Bipolar_Disease_Hca_240

Bipolar Disease Bipolar disorder is a manic-depressive illness; it is a brain disorder that, according to the National Institute of Mental Health (2009), “causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks” (para. 1). Symptoms of bipolar disorder are more severe than typical up and down emotional states experienced by most persons. The symptoms of bipolar disorder are difficult to distinguish from typical behavior at the onset of the disease. Many people go undiagnosed and untreated for years. Once diagnosed, bipolar disorder requires long-term goals to manage. These goals must involve family and friends to be effective. The brain systems receiving the greatest clinical attention in bipolar disorder studies are the serotonergic, noradrenergic, and dopaminergic transmitter systems. Distributed throughout the brain, these systems support the behavioral and visceral demonstrations of mood disorders. Miller (2006) stated, “Despite evidence showing that many of these circuits are likely to be involved, no obvious degeneration or complete dysfunction of any single neurotransmitter system has been identified. In this regard, the biological underpinnings of bipolar disorder appear to differ from classic neurodegenerative disorders such as Parkinson disease and Alzheimer disease, where clear deficits can be traced to the dopaminergic and cholinergic pathways, respectively” (para. 5). The article states that bipolar disorder may represent a disorder of altered synapses and circuits instead of an imbalance in transmitters. Symptoms Manic and depressive episodes are intense emotional states occurring in people with bipolar disorder. A manic state is characterized by overexcited or overly elated emotions and a depressive episode has extreme sadness or hopelessness. Extreme alterations in energy, activity, sleep, and behavior are included as changes in mood. Mania or Manic Episodes Mood changes of a manic or mania episode include an extended period of feeling overly happy or “high”, extreme irritability, and agitation. Behavioral changes may include rapid speech, restlessness, shortened attention span, insomnia, and impulsive behavior. The patient may experience racing thoughts. The person may exhibit an unrealistic belief in their own abilities and suddenly take on new and unrealistic projects. Impulsive behaviors may result in over spending, increased sexual activity, and investments. Depressive Episodes Mood changes include long periods of worry or emptiness and loss of normally enjoyed activities. The behavioral changes include feeling tired, poor concentration, problems remembering, and making decisions. The patient may experience restlessness, irritability, and change in sleeping and eating habits. The person may be considering death or attempting suicide (National Institute of Mental Health, 2009). Range of Moods Bipolar Disorder can cause a change of range moods. In Figure 1 below, the middle of the scale indicates a normal or balanced mood. On the left side, moods include depression that has three levels: severe depression, moderate depression, and mild low depression called dysthymia in a long-term state. On the right side of the scale are hypomania and severe mania. People who experience episodes of hypomania have higher energy and activity levels than typical mania. People with hypomania believe nothing is wrong, even when family and friends recognize the mood swings as possible bipolar disorder. Hypomania may develop into severe mania or depression (National Institute of Mental Health, 2009). Figure 1: Bipolar Disorder Range Moods A person with severe episodes of mania or depression may also experience psychotic symptoms that include hallucinations or delusions. A person may have a heightened belief of being famous and having a great deal of money and power. The opposite occurs when a person is in a depressive state. The person may believe he or she is ruined, broke, or has committed a crime. People exhibiting these psychotic symptoms can be mistakenly diagnosed with schizophrenia (National Institute of Mental Health, 2009). Diagnosing When diagnosing bipolar disorder, a medical physician may conduct a physical examination, an interview, and lab tests. Lab tests are necessary to rule out physical factors such as stroke or brain tumor. If the person’s symptoms are not physical, the physician will conduct a mental health evaluation. After the evaluation, the physician will refer the patient to a mental health professional, such as a psychiatrist, who can diagnose and treat bipolar disorder (National Institute of Mental Health, 2009). Gender is a factor in the frequency of manic and depressive episodes. For men, the first episode is more likely manic. For women, depression is usually the first episode. Women who have bipolar disorder are vulnerable after childbirth during the postpartum time. Sajatovic (2004) stated, “Mean age of onset of bipolar disorder is 21 years; however, there is frequently a 5- to 10-year interval between age of onset of illness and age at first treatment or first hospitalization. Bipolar disorder may occur in children and adolescents as well as may occur for the first time in adults over the age of 60. Bipolar disorder is generally a chronic illness, with multiple occurrences of mood episodes. More than 90% of individuals who have a single manic episode go on to have future episodes. Studies on the course of bipolar illness prior to the common use of treatment for the disorder suggest that an average of 4 episodes will occur over a 10-year period, and individuals with untreated bipolar disorder may have more than 10 episodes of abnormal mood states (highs or lows) during their lifetime. The duration of episodes and duration of between-episode periods frequently stabilize after the fourth or fifth episode” (para. 4). Treatment Bipolar disorder has no cure. However, with proper treatment, people can control mood swings and related symptoms. A maintenance treatment plan includes medication and psychotherapy for preventing relapses and reducing severity of symptoms. Mood stabilizers are usually the first choice in treating bipolar disorder. Using anticonvulsants, an anti-seizure medication, is also effective in treating moods. Prescribing antidepressants helps with moods and depression (National Institute of Mental Health, 2009). Lithium was the first medication approved by the Food and Drug Administration (FDA) in the 1970s for treatment of mania. Lithium is proven effective in controlling mania and preventing recurrence. Valproic acid or divalpoex sodium was approved by the FDA in 1995 in treating mania; this medication is an alternative to lithium (National Institute of Mental Health, 2009). Psychotherapy is effective and provides support, education, and guidance for people with bipolar disorder. Psychotherapy treatments include: • Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors. • Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem solving. • Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. • Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers (National Institute of Mental Health, 2009). Myths A few myths associated with bipolar disorder exist. One myth is that the onset of the disease happens late in life. In reality, bipolar disorder occurs in early adulthood. Another myth is that antidepressants are the common treatment. Prescribing antidepressants is only effective for the treatment of depression. Treatment for bipolar disorder is lithium. One last myth is that treatment is only necessary during acute, severe episodes of depression or mania. The fact is treatment is vital as a daily maintenance treatment program (Munson, 2004). Conclusion A person with bipolar disorder needs to have a positive and supportive environment. Family members and friends need to remember that treatment will help, and they should be supportive and understanding. Because there is no cure for bipolar disorder, part of treatment will include taking the approved medication lithium. In addition, recommended cognitive therapy, family therapy, and interpersonal therapy will help the patient. If patients have a good support system and a positive environment, it will ultimately help ensure treatment for the bipolar disorder patient. Reference Miller, K. (2006). Bipolar disorder: etiology, diagnosis, and management. Journal of the American Academy of Nurse Practitioners, 18(8), 368-373. Retrieved from CINAHL Plus with Full Text database. Munson, B. (2004). Myths and facts...about bipolar disorder. Nursing, 34(1), 31. Retrieved from MEDLINE with Full Text database. National Institute of Mental Health. (2009). Bipolar Disorder. Retrieved from http://www.nimh.nih.gov/health/publications/bipolar-disorder/completeindex.shtml#pub3 Sajatovic, M. (2004). Bipolar. Encyclopedia of Women’s Health. Retrieved from XRefer XML database.