3. Abstract
Bipolar disorder is described as chronic, relapsing illness that is characterized by
recurrent episodes of manic or depressive symptoms. This is intervened by periods that seem
almost symptom free, but not fully. It is a serious brain disorder. It is also called manic-
depressive illness. It is a tough disorder to manage as it is a dynamic and constantly fluctuating
disease. Symptoms usually onset during adolescents or early adulthood and continue over a
lifetime. This is truly a harsh diagnosis as it very much effect a person’s quality of Life, overall
health status and functioning. It is not the same as the regular ups and down one may think of.
The symptoms are more sever then that and can make it hard to go to school or work or even
keep healthy relationships. Bipolar disorder has two major types, Bipolar 1 and Bipolar 2. There
are differentiated by the length of mania symptoms. Typically as these symptoms present
themselves as depression and mania/hypomania. These symptoms cycle on and off and can last
anywhere from two to six months if left untreated. Anyone can develop this disorder and as
stated usually last a lifetime. The cause are not always simple and clear, genetics is a factor but
also abnormal brain structure and function play a role. The worst of this illness is that it is hard
to diagnose right away. Many people present with several different problems so it is not always
clear if they are separate or part of a bigger picture. Treatment includes medications in which
there are different types that can possibly help depending on the symptoms. Therapy is also
available to help and this takes place in many forms.
4. History of the Disorder
In 1852 a French Scientist named Falret developed a theory he called “folie
circular” which meant circular madness. He defined this as manic and melancholic episodes
separated by symptom free intervals. A few yearslatertwo more scientistnoticedthe same type of
cyclingepisodes. Theirprognosisforsuchsymptomswasstatedas “incurable,andterrible”.Thiswas
describedbyasa circularillnessandrecurrentconditionandbecame the prototype behindperiodic
melancholiaandperiodiccyclicdisorder. (Angst,J.,&Sellaro,R.(2000). Natural history:Historical
perspectivesandnatural historyof bipolardisorder. BiologicalPsychiatry, 48445-457.
doi:10.1016/S0006-3223(00)00909-4).
Bipolardisorderhasa huge economicimpactonthe healthcare system.In2009 the estimated
total cost for thisdisorder,whichincludedinpatient,outpatientcost,pharmaceuticalsandcommunity
care, reached $30.7 billiondollars(DilsaverSC.Anestimate of the minimumeconomicburdenof bipolar
I and IIdisordersinthe UnitedStates:2009. J AffectDisord.2011;129:79-83). I we thinkaboutthat inan
overall sense thatincludesthe personwiththe illnessandthe lossof work,lossof productivity,sick
leave,anduncompensatedcare itreachesupto $120 billionannually(Jann,M.W.(2014). Diagnosisand
Treatmentof BipolarDisordersinAdults:A Review of the Evidence onPharmacologicTreatments.
American Health & Drug Benefits,7(9),489-498.).
Disorder Characteristics
Bipolardisorderhasmany characteristics because itinvolvesmanymoodepisodes. There are
manicepisodes,depressiveepisodes,ormixedepisodeswhichhave bothmanicanddepressive
5. symptoms.Duringthese episodesthe symptomslastall dayandcan be for a weekor manyevenlonger.
Theyare intense andstrongfeelingsandhappenwithextremechange inbehaviororlevelsof energy.
Duringa manicepisode peoplemayexperience feelingsof feelingveryhigh,orjumpy.Theytalkreally
fastabout manydifferentthings,jumpingformone subjecttoanother.Theymanyexperience feelings
of irritability,theyhave trouble sleeping,andalsoinvolve themselvesinmanydifferentthingsatonce
evenif theycan possiblyfinishthem.Theycanalsodo riskythingslike spendalotof moneyorhave
recklesssexual encounters.If theyare experiencingadepressiveepisode thentheyexperiencethings
such as feelingdown,worriedalot, feelings of emptiness.Theycanforgetthingsalot or lose interestin
whattheyusedto like.Theycanfeel tiredbuthave trouble sleeping.Thoughtsof deathandsuicide can
occur (BipolarDisorder(Easy toRead).(n.d.).RetrievedApril 16,2015, from
http://www.nimh.nih.gov/health/publications/bipolar-disorder-easy-to-read/index.shtml#pub5).
As statedbefore thisdisorderhastwotypes,Bipolar1 andBipolarII.Bipolar1 isdefinedbythe
presence of maniawithepisodesof depression,the moodsswingbetweenmaniaanddepressionand
are bothequallysever.Depressionreachesstagesof major depressive andmaniaisconsideredtrue
mania.BipolarIIis characterizedbyepisodesof depressionandhypomanicepisodes,whereasthe up
phase onlyreacheshypomaniabutthe downphase still reacheslevelsof majordepressions (Donnelly,
2001). The difference betweenthe twoisbasicallythe difference inthe mania’sseverityandintensity.
Mania symptomsare impairing,theyare severe andcancause symptomsof psychosis.Whereas
hypomaniaisnotas severandlast forshorterperiodsof time.Itusuallydoesnotcause social or
occupational impairment(AmericanPsychiatricAssociation.DiagnosticandStatistical Manual of Mental
Disorders.DSM-5.5th ed.Arlington,VA:AmericanPsychiatricPublishing;2013).
6. Disorder Prevalence
The life time prevalence of Bipolardisorderinadultsisthe UnitedStatesof Americahasbeen
reportedtobe 2.6%. of the population.Of that82.9% isclassifiedassevere(National Institutesof
Health.National Institute of Mental Health.Statistics.
www.nimh.nih.gov/health/statistics/prevalence/bipolar-disorder-among-adults.shtml.Accessed April
14, 2015). Bipolarpatientswhoare hospitalizedspendabout20% of theirlifetime fromonsetin
episodes.Fiftypercentof those episodeslast2-7month.The intervalsbetweenthe firstfewepisodes
tentto be shorterbut latertheyreturnirregular,onlyabout0.4 per yearbasis(Angst,2000). Generally
individualswithBipolardisorderare predisposedtoother comorbid psychiatricdisorderthenthose with
otherpsychiatricdisorders.Othercomorbiditieswhichare quite commoninclude anxietyandalcohol
dependency.Notonlydoesthishave major consequences fortreatmentbutitcan increase the time of
episodes.Thiscanincrease the risk of druginteractions since more thanlikelytheywill be prescribed
othermedication.Possibilityof poorcompliance andsuicidalityare high(GrantBF, StinsonFS,HasinDS,
et al.Prevalence,correlates,andcomorbidityof bipolarIdisorderandaxisIand II disorders:results
fromthe National EpidemiologicSurveyonAlcohol andRelatedConditions.JClinPsychiatry.
2005;66:1205-1215.Medical Aspect).
Medical Aspect
IndividualswithBipolardisorderhave ahighaspectfor medical comorbidity.These morbidities
include cardiovasculardisease,diabetes,obesityandHepatitisCvirus.Manyreasoncan account for
these issues.Individualscanuse substanceswithanotherindividualsandleadtoHVC.Diabetesand
obesitycanoccur as side effectsformtreatmentandmedications (Jann,2014).
7. Treatment MethodologiesandEfficacy
1. Screeningindividualsforahistoryof mania,hypomaniaonthe firstpresentationof
depressionisaproactive steptowardthe recognitionof Bipolarandthe firststepof
treatment. PharmacologictreatmentforBipolardisorderinclude treatmentwithMood
stabilizers,anti-psychotics,andanti-depressants.Asfaras moodstabilizersgo lithiumhas
beenthe foundationtreatmentformore than60 years.The issueswiththismedicationare
it isnot rapidly effectiveforacute maniaandit cannot treatthe depression(Jann,2014).
Mania isbesttreatedwithan atypical antipsychotic.There isnumerousamountsof
evidence pointingthiswith.Onlyone thoughisproventobe quite effective for
monotherapyand thatis Seroquel andSeroquel XR,whichhasthe highestefficacy(DerryS,
Moore RA.Atypical antipsychoticsinbipolardisorder:systematicreview of randomized
trials.BMC Psychiatry.2007;7:40). Antidepressantsare anothertype of medicationthat
doctorsuse to treatBipolardisorder.Thisare usedtotreat the depression.The issues
thoughisthat whenon an antidepressantabipolarindividualmayundergoaextreme rapid
switchto mania.Theyare not FDA approvedforuse to treatBipolarbut theyare frequently
prescribed(Jann,2014). Therapyis alsousedintreatment.Talktherapyisone whichcan
helpanindividual change theirbehaviorstobettermanage theirlives,helpthemwithsocial
connectednessandhowtocope and getalongbetterwithfriends andfamily(National
Institutes of Health. National Institute of Mental Health. Statistics.
www.nimh.nih.gov/health/statistics/prevalence/bipolar-disorder-among-
adults.shtml. Accessed April 14, 2015).
8. Discussion
This is a challenging illness. It’s so fluid and dynamic and to last a lifetime can
make it hard to deal. Diagnosis is important to catch early and the longer untreated to
worse it can get. The healthcare cost alone is an extreme amount for most individuals.
Medication cost and doctor visits. The mainstay treatment is pharmacological. So it’s on
the doctors to diagnose right and put clients on the correct medications, as we
discussed earlier mood stabilizers were the go to but because of issues with mania
treatment and the availability of antipsychotics that have shown efficacy in treating the
mania, and depression the choices have increased drastically. This aspect alone can help
minimize the impact of this sever condition.
9. References
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. DSM-5. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013
3. Angst,J.,& Sellaro,R.(2000). Natural history:Historical perspectivesandnatural historyof
bipolardisorder. BiologicalPsychiatry, 48445-457. doi:10.1016/S0006-3223(00)00909-4
4. Derry S, Moore RA. Atypical antipsychotics in bipolar disorder: systematic review of
randomized trials. BMC Psychiatry. 2007;7:40
5. Dilsaver SC. An estimate of the minimum economic burden of bipolar I and II
disorders in the United States: 2009. J Affect Disord. 2011;129:79-83
6. Donnelly,J.,Kittleson,M.,&Eburne,N. (2001). Mental Health Dimensionsod Self-Esteem
and Emotion Well-Being. NeedhamHeights,Massachusetts:A pearsonEducationCompany.
7. Grant BF, Stinson FS, Hasin DS, et al. Prevalence, correlates, and comorbidity of
bipolar I disorder and axis I and II disorders: results from the National Epidemiologic
Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66:1205-
1215.Medical Aspect
8. Jann,M. W. (2014). DiagnosisandTreatmentof BipolarDisordersinAdults:A Review of the
Evidence onPharmacologicTreatments. American Health & Drug Benefits,7(9), 489-498.
9. BipolarDisorder(EasytoRead).(n.d.).RetrievedApril 16,2015, from
http://www.nimh.nih.gov/health/publications/bipolar-disorder-easy-to-
read/index.shtml#pub5
10. 10. National Institutes of Health. National Institute of Mental Health. Statistics.
www.nimh.nih.gov/health/statistics/prevalence/bipolar-disorder-among-
adults.shtml. Accessed April 14, 2015).
