Mental illness has plagued human kind for as long as we have been on this earth. The science of psychology has made great strides in past century. The stigma of being mentally ill has begun to fall away and people are finally starting to get the help that they need to recover. Bipolar disorder is one illness that we have come to more fully understand. Through assistance from a psychiatrist, family and medication a patient with bipolar disorder can enter remission and live a normal life. Bipolar disorder, also known as manic-depressive disorder (MDD), affects people of all races, colors, and economic backgrounds.
Approximately two million Americans aged 18 and older are affected by this disorder. Typically, patients are diagnosed during adolescence, (Mayo Clinic) but people may be diagnosed at any stage of their life. This disorder is characterized by cycling from manic (high) to depressed (low). On the downward swing from mania, patients may experience normal moods. Eventually, depression will occur (NMHA). MDD is thought to be caused by chemical imbalances in the brain. Neurotransmitters act as messengers to our neurons, or nerve cells (NMHA).
Because there is no biological test for this disorder, a physician cannot access risk or diagnose patients easily (Tate). Human genome studies have yet to discover a specific gene which causes this disorder (Tate), but those who suffer from this illness generally have relatives with some form of depression, showing a clear genetic link (NMHA). Symptomology The manic phase is when the patients mood is up. Patients often experience euphoria along with excessive energy, aggressive behavior, and irritability. Hypersexuality and exhibiting poor judgment are two symptoms that can be very worrisome.
NMHA) Often patients cannot control their behavior and may engage in unprotected sexrisking harm from violence or from sexually transmitted disease. They have a tendency to drive fast and start altercations, often ending with incarceration. Patients often tend to make loose associations and suffer from delusions of grandeur, feeling increased confidence and optimism. Other notable behaviors during the manic phase are changes in dress, hair color, getting tattoos and piercings; the patient exhibits uncharacteristic personality changes.
They may exhibit lack of cleanliness, or wear garish clothes (Butler). Sleep is also disrupted during this period; patients may feel a decreased need for sleep while feeling no fatigue (NMHA). Psychosis may be the most frightening aspect of mania. One sufferer believed that she was a terrorist and was responsible for the attacks on September 11, 2002. She stated that she had to end her life in order for the violence to stop (Fleischauer). Though psychosis is common during mania, it may not happen to all patients (NMHA).
On the opposite side of the mood spectrum is depression. Depression consists of sad moods, sleep disorders, feeling hopeless or worthless, and loss of interest in regular activities. Patients may also experience psychosomatic illnesses, fatigue, reduced or increased appetite and suicidal thoughts (NMHA). Plagued by extreme guilt and sense of worthlessness, some patients feel no choice but to end their lives. In fact, fifty-percent of MDD patients will try to commit suicide; five percent will succeed (Fleischer). Diagnosis
Diagnosing this disorder can be a difficult task. The increased energy and restlessness of mania may be mistaken for attention deficit hyperactivity disorder (ADHD). In fact, many patients seen by CORE Research, an independent clinical trials company, had been misdiagnosed with ADHD. Upon being given medication for this illness, their symptoms were exacerbated. For many, this is when the correct diagnosis is made. (Butler). Physicians must first rule out other possible diagnoses. Patients will normally be tested for drugs and their psychosocial stressors accessed.
Many drugs, including cocaine and marijuana may be causes of erratic behavior and mood swings. Also, the patients thyroid status should be assessed. A University of North Carolina study has proved that depression is three times more likely for those with hypothyroidism than those with normal thyroid function (Dranov). Psychiatrists must do a full psychiatric evaluation in order to diagnose a patient with bipolar disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) IV is used for diagnosis; the DSM-IV criteria for bipolar disorder must be met in order to diagnose a patient.
Tools such as scales are very helpful in aiding of the diagnosis of the patient. Scales are a series of questions relating to the disorder in question and according to the score, clinicians can either confirm or rule out a diagnosis. Typical scales for bipolar disorder are: Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression rating scale (MADRS), and The Global Assessment of Functioning scale (GAF) (Psychiatry). When scales are repeated during the course of treatment, efficacy of medication can be assessed.
As MDD patients are historically under-reporters of symptoms, it may be helpful for a close loved one to accompany the patient to treatment. Patients may also not recognize the extent of their behavior and it helps to have a secondary report (Butler). Treatment options Medication is the first line of defense in treating bipolar disorder. Traditionally, lithium was the drug of choice for bipolar patients. Though lithium is still used today, there are many drugs which have been shown to be valuable managing symptoms.
Anti-depressants, mood stabilizers, anti-epileptic drugs (AEDs) as mood stabilizers, typical and atypical neuroleptics, and electroconvulsive therapy (ECT) are all being used to treat bipolar disorder (Bringham). As with any medication, there are side effects and not all drugs will work for all people. Very often, patients find a working regimen by trial and error. (Butler). ECT should be considered as a treatment option for MDD. Though people are typically turned off by ECT, it has been shown to be more effective than antidepressants in depression and has shown to be equally effective for both mania and depression.
Bringham) Research Research is an invaluable tool in the psychiatric field. In order to test new medications and to test older drugs (not approved for psychiatric use) for their efficacy in treating patients with bipolar disorder, subjects are needed for these clinical trials. Patients receive free care and free medication, possibly for extended periods of time. Clinical trials can prove to be a god-send for many patients as they may be economically challenged. And with the cost of health insurance and managed care, prescription drugs may be too costly.
On the negative side of research is the inevitability that some patients may not benefit from the drug in question, or they may receive a placebo in a double-blind trial. Unfortunately, the patient may considerably decompensate and end up in a mental health facility or in jail. Though every precaution is taken to ensure patient safety, there is no way to prevent these pitfalls (Butler). Bipolar disorder can be a very debilitating, very lonely disease. With proper treatment and effective medications, many patients will be able to live long, productive and normal lives.
