolar disorder are recognized early and treated vigorously, as most suicides occur during depressive episodes. One aspect of refining the diagnosis of bipolar depressive episodes has been instructive if there are symptoms more commonly observed in bipolar than unipolar depression. It appears that diagnosis is often made in people with transient mood instability. Formal interviews have demonstrated that many of these patients had other conditions such as borderline personality disorder, unipolar depression, and impulse control disorders.

Bipolar I disorder is considered to occur approximately equally in men and women, whereas Bipolar II disorder may be more common in women than in men (American Psychiatric Association, 1994). Three main explanations may account for this discrepancy: firstly, we only included patients who were hospitalized. Previous studies suggest that women may experience a significantly higher number of hospitalizations for mania compared with men (Hendrick et al., 2000). This was seen to mirror a higher propensity for women to seek and receive treatment (Mechanic, 1986). It was also observed that family members are more likely to bring ill female relatives rather than ill male relatives to mental health facilities. The gender difference may be due to distinct societal norms for gender behaviors and/or higher likelihood for women to live with their families. Secondly, the high comorbidity rate of alcohol and drug use in men may have led to a psychiatric admission diagnosis of substance misuse rather than mania (Hendrick et al., 2000). Finally, as the prevalence of mixed mania is higher in women than in men, women are more likely to be hospitalized to prevent the risk of suicide associated with mixed states (Hantouche et al., 2006).
Dealing with bipolar disorder typically emphasizes stabilisation, the aim of which is to bring patients with mania or depression to a symptomatic recovery with a euthymic (stable) mood, and maintenance, wherein the goals are prevention of worsening symptoms, reduction of subthreshold symptoms, and improved social and work-related functioning. Treatment of both stages of the illness can be complex, because the same treatments that alleviate depression can cause mania, hypomania, or rapid cycling (defined as four or more episodes in 12 months). Additionally, treatments that reduce mania might cause rebound depressive episodes.

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