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Bipolar Disorder
Dave Cortes
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 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
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
Symptoms also can not be the result of substance use or abuse (i.e. alcohol, drugs, and
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
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
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:
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
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
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,
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
Illicit drugs, such as ecstasy, “designer drugs” such as cocaine, amphetamines, certain
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
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,
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
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.
Bipolar disorder can be treated in a combination of ways. There is medication for the
at Johns Hopkins University School of Medicine, who additionally struggles with bipolar
ineffably, psychotherapy heals" (Bower 2000).I interpret this to mean, that the appropriate
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,
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-
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
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
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
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
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
Conclusion
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
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
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