Bipolar Essay Research Paper The phenomenon of

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Bipolar Essay, Research Paper

The phenomenon of bipolar affectional upset has been a enigma since the sixteenth century. History has shown that this affliction can look in about anyone. Even the great painter Vincent Van Gogh is believed to hold had bipolar upset. It is clear that in our society many people live with bipolar upset ; nevertheless, despite the copiousness of people enduring from the it, we are still waiting for definite accounts for the causes and remedy. The one fact of which we are distressingly cognizant is that bipolar upset badly undermines its & # 8217 ; victims ability to obtain and keep societal and occupational success. Because bipolar upset has such debilitating symptoms, it is imperative that we remain argus-eyed in the pursuit for accounts of its causes and intervention. Affectional upsets are characterized by a assortment of symptoms that can be broken into manic and depressive episodes. The depressive episodes are characterized by intense feelings of unhappiness and desperation that can go feelings of hopelessness and weakness. Some of the symptoms of a depressive episode include anhedonia, perturbations in slumber and appetency, psycomoter deceleration, loss of energy, feelings of ineptitude, guilt, trouble thought, indecisiveness, and perennial ideas of decease and self-destruction ( Hollandsworth, Jr. 1990 ) . The frenzied episodes are characterized by elevated or cranky temper, increased energy, decreased demand for slumber, hapless judgement and penetration, and frequently foolhardy or irresponsible behaviour ( Hollandsworth, Jr. 1990 ) . Bipolar affectional upset affects about one per centum of the population ( about three million people ) in the United States. It is presented by both males and females. Bipolar upset involves episodes of passion and depression. These episodes may jump with profound depressions characterized by a permeant unhappiness, about inability to travel, hopelessness, and perturbations in appetency, slumber, in concentrations and driving. Bipolar upset is diagnosed if an episode of passion occurs whether depression has been diagnosed or non ( Goodwin, Guze, 1989, p 11 ) . Most normally, persons with frenzied episodes experience a period of depression. Symptoms include elated, expansive, or cranky temper, hyperactivity, force per unit area of address, flight of thoughts, inflated self esteem, decreased demand for slumber, distractibility, and inordinate engagement in foolhardy activities ( Hollandsworth, Jr. 1990 ) . Rarest symptoms were periods of loss of all involvement and deceleration or agitation ( Weisman, 1991 ) . As the National Depressive and Manic Depressive Association ( MDMDA ) has demonstrated, bipolar upset can make significant developmental holds, matrimonial and household breaks, occupational reverses, and fiscal catastrophes. This lay waste toing disease causes breaks of households, loss of occupations and 1000000s of dollars in cost to society. Many times bipolar patients study that the depressions are longer and increase in frequence as the single ages. Many times bipolar provinces and psychotic provinces are misdiagnosed as schizophrenic disorder. Speech patterns assist separate between the two upsets ( Lish, 1994 ) . The oncoming of Bipolar upset normally occurs between the ages of 20 and 30 old ages of age, with a 2nd extremum in the fortiess for adult females. A typical bipolar patient may see eight to ten episodes in their life-time. However, those who have rapid cycling may see more episodes of passion and depression that win each other without a period of remittal ( DSM III-R ) . The three phases of passion Begin with hypomania, in which patients report that they are energetic, extrospective and self-asserting ( Hirschfeld, 1995 ) . The hypomania province has led perceivers to experience that bipolar patients are & # 8220 ; addicted & # 8221 ; to their passion. Hypomania progresses into passion and the passage is marked by loss of judgement ( Hirschfeld, 1995 ) . Often, euphoric grandiose features are displayed, and paranoiac or cranky features begin to attest. The 3rd phase of passion is apparent when the patient experiences psychotic beliefs with frequently paranoid subjects. Address is by and large rapid and overactive behaviour manifests sometimes associated with force ( Hirschfeld, 1995 ) . When both manic and depressive symptoms occur at the same clip it is called a assorted episode. Those afflicted are a particular hazard because there is a combination of hopelessness, agitation, and anxiousness that makes them experience like they & # 8220 ; could leap out of their tegument & # 8221 ; ( Hirschfeld, 1995 ) . Up to 50 % of all patients with passions have a mixture of down tempers. Patients study experiencing distressed, down, and unhappy ; yet, they exhibit the energy associated with passion. Rapid cycling passion is another presentation of bipolar upset. Mania may be present with four or more distinguishable episodes within a 12 month period. There is now grounds to propose that sometimes rapid cycling may be a transeunt manifestation of the bipolar upset. This signifier of the disease exhibits more episodes of passion and depression than bipolar. Lithium has been the primary intervention of bipolar upset since its debut in the 1960 & # 8217 ; s. It is chief map is to stabilise the cycling feature of bipolar upset. In four controlled surveies by F. K. Goodwin and K. R. Jamison, the overall response rate for bipolar topics treated with Lithium was 78 % ( 1990 ) . Lithium is besides the primary drug used for long- term care of bipolar upset. In a bulk of bipolar patients, it lessens the continuance, frequence, and badness of the episodes of both mania and depression. Unfortunately, every bit many as 40 % of bipolar patients are either unresponsive to lithium or can non digest the side effects. Some of the side effects include thirst, weight addition, sickness, diarrhoea, and hydrops. Patients who are unresponsive to lithium intervention are frequently those who experience distressed passion, assorted provinces, or rapid cycling bipolar upset. One of the jobs associated with Li is the fact the long-run Li intervention has been associated with reduced thyroid operation in patients with bipolar upset. Preliminary grounds besides suggest that hypothyroidism may really take to rapid-cycling ( Bauer et al. , 1990 ) . Another job associated with the usage of Li is experienced by pregnant adult females. Its usage during gestation has been associated with birth defects, peculiarly Ebstein & # 8217 ; s anomalousness. Based on current informations, the hazard of a kid with Ebstein & # 8217 ; s anomaly being born to a female parent who took Li during her first trimester of gestation is about 1 in 8,000, or 2.5 times that of the general population ( Jacobson et al. , 1992 ) . There are other effectual interventions for bipolar upset that are used in instances where the patients can non digest Li or

have been unresponsive to it in the past. The American Psychiatric Association’s guidelines suggest the next line of treatment to be Anticonvulsant drugs such as valproate and carbamazepine. These drugs are useful as antimanic agents, especially in those patients with mixed states. Both of these medications can be used in combination with lithium or in combination with each other. Valproate is especially helpful for patients who are lithium noncompliant, experience rapid-cycling, or have comorbid alcohol or drug abuse. Neuroleptics such as haloperidol or chlorpromazine have also been used to help stabilize manic patients who are highly agitated or psychotic. Use of these drugs is often necessary because the response to them are rapid, but there are risks involved in their use. Because of the often severe side effects, Benzodiazepines are often used in their place. Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms of rapid control of agitation and excitement, without the severe side effects. Antidepressants such as the selective serotonin reuptake inhibitors (SSRI’s) fluovamine and amitriptyline have also been used by some doctors as treatment for bipolar disorder. A double-blind study by M. Gasperini, F. Gatti, L. Bellini, R.Anniverno, and E. Smeraldi showed that fluvoxamine and amitriptyline are highly effective treatments for bipolar patients experiencing depressive episodes (1992). This study is controversial however, because conflicting research shows that SSRI’s and other antidepressants can actually precipitate manic episodes. Most doctors can see the usefulness of antidepressants when used in conjunction with mood stabilizing medications such as lithium. In addition to the mentioned medical treatments of bipolar disorder, there are several other options available to bipolar patients, most of which are used in conjunction with medicine. One such treatment is light therapy. One study compared the response to light therapy of bipolar patients with that of unipolar patients. Patients were free of psychotropic and hypnotic medications for at least one month before treatment. Bipolar patients in this study showed an average of 90.3% improvement in their depressive symptoms, with no incidence of mania or hypomania. They all continued to use light therapy, and all showed a sustained positive response at a three month follow-up (Hopkins and Gelenberg, 1994). Another study involved a four week treatment of bright morning light treatment for patients with seasonal affective disorder and bipolar patients. This study found a statistically significant decrement in depressive symptoms, with the maximum antidepressant effect of light not being reached until week four (Baur, Kurtz, Rubin, and Markus, 1994). Hypomanic symptoms were experienced by 36% of bipolar patients in this study. Predominant hypomanic symptoms included racing thoughts, deceased sleep and irritability. Surprisingly, one-third of controls also developed symptoms such as those mentioned above. Regardless of the explanation of the emergence of hypomanic symptoms in undiagnosed controls, it is evident from this study that light treatment may be associated with the observed symptoms. Based on the results, careful professional monitoring during light treatment is necessary, even for those without a history of major mood disorders. Another popular treatment for bipolar disorder is electro-convulsive shock therapy. ECT is the preferred treatment for severely manic pregnant patients and patients who are homicidal, psychotic, catatonic, medically compromised, or severely suicidal. In one study, researchers found marked improvement in 78% of patients treated with ECT, compared to 62% of patients treated only with lithium and 37% of patients who received neither, ECT or lithium (Black et al., 1987). A final type of therapy that I found is outpatient group psychotherapy. According to Dr. John Graves, spokesperson for The National Depressive and Manic Depressive Association has called attention to the value of support groups, and challenged mental health professionals to take a more serious look at group therapy for the bipolar population. Research shows that group participation may help increase lithium compliance, decrease denial regarding the illness, and increase awareness of both external and internal stress factors leading to manic and depressive episodes. Group therapy for patients with bipolar disorders responds to the need for support and reinforcement of medication management, and the need for education and support for the interpersonal difficulties that arise during the course of the disorder. References Bauer, M.S., Kurtz, J.W., Rubin, L.B., and Marcus, J.G. (1994). Mood and Behavioral effects of four-week light treatment in winter depressives and controls. Journal of Psychiatric Research. 28, 2: 135-145. Bauer, M.S., Whybrow, P.C. and Winokur, A. (1990). Rapid Cycling Bipolar Affective Disorder: I. Association with grade I hypothyroidism. Archives of General Psychiatry. 47: 427-432. Black, D.W., Winokur, G., and Nasrallah, A. (1987). Treatment of Mania: A naturalistic study of electroconvulsive therapy versus lithium in 438 patients. Journal of Clinical Psychiatry. 48: 132-139. Gasperini, M., Gatti, F., Bellini, L., Anniverno, R., Smeralsi, E., (1992). Perspectives in clinical psychopharmacology of amitriptyline and fluvoxamine. Pharmacopsychiatry. 26:186-192. Goodwin, F.K., and Jamison, K.R. (1990). Manic Depressive Illness. New York: Oxford University Press. Goodwin, Donald W. and Guze, Samuel B. (1989). Psychiatric Diagnosis. Fourth Ed. Oxford University. p.7. Hirschfeld, R.M. (1995). Recent Developments in Clinical Aspects of Bipolar Disorder. The Decade of the Brain. National Alliance for the Mentally Ill. Winter. Vol. VI. Issue II. Hollandsworth, James G. (1990). The Physiology of Psychological Disorders. Plenem Press. New York and London. P.111. Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of Bipolar Disorder: How Far Have We Come? Psychopharmacology Bulletin. 30 (1): 27-38. Jacobson, S.J., Jones, K., Ceolin, L., Kaur, P., Sahn, D., Donnerfeld, A.E., Rieder, M., Santelli, R., Smythe, J., Patuszuk, A., Einarson, T., and Koren, G., (1992). Prospective multicenter study of pregnancy outcome after lithium exposure during the first trimester. Laricet. 339: 530-533. Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A. and Hirschfeld, R.M. (1994). The National Depressive and Manic Depressive Association (DMDA) Survey of Bipolar Members. Affective Disorders. 31: pp.281-294. Weisman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P., Holzer, C. (1991). Psychiatric Disorders in America. Affective Disorders. Free Press. m “”

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