Bipolar disorder is one of the less understood and well-researched mental illnesses humans can suffer from. The condition was previously known as manic depression and it is estimated that 3 to 5% of the population suffer from it worldwide. The disorder is mostly categorized by sudden variations in the mood of an individual. These changes, or mood swings, are periods when a person’s behavior and attitude shift drastically, resulting in either bursts of energy or depressive states.
Both fits of energy and depression are called episodes and take a considerable amount of time to subside. Other symptoms can include the loss of appetite and sleep, feelings of restlessness or tiredness, and other extreme physical reactions. The swings are mostly not under the person’s control and can bring difficulty into their day-to-day life and interactions with other people. While a person is also able to feel other emotions, the two states exhibit a much stronger emotional influence than other states of mind. Like many other neurological conditions, bipolar disorder is incurable, with medication and therapy existing to alleviate or mitigate its symptoms instead.
A considerable amount of research has been done into the topic, with doctors and scientists finding better, more effective ways of addressing the issue, but much more still needs to be accomplished. In this paper, a full look at the disorder will be attempted, to form a nuanced and informed understanding of how the condition manifests, functions, and emerges in an individual. A deeper look into the probable causes will be made, as well as the risk factors, pathology, options for treatment, and diagnosis tools.
The exact cause of the disorder remains unknown, but doctors and physicians have made a number of attempts to pinpoint the exact factors, both biological and genetic. It is generally believed that a person’s genetics have a high degree of influence on the likelihood of bipolar disorder, ranging from 70 to 90 percent (Gordovez & McMahon, 2020). While the environment is an exacerbating factor in many cases, clear correlations between parents and their children were only observed with biological relatives. This means that if a person’s family has a history of suffering from this mental illness, they are more likely than average to suffer from it too.
Research has shown that the chance of a first-degree relative passing the condition on to the offspring is around 10-15% (Gordovez & McMahon, 2020). A clear pattern of transmission, however, could not be established, meaning that the scientists are unable to understand the exact way the disorder is transferred. Some of the potential biological pathways for the disorder’s progression are “dopaminergic system, inflammatory cytokines, oxidative and nitrosative stress, mitochondrial dysfunction and endoplasmic reticulum stress, alterations cAMP response element-binding protein (CREB)”, among other things (Sigitova et al., 2017). Another major point of consideration for the spread and causes of BPD is assortative mating. It is generally understood that humans find partners with specific phenotypes in relation to their own.
Correlations and specific patterns can be derived from investigating how individuals find their mates, and the issue is highly relevant in the field of Bipolar disorder research. Authors of the paper “The Genetics of Bipolar Disorder” have found research indicating that individuals with BPD often find each other and produce offspring (Gordovez & McMahon, 2020).
The tendency to find people with a matching phenotype can have a significant influence on the development and occurrence of BPD, as such instances are suspected to “lead to accumulation of risk alleles in subsequent generations”, meaning that the likelihood and severity of the disorder can be increased exponentially (Gordovez & McMahon, 2020). It can be concluded that while the exact reasons behind the disease’s occurrence are unknown, but it is generally believed that one’s genes play the biggest role in the process.
Associated Risk Factors
As discussed previously, both internal and external factors contribute to one’s condition and the severity of their BPD. Cases of other mental disorders such as depression, schizophrenia, or severe anxiety can also contribute to one’s experience with bipolar disorder (Leahy, 2007). The additional disorders can be seen as both the co-morbidities to BPD and a number of additional factors that contribute to a person’s chances of suffering from it. There are a variety of events and circumstances that further exacerbate a person’s condition and make managing BPD harder. In many cases, instances of bipolar disorder can be triggered by a high amount of stress or unstable living environments. Periods of stressful events or constant exposure to stress are especially dangerous, as they put a lot of stress on a person’s mental state (Miklowitz & Johnson, 2006).
Such events as life-threatening illnesses, or a loss of a loved one are likely candidates for triggering a manic or depressive episode. A person suffering from deep trauma is more likely than an average one to suffer from BPD and show more severe symptoms. Lifestyle and habits also play a big part. Drug abuse and the use of alcohol have long since been connected with instances of bipolar disorder, and present a significant risk. Research has shown that individuals with constant exposure to either drugs or other harmful substances are more likely to suffer from mood swings more frequently (Leahy, 2007). Similar to the etiology of the disease, there are no certain contributing factors towards one’s experience with BPD, and a number of variables need to be considered. Other types of mental illnesses, genetics, and lifestyle choices all combine to a varying degree in each individual.
The pathology of Bipolar Disorder is closely connected with the work of a person’s brain, and some of its specific areas. Particularly, regions of the brain associated with strong emotions are implicated. An elevated response to stimuli from the amygdala region is observed, stemming from both positive and negative emotions (Miklowitz & Johnson, 2006). Studies observing the activity of the region have shown that it displays hyperactive tendencies in people with bipolar disorder. In other areas of the brain, including the hippocampus and the prefrontal cortex activity is diminished, however (Miklowitz & Johnson, 2006).
The aforementioned areas also display a difference in size, with the amygdala being larger than average and “prefrontal cortex, basal ganglia, hippocampus, and anterior cingulate” being slightly smaller than average (Miklowitz & Johnson, 2006). The difference in size could effectively account for a person’s elevated emotional response and an inability to properly control their emotional state. Researchers state: “amygdala might contribute to emotional sensitivity, whereas the diminished activity of the cortical regions might interfere with effective planning and goal pursuit” (Miklowitz & Johnson, 2006).
Available information suggests that persons with bipolar disorder are unable to properly respond to emotional stimuli with their brains either reacting overly excited or not excited enough. The main theory of the condition’s effect then states that people suffering from BPD experience a dysregulation in brain functionality during their episodes of mania and depression (Miklowitz & Johnson, 2006). The negative response to stimuli is diminished in a manic episode, while the response to positive stimuli is reduced in a depressive state.
As with many other psychological conditions, a variety of different treatment methods exist to meet the needs of the people. Medication is one of the more obvious choices in regulating bipolar disorder, but it is far from the most effective and universal approach to the issue. Various lifestyle changes and types of therapy also can effectively address the bigger challenges and hardships associated with the condition. Starting with the pharmacological approach, it is important to note that the alternating states of the disorder need to be addressed with different medications and require their particular sets of precautions and procedures.
Acute cases of mania presuppose the need for hospitalization or immediate medical attention as a person may not be fully in control of their actions and their body. Those exhibiting tendencies of hyperactive or impulsive behavior may need to be put in a medical facility by law enforcement or other methods. Historically, lithium salts were used as the main method of combating mania, often combined with sedatives and other kinds of antipsychotic drugs (Baldessarini et al., 2018).
Nowadays, second-generation antipsychotics are most widely used, with particular brands such as asenapine, aripiprazole cariprazine, and olanzapine being the most widely recognized (Baldessarini et al., 2018). Drugs needed to specifically address a particular patient’s condition such as anti-convulsion medication are also used in accordance with the dosage and proper procedure.
Depressive episodes, while not as violently dangerous as manic ones, also present great difficulty, mostly due to their duration and to the harm they present to a person’s mental state and well-being. Occurring more than twice as likely as manic episodes, depressive states often lead to cases of suicide and self-destructive behaviors (Baldessarini et al., 2018). Bipolar depression often eludes treatment and can leave a significant burden on the person, both medically, financially, and emotionally. Despite its prevalence, a handful of treatment options have proven to be effective and a sufficient solution is yet to be found (Baldessarini et al., 2018).
It is to be noted that the use of anti-depressants, in this case, is highly contested and the current data highlights that they are in large part ineffective or only partially effective. However, due to their high availability. and relative safety the use of anti-depressants has been a staple of addressing depressive episodes for bipolar disorder (Baldessarini et al., 2018). The research on their apparent effectiveness is few and far in between, with results ranging from it being ineffective to the opposite conclusion.
While the full scale of effectiveness of antidepressants cannot be currently stated, they can be effective in some cases of bipolar depression, reducing the symptoms by at least 30% (Baldessarini et al., 2018). Due to the lack of current relevant research into the medical implications of treating bipolar disorder with medicine, it is hard to state that the pharmacological approach is the best one.
Nonmedical approaches are also relevant to treating bipolar disorder and can be used to alleviate the severity of symptoms and help individuals live happier and more fulfilling lives. A technique under the name cognitive remediation also used for treating schizophrenia is one of these suggested options of treatment (Gitlin & Miklowitz, 2017). A review of relevant literature has suggested that the technique is somewhat effective in leading to positive outcomes in bipolar patients (Gitlin & Miklowitz, 2017).
Its main focus falls on developing relevant cognitive skills, such as problem-solving, memory, decision-making skills, and flexibility. A wide combination of skills allows individuals to have better control of their emotional states and contributes to a better array of outcomes in cases of bipolar disorder. Similar techniques, such as psychological therapy and functional remediation have also been tested and shown beneficial effects (Gitlin & Miklowitz, 2017).
Combining education and training leads to better preparedness and efficacy in managing one’s mental state and cognition. A combination of treatments is most effective in addressing the problems of the person’s environment, their reactions, and their level of awareness to make sure that they have the best ability to combat the bipolar disorder. While no studies currently exist to back this up, some researchers also suggest that treatment of comorbidities in BPD patients can lead to better outcomes and better functioning (Gitlin & Miklowitz, 2017). Cognitive therapy and other types of emotional support and education can have a large impact on how the person addresses their condition and works to combat it.
Techniques Used in Diagnosis, Care and Research
As bipolar disorder primarily affects a person’s mental and emotional state, there is a variety of methods to effectively diagnose it and create a system of care for an individual. Physical examination and various lab tests are often necessary to determine whether a person suffers from BPD. If a person is suspected for bipolar disorder, they are referred to a psychiatrist and thoroughly tested, using both direct communications and various tests to get a clearer picture of one’s character.
Further questioning of one’s family and relatives may also be required, as they can see the issue from another perspective and offer a fuller look at a person’s actions and behaviors. Other types of data gathering are also used, such as mood charting and observations over a prolonged period of time. The full mental health evaluation is complicated, as BPD can be characterized by a similar array of symptoms to other conditions, such as anxiety, depression, schizophrenia, and others. An inability to accurately pinpoint the cause of the disorder also muddles the diagnosis, as doctors cannot know for sure what deviancies to look for in the analyses they receive.
Records of elevated amygdala function or unusual size of other areas of the brain might be a sign, but it is still not a sure-fire way to diagnose the disorder. Research on the subject is done through extensive studies on BPD patients, some of them testing the effectiveness of the particular medication, others focusing on brain activity and the major biologic processes behind the condition. The current research pool is limited, as the condition has often been overlooked throughout the years.
Overall, it can be said that bipolar disorder is a difficult topic to both approaches and analyze. Significant research has been done into apparent causes and reasons behind the condition, but none of them has been able to pinpoint the exact reasoning behind its occurrence. Medical professionals have found that genetic heritability is likely a major contributing factor to bipolar disorder, but the exact transmission pathways are unknown and specific genes responsible for its emergence are also under question.
Major strides have been made in understanding the biological side of the issue, with brain functionality and response to emotional stimuli being recognized as the core reasons for extreme swings of emotion and prolonged states of either mania or depression. Many specialists note that both the genetic and environmental factors contribute to the instances of bipolar disorder, with some of the bigger risk factors coming from one’s environment and lifestyle.
Harmful habits such as drug use and substance abuse have been linked with more rapid mood swings as well as prolonged periods of mania and depression. Other types of harmful influences, such as stress or trauma, have also been connected with bipolar disorder, serving as major catalysts for entering a particular episode. Treatment options are varied, with medication and therapy being the most prevalent options.
Medication differs depending on this state of the individual and includes antipsychotic medication for cases of mania and anti-depressants for cases of depression. Limited research also suggests that various types of cognitive therapy and behavioral adjustments contribute to better outcomes in patients. While research into the subject of bipolar disorder has been steadily increasing over the years the need for better studies on the effects of medication and treatment is apparent, especially in cases of bipolar depression. Medical professionals and scientists have to recognize the growing need for addressing the problem quickly and effectively. This paper has succeeded in an attempt to form a better understanding of the subject and provide an overview of the major topics concerning the bipolar disorder.
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Leahy, R. L. (2007). Bipolar disorder: Causes, contexts, and treatments. Journal of Clinical Psychology, 63(5), 417-424. Web.
Gitlin, M. J., & Miklowitz, D. J. (2017). The difficult lives of individuals with bipolar disorder: A review of functional outcomes and their implications for treatment. Journal of Affective Disorders, 209, 147-154. Web.
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2018). Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry, 24(2), 198-217. Web.
Sigitova, E., Fišar, Z., Hroudová, J., Cikánková, T., & Raboch, J. (2017). Biological hypotheses and biomarkers of bipolar disorder. Psychiatry and Clinical Neurosciences, 71(2), 77-103. Web.
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