OVERVIEW

Bipolar disorder formally known as maniac depression is a complicated neuropsychiatric disorder characterized by fluctuating episodes of depression and mania or hypomania. A person with a bipolar disorder often presents with unpredictable mood changes. In one moment the person could be very happy and energetic (mania) whiles in the next moment, the person could be sad and desolate. These episodes may be separated by periods where the person feels normal.

Researchers suggest that the occurrence of bipolar disorder is a lot more frequent than previously thought. According to the World Health Organization, bipolar disorder affects 60 million people in the world. People suffering from this disorder are usually misdiagnosed which is clearly responsible for the lower life expectancy, the worsening of the illness and altogether the lower quality of life.

Unfortunately, all too often people with mental illnesses are victims of unjust stigmatization. They are subjected to lack of support, discrimination and neglect. Bipolar disorder can cause immense distress to not only the patients but also to the people who care for them. With early diagnosis, the underlying symptoms of bipolar disorder can be treated and may improve the quality of health.

TYPES OF BIPOLAR DISORDER

The types of a bipolar disorder include,

1. Bipolar I disorder

This is characterized by a period of depression of about 2 weeks followed by one maniac episode of one week but if not well managed can last for about 3-6 months. The period of maniac episodes might require hospitalization with symptoms of psychosis and impairment of function. A depressive episode is often not necessarily needed to make a diagnosis but some cases do present with mania and depression occurring together in practice termed “Mixed episodes” as the condition progresses.

2. Bipolar II disorder

This presents with similar periods of depressive episode seen in bipolar 1 followed with milder forms of mania symptoms called hypomania lasting for at least 4 days. Hypomania is a milder form of mania with no severe symptoms of psychosis or functional impairment. Bipolar II disorder may be difficult to set apart from unipolar depressive episodes. This is because the depressive episodes are longer than the hypomanic episode.

3. Cyclothymia disorder (bipolar III disorder)

Relative to the above two, cyclothymia disorder is a moderate form of bipolar disorder. It presents with alternating episodes between mild depression and hypomania for at least 2 years. These episodes may be separated by normal moods that do not last for more than 2 months. Symptoms of this condition do not meet the criteria of mania, hypomania and major depression.

4. Bipolar IV disorder

In this case, the episodes are triggers by certain medications (antidepressants), alcohol and specific medical conditions such as stroke, Cushing’s disease or multiple sclerosis.

5. Bipolar V disorder

A person in this case only presents with major depression despite the family history of bipolar disorder.

Symptoms Of Bipolar Disorder

The symptoms of bipolar disorder are usually associated with episodes of the various types of this disorder.

Manic episodes

A person experiencing a manic episode often presents with the following symptoms;

  • Euphoria
  • Chattiness
  • A feeling of self-confidence
  • Hyperactivity
  • A declined need for sleep
  • Irritability
  • Strong sex drive
  • A desire to engage in activities

Hypomanic episodes

Hypomania is a rather mild form of mania. It is usually the initial stage of a manic episode. A person experiencing hypomania may present with these symptoms;

  • A feeling of happiness
  • High energy
  • Less sleep
  • The need to contend with others

Depressive episode

The symptoms of bipolar depressive episodes are similar to unipolar clinical depression. Most often, people with bipolar disorder are misdiagnosed with clinical depression. The symptoms include;

  • Irritable mood
  • Loss of energy
  • Inability to sleep
  • The feeling of worthlessness
  • Loss of interest in almost all activities
  • Sadness
  • Thoughts of suicide

Symptoms in children and teenagers are hard to determine. It is often confused by parents and sometimes doctors as a normal emotional upheaval.

Causes Of A Bipolar Disorder

Even though there is no well-established mechanism as to how a bipolar disorder comes about, a number of genetic and environmental factors have been linked to it.

Genetic susceptibility:

This accounts for 60-85% of all cases. Offsprings and siblings of persons with a bipolar disorder their family are at significant risk and tendency to get a bipolar disorder in the future.

Substance abuse:

The misuse of substances like narcotics, alcohol, etc can trigger a bipolar disorder episode.

Stressful events:

Traumatic occurrence such as the loss of a loved, a medical condition, etc may also instigate a bipolar disorder.

Chemical imbalance in the brain:

The level of imbalance in one or more neurotransmitters in the brain puts one at risk of developing a bipolar disorder. A person experiencing a manic episode is said to have a very high level of serotonin whiles in depressive episodes, a person is said to have very low serotonin, dopamine or noradrenaline levels.

Also, the left side of the amygdala of a person with bipolar disorder appears less active and connected to the other parts of the brain during the depressive episode. This is a distinctive factor between bipolar depression and unipolar depression (clinical depression).

Complications Of Bipolar Disorder

Bipolar disorder if left untreated for a long time can be life-threatening and can cause considerable mortality and morbidity. Patients often experience a devastating decrease in functions which may also alter their life.

  • Heart diseases
  • Diabetes
  • Migraines
  • Thyroid problems
  • Obesity; serves as an indicator of poorer outcomes
  • Anxiety
  • Suicide
  • Eating disorders
  • Substance abuse
  • Relationship problems
  • Occupational problems (poor work or school performance); 67% of bipolar patients are inactive.
  • Financial problems
  • Attention deficit hyperactivity disorder (ADHD)

Diagnosis of Bipolar Disorder

Bipolar disorder can be very difficult to diagnose since it usually presents with symptoms similar to other illnesses. According to research, 60% of bipolar patients are initially misdiagnosed as a major depressive disorder. Also, further studies found an average of 6 years delay between the onset and diagnosis of bipolar disorder. Bipolar disorder is usually diagnosed by the following tests to rule out other illnesses;

  • Drug tests
  • Ultrasounds
  • CAT scan
  • EEG (electroencephalogram)
  • Blood test
  • Urinalysis
  • Liver function tests
  • Complete physical examination

Getting an early diagnosis can prevent further complications and significantly improve one’s life.

Treatment For Bipolar Disorder

Once a diagnosis of bipolar disorder has been reached, treatment and management follow. Treatment is very helpful to many people including those with a much more intense form of bipolar disorder. Bipolar disorder can be treated with;

• Psychotherapy:

This aids an individual to identify disturbing emotions, thoughts, and behaviour. It is usually combined with medication for effective prognosis.

• Medication:

Different medications can be used for different people. Some people find it more difficult getting a medication that works for them. The most common medication prescribed by doctors includes mood stabilizers such as lithium salts and atypical antipsychotic drugs. Consult with your doctor for the best medication choice.

• Electroconvulsive therapy:

This is a brain stimulation that helps manage the symptoms of a bipolar disorder.

• Aerobic exercise:

Overall physical activity is important. However, aerobic exercise such as jogging, cycling, running etc reduce symptom burden, neurocognitive dysfunction and cardiovascular disease risk and improve quality of life.

Living With Bipolar Disorder

Living with bipolar can be quite challenging. However, these measures have proven to reduce the symptoms and improve overall health.

• Exercise regularly

• Take your medications as prescribed

• Talk to others about your emotional states

• Join social or support groups

• Be patient and have confidence

Key Points

  • People with bipolar disorder are at significant risk for obesity
  • According to the World Health Organization, bipolar disorder is the second cause of days not worked (unproductive workdays)
  • 60% of patients are initially misdiagnosed as major depressive disorder
  • People with bipolar disorder have a higher death rate from natural causes compared to others without it
  • People with bipolar are 2.63 times more likely to have suffered an emotional, physical or sexual abuse as children.