12/18/2018

Bipolar disorder – the killer within

By Live Dr - Fri Apr 06, 1:41 pm

A  mental illness or manic depression that is characterised between mood swings and depression.

This disease was formally conceptualized by Emil Kraeplin more than 100 years ago, at which time he described it as manic-depressive insanity. However, mood problems that include depression alternating with symptoms that are now understood to be manic have been referenced in history as long ago as 200 A.D. At that time, this illness, like unipolar depression, was thought to be the result of bad blood, called black bile. In the 19th century, this illness was referred to by terms like biphasic illness, circular insanity, and dual-form insanity. Despite such unfortunate terminology for this disease, bipolar disorder is also known to be associated with achievement in some individuals. Many historical figures and current luminaries suffer from this disorder, whose creativity and accomplishments can therefore be an inspiration for current sufferers of bipolar disorder.

Individuals with maniac episodes also experience depressive episodes or a
mixed state in which both the features of mania and depression occurs at the same time.
This event is usually separated by normal moods, but in some individuals it may occur
alternatively and this is known as “RAPID CYCLING”.

Types of Bipolar Disorder:
There are 3 types of bipolar disorder. They may be classified as,
I) Bipolar disorder type 1:
Characterized by 1 are more episodes and periods of depression. In the past it
was called as “manic depression”.
II) Bipolar disorder type 2:
People with this type never had full mania, instead they experience periods
of high energy levels and impulsiveness that are not as extreme as mania (hypomania)
which alternates with periods of depression.
III) Cyclothymia:
This is the mild form of Bipolar Disorder. It involves less severe mood
swings. It is often wrongly diagnosed as Depression.

CAUSES OF BIPOLAR DISORDER:

Genetic:
A review seeking to identify the more consistent finding suggested that
several genes related to serotonin, dopamine, glutamate and cell growth/maintenance
pathway are defective. Advanced paternal age has increased chance in offspring
consistency with hypothesis of increased new genetic mutations.

Physiological:
Abnormalities in the structure or function of certain brain circuits could
underlie the Bipolar Disorder. Two meta-analyses of MRI studies in Bipolar Disorder
show an increase in volume of Lateral Ventricles, Globus Pallidus.
Also there is evidence of Hypothalamic-Pituitary Adrenal axis (HPA axis)
abnormality in Bipolar Disorder due to stress. Other factors are Mitochondria and a
Sodium-ATPase pump causing cyclical periods of poor neuron firing (Depression)
Circadian rhythms and melatonin activity also altered.

The full causes of bipolar disorder have yet to be discovered, but there is strong
evidence that one root lies in problem with brain structure.

Environmental:
This plays a very important role. Recent life events and interpersonal
relationships contribute a lot to this disorder.
Stress:
Stressful life events can trigger bipolar disorder in someone with a genetic
vulnerability. These events can tend to involve drastic or sudden changes either good or
bad such as going away to college, losing a loved one, getting fired etc.

Substance Abuse:
While substance abuse doesn’t cause bipolar disorder, it can bring on
an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy and
amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
Medication:
Certain medications most notably antidepressant drugs can trigger mania.
Other drugs that can cause mania include over-the-counter cold medicine, appetite
suppressants, caffeine, corticosteroids and thyroid medication.
Seasonal Changes:
Episodes of mania and depression often follow a seasonal pattern. Maniac
episodes are common during the summer and depressive episodes more common during
the fall, winter and spring.
Sleep Deprivation;
Loss of sleep even as skipping a few hours of rest can trigger an episode of
mania.

BASICS OF BIPOLAR DISORDER TREATMENT:
Bipolar disorder requires long-term treatment:
Since bipolar disorder is a chronic, relapsing illness, it’s important to continue
treatment even when they are feeling better. Most people with bipolar disorder need
medication to prevent new episodes and stay-symptom-free.
There is more to treatment than to medication.
Medication alone is not enough to fully control the symptoms of bipolar
disorder. The most effective treatment strategy for bipolar disorder involves a
combination of medication, therapy, lifestyle changes and social support.
It’s better to work with an experienced psychiatrist:
Bipolar disorder is a complex condition. Diagnosis can be tricky and treatment
is often difficult. For safety reasons, medication could be closely monitored.
TREATMENT FOR BIPOLAR DISORDER:
Mood stabilizers:
Lithium salts:
It is the first line of choice and most effective among the mood stabilizers.
Lithium carbonate and Lithium citrate are the lithium salts used. They are
noted for reducing the risk of suicide. It has its own side effects like hypertension, water
retention, constipation, hand trembling and intolerance to hot weather. BENZTROPINE
is used to control trembling but itself causes sedation.
Atypical Antipsychotic drugs:
Newer antipsychotic drugs such as risperidone, quetiapine and olanzapine used
in acutely maniac patients because of its action on psychomotor inhibition which may be
life saving in case of a violent or psychotic patients.
Side effects include weight gain, diabetes and in larger doses over long periods
may sometime create “tardive dyskinesia” though with much lesser probability with
typical antipsychotics such as Thorazine, stelazine or haloperidol.

Antidepressants:
They are typically administered with mood stabilizer rather than as primary
treatment for bipolar disorder. Antidepressants include serotonin reuptake inhibitors
(SSRIs).
But these pose a high risk of hypomania or mania, sometimes in individuals
with no prior history of mania.
Anticonvulsants are used in combinations with lithium salts and antipsychotic drugs.

Bipolar disorder requires long-term treatment:
Since bipolar disorder is a chronic, relapsing illness, it’s important to
continue treatment even when they are feeling better. Most people with bipolar
disorder need medication to prevent new episodes and stay-symptom-free.
There is more to treatment than to medication.
Medication alone is not enough to fully control the symptoms of bipolar
disorder. The most effective treatment strategy for bipolar disorder involves
a combination of medication, therapy, lifestyle changes and social support.
It’s better to work with an experienced psychiatrist:
Bipolar disorder is a complex condition. Diagnosis can be tricky and treatment
is often difficult. For safety reasons, medication could be closely monitored.

Credits:Dr.Krty

 

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