Treatment Options of Bipolar Disorder - Essay Example

Bipolar Disorder: Symptoms, Etiology and Treatment Options Bipolar disorder, historically referred to as manic-depressive disorder, occurs when a person experiences alternating states of elation and depression. These episodes may be frequent (rapid cycling) or only occur a couple of times each year. They may be extreme or mild enough to allow the person to remain functional. Since it can be difficult for a clinician to get accurate information from the patient, as well as the fact that symptoms described can be diagnosed as other disorders – most frequently drug or alcohol related problems or psychosis associated with schizoaffective disorders, errors in diagnosing bipolar disorder are unfortunately common. Johnson & Leahy report that in one survey an average of 8 years passed between onset of symptoms and accurate diagnosis (p.4). Bipolar disorder presents itself most commonly in late adolescence and early adulthood and is “recurrent, chronic, and the sixth leading cause of disability for people age 15 to 44” (Corcoran & Walsh, p.381). In order for a diagnosis of bipolar to be made, periods of mania and depression must be present. These episodes will vary in their magnitude which is why DSM-IV-TR has included several types and subtypes of this disorder. These will be discussed in an overview later in this paper. Common signs of mania include feelings of euphoria and inflated self-esteem which may lead the person to believe he or she is invincible. With this mindset the person often engages in harmful behaviors such as excessive spending, risky sexual encounters, and reckless driving. A decreased need for sleep and racing thoughts give this person ample opportunity to do maximum damage in a minimum amount of time. Depressive episodes may include fatigue and apathy, low self-esteem, decreased interest in activities or people that the patient would otherwise be enthusiastic about. Feelings of sadness, helplessness, and even guilt are likely to result in suicidal feelings or attempts (webmd.com). Bipolar disorder is an Axis I diagnosis. Bipolar I requires a single lifetime manic episode where depression is not a major consideration. The mania may present as described above, but may also be any major mood change such as increased irritability or quickness to anger. In addition to a drastic mood change, at least three of the following symptoms must also be present for a minimum of 1 week, or require hospitalization. These symptoms include “inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal-directed activity, and increased involvement in pleasurable activities with a high potential for negative consequences” (American Psychiatric Association, 2002 in Johnson & Leahy, p.4). Bipolar II is diagnosed when a single episode of hypomania occurs with at least a single episode of major depression. Like mania, hypomania must include at least three of the above symptoms, but the symptoms themselves are not as extreme and may only be present for a minimum of 4 days as opposed to 1 week (Johnson & Leahy, p.5). Worth noting on this topic is cyclothymia, a mild mood disorder involving mood swings that do not reach the extremes of bipolar I or II, but may still interfere with a person’s ability to work, form lasting relationships, and pursue other interests (webmd.com). Although etiology is difficult to discern in patients with bipolar disorder, much research has centered on biological causes. These studies have shown that “First-degree relatives of people with bipolar I disorder have elevated rates for that disorder (4-24%) as well as for the bipolar II (1-5%) and major depressive disorders (2-24%)” (Sadock & Sadock, 2005 in Corcoran & Walsh, p.385). Twin studies reveal even higher rates of concordance. Biological risk factors tend to concentrate on chemical processes involving the limbic and endocrine systems and physical biorhythms (Corcoran & Walsh, p.386). Johnson & Leahy describe research concentrating on brain activity during specific episodes and suggest that increased activity in the frontal cortex is present during episodes of mania (p.8). It has also been suggested that psychosocial factors may trigger or aggravate the onset of an episode. Studies have demonstrated potential links between early childhood abuse and earlier onset with more frequent cycling of symptoms (Corcoran & Walsh, p.386). Given the nature of this disorder, those suffering from it are likely to become dependent upon others for approval and acceptance. As the disorder runs its course friends and family may become “fed up” and give up trying to help or even leave. Divorce is common. The “normal” spouse suffers financial hardship as a result of the patient’s overspending during manic episodes, or he or she may discover that the partner has had affairs during these times. At the other extreme is the stress of dealing with a majorly depressed person who may miss days or weeks of school or work, or be incapable of holding down a job at all. When the spouse or significant other abandons the bipolar person it can trigger another episode or worsen the state the person is currently in. Other stressful events that might contribute to the disorder include changes in normal routine and having to alter sleep cycles (for example, airline travel to different time zones). Patients who experience stressful events after onset of their disorder are more likely to have future episodes (Corcoran & Walsh, p. 388). Bipolar disorder presents itself in ways that make it difficult to diagnose. There are those who suffer mild symptoms and may not realize anything is wrong. They view themselves as happy people, and their goal-orientation leads to productivity at work and increased creativity. They may have many friends for whom they are the “life of the party” and their co-workers and supervisors may reward their hard work with praise and promotions. Their mildly depressive moods may be seen as “just having a bad day” and do not significantly interfere with their lifestyle. Then there are those who cannot function at all, have lost everything, and contemplate (or attempt) suicide. What can be done to help people with these diagnoses? Options range from psychotherapy, group therapy and pharmacological interventions. Psychosocial treatments focus on integrating talk therapies with pharmacology in order to increase patient compliance with medication regimes and help maintain social supports by educating both the patient and the important people in their lives. The goal is to reduce “pharmacological non-adherence..., enhance social and occupational functioning, recruit family and spouse support... and identify psychosocial stresses that may trigger mood disorders” (Corcoran & Walsh, pp.395-6). This idea of involving the mental health counselor, and not just a prescribing psychiatrist, is paramount in the research of Kaut and Dickinson (2007). Sessions often focus on developing healthy communication and problem-solving skills. As mentioned earlier, stress is considered a risk factor for an increase in manic or depressed episodes, so it is important that the patient feel empowered and the family have realistic expectations. A psychologically safe environment at home is one less source of stress, and one that the patient has some extent of control over. Individual or family psychotherapy alone will not control outbreaks of mania or depression associated with bipolar disorder. Patients diagnosed with this particular illness require medication to manage mood swings. The most popular pharmacological treatment is lithium. Lithium is available in tablets, capsules or by injection and has a proven history of success in manic patients. However, it is not appropriate for children younger than 8 years old and can take up to two weeks to achieve full effectiveness. In addition, it must be taken multiple times each day in order to maintain proper blood levels which are monitored by regular blood tests. Side effects include increased thirst, weight gain, fatigue, tremors and confusion (Corcoran & Walsh, pp.391-2). Newer drugs can achieve mood stabilization in as few as 5 days and include valproate, carbamazepine and lamotrigine. Valproate was recently approved by the FDA as an antimanic drug and side effects include nausea, tiredness, weight gain and tremors. Carbamazepine is most effective in non-rapid cycling patients and side effects include dizziness, tiredness, constipation and nausea. Lamotrigine is not effective for mania, but has demonstrated success in treating bipolar depression. In addition, antidepressants are beginning to be explored as options for treating bipolar disorder. Venlafaxine and buproprion have been helpful for bipolar II patients, but are not used to treat bipolar I because they can trigger manic symptoms. Bipolar patients face a unique array of stigmas as the result of their unpredictable and socially unacceptable behaviors. They may lose jobs, alienate friends, sent their family into debt or engage in dangerous behaviors such as erratic driving or risky sexual encounters. Those suffering episodes of major depression may neglect their daily activities, find themselves unable to get out of bed, and lack the energy to perform even the most basic task. Family members constantly have to be vigilant for behavior changes, put up with unpredictable outbursts, explain their loved ones’ behavior to friends and other family members, and often find themselves acting more like a caregiver than a spouse. It is easy to understand how the patient’s spouse and others close to him or her get tired of playing this role. Situational and environmental stressors have been proven to affect mood disorders, so it is important to involve the family in psychotherapy sessions. Education about the disorder, conflict management skills and problem solving can decrease the amount of stress felt at home. Psychotherapy, a support system outside the therapist’s office, and adherence to pharmacological treatment can lead to a much more normal life for the bipolar patient. References Corcoran, J & Walsh, J. (2006). Clinical Assessment and Diagnosis in Social Work Practice. New York: Oxford University Press. Johnson, S. & Leahy, R. (2004). Psychological Treatment of Bipolar Disorder. New York: Guilford Press. Kaut, K. & Dickinson, J. (2007). The Mental Health Practitioner and Psychopharmacology. Journal of Mental Health Counseling, 29, 3, 204-225. http://www.webmd.com/bipolar-disorder/cyclothymia-cyclothymic-disorder Accessed 1 December, 2009. http://www.webmd.com/bipolar-disorder/guide/understanding-bipolar-disorder-symptoms Accessed 1 December, 2009. Read More