Bipolar Affective Disorder

The phenomenon of bipolar affective disorder has been a mystery since the
16th century. History has shown that this affliction can appear in almost
anyone. Even the great painter Vincent Van Gogh is believed to have had bipolar
disorder. It is clear that in our society many people live with bipolar
disorder; however, despite the abundance of people suffering from the it, we are
still waiting for definite explanations for the causes and cure. The one fact
of which we are painfully aware is that bipolar disorder severely undermines
its\' victims ability to obtain and maintain social and occupational success.
Because bipolar disorder has such debilitating symptoms, it is imperative that
we remain vigilant in the quest for explanations of its causes and treatment.
Affective disorders are characterized by a smorgasbord of symptoms that can
be broken into manic and depressive episodes. The depressive episodes are
characterized by intense feelings of sadness and despair that can become
feelings of hopelessness and helplessness. Some of the symptoms of a depressive
episode include anhedonia, disturbances in sleep and appetite, psycomoter
retardation, loss of energy, feelings of worthlessness, guilt, difficulty
thinking, indecision, and recurrent thoughts of death and suicide (Hollandsworth,
Jr. 1990 ). The manic episodes are characterized by elevated or irritable mood,
increased energy, decreased need for sleep, poor judgment and insight, and often
reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). Bipolar
affective disorder affects approximately one percent of the population
(approximately three million people) in the United States. It is presented by
both males and females. Bipolar disorder involves episodes of mania and
depression. These episodes may alternate with profound depressions characterized
by a pervasive sadness, almost inability to move, hopelessness, and disturbances
in appetite, sleep, in concentrations and driving.
Bipolar disorder is diagnosed if an episode of mania occurs whether
depression has been diagnosed or not (Goodwin, Guze, 1989, p 11). Most commonly,
individuals with manic episodes experience a period of depression. Symptoms
include elated, expansive, or irritable mood, hyperactivity, pressure of speech,
flight of ideas, inflated self esteem, decreased need for sleep, distractibility,
and excessive involvement in reckless activities (Hollandsworth, Jr. 1990 ).
Rarest symptoms were periods of loss of all interest and retardation or
agitation (Weisman, 1991).
As the National Depressive and Manic Depressive Association (MDMDA) has
demonstrated, bipolar disorder can create substantial developmental delays,
marital and family disruptions, occupational setbacks, and financial disasters.
This devastating disease causes disruptions of families, loss of jobs and
millions of dollars in cost to society. Many times bipolar patients report that
the depressions are longer and increase in frequency as the individual ages.
Many times bipolar states and psychotic states are misdiagnosed as schizophrenia.
Speech patterns help distinguish between the two disorders (Lish, 1994).
The onset of Bipolar disorder usually occurs between the ages of 20 and 30
years of age, with a second peak in the mid-forties for women. A typical
bipolar patient may experience eight to ten episodes in their lifetime. However,
those who have rapid cycling may experience more episodes of mania and
depression that succeed each other without a period of remission (DSM III-R).
The three stages of mania begin with hypomania, in which patients report
that they are energetic, extroverted and assertive (Hirschfeld, 1995). The
hypomania state has led observers to feel that bipolar patients are "addicted"
to their mania. Hypomania progresses into mania and the transition is marked by
loss of judgment (Hirschfeld, 1995). Often, euphoric grandiose characteristics
are displayed, and paranoid or irritable characteristics begin to manifest. The
third stage of mania is evident when the patient experiences delusions with
often paranoid themes. Speech is generally rapid and hyperactive behavior
manifests sometimes associated with violence (Hirschfeld, 1995).
When both manic and depressive symptoms occur at the same time it is called
a mixed episode. Those afflicted are a special risk because there is a
combination of hopelessness, agitation, and anxiety that makes them feel like
they "could jump out of their skin"(Hirschfeld, 1995). Up to 50% of all
patients with mania have a mixture of depressed moods. Patients report feeling
dysphoric, depressed, and unhappy; yet, they exhibit the energy associated with
mania. Rapid cycling mania is another presentation of bipolar disorder. Mania
may be present with four or more distinct episodes within a 12 month period.
There is now evidence to suggest that sometimes rapid cycling may be a transient
manifestation of the bipolar disorder. This form of the disease exhibits more
episodes of mania and depression than bipolar.
Lithium has been the primary treatment of bipolar disorder since its
introduction in the 1960\'s. It is main function is to stabilize the cycling