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Bipolar Disorder In A Nutshell
Bipolar disorder, formerly called manic-depressive illness, is one of several disorders known as mood disorders. Mania and depression alone or in combination are hallmarks of mood disorders. Mania is characterized by a feeling of euphoria in which the individual has great ideas, exhibits boundless energy, requires little sleep, and exhibits great self-confidence. While in a manic state people’s minds are racing, they speak very loudly, and they show poor judgment. Manics can compulsively spend a lot of money, engage in sexual indiscretions, and alienate people because of their anger and impatience. Hypomania refers to a milder form of mania that is an excessive amount of excitement but not so detrimental to the individual’s life.
Depression can be characterized by many symptoms, including feelings of worthlessness, guilt, and sadness. When one is depressed, life seems empty and overwhelming. A depressed individual has difficulty concentrating, can’t make decisions, lacks confidence, and can’t enjoy activities that used to be pleasurable. Physical symptoms may include weight gain or loss, sleeping too much or too little, restlessness, or lethargy. People with depression may worry about death or suicide. They may believe that they have committed the unforgivable sin and that their loved ones are better off without them.
Bipolar disorder is so named because those who suffer from it experience both mania and depression, as opposed to those with unipolar disorder, who experience only severe, common depression. Bipolar disorders are divided into two types, Bipolar I and Bipolar II. In Bipolar I the individual experiences mania and depression; in Bipolar II the individual experiences hypomania and depression. Mania or hypomania is the key to diagnosing bipolar disorder. A person who experiences a manic state at least once is thought to have bipolar disorder. Manic and depressive states may precede or follow each other or may be separated by long periods of time, and the individual may have more episodes at one pole than the other. Some individuals, known as rapid cyclists, experience four or more episodes each year.
The age of onset for bipolar disorder is younger than unipolar depression and usually begins in the late teens or twenties but rarely begins after age 40. In some cases it is preceded by a disorder called cyclothymia, which is a milder type of mood disorder, is characterized by marked moodiness and mood swings for at least two years. Bipolar disorder is a chronic illness and even with treatment less than half of individuals who experience it last five years without a manic or a depressive episode. People with bipolar are at risk of suicide during the depressive phase and are more likely to die accidentally during the manic phase due to impulsiveness and poor judgment.
The causes of bipolar disorder are not clear, but it is likely determined by several factors. Family and adoption studies often show a genetic predisposition to mood disorders. First-degree relatives of people with bipolar disorder are more likely than the general population to experience bipolar depression, unipolar depression, and anxiety. But at this point, there is no clear evidence that a particular gene is involved in the transmission of bipolar disorder; rather it seems that family history increases the vulnerability to many diseases.
Neurotransmitters in the brain have been extensively investigated and may be involved in bipolar disorder but in complex and interactional ways that are not yet understood. The relationship between neurotransmitters and the hormones secreted by the hypothalamus, pituitary, and adrenal glands seems to be important. There is also speculation that bipolar disorder may be related to circadian rhythms because some people with bipolar disorder are particularly sensitive to light and show abnormalities in sleep patterns such as entering REM sleep too quickly. , dreaming vividly, and missing deeper stages of sleep.
Stressful life events can cause episodes of mania or depression but are not the primary cause of bipolar disorder. Psychosocial factors such as attributional style, learned helplessness, attitudes, and interpersonal relationships all seem to be related to bipolar disorder but the causes are unknown; they are often the result of having such a disorder. It seems that a genetic vulnerability combined with stressful psychological and sociocultural events can result in bipolar disorder.
Three main treatment methods are most often used for bipolar disorder. Medication is often used, especially lithium. For reasons not yet fully understood, lithium reduces the frequency of episodes, and many people with bipolar disorder stay on lithium for a long time. Lithium levels must be closely monitored through blood tests, and can have side effects such as weight gain, weakness, and kidney damage. Because of the side effects of the medication and because they miss the energy of hypomania and manic states, people with bipolar disorder may stop taking their medications. Newer antidepressants that affect serotonin levels are often used, but there is some suspicion that they may contribute to faster cycling. Antiseizure medication, such as carbamazepine, is also used.
A second treatment method that is sometimes used is electroconvulsive therapy (ECT). This method is used only in severe cases where uncontrollable behavior or the threat of suicide make it impossible to wait two to three weeks for the effect of the drug. ECT, which is used to treat people who do not respond to other types of treatment, is often effective but has side effects: temporary short-term memory loss and confusion immediately after treatment.
Psychotherapy is the third treatment method. While many psychotherapeutic approaches have been tried, cognitive therapy and interpersonal therapy are the most popular today. Cognitive therapy focuses on identifying and correcting faulty thinking and cognitive styles, so that the client can gain cognitive control over emotions. Interpersonal therapy focuses on developing skills to recognize and resolve interpersonal conflicts, which often accompany bipolar disorder. Both of these psychotherapies are highly structured and short-term. Many people receive a combination of medication and psychotherapy to stabilize it and prevent relapse.
In addition to addressing the possible causes of bipolar disorder, psychotherapists help people cope with a number of problems that arise from living with the disorder. One is the difficulty of living with disruptions in one’s life that lead to manic and depressive states. People may be too sick to work or parent and may even be hospitalized. Another problem is eliminating or coping with inappropriate behavior during a manic state, when the individual may spend money relentlessly, make big promises, or say inappropriate things. A third common problem is dealing with the negative reactions and distrust of family, friends, and co-workers who are affected by the individual’s extreme mood swings. Regularly taking medication is a struggle for some people, a struggle compounded by the tendency of people in a manic or hypomanic state to feel they don’t need medication. People with bipolar disorder face constant worry that their emotions may be out of control. They often feel helpless and as if their illness is under control and could end at any time. There is also the question of why God allows people to go through such struggles. People with bipolar disorder need therapists to help them control their emotions, recognize when they are getting too high or too low, manage interpersonal relationships, cope with life’s stresses, and understanding how to accept and live successfully with bipolar disorder.
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