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Bipolar Disorder

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Bipolar Disorder

Bipolar disorder is a brain disorder that causes unusual mood swings, energy shifts, changes in activity levels and the ability to conduct the day to day activities. The mood swings range from highs characterized by elated and energized behavior called manic episodes to lows characterized by sadness and hopelessness called depressive episodes. There are four types of bipolar disorder. Bipolar 1 disorder is where the highs last for a week or where the highs are so severe one needs medical attention. The lows last for two weeks, but they may have mixed features where manic, and depressive symptoms occur at the same time (Maj & Yatham, 2013). Bipolar II disorder is where there is a pattern of depressive episodes and less severe manic episodes called hypomanic episodes. Cyclothymic Disorder is where there are many episodes of hypomanic symptoms and many episodes of depressive episodes which last for two years. There are also other specified and unspecified bipolar and related disorders that have bipolar symptoms but cannot be placed in any of the categories.

Theories of etiology

Genetic and familial theories state that the disorder is genetically inheritable with a high probability that monozygotic twins may both inherit the disease. First-degree relatives risk factor association is six times higher than the general public. Chromosome 22 is assumed to cause this condition. Another implicated theory is the dysregulation theory where they believe that an imbalance in the homeostatic system that regulates moods leads to the overexpression of a mood outside the normal limits. This causes the manic and depressive symptoms witnessed. The other theory is the chaotic attractor theory where a biochemical defect in the brain leads to the consistent lack of production of essential neurotransmitters (Maj & Yatham, 2013). The depressive or manic symptoms, however, depend on the environment. The kindling theory suggests that subclinical biochemical changes in the limbic system and consistent buildup causes the neurons to become more excitable till the symptoms appear. In short, therefore, imbalances in the brain chemistry causes the emergence of the disease and its symptoms.

Associated factors in development of the disorder

One’s genetic scheme is a risk factor for the disease. Studies have shown that people with certain genes are at a higher risk of developing the disorder than others. However, if one twin has the disorder, the other does not always have to develop it. Bipolar disorder runs in families. Therefore if one has a parent or sibling that has bipolar disorder, they have a higher probability of developing the disorder as compared to people who have no family history of the disorder (Maj & Yatham, 2013). Environmental factors act as a trigger to the emergence of the symptoms. The constant exposure to stress or the exposure to a traumatic event may cause one to experience their first symptoms, especially if they are predisposed to develop the disorder or even aggravate the symptoms such that they become problematic. Lifestyle choices such as drug abuse do not cause bipolar disorder however they have led to manic or depressive states in some cases, even when one did not have any family history of the disease. Drug abuse also triggers unnoticed symptoms.

Pathology

There exist biological differences in the structure of the brain of those who have the bipolar disorder. There are significant changes in regions of their brain such as the amygdala, basal ganglia, and prefrontal cortex. There is also significant myelination of some areas of the brain. The changes in the parts of the brain associated with the regulation of emotions are suggested to cause the disorder (Ketter, 2010). The biochemistry of the brain is also different. There is an imbalance in the neurotransmitter levels, especially serotonin and dopamine. There is also an imbalance in the hormone levels of these individuals. There is also a difference in the genetic makeup of individuals with the disorder. Some genes have been pinpointed as the cause of the disorder.

Treatment options

A combination of medication and psychotherapy are used to treat the disorder. Medication offered is meant to help control the symptoms of this disorder. The medication types include mood stabilizers, atypical antipsychotics, and antidepressants which are used to help manage the manic and depressive episodes. Psychotherapy is also used in combination with medication for effective treatment for the disorder. Some psychotherapy treatments used are cognitive behavioral therapy, family-focused therapy, and psychoeducation (Ketter, 2010). Other treatment options offered are electroconvulsive therapy where a small electric current is passed through the brain to cause a brief seizure. This causes changes in the biochemistry of the brain reversing the symptoms of the disorder. It is used for people with severe bipolar disorder who have not recovered with other treatments or for people with other conditions such as pregnancy where taking medication is too risky. Sleep medications are also used for people who can’t sleep.

Diagnostic and research techniques employed in clinical diagnosis, care, and basic science research

Research is underway to provide long term treatment for the disorder. There is ongoing research on the use of various medications such as lamotrigine in the treatment of the bipolar disorder. There is also research on the use of second generation antipsychotics for managing the symptoms (Ketter, 2010). There is also emerging data that suggests that the use of adjunctive psychosocial therapies is effective and all these are providing an important longer term treatment option for people with the disorder. Research is underway for the discovery of the potential side effects of such methods.

References

Ketter, T. (2010). Handbook of diagnosis and treatment of bipolar disorders. Washington, DC: American Psychiatric Pub.

Maj, M. & Yatham, L. (2013). Bipolar disorder: clinical and neurobiological foundations. Hoboken, N.J: Wiley.