Bipolar Disorder as Manic-depressive Illness
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day to day task (The National Institute of Mental Health, n.d.) Bipolar disorder was first recognized by the ancient Greeks. In the mid-1800’s, Jules Baillarge described a mental health disorder characterized by recurrent fluctuations between mania and depression. Emil Kraepelin noted that patients with this disorder tended to have symptom-free episodes between their episodes of depression and mania (Dikel, 2014, p. 53). In 1957 the terms unipolar, for patients who suffered from depression only and bipolar, for patients who had the mania, was created. No one knows what causes bipolar disorder. Studies have shown that the brains of people with bipolar disorder may differ from the brains of healthy people or even people with other mental illness (The National Institute of Mental Health, n.d.). There are several factors that can increase someone developing bipolar disorder. Having a parent or sibling with bipolar disorder can increase someone’s chance of being diagnosed with bipolar disorder. However, most people with a family history of bipolar disorder will not necessarily develop the disorder. Scientist do not know what gene may be involved in causing the disorder. Studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always develop the disorder, even though identical twins share all the same genes. People who have bipolar 1 suffer from two alternating and separate states (Cain, 2016). One end of the disorder being depression and the other end being elated, also known as the manic state. When a person’s mood is depressive or elated for prolonged periods of time, only then one meets the criteria for Bipolar Disorder (McKeon, 2015). The depression needs to be present for at least two weeks and it must be continuous. The elation/mania state must be present for at least four days for hypomania (meaning little mania). For mania to be considered a full-blown episode of mania it must be present for at least one week (McKeon, 2015). When someone is experiencing the depression state of bipolar they will be feeling extremely low. This is demonstrated by having low energy, sleep issues, such as sleeping too much or being unable to sleep, and their speech may be slowed down. They may also contemplate suicide. People who have depression may have broken sleep or may sleep too much. They also experience their thinking to be slowed down. They may speak slower or not speak much at all. When going into an episode of mania a person will experience tremendous energy, a decreased need for sleep, unusual talkativeness, racing thoughts and poor decision-making skills. People in the mania stage are feeling extremely euphoric. They do not comprehend the consequences of bad choices, everything seems like a good idea, which leads to poor decision-making. It is possible for someone to have a mixed episode with bipolar. This is when they experience both extremes at one time. Depressive symptoms may occur during manic episodes, and, if present may last moments, hours, or, more rarely days (American Psychiatric Association [APA], 2013, p. 129) .
The treatment of choice for bipolar mood disorder is a combination of psychotherapy (talk therapy) and medication (Dikel, 2014, p. 58). Medications used to treat bipolar disorder can be Lithium, a mood-stabilizing anticonvulsant and/or antipsychotic medication. Lithium has been proven to be effective in treating the maniac and the depressive phase of Bipolar 1 disorder. It is not a man-made medication like the anticonvulsant or the antipsychotic medication, it is an element. Although Lithium has proven to be the best for treating bipolar 1 disorder, it has a very narrow therapeutic index. This means that the toxic dose is not much higher than the therapeutic dose. Because a person has to take such high doses to make it effective, it can become very toxic if taken for long periods of time. Toxicity symptoms ataxia, drowsiness, weakness, tremors or vomiting (Wolters Kluwer, 2018, p. 916). There are several adverse reactions caused by Lithium they include but are not limited to fatigue, coma, seizures, dizziness, vomiting diarrhea, urinary incontinence and muscle weakness (Wolters Kluwer, 2018, p. 915). Even, though Lithium can be toxic, the benefits typically outweigh the risk of using this medication to treat bipolar 1 disorder. Anticonvulsants which were initially used to treat epilepsy, a seizure disorder, have also been used to treat bipolar disorder. Anticonvulsant medications create a mood stabilizing effect. The mechanism of action is not fully understood but may be due to the stabilization and reduced excitability of the cell membrane, of brain cells (Dikel, 2014). Popular anticonvulsants used are Depakote, Lamictal, and Carbatrol. Atypical antipsychotic medications are also used to treat bipolar disorder. Atypical antipsychotic medications are also known as second-generation antipsychotic medications. Antipsychotic medications used in the early 1950’s often had extremely bad physical side effects. Drug manufactures created the atypical antipsychotic medications. These are the popular medications we often see advertised on television. Medications such as aripiprazole (Abilify), olanzapine(Zyprexa), quetiapine(Seroquel), risperidone (Risperdal, lurasidone (Latuda) and ziprasidone(Geodon) are atypical antipsychotics that may be used (Dikel, 2014, p. 60) . There are also technological or alternative treatments for bipolar disorder. The two most effective are Electroconvulsive therapy (ECT) and Transcranial Magnetic Stimulation (TMS). ECT is done under general anesthesia. Small electric currents passed through the brain, inducing a slight seizure and changing the brains chemistry. ECT is very good in making the depression and mania go away, but less effective at preventing it from coming back. Also, the most common side effect is memory deficiencies TMS is a noninvasive procedure where a magnetic coil is placed near your forehead. This is to send a pulse to stimulate nerve cells in your brain that controls moods and depressions. TMS is reasonably effective in making depression go away, but less effective in preventing it from coming back (Depression and Bipolar Support Alliance, 2014). Psychotherapy is used in conjunction with medications to help reduce the stress for the individual diagnosed with bipolar and their families. Everyday stress caused by life can trigger an episode of mood disorder. Teaching an individual how to cope with these everyday stressors can help with manic or depressive episodes. Unfortunately, there is no psychotherapy that can effectively prevent all future manic or depressive episodes (Dikel, 2014). Thus, the treatment for bipolar disorder is a combination of both psychotherapy and medication. Bipolar mood disorder “cannot be cured, it can be treated like diabetes and other chronic illness, it can be managed” (Jacqui Chew). Bipolar disorder manifests in children and teens much like that of adults. When a child is experiencing a manic episode, they will be very happy and act silly in a way that is unusual for them. They may talk fast about a lot of different topics. They frequently have trouble staying focused and will attempt risky behaviors. A big indicator for parents, with bipolar disorder children in a manic state, will sleep very little with no repercussion of being tired. The need for very little sleep helps distinguish the difference between bipolar disorder diagnosis and that of attention-deficit/hyperactivity disorder (ADHD). In a classroom setting, bipolar 1 disorder looks a lot like ADHA. The student may appear to be very agitated, moving quickly and having difficulty settling down (Dikel, 2014, p. 57). In addition, bipolar manic episodes tend to happen occasionally and not are continuous like those of ADHD. The depression side of bipolar 1 disorder in children and teens is manifested in feeling very sad, complaining about physical pain (stomach aches and headaches), sleep issues (too much or too little) eating, (too much or too little), having little energy or interest in fun activities, feeling guilty/worthless and thinking about death or suicide. Getting kids to talk about their emotions is hard. Although it is necessary to understand where they are mentally.
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Many people who have bipolar 1 disorder will often engage in problematic substances, such as drugs and alcohol. This includes children as well. It is my personal belief that they turn to drugs and alcohol as a way to self-soothe. However, using alcohol and recreational drugs can make the symptoms worse and more likely to come back.
Bipolar disorder does not discriminate. People who suffer from bipolar disorder are Doctors, accountants, teachers, artists, and people who run large companies (Chew, 2016). Bipolar disorder affects approximately 5.7 million Americans over the age of 18 (The National Institute of Mental Health, n.d.). Bipolar disorder usually presents around the median age of 25, It can, however, start as early as childhood and as late as 40’s and 50’s. It affects men, women, and children across every ethnic group and social economic class.