Manic Bipolar Disorder

Definition:

This is a disease which is also known as Bipolar Affective disorder or Manic bipolar is brain disorder, in which a certain change in the mood of the effected appears, in energy  activity-level, and his ability to carry routine work changes, his mood changes certainly changes from happiness to anger.

Every one of us may be affected by this disease in the early age or in the old age, in some its symptoms may appear in childhood some in the later age.

In the patients of this disease their mood certainly changes from sad to happiness as they are the happiest of all in the world… This is called bipolar because in this disease the mood of person changes between the two opposite poles.

There are two stages in this disease;

1. Manic state

1. Depressive state

Signs and Symptoms:

Causes of Bipolar Disorder:

The causes of diseases are not yet exactly known by the science but some are considers as the causes of bipolar disorder which become the reason for change me brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortical.  In the mood suddenly it also results from a chemical imbalance within the brain. The brain’s functions are controlled by chemicals called neurotransmitters.

External environmental factors also cause of bipolar disorder, these include Stress, medication, and seasonal changes, sleep deprivation etc are also causes of bipolar disorder.

Diseases having similar symptoms:

Some diseases have similar symptoms and medications as bipolar disorder. Some of them are these

Head trauma, Thyroid problem, Brain tumor, AIDS, Diabetes, Panic disorder etc have similar symptoms.

How is bipolar disorder diagnosed?

The diagnose of the bipolar disorder is based on the self experience or the other family member of friend. The first step to diagnose the bipolar disorder is to consult with the doctor who may conduct some test or interview or physical examination. Currently it is not identified through the blood test or any type of brain scan. The doctor may refer to a trained mental health professional such as psychiatrist who is experienced in diagnosing and treating bipolar disorder. He or she should discuss any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms.

Treatment:

As there is no proper medicine and treatment for this disease. Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms.

The treatment of the bipolar disorder involves two steps psychosocial and medication.

Psychosocial

Psychotherapy is an important treatment of bipolar treatment in this The psychiatrist can discuss feelings, thoughts, and behaviors that cause you problems.. he practices different methods to get the patient out of these problems.

Medication:

Medicines used to treat the bipolar disorder are known as mood stabilizers. Lithium carbonate, which is and preventing relapses, more so for manic than for depressive episodes used to treat manic episodes, is the first known stabilizers. Carbamazepine is used for the treatment of bipolar disorder in 1980 for long time, other known medicine for this are lamotrigine, opiramate, etc

Self Help in treatment:

Self help in treatment of bipolar disorder is an important factor; we got out of this disease with self help. Here are some ways how we can help us to get over this disease,

Get education more about bipolar disorder.

Avoid from high stress situations.

Healthy sleeping, eating, and exercise stabilizes mood.

Regarding to mental illness it is very difficult to tell some specific and obvious signs and symptoms of the illness and especially in case of bipolar disorder it is nearly impossible to give any quite clear sign of mood episodes. Here by I copied the words of Carrie Bearden, PhD, an associate professor in residence of psychiatry and behavioral sciences and psychology at the David Geffen School of Medical at UCLA, he says that:
“Chalking it up to moodiness or trouble at work or tiredness is pretty common. The disorder varies in severity.”
Here are ten signs of the bipolar disorder which are very difficult to analyze in the patient:
1. Great mood:
Actually bipolar disorder is the up and down episodes of mania and depression and mostly during the manic episode the patient is completely cut off from the reality.
Another sign of bipolar disorder is hypomania in which the patient feels excited and his/her spirits are quite high and his/her energy is also very high but still he/she has total grip on the reality.
Dr Bearden says about hypomania that it is a pretty enjoyable state and patients enjoy it because their energy is high. His/her mood is elevated in this state he/she experiences a lot more energy then normal in them and their sense of creativity is also increased. This state can lead the patient to the euphoria state which is the up bar of the bipolar disorder and patients enjoy this state of bipolar disorder.
2. Laziness or inability in completing pending tasks:
The most important and obvious sign of bipolar disorder is lots of pending works and tasks but the patients who have the ability to utilize their elevated energies in hypomania phase are proved to be very productive and fruitful.
Don Malone, MD, the director of the Centre for behavioral health and chair of the Department of Psychiatry at Cleveland Clinic in Ohio says about the people who didn’t go step by step in completing their tasks, plan huge ideas, unreal projects and leave them incomplete that:
“They can be quite distractible and may start a million things and never finish them.”
3. Depression:
The depressive phase of the bipolar disorder is same as that of the normal depression cases. Dr Malone says that:
“They have the same problems with energy, appetite, sleep and focus as others who have plain old depression. Antidepressants can be downright dangerous in people with bipolar because they can send them into mania.”
Antidepressants alone didn’t cure the depression of the bipolar patients even they can worsen their condition and send them into a break-with-reality episode.
4. Irritation:
Some patients of the bipolar disorder have to face mixed mania in which they have to go through the symptoms of both mania and depression. In this state of mixed mania the patient is quite irritable.
Everyone has the chances of getting problems in his/her life and hence they can also be irritable either they are not bipolar patients. That’s why this sign of bipolarity is the most difficult to catch. Dr Bearden says about this situation that:
“We are all irritable or moody sometimes but in people with bipolar disorder it often becomes so severe that it interferes with their relationships – especially if the person is saying, ‘I don’t know why I’m so irritable… I can’t control it.”
5. Pressured speech:
There are some people who naturally have the ability to talk a lot whom we call talkative, motor mouth or chatty Cathy. But pressured speech is something different and it is the most important sign of bipolar disorder.
According to Dr Bearden this situation occurs when the patient is really not in a two way conversation. The try to talk more rapidly then you and if you wanna say a word they will just likely talk over you. They also jump around various topics which are totally irrelevant with the already discussing topic but the point to ponder is when the person does so when he/she is not in a habit of doing so. Mostly they do so when they are in manic phase.
6. Trouble at work:
Bipolar disorder patients have to face quite hard troubles at their work place because many of their disorder signs become hindrance in their capability of doing work and interacting positively with others.
Along with the above mentioned problems they also have difficulties with sleeping, irritability and an elevated ego during the manic phase and during depression they suffer excessive sleeping and other mood problems. According to Dr Malone most of the problems at work place are interpersonal.
7. Drug abuse:
Dr Bearden says that about 50% patients of the bipolar disorder are also involved in some substance abuse problem especially alcohol.
People use it both in manic and depression phase, to slow themselves in the former phase and to elevate their mood in the later one.
8. Erratic behavior:
During the manic phase of bipolar disorder, the patient has a swollen self esteem and ego. Dr Malone says that:
“They feel grandiose and don’t consider consequences; everything sounds good to them.”
When the patient is going through this phase he/she shows two type of behaviors of the most; one is engaged themselves in sprees and second is increased and unexpected sexual behavior.”
Dr Malone further quoted that:
“I have had a number of patients who have had affairs who never would have done that if they weren’t in a manic episode… during this episode they exhibited behavior that is not consistent with what they would do normally.”
9. Sleeping problems:
Bipolar patients often have sleeping problems like when they are in a depressive phase they may sleep a lot even too much and feel tired most of the times.
Contrary to this during a manic phase they don’t sleep for enough time and still don’t feel tired. Being in a manic phase, feels great and lots of energy even with sleep of just few hours. Dr Bearden suggests a scheduled sleep for a bipolar disorder patient.
10. Flight of ideas:
This sign of bipolar disorder is hard to detect but it mostly occurs when the person is in manic phase. His/her mind is felt like racing and the patient can’t control or slow down his/her thoughts and ideas.
This flight of ideas is accompanied with pressured speech and according to Dr Bearden the bipolar patient never admits that their mind is racing or their ideas are out of their control.

The causes and factors causing the bipolar disorder vary with individuals and studies have accounted that both genetic and environmental factor is responsible for bipolar disorder. These studies were twin studies and results are different in monozygotic twins and dizygotic twins. The rate of bipolar l according to the twin studies in monozygotic twins is about 40% constantly while the rate of same disorder in dizygotic twins is about 0-10%.

The proportion of the occurrence of the bipolar disorder in next generation is about 0.71. They are three main factors which cause bipolar disorder and they are described below one by one:

• Genetic
• Physiological
• Environmental

• Genetic:

Sometimes certain chromosomal sites and genes are observed which seems to be responsible for the growth of bipolar disorder but these results are not same all the time and keep on changing. This property of the genes to cause bipolar disorder does not replicate in all cases. In 1969 for the first time a genetic link was found responsible for causing mania but the results are not consistent yet. The results of Meta analyses of gene linkages is either no genome-wide results or only two genome-wide peaks located at 6q and 8q21 chromosome. These two peaks are obtained by using other methods. Genome-wide study is not so specific, every time it locates new loci due to which the case gets complicated.

Heterogeneity is a law which states that different genes are responsible for bipolar disorder in different families. Genes related to serotonin, dopamine, glutamate and other cell growth hormones give constant results for the study.

• Physiological:

There are certain circuits in brain which are necessary for normal body function and the abnormalities in these circuits can cause bipolar disorder. There is an increase reported in lateral ventricles, globus pallidus and the white matter called hyperintensities by the two Meta analyses MRI. The people who are genetically weak are more exposed to bipolar disorder and they easily become its victim. Bipolar disorder occurrence is expressed by sudden changes in the patient’s mood. The mood episode can start of its own. Due to stress an abnormality has been produced in the HPA axis which leads to bipolar disorder.

Depression is the poor neuron firing while mania is the hypersensitive neuron firing and both of them are caused by mitochondria and sodium ATPase pump. These are the causes of bipolar disorder type l but there are different causes for bipolar disorder type ll and those are circadian rhythms melatonin activity.

• Environmental:

It has been proved experimentally that environmental factors not only induce bipolar disorder but also enhance its effect. Environmental factors are effective in those people who are genetically dispositional. Environmental factors shows consistent results and it has been seen that there are certain incidents in our daily routine life which cause induction and recurrence of different mood episodes and this is bipolar disorder. These environmental factors may be any event or any interpersonal relationships which can induce bipolar disorder. Mostly patient’s histories shows that they have bad abusive or traumatic experiences in their childhood or adolescence and this later on become the cause of bipolar disorder and it starts from an onset which gets severe and become worse to result in PTSD.

Bipolar disorder which is also called manic-depressive disorder is a kind of psychiatric disorder related to a category of mood disorders and is defined as the presence of one or more intervals of abnormally elevated energy levels, cognition and mood with or without one or more intervals of depression. Clinically these elevated moods are mania and if they are mild then they are known as hypomania. People who came to experience such manic episodes also experience depressive episodes or symptoms while they can also come across mixed episodes which have features of both mania and depressive episodes at the same time. Between these episodes there is a period of normal mood but in some patients, depression and mania alternate rapidly and this condition is called rapid cycling. Episodes of extreme mania can lead to symptoms like delusions and hallucinations. This disorder has sub-phases like Bipolar l, Bipolar ll, cyclothymia and many others. This subdivision depends upon the severity and nature of the mood episodes and the range of mood episodes is usually called bipolar spectrum.

In USA the rate of bipoolar 1%, bipolar ll 0.5%-1% and sub-threshold cases 2%-5% is recorded. The diagnosis of this disorder is based on the patient’s personally reported experiences and observed behavior. The bipolar disorders are usually associated with distress, disruption and a high risk of suicide especially during depressive episodes while in others it may be attached with creativity, goal striving and positive achievements.

Genetic as well as environmental factors are involved in the development of bipolar disorders. It can be treated by using mood stabilizers and other psychiatric drugs. The patients who don’t harm anyone can also be treated using psychotherapy otherwise involuntary commitment is used. Bipolar disorder is sometimes misdiagnosed as having schizophrenia.

Symptoms of bipolar disorders are very complicated and are not understood even by mental health professionals. In the beginning the symptoms look like that of depression and for the diagnosis of bipolar disorders it is noted that a person more often feel depressed or not. Initially bipolar disorder patients are treated as depression patients.

The symptoms of the depressive episode of bipolar disorder are persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness in addition to disturbances in sleep and appetite, fatigue and loss of interest in usually enjoyable activities, more problems concentrating, loneliness, self-loathing, apathy or indifference, depersonalization, loss of interest in sexual activity, shyness or social anxiety, irritability, chronic pain which can be with or without a known cause, lack of motivation, and morbid suicidal idealization. Severe cases can lead upto delusion or hallucinations and this condition can lasts for even six months if leaf untreated.

Manic episodes are characteristic of bipolar disorder and it is diagnosed by the presence of distinct period of elevated mood which can further change into euphoria. Such patients have sleepless nights without getting tired even for nights, pressured speech, low attestation span, distraction, become aggressive, intolerant or intrusive. The patient start using alcohols and other depressants like cocaine or other stimulants, or sleeping pills.

The bipolar disorder is thought to be connected with the creativity of the person means those who are more creative have more chances of having bipolar disorder. Temperament is also a factor responsible for bipolar disorders. Sometimes setting high goals in life can also be the cause of bipolar disorder or low self esteem and difficulties in social adjustment is also a factor of this disorder.

Diagnosis depends upon the patient’s experiences and secondarily on the psychiatrist, nurse, social worker, clinical psychologist or other clinician experiences. It depends on the presence and duration of the symptoms. World wide Diagnostic and Statistical Manual of Mental Disorders, the current version being DSM-IV-TR, and the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems and currently the ICD-10 used for the diagnosis of bipolar disorder.

Schizophrenia, schizoaffective disorder, drug intoxication, brief drug-induced psychosis, schizophreniform disorder and borderline personality disorder are some other mental disorders which may be mixed with bipolar disorder due to similar symptoms.

There are several pharmacological and psychotherapeutic techniques which are used for the treatment of bipolar disorder and the patients as well can help themselves for their recovery using personal recovery journey. For serious patients psychotherapy is used which alleviate the core symptoms, recognize episode triggers, reduce negative emotions in relationships and practicing such factors which lead the patient towards recovery. Cognitive behavioral therapy, family-focused therapy, psychoeducation, interpersonal and social rhythm therapy are considered to be most effective in bipolar disorders.

Medications of certain types are also used as the treatment of bipolar disorder like mood stabilizers such as lithium carbonate or lamotrigine. The former medication reduces the suicide feelings in bipolar patients while the later is used to prevent depressions. In some severe cases depending upon the severity lithium based products or on their own can be used in combination.

Acute manic episodes can be treated using antipsychotic medications such as chlorpromazine and the atypical antipsychotics quetiapine, olanzapine, olanzapine and quetiapine. After reduction in symptoms by the use of medicines they should not be discontinued irregularly as relapse can occur.

50% cases of mania or mixed episodes get recovery within six weeks while 98% in two years. The rate of symptomatic recovery is 72% while that of functional recovery the rate is 43%. The disorder can occur again due to discontinuation of medication and if the patient is under- or over-medicated relapse can occur.

The mortality rate of bipolar disorder patients is very low as none of them has never attempted suicide. The annual average of suicides due to bipolar disorder in both males and females is 0.4%.

There are several types of treatments for bipolar disorder which are described below one by one.
1. Comprehensive treatment for bipolar disorder:
Comprehensive treatment is a type of treatment which includes all the aspects related to the disorder like symptoms, restoration of the abilities and fixation of the problems due to disorder and tries to diminish them. It include further following steps:
• Medication:

The fundamental part of bipolar treatment is the use of certain medication as the mood stabilizing drugs can give a hand in reducing the peaks and valleys of the bipolar disorder and ultimately controls the symptoms of the disorder.

• Psychotherapy:
Consulting a therapist and attending sessions with him is very important for a bipolar disorder because it helps the patient how to cop with the disorder and the problems in his/her life due to the disorder. These sessions can also help the patient to manage with the situations of difficulty and uncomfortableness which he can encounter due to the disorder. It also helps him/her to resolve their problems, restore their relationships and how to regulate the stress and mood fluctuations.

• Education:
The best solution to emerge out of the problems and symptoms of the disorder is to know thoroughly about it. The more we know about the disease the more easily we can fight with it. So it is better that the patient and his/her relatives are thoroughly aware of the disorder so that they can avoid certain unhappy experiences due to the disorder.
• Life style management:
Some certain changes in life style can change the symptoms of the disorder as well as the mood episodes and the changes included under this treatment are regular sleep schedule, saying no to alcohol and any kind of drugs, doing regular exercise session, keeping stress low and taking proper exposure of sunlight.
• Support:
The most precious thing which gets you back to life from bipolar disorder is the support of your loved ones. The support of the friends and family is quite important for the patient. He/she can also join bipolar disorder groups where they can share their problems with those who are facing the same problem.
2. Medication treatment:
In most people with severe kind of bipolar disorder medication is required to control their symptoms and to keep them normal and the use of the medications consistently can not only reduce the symptoms of the disorder and frequency of the mood episodes but also cease them sometimes.
Steps involved in medication treatment are:
• Regular sessions with the physician:
In bipolar disorder it is necessary to check the levels of medications that either they are in therapeutic range or not by blood tests. In this disorder the most important thing is to manage the balancing dose and regular check ups will also help to be safe and symptom free.
• Consistent use of medications:
Don’t stop taking the medications just after feeling a little better until your physician tell you to do so because some people with bipolar disorder require long term medications otherwise the disorder can again come back.
• No extra expectations:
Medications only minimize the symptoms of the disorder like that of mania and depression but it doesn’t nip the disorder in the bud. For that one has to change his/her lifestyle for best results and he/she should take therapy sessions also.
• Say NO to antidepressants:
It has been proved by researches that antidepressants are not the treatment of bipolar disorder in fact they initiate mania or rapid transformations in depression and mania.
3. Therapy treatment:
Treatment by therapy has been one of the successful treatments for the patients of bipolar disorder and much more better, effective and faster results can be received from therapy treatment. There are three types of therapies done on the patients of bipolar disorder which are:
• Cognitive-behavioral therapy
• Interpersonal and social rhythm therapy
• Family-focused therapy

Unfortunately for a thousand of Americans they suffer from a condition known as Bipolar Disorder. Bi, meaning two, is exactly what bipolar disorder essentially has. Along with polar (contrasting phases) means that there are two contrasting phases in a person’s life that has bipolar disorder. People who are found to have this condition typically have very dramatic and unpredictable mood swings.

According to studies, due to the embarrassment that many people have about the condition, roughly 75% of people who have bipolar disorder will never be treated or will not be treated properly. If you are someone who is experiencing bipolar disorder symptoms then you should not hesitate going to get tested. There is a very good success rate when it comes to treating people so that they can live normal lives. A lot of people have misconceptions about the medication that you may require to be able to live a healthy lifestyle. However, medication has come a long ways over the last decade and there are several forms and doses that a person may need. A good psychiatrist should be able to help someone who is experiencing bipolar disorder symptoms feel normal again.

Bipolar Mania / Hypo-mania Symptoms:

#1: Irritability or Euphoria

Have you ever experienced times in your life where you simply seemed like you wanted to yell at someone for really no apparent reason? Someone with a bipolar disorder experiences this to a more significant degree than someone who does not have it. Although Hypo-mania is sometimes expressed as the more outgoing and overly happy side when it comes to having a bipolar disorder, many people who have this condition can also quickly swing back to the other side which is depression.

#2: Excessive Talking

I know that my wife talks a lot, but when it comes to someone with bipolar disorder she is no match. Someone with a severe condition will often times speak quickly and tend to not let you have a word in the conversation. At times, because their mind is racing so quickly, it may be difficult to even follow what they are talking about.

#3: Inflated Self-esteem

Someone with bipolar disorder during those times when they are having an issue with hypo-mania will tend to have a little extra pep in their step. This meaning that they appear to have an inflated ego and more self-esteem about themselves than they do a lot of other time. Generally someone with a more severe condition of bipolar disorder will have an extreme case where it may even be difficult to be around the person because they seem so arrogant.

#4: Unusual Energy, No sleep needed

Have you ever seen someone who takes a form of drug that is an accelerant? This is a lot of what someone who is having an episode of hypo-mania will act like except that they do not need any form of drug to get the same result. It seems like they are talking a lot, they have lots of energy. Many people who experience this feeling as a result of hypo-mania will sometimes go shopping and spend all day doing it perhaps even into the late night hours. It will almost seem as if they have no sense of time.

#5: Quick desire for self-gratification

Unfortunately for a lot of people who are in serious bipolar disorder hypo-mania episodes will tend to also be a large amount of debt. A lot of people when they are experiencing hypo-mania episodes will immediately go out and buy things that they not only do not need but also can not afford. I have seen people with multiple vehicles that have purchased them even when they could not technically afford them. I have also seen people who have lost their homes because they have made terrible financial decisions. There are even people who will take money from their retirement and spend it on clothes or other items that will never really last and they are forced to continue working the rest of their lives.

Bi-Polar Depression / Major Depression Symptoms:

Since this condition is known as bipolar which essentially two opposite contrasting presences you can simply imagine the exact opposite of the things mentioned above.

Generally someone in a Bipolar depression state will have bipolar depression symptoms such as a desire to stay indoors all the time, very low self-esteem, they generally will keep to themselves perhaps even keeping themselves locked behind a door away from others in the household, they will sleep a lot more than a normal human would naturally. These are just a few signs that someone may be experiencing a form of depression which could also be linked to bipolar disorder symptoms.

Bipolar disorder is characterized by a grave brain sickness. It may be known as manic depressive sickness. Children suffering from this sickness have unusual mood changes. Manic and depression are two terms which are linked with the mood of patient. When the mood of child is happy then it is called manic. When the mood is gloomy then it is called depression. These two conditions are not usual as the normal children become happy or sad. These kinds of children show their behavior of happiness and sadness at their peak. The situation can severe in many cases and the patient may decide to suicide. These children need an extra care and love. These children can not do well in school and they can not do their daily activities well.

This disorder does not occur only in children but also in teens and adults. This is different from children in a sense that adults may not face the severity of it as it can be faced by the children. In children it is called early-onset bipolar disorder. This is more severe in a sense that children have to face this disorder at their early life of growth and development and it can be lasting.

Factors:

There are many factors that can be responsible for it

·        Genetic disorder can also be a cause of bipolar disorder.

·        Tension can also cause this disorder.

·        An infection in brain can cause malfunctioning of it. This can cause bipolar disorder.

Factors causing this disorder are not always obvious. Some scientists are trying to seek the causes of it.

Symptoms

This disorder occurs in episodes. These episodes can be manic or depressive. In manic episodes child feels happy while it feels gloomy in depressive episodes. These episodes can be experienced for days or even for weeks. These episodes are severe. The situation is powerful and occurs with strange changes in moods and energy levels.

Children and elders that experience manic episodes may

• Have short temper.
• Speak many different things.
• Suffer from nervousness.
• Have problem while concentrating.
• Discuss sex frequently.
• Take part in dangerous things.

People who experience depressive episodes may

• Suffer from sadness.
• Experience stomach pain and headache.
• Slumber for a short time or too much.
• Take too much food or little.
• No focus on fun.
• Talk and think about death and suicide.
• There is a question which arises. Can a child have other disorders?
• They can involve in drinking or in drugs
• They can not focus on one thing
• Sometimes they have hyperactivity.
• They do those things which can result in extreme results .

Diagnosis

You need not to do any blood tests brain scans. The only thing that a doctor can ask is the behavior and sleeping pattern. But doctor can do some tests to see any other disease or disorder. He may ask about drinking the family medical problems including nervousness and drinking.

Treatment

Still now there is no cure of bipolar disorder. Treatment can help to prevent symptoms.

• Medication can help to prevent symptoms. This is difficult for children because they have to take small amount of medicines. There is a difficulty to see which medicine suits them and how much dose should be given to them.
• Different kinds of therapies can help to change the behavior of a child and he can make his daily activities better.
• Environment also plays an important role in the behavior of such children. So parents, family and society can play a significant role in making the child behavior good.