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<!DOCTYPE html PUBLIC "-//ABISOURCE//DTD XHTML plus AWML 2.2//EN" "http://www.abisource.com/2004/xhtml-awml/xhtml-awml.mod"><div> <html xmlns="http://www.w3.org/1999/xhtml" xmlns:awml="http://www.abisource.com/2004/xhtml-awml/"> <head> <meta http-equiv="Content-Type" content="application/xhtml+xml; charset=UTF-8" /> <title> Abiword HTML Document </title> </head> <body> <p awml:style="header"> <span>2</span> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> REVIEW OF BIPOLAR DISORDER </p> <p awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> <p awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> </body> <div> <p style="margin-left:36.000000pt;text-indent:-18.000000pt"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Introduction</span> </p> <p> <span style="font-size:12pt;font-family:'Times New Roman'">Bipolar disorder (which was earlier called manic depression, or manic-depressive illness) is a mental health disorder that includes unusual shifts in -mood, energy, and levels of activity. Disorder also affects concentration, and also the ability of carrying out day-to-day tasks.</span> </p> <p> <span style="font-size:12pt;font-family:'Times New Roman'">We may distinct three types of bipolar disorder; what is in common is that all of them include clear changes in mood, energy, and activity levels. Moods may vary from’’ups’’ (when the patient is elated, irritable, or has energized behavior –also known as</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">manic episodes</span><span style="font-size:12pt;font-family:'Times New Roman'">) to very ’’downs’’ (when the patient is sad, indifferent, or in hopeless periods –also known as</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">depressive episodes</span><span style="font-size:12pt;font-family:'Times New Roman'">). Hypomanic episodes are less severe manic periods. (1)</span> </p> <p> <span style="font-size:12pt;font-family:'Times New Roman'">Bipolar I disorder. Patient had a minimum of one manic episode that may be preceded or followed by hypomanic or major depressive episodes. Sometimes, mania may trigger a psychosis (break from reality).</span> </p> <p> <span style="font-size:12pt;font-family:'Times New Roman'">Bipolar II disorder. Patient had a minimum of one major depressive episode and a minimum of one hypomanic episode, but never had a manic episode.</span> </p> <p> <span style="font-size:12pt;font-family:'Times New Roman'">Cyclothymic disorder. Patient had a minimum of 2 years -or one year in children and teenagers -of several periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).</span> </p> <p> <span style="font-size:12pt;font-family:'Times New Roman'">Other types. These include, for example, bipolar and other similar disorders caused by certain drugs or alcohol or due to a medical condition, such as stroke, multiple sclerosis or Cushing's disease.</span> </p> <p> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Epidemiology</span> </p> <p style="text-indent:18.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">One of the large surveys, that included 11 countries, found the overall lifetime prevalence of bipolar and bipolar like disorders was 2.4%, with a prevalence of 0.6% for bipolar type I and 0.4% for bipolar type II. In one of the epidemiological investigations in England, the recent Adult Psychiatric Morbidity Survey 2014, was found lifetime prevalence of bipolar disorders was 2%. Meta-analysis of 25 studies, that has been conducted recently -found a pooled lifetime prevalence of 1.06% and 1.57% for types of bipolar disorder I and II, respectively; it should be mentioned that the majority of the included studies were from North or South America. A similar prevalence has been found in the UK, Germany and Italy. And what is the reason for international variations in the prevalence of bipolar? It is not entirely clear, but it is thought that -ethnicity, cultural factors and variations in diagnostic criteria and study methodology may each have an impact. Several studies report equal distribution in bipolar, regarding sex. With regards of age, it appears to be that the mean age of onset for bipolar is in the early twenties, even if findings vary between 20–30 years.</span> </p> <p> </p> <p style="text-align:center"> </p> <p style="text-align:center"> </p> <p style="text-align:center"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Etiology and Pathophysiology</span> </p> <p style="text-indent:18.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">Etiological factors are named in the following. Even if a specific genetic link to bipolar disorder has not been precisely determined, research shows that bipolar disorder tends to run in families, and is -heritable. Patients may inherit a tendency to develop the illness, and this may be triggered by factors of environment, for example –by some distressing life event. Development of the brain, structure, and chemicals which act as messengers between nerve cells (also known as neurotransmitters), are also thought to play a role in the development of bipolar disorder. To explain</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'"></span><span style="font-size:12pt;font-family:'Times New Roman'">bipolar disorder -specifically mania,</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">catecholamine hypothesis</span><span style="font-size:12pt;font-family:'Times New Roman'"> has been used; hypothesis assumed that mania is due to an excess, and depression is due to a depletion of catecholamines. A numerous of</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">serotonin hypotheses</span><span style="font-size:12pt;font-family:'Times New Roman'"> have been proposed. There is one hypothesis, known as ’</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">’permissive hypothesis’’</span><span style="font-size:12pt;font-family:'Times New Roman'"> of serotonin function, which claims that low serotonergic function have an impact on both -manic and depressive states through defective dampening of other neurotransmitters (mostly norepinephrine and dopamine).</span> </p> <p style="text-align:center;margin-left:18.000000pt"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Diagnosis</span> </p> <p style="margin-bottom:0.000000pt;text-indent:18.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">It is often difficult for bipolar disorder to be recognized and diagnosed. This might be caused by the fact that some symptoms may feel good to a patient, which could lead to denial of the problem. Bipolar disorder is difficult to diagnose, also because its symptoms may appear to be part of another illness, or attributed to other problems such as substance abuse, poor school performance, or trouble in the workplace. Symptoms of bipolar disorder are divided into two categories: mania and depression. Mania, the symptoms of mania, which can last up to three months, if untreated, include: excessive energy, activity, restlessness, ’’racing thoughts’’ and rapid talking (also called ’’pressured speech’’). A person may feel extreme high or euphoric feelings –’’on the top of the world’’, and even bad news or tragic events, can't change this. One may also be easily irritated or distracted. Considering need for sleep – it is usually decreased in this phase, so the individual may go days with little or no sleep at all, without feeling tired. A person may have unrealistic beliefs in its ability and powers – self-confidence might become exaggerated, and the optimism might become unwarranted; person may feel that nothing can stop me for accomplishing any task, which may lead to over ambitious work plans. A characteristic of mania, is also a poor judgment; this means that person may make very poor decisions, which may lead to different kind of behaviours and consequences. Sex drive might become unusual in this phase, and it is noticed that the person also has elevated need of drugs abuse (particularly cocaine, alcohol or sleeping medications).</span> </p> <p style="text-indent:18.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">For depression,</span><span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'"></span><span style="font-size:12pt;font-family:'Times New Roman'">an episode of depression can come before a manic, hypomanic, or normal period of mood; or -after them. Symptoms include feelings of persistent sadness, anxiety or emptiness. Changes in sleep might include -getting too much or too little sleep, or waking in the middle-of-the-night, -or unusually early in the morning. Characteristic of appetite is that he becomes reduced, and weight loss might occur; on the other hand, appetite might become increased, which is usually followed by gain of weight. One may feel irritability or restlessness, and have difficulties in concentrating, remembering or making decisions. This may affect a person's ability to fulfil work, school or other obligations. Person might feel unusual fatigue or loss of energy. Sometimes physical symptoms -like chronic pain or digestive issues (upset stomach or diarrhoea) (which are often resistant to treatment) occur. One may feel guilty, hopeless or worthless; these feelings are usually accompanied with the thoughts of death or suicide, including suicide attempts.</span> </p> <p awml:style="List Paragraph"> </p> <p awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Assessment</span> </p> <p style="text-indent:36.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">Proper diagnosis of bipolar disorder may be time-consuming; but if illness is diagnosed and then treated properly, it may help people (with bipolar disorder) lead healthy and active lives. To determine if patient have bipolar disorder, a process of evaluation may include:</span><span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'"></span><span style="font-size:12pt;font-family:'Times New Roman'">physical exam, psychiatric assessment, mood charting and criteria for bipolar disorder. Doctor may do a physical exam and lab tests to identify any medical problems that could be causing patient’s symptoms. Psychiatric assessment,</span><span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'"></span><span style="font-size:12pt;font-family:'Times New Roman'">doctor may refer patient to a psychiatrist, with whom the patient will talk about thoughts, feelings and behaviour patterns. Patient may also fill out a psychological self-assessment or questionnaire. With the permission of a patient, members of the family or close friends may be asked in order to provide information about his symptoms. Mood charting, patient may be asked to keep a record (on daily bases) of moods, sleep patterns or some other factors which could help with diagnosis of disorder, and also defining the right treatment. Criteria for bipolar disorder, psychiatrist may compare patient’s symptoms with the criteria for bipolar and related disorders in the</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">Diagnostic and Statistical Manual of Mental Disorders</span><span style="font-size:12pt;font-family:'Times New Roman'"></span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">(DSM-5)</span><span style="font-size:12pt;font-family:'Times New Roman'">, published by the American Psychiatric Association.</span> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Management</span> </p> <p style="text-indent:36.000000pt"> <span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">The Practice Guideline for the Treatment of Patients with Bipolar Disorder</span><span style="font-size:12pt;font-family:'Times New Roman'"> has been developed by APA -The American Psychiatric Association. There are principles of psychiatric management outlined in the following. First principle is establishing and maintaining a therapeutic alliance, as this is significant for managing severe episodes and maintaining adherence. The second principle is monitoring the patient's psychiatric status, this is mandatory for early detection of recurrence. After that is providing education regarding bipolar disorder. By carrying out discussion on an ongoing process, use of educational brochures, and use of literature written by peers is beneficial for patient</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">.</span><span style="font-size:12pt;font-family:'Times New Roman'"> More than that, enhance treatment adherence it is a supervision of ambivalences about treatment and use of psychological defence of denial</span><span style="font-style:italic;font-size:12pt;font-family:'Times New Roman'">.</span><span style="font-size:12pt;font-family:'Times New Roman'"> On to fifth principle is promoting regular patterns of activity and wakefulness, as these factors affect the mood. For principle 6, promoting awareness of and adaptation to the psychosocial effects of bipolar disorder, it discusses the cascade effect of the disorder altogether psychosocial spheres. The next is identifying new episodes early, this upgrades mastery and decreases morbidity. The last 3 principles mention about decreasing all morbidity and consequences of bipolar disorder. Early treatment, management of stressors, and adherence are crucial; Promoting acceptance of the diagnosis, which is reducing stigmatization, promote a way of “control” through medication, promote avoidance of substances; promoting emotional wellbeing, which can strengthen self-esteem, resolve interpersonal difficulties, and promote vocation.</span> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Natural history</span> </p> <p style="text-indent:36.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">Main characteristic of the natural course of bipolar disorder is high rate of relapse and recurrence at rates of 80 to 90 percent. Full functional recovery between affective episodes often lags behind symptomatic recovery. The cumulative possibility of recurrence throughout the first year of follow-up was above 50 percent, by the end of the four years was about 70 percent, and by five years was nearly 90 percent.</span> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Treatment</span> </p> <p style="text-indent:36.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">Proper treatment can help people with bipolar disorder lead healthy and active lives, even ones with the most severe forms of bipolar disorder. Treatment plan that is effective usually includes combination of medication</span><span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'"></span><span style="font-size:12pt;font-family:'Times New Roman'">and</span><span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'"></span><span style="font-size:12pt;font-family:'Times New Roman'">psychotherapy. It is a lifelong illness, but the continuous treatment may help people manage these symptoms. Medications, sometimes is needed to several medications be tried to best medication be found. Medications used for treating bipolar disorder include mood stabilizers and second-generation (“atypical”) antipsychotics, and also those that are being prescribed usually for treating sleeping problems and anxiety. Sudden stopping of using medications, without counselling with doctor should be avoided, because of rebound syndrome or worsening symptoms. Psychotherapy, it can be effective part of treating patients; it includes different techniques that may support and educate patients, in that way helping them to identify and change troubling thoughts, emotions, and behaviours. Other treatments found helpful are named in the following. Electroconvulsive Therapy (ECT). Transcranial magnetic stimulation (TMS). Supplements.</span> </p> <p> </p> <p> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> </p> <p class="list_paragraph" style="text-align:center" awml:style="List Paragraph"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Conclusion</span> </p> <p style="text-indent:36.000000pt"> <span style="font-size:12pt;font-family:'Times New Roman'">Bipolar disorder is a complex lifelong illness, with several factors likely to play role in its development. It often may be difficult to recognize and diagnose. It might be time-consuming, but the proper diagnosis and treatment can help patients lead healthy and active lives. For understanding and managing the patient, a therapeutic alliance is crucial. Medications for treating bipolar disorder should be used in accordance with advice of a doctor, and should be avoided stop using suddenly, because of the following consequences. Despite of the decades of investigation, many questions about bipolar disorder remains to be without an answer; on the other side, many of them helped us revolutionise approach to the treatment, and in this way provide a better quality of life of patients.</span> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p style="text-align:center"> <span style="font-weight:bold;font-size:12pt;font-family:'Times New Roman'">Reference</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'"> Clemente, AS, Diniz, BS, Nicolato, R. 2015. Bipolar disorder prevalence: a systematic</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> review and meta-analysis of the literature. Rev Bras Psiquiatr. 37: 155–161.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Dion GL, Tohen M, Anthony WA, et al. 1998. Symptoms and functioning of patients</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> with bipolar disorder six months after hospitalization. Hosp Comm Psychiatry.</span> </p> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> 39:652–7.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Fajutrao, L, Locklear, J, Priaulx, J. 2009. A systematic review of the evidence of the</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> burden of bipolar disorder in Europe. Clin Pract Epidemiol Ment Health. 5: 3.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Goodwin FK, Jamison KR. 1990. Manic-Depressive Illness. New York, NY. Oxford</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> University Press.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Hilty DM, Brady KT, Hales RE. 1999. Bipolar disorder in adults: A review of recent</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> literature. Psychiatric Services. 50:201–13.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'"></span><span style="font-size:12pt;font-family:'Times New Roman'">Hirschfeld RMA, Bowden CL, Gitlin MJ, et al. 2006. Practice guideline for the</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> treatment of patients with bipolar disorder (revision). Am J Psychiatry.</span> </p> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> 159(Suppl):1–35.</span><a href="http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm"><span style="font-size:12pt;font-family:'Times New Roman'">www.psych.org/psych_pract/treatg/pg/prac_guide.cfm</span></a><span style="font-size:12pt;font-family:'Times New Roman'">.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Keller MB, Waternaux CM, Tsuang MT. 1993. Bipolar I: A five-year prospective follow-</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> up. J Nerv Mental Dis. 81:238–45.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Merikangas, KR, Jin, R, He, JP. 2011. Prevalence and correlates of bipolar spectrum</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> disorder in the world mental health survey initiative. Arch Gen Psychiatry. 68:</span> </p> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> 241–251. Google Scholar | Crossref | Medline</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Marwaha, S, Sal, N, Bebbington, P. 2016. Chapter 9: bipolar disorder. Leeds: NHS</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> Digital. Google Scholar</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Tsuchiya, KJ, Byrne, M, Mortensen, PB. 2003. Risk factors in relation to an emergence</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> of bipolar disorder: a systematic review. Bipolar Disord. 5: 231–242.</span> </p> <span></span><span style="font-size:12pt;font-family:'Times New Roman'">Tohen M, Waternaux CS, Tsuang MT. 1990. Outcome in mania: A 4-year prospective</span> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> follow-up of 75 patients utilizing survival analysis. Arch Gen Psychiatry.</span> </p> <p awml:style="List Paragraph"> <span style="font-size:12pt;font-family:'Times New Roman'"> 47:1106–11.</span> </p> <p awml:style="List Paragraph"> </p> <p style="text-align:justify"> </p> <p awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> <p awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> <p awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> <div> </div> <p awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> <p class="header" style="margin-right:18.000000pt" awml:style="header"> </p> </p> </div> </html> </div> ">
