Bipolar Disorder 2010



Bipolar Disorder

(**All information below is NOT original)


Bipolar Disorder 2010 - The Neuron1


What Type of Disorder Is It?
It's Mood Disorder. 2
Here are some facts about Mood Disorders...
  • "Many behavioral and Cognitive changes accompany depression.
  • Depression is widespread.
  • Compared with men, women are twice as vulnerable to major depression, even more so if they have been depressed before.
  • Most major depressive episodes self-terminate.
  • Stressful events related to work, marriage, and close relationships often precede depression."


So What Is Bipolar Disorder?
3
Definition: "Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks."

Who Gets It?:
"Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25.1 Some people have their first symptoms during childhood, while others may develop symptoms late in life.Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life."

What Are The Symptoms of Bipolar Disorder ?4
"People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.Symptoms of bipolar disorder are described below.

Symptoms of mania or a manic episode include:Symptoms of depression or a depressive episode include:
Mood Changes
  • A long period of feeling "high," or an overly happy or outgoing mood
  • Extremely irritable mood, agitation, feeling "jumpy" or "wired."
Behavioral Changes
  • Talking very fast, jumping from one idea to another, having racing thoughts
  • Being easily distracted
  • Increasing goal-directed activities, such as taking on new projects
  • Being restless
  • Sleeping little
  • Having an unrealistic belief in one's abilities
  • Behaving impulsively and taking part in a lot of pleasurable,
    high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.
Mood Changes
  • A long period of feeling worried or empty
  • Loss of interest in activities once enjoyed, including sex.
Behavioral Changes
  • Feeling tired or "slowed down"
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Thinking of death or suicide, or attempting suicide.

In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.Scale of Severe Depression, Moderate Depression, and Mild Low Mood

One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.
At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.
During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.
Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.
People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness."



Bipolar Disorder 2010 - The Neuron5

What Are The Known Causes for Bipolar Disorder? 6
"Doctors and scientists don't know the exact cause of bipolar disorder, but they think that biochemical, genetic, and environmental factors may all be involved. It's believed this condition is caused by imbalances in certain brain chemicals called neurotransmitters. If the neurotransmitters aren't in balance, the brain's mood-regulating system won't work the way it should.
Genes also play a role. If a close relative has bipolar disorder, a person's risk of developing the condition is higher. This doesn't mean, though, that if you have a relative with bipolar disorder you will automatically develop it! Even in studies involving identical twins raised in the same home, one twin sometimes had bipolar disorder whereas the other did not. Researchers are now working on identifying the gene or genes involved in bipolar disorder. Environmental factors may play a role in bipolar disorder. For some teens, stresses such as a death in the family, their parents' divorce, or other traumatic events could trigger a first episode of mania or depression. Sometimes, going through the changes of puberty can set off an episode. In girls, symptoms can be tied to their monthly menstrual cycle."


What Are The Possible Treatments? 7
"To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.18-20 This is also true for people with the most severe forms of the illness.Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.

Medications

Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state's licensing agency to find out more.Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively.

  1. Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:
  • Lithium (sometimes known as Eskalith or Lithobid) was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
  • Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder.23, 24 Also see the section in this booklet, "Should young women take valproic acid?"
  • More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder.
  • Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.

  1. Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called "atypical" to set them apart from earlier medications, which are called "conventional" or "first-generation" antipsychotics.
  • Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis.28 Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms. However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease. These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.
  • Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.
  • Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.
  • Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.
  1. Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person's risk of switching to mania or hypomania, or of developing rapid cycling symptoms.29 To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.
Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.30
  • Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.
Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.

Psychotherapy

In addition to medication, psychotherapy, or "talk" therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
  1. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
  2. Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
  3. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
  4. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.
A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor's instructions for any psychotherapy will provide the greatest benefit.

Other Treatments

  1. Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments. Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.43Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.44
  2. Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.
People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects."

Case Study - Real Life Stories 8

" Case A

This case involved a fifty-five year old male diagnosed with bi-polar depression. The man suffered from a range of issues, including severe migraines, intermittent hypersomnia (sleeping constantly) and hypomania (insomnia), diffuse and chronic muscle tension, debilitating fatigue and agitated depression. The man had a history of repeated attempted suicide. Prescribed medications provided little or no relief for him.
After an initial session of Neurofeedback training he reported no noticeable changes whatsoever. Early into training he arrived for an appointment with a self-described “intense and driving headache”. He subsequently reported that the pain from his headache had receded “by several notches” by end of session. Over the next few sessions the man reported feeling anxious, agitated, depressed, and confirmed not sleeping more then a few hours at a time. Soon thereafter he reported sleeping a solid six hours “for the first time in over a year”. As training progressed, he reported less headaches overall, but was experiencing enduring muscle tension and continued emotional lability. Shortly thereafter clinical evaluations revealed a condition of Fibromyalgia. Despite setbacks the man reported sleeping seven hours a night fairly restfully on a more regular basis and marginal mood improvement. Thereafter he reported his spouse had observed that he was more animated and yet, calmer. Later into the training he proudly stated that he was in his second month of working out, experiencing “far less” muscle tension and feeling more motivated to tackle many projects previously set aside. Toward the end of training he described feeling like he was “floating, light, but grounded, and feeling very calm.” At discharge he reported feeling as “sharp as ever; where I have been for most of my life [before depression].” He had re-initiated his professional consultancy, and was once again able to compete in a business environment.

Case B

This case involved a forty-two year old female who had a complex array of concerns, including depression, anxiety (with some panic attacks), prickling sensations on her scalp, sudden involuntary muscle "jolts" every time she reposed, migraine headaches, sleep disruption, a lack of focus, racing thoughts, excitability with uncontrollable talkativeness and extreme irritability. She also suffered from low self-esteem and a residual feeling of guilt as a result of repeated exposure to violence early in life.
The issues the woman was struggling with were preventing her from securing a professional position that could pay her sufficiently enough to support her and raise a child. The woman was compliant with her prescribed antidepressant and two sleep aids prescribed by a physician. These did not alleviate her symptoms.
After completing initial Neurofeedback training the woman reported a decrease in some of her anxiety-related symptoms, with only incremental improvements in sleep. Early into her training she was compliant with our recommendations for observation in a sleep clinic and an evaluation by a psychiatrist. The sleep clinic found no abnormalities in her EEG, however the psychiatrist diagnosed her as having bipolar disorder, and prescribed a mood stabilizer. The woman was compliant with her medications, and as training progressed, despite numerous changes in medications, she continued to improve in all areas. Her sleep was more normalized, her irritability and anxiety diminished, and she no longer experienced the involuntary jolt sensations or prickling across her scalp. The woman reported feeling calmer and calmer, with episodes of racing thoughts significantly diminished. By mid-program she was apparently stable and was offered and accepted an advanced professional position, stating she felt “ready to meet the demands” of a work environment. As her training progressed, she continued to experience greater and greater control over her anxieties. By discharge the woman had successfully titrated off of all medications, was engaged to be married, and had received a promotion at work. "


Related Disorders 9
  • Alcoholism
  • Drug addiction
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Attention-Deficit Hyperactivity Disorder
  • Panic Disorder
  • Social Phobia.

Related Links - FYI


Visual - For Your Better Understanding

"Living with Bipolar Disorder"
10



"What is Bipolar Disorder? (Bipolar #1)"
11



Bipolar Disorder 2010 - The Neuron12



WAPA. WAPA. WAPA. WAPA. WAPA. WAPA. WAPA.

1. image: http://kirstyne.wordpress.com/2007/12/14/bipolar-disorder/
2.
Myers, D. G. (2004). Psychology, 7th Edition (Hardcover), David Myers (7th ed.). New York: Worth.
3. NIMH · What is bipolar disorder?. (n.d.). NIMH · Home. Retrieved March 18, 2010, from http://www.nimh.nih.gov/health/publications/bipolar-disorder/what-is-bipolar-disorder.shtml
4. NIMH · What are the symptoms of bipolar disorder?. (n.d.). NIMH · Home. Retrieved March 18, 2010, from http://www.nimh.nih.gov/health/publications/bipolar-disorder/what-are-the-symptoms-of-bipolar-disorder.shtml
5. image:
http://www.onlinecounselingblog.com/2009/03/treatment-for-bipolar-disorder/
6. Bipolar Disorder . (n.d.). KidsHealth - the Web's most visited site about children's health. Retrieved March 18, 2010, from http://kidshealth.org/teen/your_mind/mental_health/bipolar.html#
7. Bipolar Disorder . (n.d.). KidsHealth - the Web's most visited site about children's health. Retrieved March 18, 2010, from http://kidshealth.org/teen/your_mind/mental_health/bipolar.html#
8. Case Study: Bi-Polar Disorder - Neurofeedback Center of Virginia * Neurotherapy Associates * Falls Church, VA. (n.d.). Home - Neurofeedback Center of Virginia * Neurotherapy Associates * Falls Church, VA. Retrieved March 18, 2010, from http://www.neurotherapyassociates.com/index.php?option=com_content&task=view&id=50&Itemid=65
9. Bipolar Disorder. (n.d.). Internet Mental Health. Retrieved March 18, 2010, from http://www.mentalhealth.com/dis/p20-md02.html

10. video: http://www.youtube.com/watch?v=kKm526pnMSg
11. video: http://www.youtube.com/watch?v=MBUOoQk0hhU
12. image: http://bipolar.about.com/b/2005/08/09/yvonne-manic-depressive.htm

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