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 definate explanations for the causes and cure. The one fact
of which we are pianfully aware4 is that bipolar disorder severely undermines
its\' victoms ability to obtain and maintain social and occupational success.
Because bipolar disorder has such debilitating symptoms, it is imperitive that
we remain vigilent 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 guilt and worthlessness, guilt,
difficulty thinking, indecision, and recurrent thoughts of death and suicide.
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 (approximatly 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. 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 states and psychotic states are misdiagnosed as schizophrenic.
Speech patterns help distinguish between the two disorders (Lish, 1994).

Prevalence and Age of Onset

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. 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.
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