Bipolar Affective Disorder

The phenomenon of Bipolar Affective Disorder has been a mystery since
the 16th and 17th century. The Dutch painter Vincent Van Gogh was thought to of
suffered from bipolar disorder. It appears that there are an abundance of
people with the disorder yet, no true causes or cures for the disorder. Clearly
the Bipolar disorder severely undermines their ability to obtain and sustain
social and occupational success. However, the journey for the causes and cures
for the Bipolar disorder must continue.

Affective disorders are primarily characterized by depressed mood,
elevated mood or (mania), or alternations of depressed and elevated moods. The
classical term is manic-depressive illness, a newer term is Bipolar disorder.
The two are interchangeable. Milder forms of a depressive syndrome are called
dysthymic disorder, mild forms of mania are hypomania and the milder expressions
of Bipolar disorder are called cyclothymic disorders. The use of the term
primary affective disorder refers to the individuals who had no previous
psychiatric disorders or else only episodes of mania or depression. Secondary
affective disorder refers to patients with preexisting psychiatric illness other
than depression or mania (Goodwin, Guze. 1989, p.7 ).

Bipolar affective disorder affects approximately one percent or three
million persons in the United States, afflicting both males and females.
Bipolar disorder involves episodes of mania and depression. 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 ). 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. Mood is
either elated, expansive, or irritable, hyperactivity, pressure of speech,
flight of ideas, inflated self esteem, decreased need for sleep, distractibility,
and excessive involvement in activities with high potential for painful
consequences. 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 in a psychotic state are misdiagnosed as schizophrenic.
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 begins with hypomania, which patients report
that they are energetic, extroverted and assertive. The hypomania state has let
observers to feel that bipolar patients are "addicted" to their mania.
Hypomania progresses into mania as the transition is marked by loss of judgment.
Often, euphoric grandiose characters are recognized as well as a paranoid or
irritable character begins to manifest. The third stage of mania is evident
when the patient experiences delusions with often paranoid themes. Speech is
generally rapid and behavior manifests with hyperactivity and sometimes

When both manic and depressive symptoms occur at the same time it is
called a mixed episode. These people are a special risk because of the
combination of hopelessness, agitation and anxiety make 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 very
dysphoric, depressed and unhappy yet exhibit the energy associated with mania.
Rapid cycling mania is yet 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 experiences
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
characteristic of bipolar disorder. In four controlled studies by F. K. Goodwin
and K. R. Jamison, the overall response rate for bipolar subjects treated with
Lithium was 78% (1990).