PEDRO, Ma. Eloisa T. TAHILAN, Diovelyn L. Group 19 BIPOLAR DISORDER I.

Overview Definition

Prof. Lailani S. Galutira Clinical Instructor NCMH

Bipolar disorder is a mental disorder that is characterized by periods of deep, prolonged, and profound depression that alternate with periods of an excessively elevated or irritable mood known as mania. Between these highs and lows, patients usually experience periods of higher functionality and can lead a productive life. Incidence
y Bipolar disorder is the fifth leadin g cause of disability worldwide y Bipolar disorder is the ninth leading cause of years lost to death or disability

worldwide.
y The number of individuals with bipolar disorder who commit suicide is 60 times higher

than that of the general population y People who have bipolar disorder are at a higher risk of also suffering from substance abuse and other mental health problems y Males may develop bipolar disorder earlier in life compared to females y Blacks are sometimes diagnosed more often with bipolar disorder compared to whites Causes Researches show that the possible causes of bipolar disorders can not be traced from one cause, rather, researchers agree that the disease is multi factorial. The following are the risk factors considered: 1. Biologic Theories a. Genetics Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disord er will not develop the illness. Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far -reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Us ing the database, scientists will be able to link visible signs of the disorder with the genes that may

influence them. So far, researchers using this database found that most people with bipolar disorder had:
y Missed work because of their illness y Other illnesses at the same time, especially alcohol and/or substance abuse and

panic disorders
y Been treated or hospitalized for bipolar disorder.

The researchers also identified certain traits that appeared to run in families, including: y History of psychiatric hospitalization y Co-occurring obsessive-compulsive disorder (OCD) y Age at first manic episode y Number and frequency of manic episodes. However, studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder. . Neurotransmitters Bipolar disorder is one of the disorders caused by unbalanced neurotransmitter levels such as the following:
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2. Psychodynamic Theory Family dynamics during early life are responsible for manic behaviour in later life. Such family dynamics include the following:

y y y

Serotonin o The neurotransmitter serotonin regulates mood, anxiety, emotions and cravings. Low serotonin levels lead to unstable moods, insomnia and overeating. Epinephrine o Epinephrine is another name for adrenaline. This neurotransmitter is responsible for regulating metabolism and mental awareness. Dopamine o Dopamine affects our behaviors and addictions. Having low levels of dopamine could cause addictive behaviors (promiscuous sex, excessive spending, etc.) found in many people diagnosed with bipolar disorder. GABA o GABA (gamma-aminobutyric acid) is a neurotransmitter that calms the brain and induces sleep. Low levels of GABA create anxiety, depression, alcoholism and tremors.

a. Mother enjoys being the caregiver if life and resents autonomy b. Polar events of childhood are significant for some people that an adult emotional counterpart (receiving praise that gives a feeling of elation then disapproval that gives depression) c. Alternating identification with parents (mother depression; father mania) 3. Mania as defense against massive denial of depression. Mood Episodes Manic Episode y DSM IV Criteria a. A distinct period of abnormal and persistent, elevated, expansive or irritable mood that lasts at least one week (or less if hospitalization is required) b. At least 3 of the following symptoms must occur during the episode (or 4 if the client is only irritable: o Inflated self esteem or grandiosity o Decreased need for sleep o Very talkative o Flight of ideas or subjective feeling that thoughts are racing o Distractibility o Increase in goal directed activity or psychomotor agitation o Excessive involvement in pleasurable activities that have a high potential for personal problems c. Mood disturbance is severe enough to cause problems socially, or at work, or the person needs to be hospitalized to prevent harm to self or to others d. Not due to a substance Hypomanic Episode y DSM IV Criteria a. Meets most of the criteria for the manic episode, with two major exceptions: the symptoms must last at least 4 days and the person must manifest an unequivocal change in functioning that is observable by others b. Not severe enough to result in significant hospitalization Dysthymic Episode y A mood problem that is more on chronicity rather than severity y DSM IV Criteria a. Depressed mood for at least two years for more days than not and when the three other DSM IV criteria for depression are met Major Depressive Disorder y DSM IV Criteria a. At least a two week period of maladaptive functioning with at least five of the following symptoms present during that two week, one of which must be (1) or (2):

1. Depressed mood 2. Anhedonia 3. Appetire disturbance 4. Sleep disturbance 5. Psychomotor disturbance 6. Fatigue or loss of energy 7. Feelings of worthlessness or excessive or inappropriate guilt 8. Diminished ability to concentrate of indecisiveness 9. Recurrent thoughts of death or suicidal ideation b. Marked distress / impaired functioning which can be social or occupational c. No evidence of physical or substance induced etiology or of the presence of major medical disorder that accounts for the patient s depressive symptoms Types
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Mood Continuum a scale showing the ranges of motion experienced by a person with a bipolar disorder:
mania hypomania NORMAL dysthimia major depression

1. Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.

2. Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full -blown manic or mixed episodes.

3. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior. 4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild

depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Rapid-Cycling Bipolar Disorder occurrence of four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year

II. Manifestations Psychomotor, Alteration of Affect, Alteration of Perception Loud, rapid, jumbled Pscychomotor: speech, flight of ideas, Hyperactive and tends to monopolize agitated pacing, the conversation flamobouyant gestures, singing, wears colourful and dresses and excessive use of make up, few hours of sleep, poor nutrition Speech Cognition, Social Interaction, Effects on Occupation Manipulate the self esteem of others, ability to find vulnerability in others, ability to shift responsibility, keeps pushing limit, alienation of family

Manic Hypomanic Episodes

Alteration in Affect: Elated, euphoric, grandiosity, lability Alteration in Perception: Delusion and hallucination, consistent with mood and Pscychomotor: speech; Restlessness, anergia. Lack of motivation Alteration in Affect: Apathy, anxiety, worthlessness

Slowed monotonous mutism Dysthymic and Major Depressive Episode

Alteration in Perception: Delusion and hallucination, alteration in physical nature: abdominal pain, anorexia, chest pain, constipation, dizziness, fatigue, headache, indigestion, insomnia, menstrual changes, nausea and vomiting, sexual dysfunction III. Management / Treatment 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. This is also true for people with the most severe forms of the illness. Because bipolar disorder is a lifelong and recurrent illness, pe ople 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. A. Medications 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. 2. 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. 3. Antidepressants are most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. B. Psychotherapy 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.