Order from us for quality, customized work in due time of your choice.
Fluctuations of mood are natural in humans as a reaction to internal and external stressors. However, recurrent mood swings that negatively affect a persons social or professional life can be a sign of a psychological disorder. Bipolar disorder is a mental impairment characterized by abrupt changes from depressive state to mood elevation. The disorder is among the leading causes of disability in young people (Grunze, 2015). There are two forms of bipolar disorder, which may be difficult to distinguish. Bipolar I is diagnosed when a patient experiences major depressive episodes with occasional manic episodes (Garrett & Hough, 2018). Bipolar II is characterized by major depression episodes, followed by mild hypomania (Garrett & Hough, 2018). In patients with bipolar disorder, stress serves as a switch from depression to a hypomanic state (Garrett & Hough, 2018). However, as the condition progresses, the episodes of depression may occur without any triggers (Garrett & Hough, 2018). The present paper aims at reviewing the diagnosis and treatment of bipolar disorder.
Diagnosis
DSM-5 Criteria
Bipolar disorder is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association (APA, 2013). According to DSM-5, to diagnose bipolar disorder, a patient should have experienced at least one episode of mania or hypomania. Under episode of mania, DSM-5 understands the elevated, expansive, or irritable mood experienced for the most part of the day, nearly every day, lasting for at least one week (APA, 2013). Hypomania is described similarly, but the episode should last only for four consecutive days (APA, 2013). During the episodes of mania or hypomania, a patient should experience at least three of the following symptoms: inflated self-esteem or grandiosity, decreased need of sleep, increased communicativeness, racing thoughts, elevated reaction to distractions, psychomotor agitation, and engaging in activities associated with negative consequences (APA, 2013). Mania or hypomania should be preceded or followed by a depressive episode.
The depressive side of bipolar disorder is characterized by depressive mood, lack of interest in life, or inability to find pleasure. According to DSM-5, patients should experience at least five symptoms of depression. First, a person with depression experiences a depressed mood most of the day, nearly every day (APA, 2013). Second, the condition can be associated with a loss of interest and pleasure in almost all activities (APA, 2013). Third, patients may experience a significant weight loss or absence of appetite (APA, 2013). Fourth, a person may engage in purposeless activities (APA, 2013). Fifth, depression causes fatigue or energy loss (APA, 2013). Sixth, patients may feel guilty or worthless without an apparent reason (APA, 2013). Seventh, the condition can cause indecisiveness or inability to concentrate (APA, 2013). Eighth, depression is associated with suicidal thoughts without a particular plan or suicide attempts (APA, 2013). While DSM-5 criteria for bipolar disorder seem specific and easy to use, some conditions have similar symptoms.
Differential Diagnosis
The central idea of differential diagnosis is to distinguish a condition by eliminating the possibility of other disorders that have similar symptoms. Therefore, the first step in the differential diagnosis is to establish three or more conditions that have comparable representation. First, bipolar disorder should be distinguished from cyclothymic disorder, which is characterized by frequent alternation between hypomanic and mild depressive episodes that are not severe enough for a diagnosis of bipolar II (Garrett & Hough, 2018, p. 666). Second, unipolar depression is also frequently misdiagnosed with bipolar disorder (Hirschfeld, 2015). Finally, attention deficit hyperactivity disorder (ADHD) also has similar symptoms and may be confused with bipolar disorder (Richard-Lepouriel et al., 2016). Therefore, it is of extreme importance to follow the DSM-5 screening recommendations to avoid invalid diagnoses.
To diagnose bipolar disorder, a person needs to demonstrate signs of both depression and mania. Therefore, I would start the diagnosis procedure by asking the patient to describe his or her psychological well-being. If I have enough ground to suppose bipolar disorder, I will ask the patient to complete The mood disorder questionnaire recommended by SAMSHA (n.d.). If the patient meets the criteria mentioned in the screening tool, I will ask specific questions approved by APA (2013) to distinguish between bipolar disorder and three other conditions mentioned above. If a patient demonstrates the signs of at least five depression symptoms, but the mania symptoms are insufficient, I will proceed to test for unipolar depression. If the criteria for mania or hypomania are met, but the depression symptoms are insufficient, I will consider ADHD. If a patient cycles between depression and mania regularly, but the depressive symptoms are mild, I will start testing for cyclothymic disorder. However, it should be kept in mind that many psychological impairments share symptoms; therefore, the differential diagnosis may need to include other conditions.
Prevalence
The information about the prevalence of bipolar disorder differs considerably between countries. According to Rowland and Marwaha (2018), the differences may be attributed to ethnicity, cultural factors, and variations in diagnostic criteria and study methodology (p. 258). In the US, 2.8% of adults had bipolar disorder in 2016 (National Institute of Mental Health [NIMH], 2017). Multiple studies confirmed that the prevalence of the condition in adults is not affected by gender, as 2.9% of males and 2.8% of females have bipolar disorder (Rowland & Marwaha, 2018; NIMH, 2017). However, in children and adolescents, the condition is more prevalent in females (3.3%) than in males (2.6%) (NIMH, 2017). There is no evidence that the prevalence of bipolar disorder differs according to socioeconomic status, race, or ethnicity (Rowland & Marwaha, 2018). However, there studies that confirm that the condition may be more prevalent in the LGBTQ population (Whitehead, 2010). However, the findings are outdated, and there are no official statistics concerning the onset of bipolar disorder according to sexual orientation.
Etiology and Implications for Treatment
The etiology of bipolar disorder is unclear; however, recent studies confirmed that the condition depends on numerous factors. First, bipolar disorder can be explained by genetics, as the children of parents who had major depressive disorder or bipolar disorder are more likely to have these conditions (Ayano, 2016). It can be explained by the fact that Bipolar I has a major genetic component, with the involvement of the ANK3, CACNA1C, and CLOCK genes (Ayano, 2016, p.2). There are no interventions that can affect genetics; therefore, such findings have no implications for treatment.
Second, the condition can be explained by abnormalities in brain structure and neurotransmitters. According to Garrett and Hough (2018), patients with bipolar and major depression disorders demonstrate volume deficit in the dorsolateral cortex, the anterior cingulate cortex, and the hippocampus, but increased volume in the amygdala. At the same time, disparities in epinephrine levels can also explain both depression and mania (Ayano, 2016). This implies that the symptoms of the condition may be controlled with substances, which promotes pharmacological treatment strategies.
Third, bipolar disorder may be explained by recent life events. According to Ayano (2016), 20% to 66% of bipolar patients had at least one stressful event immediately before the first onset of the condition. These findings imply that the condition may be addressed by re-evaluating the past events and learning effective coping mechanisms. Therefore, it can be stated that the condition may be treated using psychosocial therapies.
Treatment
There are different treatment methods utilized to manage bipolar disorder that can be divided into psychosocial and psychopharmacological interventions. Among the most common psychosocial treatments, Ayano (2016) emphasizes psychoeducation, CBT, and family intervention. Psychoeducation is usually a discrete program that offers information about the condition and provides support and management strategies (Ayano, 2016). CBT aims at making a direct link between current behaviors and past events to reduce the associated distress (Ayano, 2016). Family interventions are aimed at supporting and teaching family members to lower their distress and help them learn to provide care for the patient (Ayano, 2016). These four methods have a different level of effectiveness as their success depends on the skills of the therapists and a wide variety of environmental factors.
Psychopharmacological interventions include treatment programs based on the administration of mood stabilizers, antipsychotics, anti-depressants, and anti-anxiety medications. The most commonly used mood stabilizers are Tegretol, Depakote, Lamictal, and Lithobid (Ayano, 2016). Antipsychotics, such as Abilify, Saphris, Symbyax, and Latuda, can be used for controlling both mania and depression symptoms, especially if they occur with hallucinations or delusions (Ayano, 2016). At the same time, Benzodiazepines Diazepam, Lorazepam, Clonazepam are also valid for managing symptoms of bipolar disorder in some instances.
While medication administration seems to be an efficient method to address bipolar disorder, there are side effects that can be considered. According to Bai, Liu, Xu, Yang, and Gao (2019), utilization of mood stabilizers and antipsychotics is associated with a chance of discontinuations due to adverse effects, weight gain, somnolence, akathisia, nausea, and vomiting. The side effects include tremors, hair loss, sexual problems, liver damage, kidney damage, skin reaction, and diarrhea (Bai et al., 2019). Therefore, psychopharmacological interventions are possible only under the condition of close monitoring of side effects.
Community Resources in New Jersey
New Jersey has a variety of resources that can help people with mental disorders find free help. First, the patients may contact the Division of Mental Health and Addiction Services in New Jersey (RtoR, n.d.). The Division oversees the adult system of community-based behavioral health services and can help anyone to find appropriate resources to treat bipolar disorder is addressed. The Division may be reached by phone or by filling an online form on the official website. Second, patients with bipolar disorder can contact RtoR authorities for free personalized help finding mental health resources in New Jersey (RtoR, n.d.). They can be reached by filling in the contact form on the official website (RtoR, n.d.). Finally, a patient may contact the National Alliance on Mental Illness in New Jersey that offers a variety of individual, group, and family programs to provide education and support to people who have various mental disorders. The company can be contacted by phone, email, or various social media.
Conclusion
Bipolar disorder is a complex condition that affects almost 3% of the adult population in the US. It is characterized by abrupt changes in mood from depression to mania. Even though the illness has its distinct features, it may be difficult to diagnose since other conditions may mimic its symptoms. The condition may be treated using both psychosocial and psychopharmacological interventions; however, the administration of medications is associated with significant side effects. Any person in New Jersey can contact a wide variety of community resources to get free personalized help finding mental health resources.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Arlington, VA: American Psychiatric Association
Ayano, G. (2016). Bipolar disorder: A concise overview of etiology, epidemiology diagnosis, and management: Review of literature. SOJ Psychology, 3(1), 1-8.
Bai, Y., Liu, T., Xu, A., Yang, H., & Gao, K. (2019). Comparison of common side effects from mood stabilizers and antipsychotics between pediatric and adult patients with bipolar disorder: a systematic review of randomized, double-blind, placebo-controlled trials. Expert Opinion on Drug Safety, 18(8), 703-717.
Garrett, B., & Hough, G. (2018). Brain and behavior: An introduction to behavioral neuroscience (5th ed.). Los Angeles, CA: SAGE Publications, Inc.
Grunze, H. (2015). Bipolar disorder. In M.J. Zigmond, L.P. Rowland, & J.T. Coyle (Eds.), Neurobiology of Brain Disorders (pp. 655-673). Cambridge, MA: Academic Press.
Hirschfeld, R. (2015). Differential diagnosis of bipolar disorder and major depressive disorder. Journal of Affective Disorders, 169, S12-S16.
National Institute of Mental Health. (2017). Bipolar disorder. Web.
Richard-Lepouriel, H., Etain, B., Hasler, R., Bellivier, F., Gard, S., Kahn, J. P.,& & Leboyer, M. (2016). Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients. Journal of Affective Disorders, 198, 230-236.
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251269.
RtoR. (n.d.). Mental health resources in New Jersey. Web.
SAMHSA. (n.d.). The mood disorder questionnaire. Web.
Whitehead, N. E. (2010). Homosexuality and co-morbidities: Research and therapeutic implications. Journal of Human Sexuality, 2, 124-175.
Order from us for quality, customized work in due time of your choice.