Psychology

Bipolar disorder lies in the category of manic depressive disorders. The disorder affects the brain and causes strange mood shifts, change in activity levels as well as causing inability of the afflicted individuals to perform daily tasks (National Institute of Mental Health). The affected individuals have unusually elevated energy levels and other symptoms, which make the individuals to have a damaged relationship, poor school and workplace performance and in severe case, suicide (National Institute of Mental Health). This shows that the symptoms are different from the usual ups and downs that normal individuals undergo in everyday lives. Although the symptoms are often severe, bipolar disorder is easily treated and afflicted individuals can lead normal lives. Symptoms Individuals with bipolar disorder express very unusual and intense emotional stress that normally occurs in specific periods known as mood episodes (Basco 81). They may be in overexcited state (manic episode) or in extremely sad state (depressive episode) (Basco 81). In some situations, mood episodes may show symptoms of both depression and mania. Mood changes for manic episode include agitation, extreme irritability, overly happy and outgoing mood while the mood changes for depressive episodes include long periods of worry or feeling of emptiness (Mayo Clinic Staff). Sometimes there is loss of interest in some activities that the individuals once enjoyed such as sex. Behavioral changes in manic episodes talking at a fast pace, jumping from one concept to another and having what can be termed as racing mood. The individuals are easily distracted, are restless and do not sleep enough (Mayo Clinic Staff). They have unrealistic ideologies about ones abilities and behave in an impulsive manner usually taking plenty of pleasurable behaviors with high risks such as impulsive sex, spending spree and impulsive investments in business (Mayo Clinic Staff). Behavioral changes in depressive episodes include problems of concentration, making decisions and remembering, feeling of tiredness growing irritable or being restless. The individuals with depressive episodes may have problems with sleeping and eating (Medline Plus). In severe cases, depressive episode individuals may develop suicide thinking or having attempted suicide.Diagnostic Criteria The disorder often develops in individuals during early adult years or late teen stages with half of the total bipolar cases diagnosed before individuals attain the age of 25 (Medline Plus). However, in some individuals, the symptoms start appearing in early childhood while others start showing bipolar symptoms in late years of adult stage. It is not easy to identify bipolar disorder as it begins since the symptoms may almost appear like other complications that may not be recognized as a major problem (Medline Plus). It may take long before the problem is properly identified and proper medication provided. Bipolar disorder is generally a long term complication just like heart disease or diabetes and has to be managed throughout the entire life of the afflicted individual.

In order to have a proper diagnosis, it is necessary to talk to a physician who should then carry out a physical examination, oral interviews and various laboratory tests. Although bipolar disorder may not concurrently be diagnosed through brain scans and blood tests, the tests are imperative in ruling out other contributing causes such as brain tumors and stroke ((National Institute of Mental Health). The doctor may be required to carry out an evaluation of mental health in case the problems of stroke and brain tumors are not as a result of other illnesses. In most cases, patients are referred to a mental health expert such as a psychiatrist who is specialized in the diagnosis and treatment of the disorder (National Institute of Mental Health). Criteria for diagnosing bipolar disorder are given in the current fourth version of Diagnostic and Statistical Manual of Mental Disorder (DSM-IV-TR) and the current World Health Organizations International Statistical Classification of Diseases and Related Problems (ICD-10) (National Institute of Mental Health).

Psychiatrists or doctors should carry out a complete diagnostic examination. It is important for the physician or psychiatrist to discuss and identify family history of the disorder or other allied illnesses in order to establish the complete history of the symptoms expressed by the patient (Medline Plus). Because the patient may not explain the exact ways he or she expresses the symptoms of bipolar disorders, it is necessary for the psychiatrist to discuss the family medical history and symptoms with a close relative of the patient. If the afflicted individual is married and stays together with the partner, the spouse can be of great importance in explaining the symptoms.

The common sign among individuals with bipolar disorder is that they readily tend to seek assistance when they have depression than when they are manic or experiencing hypomania (Rheieck, and Steikuller 12). This shows why it is important to carry out a careful evaluation of medical history in order to ensure that the problem is not misdiagnosed as a major disorder of depression known as unipolar depression. With unipolar disorders, individuals do not experience manic depression that is often expressed in individuals with bipolar disorder. It is also important to include previous inputs and records about the patient from the family members and friends in medical histories.Possible Causes and Probable Effect

There are various causes of bipolar disorders which may include genetic causes, childhood precursors, life experiences and events, neural processes, melatonin activity and psychological causes (Basco 122). Chromosomal regions as well as individual genes have been identified and linked to the cause of bipolar disorders. The base pair changes for DNA sequence of TPH1 and P2RX7 genes have been blamed on the cause of the condition. Genes related to dopamine (SLC6A3 and DRD4), serotonin (TPH2 and SLC6A4) and dopamine (DTNBP1 and DAOA) have been identified to contribute to the condition although to a small extent (Rheieck, and Steikuller 14). Melatonin activity has been indicated for bipolar disorder. For instance in the eye, the hypersensitive melatonin receptors causes a rapid drop in melatonin levels during sleep time (National Institute of Mental Health). Valproic acid, used for stabilizing mood, increases melatonin receptor transcription and reduces the sensitivity to light in healthy subjects. However, the extent to which alteration of melatonin may lead to bipolar disorder has not been fully deciphered.Treatment There is no known cure for bipolar disorder although proper care given to the bipolar patients can greatly improve the lifestyle of patients (Medline Plus). With proper treatment of bipolar disorder cases, the individuals will gain an improved control of their mood swings as well as other related symptoms. There is need for a long-term treatment plan for bipolar disorder patients since the condition is a recurrent and lifelong illness. Long-term treatment such as psychotherapy and medications will offer a better control over the symptoms as the symptoms severity will be reduced and prevented from reoccurring (Basco 147).

The diagnosis and prescription of treatments for bipolar disorder is mainly done by medical doctors, psychiatrists or in some states, psychiatrist nurse practitioners, clinical psychologists and advanced psychiatrist nurses (Mayo Clinic Staff). However, not every individual responds to bipolar disorder medications. It is therefore important to keep a daily chart that shows the symptoms, treatments used, sleep patterns and various life events. These recordings will help the doctor track the details and give effective treatment. This also enables the doctor to make decisions on the change or switch of medications incase the ones used do not work with the patient. Medication options for treating bipolar disorders include mood stabilizing medications, atypical antipsychotic medications and antidepressants (National Institute of Mental Health). Apart from medication and psychotherapy, other treatments include sleep medications and electroconvulsive therapy (ECT).

Mood stabilizing medications form the treatment of choice to help individuals suffering from bipolar disorder. The individuals with bipolar disorder may continue with the mood stabilizers for a number of years. Majority of mood stabilizing medications are anticonvulsants with the exception of lithium (National Institute of Mental Health). Anticonvulsants are usually used in the treatment of seizures although they can also be used in the treatment of moods particularly in bipolar disorders. Lithium is effective in the control of mood symptoms although the levels of thyroid hormone should closely be checked as lithium causes hypothyroidism which is often associated with bipolar disorder particularly in women (National Institute of Mental Health). An alternative to lithium is valproic acid which is equally effective in the prevention of manic recurrence or depressive episodes. Atypical antipsychotic medications have sometimes been used in the treatment of bipolar disorder symptoms although they are often taken together with other medications (National Institute of Mental Health).

They are referred to as atypical since they are different from other first generation or conventional antipsychotics. Olanzapine is an example of atypical antipsychotic medication which when administered with antidepressants, can greatly relive severe symptoms of psychosis and mania. Other atypical medications used include Aripiprazole, Quetiapine and Risperidone (National Institute of Mental Health).

Other forms of medications used in treating bipolar disorders belong to the class of antidepressants. Antidepressants are usually used in the treatment of depression symptoms in bipolar disorder cases (National Institute of Mental Health). Bipolar disorder patients are advised to take mood stabilizers in addition to antidepressants.  This is recommended because relying on antidepressants alone may increase chances of patients switching   from mania or hypomania or even developing symptoms of rapid cycling (National Institute of Mental Health). It is therefore important for doctors who prescribe antidepressants agents for the treatment of bipolar disorder to include mood stabilizing agents. Fluoroxetin, sold as Prozac and Paroxetine marketed as Paxil are some of the antidepressant medications that are widely prescribed by physicians for the treatment of bipolar depression symptoms (National Institute of Mental Health). Psychotherapy is another form of treatment given to individuals with bipolar disorder apart from the medications (Mayo Clinic Staff). It is also referred to as talk therapy which can provide education, support and guidance to individuals with the condition together with other family members. Psychotherapy methods include family-focused therapy, cognitive behavioral therapy (CBT), psychoeducation and interpersonal and social rhythm therapy (National Institute of Mental Health).Prognosis

It always comes out that good prognosis is only feasible when good treatment is provided and a good treatment is possible if doctors make accurate diagnosis of the condition. In most cases, bipolar disorders are often misdiagnosed or under-diagnosed and as a result, it becomes difficult for individuals with bipolar disorder to be given competent and timely treatments. Although bipolar disorders can be a very severe medical condition, which can disable individuals, bipolar individuals can comfortably live satisfying and full lives with the use of medications (Rheieck, and Steikuller19). Even when no medications are used, bipolar disorder patients can experience from normal to near normal lifestyles between episodes.