Bipolar Disorder

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“Bipolar disorder is a severe biologic illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal (Oztalay, 2011). The following is a short synopsis according to the DSM-IV-TR, “Criteria for Bipolar Disorder” includes a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least:- 4 days for hypomania- week for mania (DSM-IV-TR, 2000). During the period of mood disturbance, at least three or more of the following symptoms have persisted and have been present to a significant degree:- Inflated self-esteem or grandiosity- Decreased need for sleep- More talkative than usual or pressure to keep talking- Excessive involvement in pleasurable activities that have a high potential for painful consequences (Oztalay, 2011). Psychodynamics of the Disease The onset of the disease usually occurs during late adolescence or in the mid twenties. However, the disease has been known to occur up into the fifth decade of life. The mood swings that accompany this disorder are of several types. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep, Impairment in normal social functioning usually requiring hospitalization; Hypomanic Episode, evidenced by a milder form of the Pure Mania, without the loss of normal functioning that would require hospitalization; Major Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death; the last episode associated with Bipolar disorders is the Mixed Episode in which, patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts them at significant risk of suicide (Lehne, 2002).

The sixth leading cause of disability in the world, BD is an episodic, chronic illness affecting approximately 5.7 million adult Americans. BD occurs in all races, ethnic groups, and social classes. Although it affects males and females equally, males tend to have an earlier onset. BD reduces life expectancy by 9.2 years, with up to 33% of sufferers attempting suicide and 15% completing it (NLM, 2012). Etiology

Research shows that in persons with BD, neuropathologic changes occur in the amygdala, a structure deep within the brain’s temporal lobes that plays a key role in memory and processing of emotions. Studies also reveal abnormal levels of the neurotransmitters norepinephrine, serotonin, dopamine, glutamate, and gamma-aminobutyric acid (GABA) in this area. Norepinephrine plays a role in mood regulation, arousal, and memory; dopamine acts as the brain’s natural reward system. Serotonin is involved in mood regulation, anxiety, pain perception, appetite, sleep, sexual behavior, and impulsive behavior. Glutamate is the primary excitatory neurotransmitter; GABA, the primary inhibitory transmitter. Evidence suggests that levels of norepinephrine, serotonin, and dopamine are decreased in people with depression. Increasing GABA levels and decreasing glutamate levels can improve or stabilize mood (Lehne, 2002). Research with twins suggests BD is inheritable: When one twin has BD, the other is at high risk for developing it. Also, more than 66% of people with BD have a first-degree relative who suffers from BD or a major depressive disorder (Lehne, 2002) Hypomanic Episodes

A hypomanic episode is an abnormally elevated, expansive, or irritable mood lasting at least 4 days that doesn’t severely impair the ability to function. It’s marked by three or more of the features listed above for manic episodes. During this time, the person may appear extremely happy and believe he or she is functioning well, with high productivity and creativity. No psychotic features are present and...
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