Manic-Depression (Bipolar) Disorder, Research Paper Example

Introduction

Among the whole realm of existing psychiatric disorders, the manic-depression bipolar disorder occupies a separate place due to the heterogeneity of its symptoms and revelations. It has existed as far back as in ancient times, but the disorder as a clinical problem was recognized and described only about a century ago, in the whole multitude of symptoms and complications. Many famous and creative people are known to have had the bipolar disorder; however, the fact that its occurrence in artistic people is higher does not mitigate the seriousness of a diagnosis. Thus, understanding the nature of the problem is key to finding the range of solutions to it.

The most distinguishing peculiarity of a manic-depression disorder is that it combines symptoms of both a mania and a depression in a natural way, causing the people’s mood to jump up and down, arousing irritability and making people too perceptive of the surrounding reality. The bipolar disorder becomes the cause of rapid and unexplainable changes of mood and behavior, occurrence of weird actions, emergence of delusions and even hallucinations. The perception of self and the surrounding world becomes too distorted for the ill person to preserve objective reasoning. Hence, a mania in a patient with a manic-depressive state can cause various ridiculous delusions and misconceptions, or may cause pessimistic, suicidal thoughts and incentives. Any alteration from mania to depression and back is traumatic for the individual’s internal psychological equilibrium, but some patients appear to like their manic states of elevation and report regrets in parting with them.

There is no cure for the disease found yet; however, the causes of the disorder have been detected with more clarity. The modern psychiatry distinguishes the possibility of genetic inheritance of the illness, the neurotransmission misbalance marked by the absence of some essential fatty acids and proteins taking part in the development and normal functioning of the brain, and the circadian deregulation (Frank, 2005). Nevertheless, it is essential to get a deeper insight into the realm of symptoms existing for the bipolar disorder, as well as the possibilities for treatment in order to be able to provide an adequate assessment of the treatment possibilities.

Symptoms of Manic-Depression (Bipolar) Disorder

According to the opinion of prominent psychiatrists, the patients with a manic-depression disorder often feel complications with awareness of the illness, so being more informed about the symptoms they may experience is likely to increase their treatment potential. The reason for this is that knowing about other patients who have survived the manic depression makes them believe that they will also succeed in overcoming the disease. In addition, successful treatment options available in the modern psychiatry may give a better perspective of the disease to patients and empower them on the path to cure (Torrey & Knable, 2005).

The manic depression disorder is called bipolar because patients often experience alterations of opposite states, including attacks of mania and depression. The mania component of the bipolar disorder generally includes the following symptoms: the state of happiness and euphoria, irritation, frequent shift of moods, distraction in thoughts, difficulties in concentration and accelerated speech, decreased inhibition and increased sense of importance, paranoid and grandiose delusions (frequently accompanied with hallucinations), increased physical activity (including sexual one), increased writing, lack of sleep, risky behaviors etc. (Torrey & Knable, 2005). Miller (2007) also includes such common symptoms as exaggerated optimism, aggressive behaviors, refusal to be interrupted, impatience, and poor judgment. Depressive states are contrary to the described manic symptoms, which causes the bipolarity of the illness and hard adaptation of the patient to the states in which he or she finds him- or herself. Depressive states are often accompanied with thoughts about sin and death, pessimism and apathy (Torrey & Knable, 2005).

The euphoria experienced by patients with a manic-depression bipolar disorder is actually a very pleasant experience with which many of them do not feel like parting; according to the descriptions of numerous patients, the state may be enhanced by the deepened and sharper perception of colors, smell and taste, sharper feelings of satisfaction and delight when watching some romantic movie or listening to a piece of classical music. The manic-depression state does not necessarily cause highly elevated feelings – the state may be average, which is called hypomania. In addition to the elevated perception of the beauty in the world, patients often develop a mystical feeling of unity with God and nature. However, the sense of irritation may well be united with the feeling of euphoria, and may be experienced simultaneously with it, or alter with it (Torrey & Knable, 2005).

The accelerated speech and thoughts are also a remarkable phenomenon in the manic-depression state of patients; healthy people’s thoughts are known to shift once in 5-6 seconds, while the thoughts of manic-depressed patients shift in less than 2 seconds. This state is called the ‘flight of ideas’ (Torrey & Knable, 2005). Many patients feel unable to keep track of their thoughts and speak much faster in an attempt to reveal them. The refusal to be interrupted, lack of concentration and aptness to writing may be the direct results of speeded thoughts (Miller, 2007).

Another symptom, increased self-esteem, appears to be much more threatening than it was initially considered. The matter is that the patient without proper treatment may develop a frank grandiosity that will lead to delusions (reasoned or absurd) and even auditory hallucinations (Torrey & Knable, 2005). In addition, the delusions a patient experiences may be of paranoid nature, which makes paranoid schizophrenia and manic depressed states difficult to distinguish at the early stages of their development. Buying sprees mark the disrupted reasoning of patients, and disorderly writing also serves as a definite sign of being in a manic-depression bipolar disorder state: clinicians noted that patients write in all directions of the paper, with words crossing each other many times, so the potential patients writing to hospitals could be detected even without opening the envelopes. Finally, increased activity and lack of sleep as some of the evident symptoms of manic depression states may lead to the patient’s exhaustion and death in case they are not treated in due course (Torrey & Knable, 2005).

Structured and Unstructured Interviews as a Type of Therapy

The most common methods of obtaining a diagnosis in cases of manic-depression bipolar disorder states are conducting structured and unstructured interviews that enable the clinician to review diagnostic requirements for a mania and/or a depression. However, the successful and correct diagnoses are more frequent with the application of unstructured interviews than the formal structured ones. The reason for this is that a structured interview simply contains a summary list of criterion symptoms, while an unstructured interview can afford a much wider perception of a disorder and will provide the psychiatrist with a clearer idea of the disease (Frank, 2005).

There is a set of tools for structured interviews in the cases of manic-depression bipolar disorder states. They include such formal, validated, structured interviews as the Structured Clinical Interview for DSM-IV-TR and the Multi-International Neuropsychiatric Interview. Both are useful in cases when the diagnostic picture is not a clear one because of the multiple medical or psychiatric co-morbidities (Frank, 2005). To assess the severity of mania symptoms, the Bech-Rafaelsen Mania Scale and the Young Mania Rating Scale may be applied. Such tool as the 17-item Hamilton Depression Rating Scale is applied when the necessity to assess the severity of depression arises. The Bech0Rafaelsen scale has some advantage over the Hamilton scale because the latter has a more general format of questions, so both can be combined in cases when the proper diagnosis is needed. Nonetheless, the Young Mania Rating Scale is more appropriate for application in the cases of assessing mania or hypomania in the outpatient setting (Frank, 2005).

Treatment Options for Extreme Components of Mania

The most important facts that one has to keep in mind are that there is no absolute cure for the manic disorder yet known, and that it usually takes up to 10 years to initiate treatment. Thus, a combination of medication and psychotherapy is needed to achieve higher results. The mood-stabilizing medications used in the cases of the discussed disorder are: lithium, valproate, carbamazine etc. They help reduce the number and severity of manic episodes and prevent the occurrence of depression. However, the efficiency of psychotherapy is proven only in cases of mild mania episodes because of the inability of patients with severe manic symptoms to concentrate and perceive information (Miller, 2007). Hence, treating mania is a more specific task with distinguished procedures and peculiarities.

According to Young, Nicol, and Michalak (2010), treatment of mania may include several levels, the choice of which depends on the patient’s response to treatment. There are first-line and second-line medications that have proven to have a pronounced effect on the manic episodes in patients. The first line includes aripiprazole, asenapine, carbamazepine, haloperidol, lithium, olanzapine, quetiapine etc. The second-line ones include chlorpromazine, paliperidone, phenytoin, pimozide and tamoxifen (Young et al., 2010). One should also note that the propriety of medication choice is determined by the type of mania experienced by the patient: it may be euphoric, dysphoric, and psychotic. The euphoric mania type is the mainstream one, the oldest detected, while the dysphoric type is characterized by the depressed features in the patient’s mood. This type of mania may not be efficiently treated with the help of lithium, but valproate, carbamazepine and olanzapine may prove to be more efficient (Young et al., 2010). The psychotic type of mania has been detected only recently as a separate subtype of manic episodes, so the conventional treatment methods are often less efficient for such occurrences.

Traditionally, the types of mania treatment are subdivided as follows: lithium (more efficient for the pure, euphoric mania), anticonvulsants, typical neuroleptics, and electroconvulsive therapy (ECT) (Young et al., 2010). The initial treatment phase is determined due to the specific set of factors: the symptoms of mania characterizing its type, the previous experience of the patient and clinician, the evidence for efficacy as maintenance treatment, modification of medical factors and specific safety profile, the route and ease of administration, and patient’s preference Young et al., 2010). Further, the treatment options are modified according to the measure of patient’s response to it. In case there is full response to the chosen treatment in two weeks, then the chosen treatment is continued to ensure full remission and is followed by maintenance treatment methods (Young et al., 2010).

However, there are surely many cases in which no response or partial response are observed in the process of treatment. Then, in cases of partial response, the treatment is continued and dosage of medication is optimized. In case no further improvement is observed in the next 3 weeks, the combination with other first-line medications is considered. In cases of no response initially, the medication is switched for another first-line one, and in case of no further improvement the combination of two first-line medications is applied. In both cases of partial and no response, the following procedure in case of no responses to the altered and modified treatment options is to use the combined treatment with the help of first and second line medications, and to consider the propriety of ECT.

Successful Treatment with Medications

One case of successful treatment described in the available literature on manic bipolar disorder is the one of Joanne Kolodzik. The woman suffered from a depression many years but did not reveal it; she confessed to having cyclothymia, and as a result of sudden changes in her life, attempts to find her destiny she started to experience manic episodes as well:

“I fell into a deep depression, hypomania for about a month, and following that, a manic state with psychotic features. My mother had brought me home from the convent when I was twenty-five years old, but was puzzled by the nonstop talking which I exhibited. It did not make any sense at all. Then I started writing my disparate thoughts into a notebook. They did not make any sense either” (Depression and Bipolar Support Alliance, 2010).

The patient received lithium carbonate for about a month in 1976, which proves the widespread and long-term application of lithium in treatment. Nowadays the patient reports having no hospitalizations for about 23 years already, but states that she takes “four psychotropic medications per day”. She shares her experience of mania in having both pleasant and frightening delusions, and trying to direct the increased energy from manias into constructive activities – sending cards or buying gifts.

Another example proving the successful treatment of manic-depressive bipolar disorder states with the help of medications is the one of Coleen presented at the site of the Depression and Bipolar Support Alliance (2010). The initial symptoms described by the patient suit the mild forms of delusions and prove the fact that creative people have the bipolar disorder more often and do not refer to it as a mental illness for a long time:

“I do know that I was a very artistic and gifted child. I had a huge inner world that didn’t fit well with the world outside me. My grasp on reality always seemed a bit tenuous, and I felt like I was different and special someone with a superhuman calling and mission” (Depression and Bipolar Support Alliance, 2010).

This patient reports having an eating disorder in the early years, having the drug and alcohol abuse problems at the age of 13, and cyclothymia for many times in life, being married, divorced and remarried. The patient recognized the necessity of treatment only when she saw the signs of the same bipolar disorder in her son. So, it was only at 45 when she agreed to taking medications, and now she reports feeling much better and agreeing to take medicines for the rest of her life only to preserve the improved quality of life she acquired.

References

Depression and Bipolar Support Alliance (2010). Retrieved October 15, 2010, from http://helpguide.org/mental/bipolar_disorder_diagnosis_treatment.htm

Frank, E. (2005). Treating bipolar disorder: a clinician’s guide to interpersonal and social rhythm therapy. New York: Guilford Press.

Miller, A.R. (2007). Living with Depression. New York: Infobase Publishing.

Torrey, E.F., & Knable, M.B. (2005). Surviving manic depression: a manual on bipolar disorder for patients, families, and providers. New York: Basic Books.

Young, A.H., Nicol, I., & Michalak, E.E. (2010). Practical Management of Bipolar Disorder. Cambridge: Cambridge University Press.