Going to Extremes: Bipolar Disorder.
There is a tendency to romanticize bipolar disorder. Many artists, musicians and writers have suffered from its mood swings. But in truth, many lives are ruined by this disease; and without effective treatment, the illness is associated with an increased risk of suicide.
Bipolar disorder, also known as manic-depressive illness, is a serious brain disease that causes extreme shifts in mood, energy, and functioning. It affects approximately 2.3 million adult Americans--about 1.2 percent of the population. Men and women are equally likely to develop this disabling illness. The disorder typically emerges in adolescence or early adulthood, but in some cases appears in childhood. Cycles, or episodes, of depression, mania, or "mixed" manic and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life.
Depression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.
Mania: Abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity such as shopping; physical agitation; and excessive involvement in risky behaviors or activities.
"Mixed" state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.
Especially early in the course of illness, the episodes may be separated by periods of wellness during which a person suffers few to no symptoms. When 4 or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse.
Severe depression or mania may be accompanied by symptoms of psychosis. These symptoms include: hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Psychotic symptoms associated with bipolar typically reflect the extreme mood state at the time.
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with the illness have some residual symptoms. Certain types of psychotherapy or psychosocial interventions, in combination with medication, often can provide additional benefit. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy Interpersonal and Social Rhythm Therapy (IPSRT), developed by Dr. Ellen Frank and colleagues at the University of Pittsburgh, is based on the idea that disruptions in daily routines and problems in interpersonal relationships can cause recurrence of the manic and depressive , family therapy, and psychoeducation.[6,7]
Lithium has long been used as a first-line treatment for bipolar disorder. Approved for the treatment of acute mania in 1970 by the U.S. Food and Drug Administration (FDA FDA
Food and Drug Administration
n.pr See Food and Drug Administration.
n.pr the abbreviation for the Food and Drug Administration. ), lithium has been an effective mood-stabilizing medication for many people with bipolar disorder.
Anticonvulsant medications, particularly valproate valproate /val·pro·ate/ (val-pro´at) a salt of valproic acid; the sodium salt has the same uses as the acid.
n. and carbamazepine carbamazepine /car·ba·maz·e·pine/ (kahr?bah-maz´e-pen) an anticonvulsant and analgesic used in the treatment of pain associated with trigeminal neuralgia and in epilepsy manifested by certain types of seizures. , have been used as alternatives to lithium in many cases. Valproate was FDA approved for the treatment of acute mania in 1995. Newer anticonvulsant medications, including lamotrigine, gabapentin, and topiramate, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants Anticonvulsants
Drugs used to control seizures, such as in epilepsy.
Mentioned in: Antipsychotic Drugs, Osteoporosis may be helpful.
According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome Polycystic Ovary Syndrome Definition
Polycystic ovary syndrome (PCOS) is a condition characterized by the accumulation of numerous cysts (fluid-filled sacs) on the ovaries associated with high male hormone levels, chronic anovulation (absent ovulation), in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses menses /men·ses/ (men´sez) the monthly flow of blood from the female genital tract.
n. , obesity, and abnormal growth of hair. Therefore, young female patients taking valproate should be monitored carefully by a physician.
During a depressive episode, people with bipolar disorder commonly require additional treatment with antidepressant medication. Typically, lithium or anticonvulsant anticonvulsant /an·ti·con·vul·sant/ (-kon-vul´sant) inhibiting convulsions, or an agent that does this.
A drug that prevents or relieves convulsions. mood stabilizers are prescribed along with an antidepressant to protect against a switch into mania or rapid cycling. The comparative efficacy of various antidepressants in bipolar disorder is currently being studied.
In some cases, the newer, atypical antipsychotic drugs Antipsychotic Drugs, Atypical Definition
The atypical antipsychotic agents, sometimes called the "novel" antipsychotic agents are a group of drugs which are different chemically from the older drugs used to treat psychosis. such as clozapine clozapine /clo·za·pine/ (klo´zah-pen) a sedative and antipsychotic agent; used in the treatment of schizophrenia.
n. or olanzapine may help relieve severe or refractory symptoms of bipolar disorder and prevent recurrences of mania. More research is needed to establish the safety and efficacy of atypical antipsychotics as long-term treatments for this disorder.
More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar unipolar /uni·po·lar/ (u?ni-po´ler)
1. having a single pole or process, as a nerve cell.
2. pertaining to mood disorders in which only depressive episodes occur. major depression, indicating that the disease has a heritable her·i·ta·ble
1. Capable of being passed from one generation to the next; hereditary.
2. Capable of inheriting or taking by inheritance. component. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. Scientists are continuing their search for these genes using advanced genetic analytic methods and large samples of families affected by the illness. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process.
Researchers are using advanced imaging techniques to examine brain function and structure in people with bipolar disorder.[10,11] An important area of imaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders. Better understanding of the neural circuits involved in regulating mood states will influence the development of new and better treatments, and will ultimately aid in diagnosis.
New Clinical Trial
NIMH has initiated a large-scale study at 20 sites across the U.S. to determine the most effective treatment strategies for people with bipolar disorder. This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD STEP-BD Systematic Treatment Enhancement Program for Bipolar Disorder ), will follow patients and document their treatment outcome for 5 to 8 years. For more information, visit the Clinical Trials page of the NIMH Web site.
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 Sachs GS, Printz DJ, Kahn DA, et al. The expert consensus guideline series: medication treatment of bipolar disorder
Bipolar disorder has not currently been cured but it can be managed. 2000. Postgraduate Medicine, 2000; Spec No: 1-104.
 American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international. . Practice guideline for the treatment of patients with bipolar disorder. American Journal of Psychiatry The American Journal of Psychiatry (AJP) is the most widely read psychiatric journal in the world. It covers topics on biological psychiatry, treatment innovations, forensic, ethical, economic, and social issues. , 1994; 151(12 Suppl): 1-36.
 Frank E, Hlastala S, Ritenour A, et al. Inducing lifestyle regularity in recovering bipolar disorder patients: results from the maintenance therapies in bipolar disorder protocol. Biological Psychiatry, 1997; 41 (12): 1165-73.
 Vainionpaa LK, Rattya J, Knip M, et al. Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Annals of Neurology, 1999; 45(4): 444-50.
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NIH - The United States National Institutes of Health. Publication No. 98-4268. Rockville, MD: National Institute of Mental Health The National Institute of Mental Health (NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in mental illness. , 1998.
 Soares JC, Mann JJ. The anatomy of mood disorders-review of structural neuroimaging studies. Biological Psychiatry, 1997; 41(1): 86-106.
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1. The branch of anatomy that deals with the nervous system.
2. of mood disorders. Journal of Psychiatric Research, 1997; 31(4): 393-432.