KOYAUNIVERSITY

Clinical psychology

BipolarPrepared By

Mariwan Esmahel

Mustafa Sleman

What is bipolar ?

Bipolar disorder, also known as bipolar affective disorder or manic-depressive illness, is a chronic, recurrent illness associated with tremendous societal costs: increased healthcare costs, loss of productivity, lower quality of life and suicide.1,2 It is a category of mood disorders and is the most common severe persistent illness. This condition is characterized by:Periods of deep, prolonged and profound depressionMania (medical condition characterized by extremely elevated mood, energy and unusual thought patterns)

These episodes of depression and mania are separated by normal mood. In some persons, a condition called rapid cycling occurs, where depression and mania rapidly alternate (more than four episodes of mood swings in a year).Manic-depressive illness was coined by Emil Kraepelin a German scientist in the late 19th century (1856–1926).3 Distress, disruption, and high suicidal rate are associated with this condition.4

Bipolar disorder is classified into the following types:1. Bipolar I: This is known as classic manic-depression and is characterized by depression alternating with episodes of mania, leading to severe impairment of function.2. Bipolar II: This is a milder disorder consisting of depression alternating with periods of hypomania. Hypomania is a less severe form of mania that does not lead to major impairment of function.3. Cyclothymic disorder: This condition is characterized by oscillating moods.

Causes of Bipolar DisorderGenetics: Bipolar disorder has a major genetic component. Evidences show that first-degree relatives of people with bipolar disorder are more likely to suffer from this illness. Offspring of a parent with bipolar disorder have a 50% chance developing this illness. A genome-wide study found that 10 genes of small effect was associated with bipolar disorder.1

A recent study by Tsuang et al. indicated a genetic link between schizophrenia and bipolar disorder.2

Biochemical: Abnormalities in biochemical pathways contribute to this condition. Blood pressure reducing drugs like reserpine decrease the production of catecholamine (a group of amines that have important physiological effects as neurotransmitters and hormones, and include epinephrine, norepinephrine and dopamine) from nerve terminals causing both mania and depression. Drugs like cocaine act on neurotransmitter system causing mania. Hormonal imbalance and response to stress also contributes to this illness. Tricyclic antidepressants can trigger mania.3

Environmental: Environmental factors may play a role in bipolar disorder. Death in the family, separation of parents, changes during puberty, external stressors due to nature of work are some of the factors contributing to it. 

10 Subtle Signs of Bipolar DisorderGreat moodBipolar disorder is characterized by up-and-down episodes of mania and depression. During a manic phase, some patients can have a total break from reality.

But hypomania, which is also a symptom of the disorder, is a high-energy state in which a person feels exuberant but hasn’t lost his or her grip on reality. 

"Hypomania can be a pretty enjoyable state, really," Dr. Bearden says. A person’s mood can be elevated, they may have a lot of energy and creativity, and they may experience euphoria. This is the "up" side of bipolar disorder that some people with the condition actually enjoy—while it lasts.

Inability to complete tasks

Having a house full of half-completed projects is a hallmark of bipolar disorder. People who can harness their energy when they are in a hypomanic phase can be really productive. 

Those who can’t often go from task to task, planning grand, unrealistic projects that are never finished before moving on to something else.

"They can be quite distractible and may start a million things and never finish them," says Don Malone, MD, the director of the Center for Behavioral Health and chair of the Department of Psychiatry at Cleveland Clinic, in Ohio.

DepressionA person who is in a bipolar depressive state is going to look just like someone who has regular depression. "They have the same problems with energy, appetite, sleep, and focus as others who have 'plain old depression,'" Dr. Malone says. 

Unfortunately, typical antidepressants alone don't work well in patients who are bipolar. They can even make people cycle more frequently, worsening their condition, or send someone into a break-with-reality episode. 

"Antidepressants can be downright dangerous in people with bipolar because they can send them into mania," he says.

IrritabilitySome people with this condition suffer from "mixed mania," where they experience symptoms of mania and depression at the same time. During this state, they are often extremely irritable. 

Everyone has bad days, which is one reason this kind of bipolarity is much harder to recognize. 

"We are all irritable or moody sometimes," Dr. Bearden says. "But in people with bipolar disorder it often becomes so severe that it interferes with their relationships—especially if the person is saying, 'I don’t know why I’m so irritable…I can’t control it.'"

Rapid speechSome people are naturally talkative; we all know a motormouth or Chatty Cathy. But "pressured speech" is one of the most common symptoms of bipolar disorder. 

This kind of speech occurs when someone is really not in a two-way conversation, Dr. Bearden says. The person will talk rapidly and if you try to speak, they will likely just talk over you. 

They will also sometimes jump around to different topics. "What’s kind of a red flag is when it is atypical for the person to talk like this," doing it only when they are in a manic cycle but not at other times, she says.

Trouble at workPeople with this disorder often have difficulty in the workplace because so many of their symptoms can interfere with their ability to show up for work, do their job, and interact productively with others.

In addition to having problems completing tasks, they may have difficulty sleeping, irritability, and an inflated ego during a manic phase, and depression at other times, which causes excessive sleeping and additional mood problems. 

A lot of the workplace problems can be interpersonal ones, Dr. Malone says.

Alcohol or drug abuseAbout 50% of people with bipolar disorder also have a substance abuse problem, particularly alcohol use, Dr. Bearden says. 

Many people will drink when they are in a manic phase to slow themselves down, and use alcohol to improve their mood when they are depressed.

Erratic behaviorWhen they are in a manic phase, people with bipolar disorder can have an inflated self-esteem. 

"They feel grandiose and don't consider consequences; everything sounds good to them," Dr. Malone says. 

Two of the most common types of behavior that can result from this are spending sprees and unusual sexual behavior. "I have had a number of patients who have had affairs who never would have done that if they weren't in a manic episode…during this episode they exhibited behavior that is not consistent with what they would do normally," he says.

Sleep problemsPeople with this condition often have sleep problems. During a depression phase, they may sleep too much, and feel tired all the time. 

During a manic phase, they may not sleep enough—but still never feel tired.

Even with just a few hours of sleep each night, they may feel great and have lots of energy.

Dr. Bearden says staying on a regular sleep schedule is one of the first things she recommends for bipolar patients.

Flight of ideasThis symptom may be something that is hard to recognize, but it occurs frequently when someone is in a manic phase. People feel like their mind is racing and that they can't control or slow down their thoughts. 

This flight of ideas sometimes occurs with pressured speech.

People with bipolar may not recognize or admit that their mind is racing out of control, says Dr. Bearden.

Successful treatment of bipolar disorder depends on a combination of factors. Medication alone is not enough. In order to get the most out of treatment, it's important to educate yourself about the illness, communicate with your doctors and therapists, have a strong support system, make healthy lifestyle choices, and stick to your treatment plan.

Recovering from bipolar disorder doesn’t happen overnight.A s with the mood swings of bipolar disorder, treatment has its own ups and downs. Finding the right treatments takes time and setbacks happen. But with careful management and a commitment to getting better, you can get your symptoms under control and live fully.

Bipolar disorder treatment

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