Psychology

This paper is a careful and detailed discussion and explanation of Bipolar disorder and its purpose is to abstract conceptual relationships from subjective to objective experience, connecting ideas together in a logical and rational fashion (Brondolo, 2008). A psychological manifestation discussed in this paper is an example of identification through psychological studies and research. Furthermore, conclusions that are drawn are always directed outward to some objective product or practical outcome. In the situation presented through the identification of behavior, signs and symptoms exhibited by the disease process, the main concern of such manifestation is to elaborate as fully as possible all the ramifications and implications of an idea (Albrecht, 2007). A healthy individual experiences a variety of mood swings and has a large equal repertoire of affective kind of expressions they feel in hold of their affects and moods. Management of care for this kind of patient is crucial in the course of treatment. Medical interventions and care must involve the whole family and community where the patient is in. Moreover, professional care rendered by the health provider discussed in this paper and other members of the health care team follows standard rules and are directed toward complete recovery and to regain and achieve proper functioning of patient (Brondolo, 2008).

Bipolar Disorder
Bipolar disorder, also termed as manic-depressive illness, is an illness of the brain that results to unusual shifts in the energy, mood and ability to function of a person. This illness varies from the common ups and downs that everybody goes through the sign and symptoms of bipolar disorder are considered as severe (Brondolo, 2008). They can result in bad family or social and interpersonal relationships, poor school attention or job performances, and cause even suicidal ideation. However, there is still good news this disorder can be treated, and individuals with this disorder can live fully and have productive lives. There are about 2 million American adults or about 1 percent of the total population age range from 18 and above in are considered having a bipolar disorder. This disorder typically develops in the stage of late adolescence or manifests at early adulthood (Taylor, 2006).

However, there are people who have their first signs and symptoms during their childhood and some people develop the manifestations later in their life. It is usually not identified as a disorder, and an individual may suffer for a numbers of years before it is properly recognized and treated. Like other diseases such as vascular diseases or diabetes mellitus, bipolar disorder is an illness considered as chronic or long-term that must be managed carefully throughout the life of a person (Albrecht, 2007).
Figure 1. Description of Bipolar disorder

In some individuals, however, manifestations of depression and mania may happen together in what is termed as a state of mixed symptoms of bipolar episodes. Symptoms of an episode of a mixed bipolar state commonly associated with problem with sleeping, significant variation in psychosis, agitation appetite, and suicidal ideation. An individual may have a very lonely, sad and hopeless mood while at the same moment he may be feeling extreme energy (Albrecht, 2007).

Bipolar disorders may show to be a problem other than psychological problems, for example, drug use or alcohol abuse, poor work or job and school performance, or damaged interpersonal relationships. Such conditions in fact may be manifestations of an underlying psychological disorder (Taylor, 2006).

Symptoms of Bipolar Disorder
Bipolar disorder can cause dramatic mood shifts from overly irritable or high to hopeless or extremely sad feeling, and then back to normal mood again, often with moment of normal mood in between intervals. Severe swings in behavior and the level of energy goes along with these mood shifts. The moment of lows and highs are termed as episodes of mania and depression (Burgess, 2006).

Table 1. Signs and Symptoms of Manic Episode
Signs and symptoms(manifestations) of manic episodeIncreased activity level, energy elevation, and restlessness
Extremely euphoric mood and overly high good mood
Extreme irritable
talking very fast and Racing thoughts and, shifting from one thoughts to another
Easy Distractibility, or cant concentrate fully
Sleeplessness
Unrealistic thoughts, ideas or beliefs in ones powers and ability
Poor status on judgment
Spending sprees
A long lasting behavior period that vary from normal
Elevated sexual desire
Abuse of alcohol, drugs, specifically cocaine and medications that induces sleep
aggressive , provocative or intrusive kind of behavior
Denial

A manic episode is recognized if there are 3 or more elevated mood occurs associated with other symptoms in most of the day, manifests nearly every day of the week or longer. If there is irritable mood, another four manifestations must be evident.

Table 2. Signs and symptoms of depressive episode
Signs and symptoms (manifestations) of depressive episodeLong lasting anxiety, anxiety or empty mood
Feelings of pessimistic or being hopeless
Feelings of decreased self worth, guilt, sad or helpless
decreased appetite or interests in certain activities, including sexual relationships and intercourse
 Feeling of being tired, weakness or of being slowed down
Difficulty in remembering things, concentration and decision making
Irritability or Restlessness
Sleeplessness or sleeping too much
unintended gain of weight or loss and Changes in appetite
other consistent physiological symptoms or Chronic pain that are not caused by any  physiological alterations or injuries

Ideas of suicide or death, or tendency of suicide attempts
Diagnosis of depressive episode happens if five or more of this manifestation lasts most of the day, for a period of two consecutive weeks or longer.

Diagnosis of Bipolar Disorder
Like other psychological illnesses, bipolar disorder cannot yet be recognized physiologically, for instance, through a brain scan or blood test. Therefore, a diagnosis of this disorder is carried out on the symptoms basis, illness course, and, when available, history of family. The criteria of diagnosis for bipolar disorder are explained in the fourth edition of (DSM-IV) or Diagnostic and Statistical Manual for Mental Disorder (Brondolo, 2008).

Major Depressive Episode
DSM-IV-TR Criteria
Five or more of the following manifestation have been identified during the same 14 day period and a change from previous functioning represent at least one of the manifestations is either (1) loss of pleasure and interest or (2) depressed mood. Depression most of the day, nearly every day, as represented by either report based on subjected cues (e.g., feels empty or sad) or observations are cited by other people (e.g., appears tearful) (American Psychiatric Association, 2008).

In adolescents or children, depressive episode can be an irritable feeling markedly decreased pleasure or interest in all, activities most of the day, or almost all, nearly everyday (as showed by either observation or subjective account or opinion made by other people).In children, failure considers to make when weighing on expected gains. Hypersomnia or Insomnia or nearly everyday is experienced. Psychomotor retardation or agitation nearly every day is manifested (observable by other people, not merely subjective thoughts of restlessness, irritability or being slowed down). Psychomotor retardation or agitations nearly every day are observed by other people, not merely subjective thoughts of restlessness, irritability or being slowed down. Loss of energy or fatigue experienced nearly every day. Feelings of excessive or inappropriate guilt and worthlessness (which may be considered as delusional nearly every day - not merely guilt or self-reproach about being sick (American Psychiatric Association, 2008).

Decreased ability to concentrate or think, or feeling of indecisiveness are experienced nearly every day (either by observed by other people or subjective account by the patient). There is a recurrent idea of death (not just fear about dying), recurrent thought of suicidal ideation without a specific plan, or attempt of suicide or specific plans for committing suicide (Albrecht, 2007).

The manifestation do not reached criteria for a mixed episode. The symptoms cause significant clinical distress or social impairment, occupational, or other areas of important functioning. The signs and symptoms are not caused by direct physiological affectations of a drug or substance abuse or a general medical condition like goiter and hypothyroidism. The manifestations are not accounted better for by bereavement like loss of a loved one, or symptoms persists for a period of more than 2 months or characterized by significant morbid preoccupation or functional impairment with feeling of worthlessness, psychotic symptoms, suicidal ideation, or psychomotor agitation or retardation  (American Psychiatric Association, 2008).

Manic Episode
DSM-IV-TR Criteria
Manic episode is a  significant period of persistently and abnormally elevated, or irritable and expansive mood, lasting for about 1 week (or any period if the hospitalization is vital) , during the time of mood disturbances, three or more of the following manifestations is persistent (four if the behavior is irritable only) and have been involved to a significant degree

The manifestations do not meet mixed episode criteria. The disturbance in mood is sufficiently severe that results to marked impairment in social and occupational functioning or in usual occupational or social relationships activities with others, or to necessitate a confinement in health facilities or hospitalization to prevent injury to self or other people, or there are some psychotic characterizations. The symptoms are not because of the direct effects of a substance physiologically (e.g. abuse of drugs, medications, or other mode of treatment) or a general physical and medical condition (e.g., goiter or hyperthyroidism) (American Psychiatric Association, 2008).

Etiology
Scientists are studying about the possibility and other causes of bipolar disorder through different types of studies. Most of the scientists agree that there are no causes for bipolar disorder rather, many features work together to develop the illness. Because bipolar disorder have the tendency to run in family, researchers have been looking for specific genes or genetic factors, the microscopic of building blocks DNA present in all human cells that can influence the mind and body work and developed and passed down through the generations that may elevate a persons risk of developing bipolar disorder. But genes are not considered as the whole story (Taylor, 2006).

Researches on identical twins, who shared the same genes, indicate that same genes and other features play an important function in bipolar disorder. If this kind of disorder were affected by genes only, then the identical twin of mother with the disorder would commonly form the illness, and study has shown that this is not the only case (Brondolo, 2008). In addition, results from research of genes suggest that bipolar disorder, like other psychological illnesses, does not happen because of a single gene only. It shows likely that different kind of genes act together, and in mixture with other risk factors of the individual or the surrounding of person, to develop the disorder. Scientists continually advance researches that will lead to the discoveries and to a new and better mode of medical interventions for bipolar disorder. The brain-imaging studies also aid scientists in learning what is abnormal in the brain to develop bipolar disorder and other psychiatric illnesses (Taylor, 2006).

Risk factors
Genetic Factors
Bipolar disorders have the characteristic that runs in the family. There is a high incidence that there is a genetic factor to this disorder. 80 to 90 of people with bipolar disorder have a family member with either bipolar disorder or depression.

Medical and Conditions Medications
Medications or drugs such as corticosteroids and medical conditions such as neurological diseases and thyroid disease such as Parkinsons syndrome may accompany with features of this disorder. The medical diagnosis of bipolar disorder is executed only when none of these medical conditions are present.

Cultural Issues
The issue on how a certain society responds is essential to the detection or diagnosis and treatment course of mental disorders like bipolar. In some countries or cultures, mental illnesses are blamed on supernatural power or witches. It aids the individual who is experiencing the disease to know that their uncommon behavior is not acceptable and they are not responsible for, but the product of a witchs spell (Brondolo, 2008). Current epidemiological research and studies in the United States of America show that Bipolar I Disorder is considerably common equally in women and men (compare to Major Depressive Disorder, which is more prevalent in women). Gender also shows to be directly related to the type and number of Major Depressive and manic Episodes. Individuals who are diagnosed with bipolar disorder manifest signs and symptoms within a conceptual framework that is based in their values, cultural beliefs and norms (Taylor, 2006).

Treatment
Most individual with bipolar disorder even those individuals who have the most severe type can achieve the highest possible stabilization of mood swings experienced and related manifestations with proper dose of treatment. Because the bipolar illness is a recurrent type of disease, a preventive long-term treatment is highly recommended and always been indicated. A medical strategy that integrates psychosocial treatment and medication is optimum intervention for the management of disorder over a period of time (Brondolo, 2008).

In some cases, bipolar disorder is better managed and controlled if the course of treatment is continuously than if it is off and on. Apparently, even when there are no intervals in treatment, changes in mood can experience and should be consulted directly to your doctor. The psychiatrist may be able to avoid a full-blown symptoms and episode by making modifications to the plan of treatment. Closely working with the physician and communicating effectively and openly about the course of treatment options and concerns can make a significant difference in effective treatment (Taylor, 2006).

Conclusion
People with bipolar disorder have different manifestation of symptoms from episode of mania to depression. They receive pharmacological interventions andor psychosocial therapy by voluntarily participating in researches or clinical studies. Researches in psychiatric health can produce information about the effectiveness of a combination of treatments or medications, the benefits of psychotherapy or a behavioral intervention and the validity of a diagnostic procedure, or the prevention method success. Clinical researches also guide physicians and scientists in knowing how the condition lessens, progresses, develops, and affects both body and mentation. Many people diagnosed with bipolar disorder lead healthy, progressive and productive lives because of new modalities of treatment and knowledge discovered by means of adherence to medical interventions, psychotherapy and clinical researches and studies. These researches and studies are not always applicable for everybody. However, it is necessary for each person to carefully consider the possible benefits and risks.