Bipolar Disorder – Part 3

What causes bipolar disorder – We have not yet discovered a single cause of bipolar disorder although there may be several potential factors, including, genetics, stress, organic brain disorder, etc. Could there be a possible sleep and metabolic overlay?

BIPOLAR DISORDER – CAUSES, DIAGNOSIS AND UNDERSTANDING

Genetics. The chances of developing bipolar disorder are increased if a child’s parents or siblings have the disorder. But the role of genetics is not absolute: A child from a family with a history of bipolar disorder may never develop the disorder. Studies of identical twins have found that, even if one twin develops the disorder, the other may not.

Stress. A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person’s handling of stress may also play a role in the development of the illness.

Brain structure and function. Brain scans cannot diagnose bipolar disorder, yet researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder.

THE DIAGNOSIS OF BIPOLAR DISORDER

To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview and order lab tests.

While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism.

If no other illnesses (or medicines such as steroids) are causing the symptoms, the doctor may recommend mental health care.

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Mental health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the “type” of bipolar disorder a person may be experiencing.

To determine what type of bipolar disorder a person has, mental health care professionals assess the pattern of symptoms and how impaired the person is during their most severe episodes.

A study performed in 2000, reviewed the first completed surveys – Over one-third sought professional help within 1 yr of the onset of symptoms yet 69% were misdiagnosed, most frequently as unipolar depression.

THE FOUR TYPES OF BIPOLAR DISORDER

Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person’s manic episodes must last at least seven days or be so severe that hospitalization is required.

Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a “full” manic episode.

Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.

Bipolar Disorder, “other specified” and “unspecified” is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.

THE TREATMENT OR MANAGEMENT OF BIPOLAR DISORDER

Bipolar disorder is treated/ managed in several ways:

PSYCHOTHERAPY IN THE TREATMENT OF BIPOLAR DISORDER.

Psychotherapy such as cognitive behavioural therapy and family-focused therapy can be useful. Generally the sufferer will have both poor coping skills in life and various damaging coping skills acquired along the way. Treatment can take years.

MEDICATIONS IN THE TREATMENT OF BIPOLAR DISORDER

Medications, such as mood stabilizers, antipsychotic medications and, to a lesser extent, antidepressants. Antidepressants should be used with extreme care as they may worsen the manic periods. It is a careful balancing act over many months.

SELF-MANAGEMENT STRATEGIES IN THE MANAGEMENT OF BIPOLAR DISORDER

Self-management strategies, like education and recognition of an episode’s early symptoms. This is likely combined the the above.

COMPLEMENTARY HEALTH APPROACHES IN THE MANAGEMENT OF BIPOLAR DISORDER

Complementary health approaches, such as aerobic exercise meditation, faith and prayer can support, but not replace, treatment.

BIPOLAR DISORDER AND Step-BD

The largest research project to assess what treatment methods work for people with bipolar disorder is the Systematic Treatment Enhancement for Bipolar Disorder, otherwise known as Step-BD.

Step-BD followed over 4,000 people diagnosed with bipolar disorder over time with different treatments.

Awareness and diagnosis is always (must always) be the first step in caring, and management of this debilitating disorder.

POOR SLEEP AND BIPOLAR DISORDER

CLICK HERE – Sleep Disturbance in Bipolar Disorder Across the Lifespan

People with bipolar disorder may have a genetic link to sleep-wake cycle problems that can trigger symptoms of depression and mania.

Sleep loss may lead to a mood episode such as mania (elation) in some patients. Worrying about losing sleep can increase anxiety, thus worsening the bipolar mood disorder altogether. Once a sleep-deprived person with bipolar disorder goes into a manic state, they need sleep even less.

THE POOR MANAGEMENT BIPOLAR DISORDER

A study performed in 2000, reviewed the first completed surveys – Over one-third sought professional help within 1 yr of the onset of symptoms yet 69% were misdiagnosed, most frequently as unipolar depression.

Those who were misdiagnosed consulted a mean of 4 physicians prior to receiving the correct diagnosis.

Over one-third waited 10 yrs or more before receiving an accurate diagnosis.

Despite having underreported manic symptoms, more than half believe their physicians’ lack of understanding of BPD prevented a correct diagnosis from being made earlier!

In 2000, they reported a greater negative impact of BPD on families, social relationships, and employment than in 1992. 

Perceptions and impact of bipolar disorder: How far have we really come? Unfortunately few papers are available without cost on this subject (?)

PS. Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. This is perhaps hardly surprising since the body is “speed governed” by the thyroid.

Thanks to – The National Institute of Mental Health National Alliance of Mental Illness.

Each phase of this flexible, evidence-based treatment is vividly detailed, from screening, assessment, and case conceptualization through acute therapy, maintenance treatment, and periodic booster sessions

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