Bipolar Disorder Paper
Bipolar disorder refers to a complex psychiatric condition distinguished by episodes of mania (or hypomania) and major depression interspersed with periods of normal mood and functioning (Marzani & Price Neff, 2021). Bipolar disorder is commonly associated with considerable psychiatric and medical comorbidity, significant functional disability, early mortality, and impaired quality of life.
According to McIntyre et al. (2020), the lifetime prevalence of bipolar disorder is 1 to 3 %, with an average age of onset at 20 years. Additionally, males and females are equally affected, and the concordance rate of this condition in monozygotic twins is approximately 40 to 70%.
The etiology of bipolar disorder is complex and multifactorial encompassing biological factors and psychosocial factors. Triggers include physical illness, sleep disturbances, psychosocial stress, childhood traumatic experiences, and medications such as dexamethasone. The subsequent paragraphs will explore the clinical manifestation, treatment, and community resources for this condition.
Signs and Symptoms
Bipolar disorder manifests as recurring symptoms of mania/hypomania and/or depression, interspersed with asymptomatic periods. The DSM-5 vividly highlights features of depression, including depressed mood, sleep disturbances, anhedonia, recurrent suicidal ideation, fatigue, weight change not associated with appetite, psychomotor changes, diminished concentration, and feelings of guilt/worthlessness (American Psychiatric Association, 2020).
On the other hand, mania is characterized by grandiosity or elevated self-worth, increased talkativeness, decreased need for sleep, increased goal-directed activity or psychomotor agitation, distractibility, racing thoughts or flight of ideas, and excessive involvement in risky activities (American Psychiatric Association, 2020).
The critical difference between mania and hypomania is the intensity of the symptomatology. For instance, manic symptoms are more severe and often require hospitalization (Camacho et al., 2018). Similarly, hypomania does not cause significant occupational and social impairment or psychosis (Camacho et al., 2018).
Treatment of bipolar disorder is elemental. It encompasses acute treatment aimed at resolving mania and psychosis to prevent harm to the patient and others and maintenance therapy to prevent manic episodes, reduce suicide risk and improve social functioning (Marzani & Price Neff, 2021).
Mild to moderate acute mania is treated with monotherapy with lithium, valproic acid, or atypical antipsychotics such as olanzapine (Marzani & Price Neff, 2021). Severe acute mania is treated with combination therapy with a mood stabilizer such as lithium or valproic acid plus an antipsychotic such as quetiapine.
Similarly, acute depression is managed with an atypical antipsychotic plus a mood stabilizer. Maintenance therapy is principally by lithium. However, valproic acid, lamotrigine, and quetiapine can also be used. Additionally, antidepressants may be considered in patients with predominantly depressive bipolar II disorder.
Nonpharmacological treatments are fundamental in bipolar disorders. They include psychological interventions such as cognitive behavioral therapy, patient education, and electroconvulsive therapy. According to Özdel et al. (2021), cognitive behavioral therapy and patient education should form part of initial and long-term treatment as they are associated with enhanced social function, decreased need for pharmacotherapy, and reduced relapse rates. Electroconvulsive therapy should be considered in severe/refractory mania and mania in pregnancy.
Community Resources and Referral
Several community resources are available for patients with bipolar disorders, including a community pharmacy for obtaining medications and refills, a psychiatrist for consultation, a psychologist for offering psychological interventions, support groups, health education programs, and community health centers for health screening. Patients with suspected bipolar disorder should be referred to a psychiatrist for evaluation of suicide risk and initiation of treatment. Similarly, they should be referred to a psychologist for psychological interventions.
Bipolar disorder is a relatively common mood disorder that consists of episodes of mania/hypomania and depression interspersed between periods of normal functioning. Consequently, patients manifest clinically with symptoms related to depression, mania, and/or hypomania. Treatment involves initial and maintenance therapy and should incorporate both pharmacological and non-pharmacological interventions.
American Psychiatric Association. (2020). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425596
Camacho, M., Almeida, S., Moura, A. R., Fernandes, A. B., Ribeiro, G., da Silva, J. A., Barahona-Corrêa, J. B., & Oliveira-Maia, A. J. (2018). Hypomania symptoms across psychiatric disorders: Screening use of the hypomania check-list 32 at admission to an outpatient psychiatry clinic. Frontiers in Psychiatry, 9, 527. https://doi.org/10.3389/fpsyt.2018.00527
Marzani, G., & Price Neff, A. (2021). Bipolar disorders: Evaluation and treatment. American Family Physician, 103(4), 227–239. https://pubmed.ncbi.nlm.nih.gov/33587568/
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Özdel, K., Kart, A., & Türkçapar, M. H. (2021). Cognitive Behavioral Therapy in treatment of Bipolar Disorder. Noro Psikiyatri Arsivi, 58(Suppl 1), S66–S76. https://doi.org/10.29399/npa.27419