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Running head: BIPOLAR DISORDER 1

Bipolar Disorder

Dave Cortes

Medical Careers Institute

20 October 2010
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Abstract

Bipolar disorder is a chronic and recurrent serious mental disorder that completely affects

the individual and friends and family. Despite being relatively common, this disorder often goes

unrecognized, misdiagnosed, and untreated. Having bipolar can affect the way that everyday life

is carried out being it simple issues or more complex. This disorder affects all age groups

whether directly or indirectly; meaning, if the individual is diagnosed at the age of 25 and has

children it directly affect the daily life of the smaller children as well.
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BIPOLAR DISORDER

BIPOLAR; Mental illness characteristically relating cycles of depressive and manic,

hypomanic, or mixed-symptom episodes, previously known as manic-depressive disorder.

Bipolar disorder, other wise known as "manic depression", is often not recognized by the patient,

friends, relatives, or even physicians. An early sign of manic depressive illness may be

hypomania. This is a state in which the person shows a high level of energy, excessive

moodiness or irritability, and impulsive or reckless behavior. The person that is bipolar does not

have delusions or hallucinations. They often do not lose touch with reality in the sense that they

know what is real and who they are. What can manifest as a problem, however, is the fact that

they are apt to overestimate their capabilities and fail to see the obvious risks involved in their

embarkations. Hypomania may make a person experience an overall “good” feeling. Although

the ‘highs’ can intermittently enjoyable, these extreme emotions are frequently distressing and

can be very disruptive to people’s lives. Consequently, the individual often will deny that

anything is wrong even when family and friends are aware of the mood swings.

In its early stages, bipolar disorder may disguise itself as a problem other than a mental

illness. For instance, it may first appear as alcohol or drug abuse, poor work performance, or

poor school work and or overall behavior.

If it is left untreated, the disorder tends to worsen, and the person may experience

episodes of full-fledged mania and depressive episodes. One of the usual differential diagnoses

for bipolar disorder is the symptoms are not better accounted for by Schizoaffective Disorder and

is not applied to Schizophrenia, Schizophrenia form Disorder, Delusional Disorder. The


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symptoms of manic depression must cause a significant of distress or impairment in social,

occupational, or other important areas of functioning.

Symptoms also can not be the result of substance use or abuse (i.e. alcohol, drugs, and

prescription medications) or caused by a general medical condition.

Who Bipolar affects?

Bipolar disorder has an effect on approximately 3 million people in the United States, in

any given year. People who develop bipolar disorder eventually find the emotional ride

intolerable and kill themselves" (Bower, 2000). "Suicide is the second major cause of death

worldwide in women between the ages of 15 and 44. Young men in the early course of their

illness are at the highest risk of suicide, especially those with a history of suicide attempts.

(Rifmer & Angst, 2005) Almost all of suicides are connected to mental illness, and most mental

illnesses are treatable" (Jamison, 1980). Both women and men are affected at the same rate.

There are few risk factors that unfailingly predict a significant likelihood of being

diagnosed with bipolar disorder. One’s family and genetic history appear to both have some

influence over the possibilities of being diagnosed with the disorder. The disorder is more

common in those who have a sibling or parent with the illness and in families having several

generations affected with mood disorders. (Grohol, Psy.D, 2010)

The absolute cause of bipolar disorder is not exactly known. However, genetics,

environmental factors and neurochemical factors probably interact at many levels to play a role

in the onset and progression of the disorder.


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Overall, it is thought that it is a predominantly biological disorder that occurs in a specific

part of the brain and is due to a breakdown of the neurotransmitters. As a biological disorder, it

may remain dormant and be activated unexpectedly or it may be triggered by stressors in life.

Some triggers include divorce, the loss of a job or even more so the loss of a family member.

Although no knows the exact causes of the disorder, researchers have found one important clue:

Bipolar disorder is said to be ancestral, meaning that it “runs in families.”

Half the people having bipolar disorder have a family member with some sort of mood

disorder, such as depression or etcetera. An individual with one parent having bipolar disorder

has a 15 to 25 percent chance of having the condition. People who have a non-identical twin with

the illness have a 25 percent chance of having the disorder. This is the same risk as if both

parents have bipolar disorder. People who have an identical twin with bipolar disorder have an

even larger risk of developing the illness, than a non-identical twin. Studies of adopted twins,

where a child whose biological parent had the disorder is raised in an adoptive family, has helped

researchers learn more about the genetic causes verses environmental and life events.

Bipolar disorder is primarily a biological disorder that occurs due to the dysfunction of

certain neurotransmitters in a specific area of the brain. Neurotransmitters like norepinephrine,

serotonin and many others are a few that are affected by this disorder. Over its lifespan, it may

keep dormant and be activated on its own or it may be triggered by external factors such as

psychological stress and social circumstances.

Bipolar disorder is appearing at increasingly early ages. This increase in earlier

occurrences may be due to under diagnosis of the disorder in the past. There has been a change

in the age of inception may be a result of social and environmental factors that are not clearly
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understood. Any type of life event may trigger a mood episode in a person with the genetic

characteristics for bipolar disorder. Yet, without clear genetic factors, altered health habits,

alcohol or drug abuse or hormonal problems can trigger an episode.

Substance abuse is also a way to trigger an episode but is not considered a cause of

bipolar disorder although; it can worsen the illness by interfering with recovery. Use of alcohol

or tranquilizers may produce a more severe depressive phase. Antidepressants medications can

trigger a manic episode in people who are vulnerable to bipolar disorder.

Illicit drugs, such as ecstasy, “designer drugs” such as cocaine, amphetamines, certain

over-the-counter medications, appetite suppressants, cold preparations, prescribed medications

taken for thyroid problems and corticosteroids like prednisone may cause an unwanted episode.

Therefore, a depressive episode must be treated with awareness in those people who have had

manic episodes. Because a depressive episode can turn into a manic episode when antidepressant

medications are taken, an anti-manic drug is also suggested to prevent a manic episode. The anti-

manic drug creates a “ceiling,” partially protecting the person from antidepressant-induced

mania. Other types of medications can produce a “high” that resembles mania such as appetite

suppressants, for example, may trigger increased energy, decreased need for sleep and increased

talkativeness. After stopping the medication, on the other hand, the person returns to his normal

mood. If the person has a family history of bipolar disorder, have them notify their physician so

as to help avoid the risk of a medication-induced manic episode. Excessive caffeine will also set

an episode off however; little to moderate use is ok. If a person is susceptible to bipolar disorder,

stress, frequent use of stimulants or alcohol, and lack of sleep may prompt onset of the disorder.
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Conflicting rates of bipolar disorder have not been reported for different races. Inferior

socioeconomic status may be slightly linked to a higher rate of bipolar disorder. Both men and

women have an equal chance of being diagnosed with the disorder. The first episode in men have

a tendency to be diagnosed as a manic episode, while women are more likely to first experience a

depressive episode.( 2010, Psych Central) The estimated average age for the onset of bipolar

disorder is during the early 20s, although there have been reports of the disorder beginning as

early as elementary school. In fact, bipolar disorder appears before age 20 in about one in five

manic individuals. Younger patients first may suffer cyclothymia, which is basically a less

extreme form of bipolar disorder characterized by hypomanic and mild depressive episodes.

Although people with cyclothymia display a reduced amount of intense symptoms, nearly half of

them will progress to having a full manic episode. Younger patients who have full manic

episodes are called juvenile bipolar patients. (Grohol, Psy.D., 2010)

Gender variations?

"Three potential gender variations in the course of bipolar disorder that have been

suggested. (1) The occurrence of rapid-cycling bipolar disorder is superior among bipolar

women than among bipolar men. (2) Women having Bipolar may be at a higher risk for

depressive episodes, and at a lower risk for manic episodes, than bipolar men. (3) Bipolar women

may have a better chance than bipolar men to have or developed mixed, as opposed to pure,

mania "(Leibenluft, 1994).

The noted differences may be caused by the hypothyroidism, which is more familiar in

women and gonadal steroids (hormones and menstrual cycles). Also there is a extreme chance of
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depression during the postpartum period. Since women have a superior probability of depression,

then some rapid cycling and mixed states could be due to the medications treating the depression.

The symptoms of the different types of episodes help the doctor to diagnose what type of

bipolar disorder that may be present. Four types of Bipolar are present and they are bipolar type

I, bipolar type II, rapid cycling, and schizoaffective.

Mixed episodes can be the most hindering of all. This episode has both mania and

depression at the same time or alternating back and forth during the day. One may feel, excited

and agitated as in mania, but also feel depressed and irritable. I have actually witnessed my wife

alternate between laughing and crying several times in just a minute or two with racing thoughts

at the same time and was talking about five different things at the same time, the person she was

talking with couldn’t understand her, nor could I. And it is said that varied episodes are more

common in women.

How bipolar is treated?

Bipolar disorder can be treated in a combination of ways. There is medication for the

acute manic episode, preventative treatment, psychotherapy, behavior modification and

electroshock therapy. According to psychologist Kay Redfield Jamison, professor of psychiatry

at Johns Hopkins University School of Medicine, who additionally struggles with bipolar

disorder, "Lithium (one of the most used medications)…makes psychotherapy possible…but

ineffably, psychotherapy heals" (Bower 2000).I interpret this to mean, that the appropriate

prescribed medications and psychotherapy go together.


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Two of the most important medications used to control symptoms of bipolar disorder are

antidepressants and mood stabilizers. Other medications that may be prescribed are sleep-aids,

anti-anxieties, or anti-psychotic medications and for acute manic, occasionally depression,

hypomanic and mixed episodes, mood stabilizers are also prescribed.

In the United States the most generally used mood stabilizers are Lithium, Valproate

(Depakote), Riperidone and Carbamazepine (Tegretol). Lithium is commonly used for patients

with more euphoric moods, Depakote or Tegretol if your mood is mixed or irritable or rapid

cycling. Depakote and Tegretol are antiepileptic medications that work to calming the brain.

"Lithium is eradicated by the kidneys and the primary elimination route for the older anti-

epileptic agents (Depakote and Tegretol) is liver metabolism" (Lam, 1999).

Blood tests are performed to determine the correct dosage and also to watch for any

problems with liver function with the use of Depakote and thyroid function with the use of

Lithium. Each person reacts differently to the medications, so if one does not work for you or if

there are side effects that don’t subside, your doctor may prescribe another. Also, Neurontin (a

mood stabilizer) does not need to be followed by blood tests, has very few side effects, and is

virtually impossible to overdose on.

Depression is remedied with anti-depressants, but they are usually used with a mood

stabilizer. An anti-depressant lacking a mood stabilizer can cause you to go into a manic episode.

Common anti-depressants are Prozac, Paxil, Wellbutrin, and Effexor just to name a few. Most of

these medications increase the re-uptake of serotonin, which is a chemical in the brain.

Antidepressants may take several weeks to work, therefore, sometimes the doctor may order

something to help with the agitation, anxiety or sleep deprivation in the meantime. Even though
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the first drug given usually works, it is common to go through several anti-depressants before

finding the one that works best.

The relation between creativity and bipolar…

According to Kay Redfield Jamison, professor of psychiatry at Johns Hopkins University

School of Medicine, "The incidence among creative people is 10 to 20 times greater than that of

the general population" (Jamison, 1998). "In previous studies to include Jamison’s own, the

survey of 47 British writers and artists, sustain her hypothesis that “Creative individuals are

especially subject to mood disorders and suicide" (Even, 1995).”Jamison’s work suggests that

periods of creative productivity are preceded by an elevated mood. It is as if certain types of

moods open up thought, allowing for greater creativity" (Jamison, 1998), (Neihart, 1999).

One article written in Harvard Business Review stated "In our consulting experience during the

last decade, researchers have found manic depressive that are executives at the top of some of the

most successful U.S. companies such as chairmen, CEOs, and senior VPs. There are also

representatives among the ranks of the United States’ most brilliant entrepreneurs. They are risk

takers. They build empires. And they frequently become wealthy. High political offices have

always attracted its share of manic-depressive leaders, including Winston Churchill, Theodore

Roosevelt, and Abraham Lincoln" (Lieblich 2000).

Some well known writers and artists in our past with probable mood disorders are

Vincent Van Gogh, Michelangelo, Leo Tolstoy, Edgar Allen Poe, F. Scott Fitzgerald and Charles

Dickens to recognize a few. The names of famous people that you too may know with bipolar

disorder and may or may not know that they had it are as follows: Patty Duke (actress), Kay
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Redfield Jamison (psychiatrist), Buzz Aldrin (astronaut), Francis Ford Coppola (director),

Thomas Eagleton (lawyer, former U.S. Senator), Carrie Fisher (actress), Sol Wachtler (Judge)

past in 1993, Robert Schumann (composer), Jean-Claude Camille François Van Varenberg, also

know as, Jean Claude Van Damme (martial artist, actor), and many others. This disorder did not

hinder them from accomplishing success in their lives.

Conclusion

Bipolar disorder can be a very disabling illness caused by an inherited chemical

imbalance of the brain. The extreme mood swings between mania and depression can interrupt or

even ruin a person’s life and their family’s life. The spur of the moment thought and acts, I have

lived it and it has taken my children to another state and my entire marriage to an end, which is

something that I never saw coming. The depression or mania of bipolar disorder can be

manageable once it is evened out or stabilized with medications. Personal therapy, behavior

modification and group therapy can also be helpful in sustain stability in this disorder.
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Case Study

Brandy C. is a 30 year old female referred for an evaluation by her primary care provider

based on concerns that the source of her chronic Restless Leg Syndrome was induced by anxiety.

During the interview, Brandy was meek but responsive to the questions asked. She allowed a

number of worries that included concerns about her health, her children’s safety, her work

performance, with no regard to her relationship. Brandy’s greatest worries were related to

threats to her health and safety. Brandy’s mother, Mrs. A., reports that she had recently been

very averse about doing anything outside with her family or friends as she feared she would

contact Lyme disease from a tick bite or West Nile virus from a mosquito bite. Mrs. A. reports

that Brandy was also very distressed by news reports about negative events locally and around

the world (e.g., kidnapping, crime, murders, and the War on Terrorism) and now they no longer

have the news on when Brandy is home. Her husband Mr. C. described her as overly

conscientious about her work, facebook and often being concerned about major adult matters

(i.e., finances, job security and children). Symptoms that accompanied Brandy’s worries

primarily involved stomach pain and headaches and at times over all lethargy. Brandy’s husband

stated that when worrying about something, Brandy had a tendency to be quite reserved and was

unwilling to discuss any important matters or situations affecting their marriage with him at all.

Brandy said that she worried often and could not “turn off” her worried thoughts and would often

have thoughts the ended in a tragic demise.

Brandy decided one day that she didn’t want to be married anymore and with of one

month moved to another state found a home and left her government job to work for a local

company in her new locale. Leaving her husband and one of their two children she started a new

life and fails to look at what has been done to her husband or their children. Her medical history
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was unremarkable up until the past two years where she was diagnosed with having Sarcoidosis.

Being diagnosed with Sarcoid set off her also newly diagnosis of depression and anxiety

disorder. Brandy was described as irritable and difficult to soothe as an infant. Development

milestones were met within normal limits. She was described as very respectful and had a small

history of wild behavioral problems as a child. Family history included depression in her

maternal grandmother and paternal grandfather and maternal history of separation anxiety

disorder as a child. Brandy has four younger siblings who were high functioning and without

significant noted problems.


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