Bipolar Disorder: Prevalence, Neurobiology, and Treatment, With a Focus on Expectant Women

Bipolar disorder is a psychotic disorder whose aetiology has not been established. The explanation offered by healthcare providers revolves around the causal relationship between di-polar 1 and environmental and genetic factors. Neurobiological bipolar 1 occurs when the hypothalamic-pituitary-adrenal axis is dislocated. Pharmacological and therapeutic interventions are often recommended modes of treatment because the disorders often require the management of symptoms (Tchikrizov et al.,2023). The modes of intervention also have side effects that will require monitoring to avoid adverse incidents. Diagnosis is often conducted using DSM-5 for psychotic disorders. There are risk factors associated with the prevalence of the condition among patients. In this regard, the paper aims to reflect on treating patients diagnosed with bipolar disorder.

Prevalence of Bi-polar 1

The prevalence of bipolar 1 disorder globally, according to the World mental health survey, stands at 0.6%, while the rate is 0.4% for bipolar 11. In America, for adults above the age of 18 years, the disorder affects approximately 1% of the population, while 9% of those diagnosed with bipolar experienced bipolar 11 (Tchikrizov et al.,2023). The prevalence among men and women is almost similar, with a difference of 0.1%; prevalence in males is 2.9% and 2.8% in women (Carter & Regner, 2022). For adolescents (children between 13 and 18), the prevalence is estimated at 0.3% (Tchikrizov et al.,2023). Similarly, the lifetime risk of being diagnosed with bipolar 1 disorder ranges between 10% and 5%. This range factors the increased risk in people with a historical background of bipolar 1 disorder in their family line. Data indicates that the prevalence of bipolar in people whose relatives have previously been diagnosed with bipolar is 7 times higher than in those who have no historical background of bipolar in their family tree.

Neurobiology of Bipolar 1 Disorder

The neurobiology of bipolar 1 remains to be unclear. There are, however, attempts to explain the neurobiology of the disorder. For instance, the neurobiology of the disorder is associated with dysfunctionality of the hypothalamic-pituitary-adrenal (HPA). A dysfunctional HPA affects the neuro-progression of the victims, leading to the recurrent disposition of the HPA axis. This can induce mood swings, anxiety, and depression; in severe cases, these episodes become refractory (Carter & Regner, 2022). Neuroprogression, in this case, occurs because of stressors related to environmental factors, such as poor psychosocial conditions. Other factors such as trauma, genetics, and other vulnerabilities also affect the neuro progression leading to bipolar episodes. HPA dysfunction occurs when inflammation, epigenetic and neurotrophic changes occur.

Differences Between the Different Types of Bipolar Disorder

The similarities and differences discussed in this case will be between bipolar 1 and bipolar 11 disorders. In the diagnosis of bipolar 1 disorder, the maniac episode being experienced by the patient should be greater than 1 . Maniac episodes, in this case, can be described as elevated energy levels and expressions. The maniac episode needs to have occurred for more than one week. The maniac episodes experienced are also experienced by people diagnosed with bipolar 11 disorders (Tchikrizov et al.,2023). However, the major source of difference occurs in the intensity or severity of the maniac episode. In bipolar 11, the maniac episode is often referred to as the hypomania episode because the episodes are more severe when compared to the maniac episodes experienced by people with bipolar 1 disorder. The hypomanic episodes being experienced by the patient also need to be greater than 1. In bipolar 11 disorders, diagnosis occurs when the hypomanic episode occurs alongside major depressive episodes that are often greater than 1. The neurobiology of both disorders remains to be unclear. However, the mania and hypomania episodes experienced in both disorders are induced by the recurrent disposition of the hypothalamic-pituitary-adrenal axis.

Symptoms of Manic and Hypomanic Episodes

The table below highlights the symptoms associated with manic and hypomanic episodes experienced in people with bipolar 1 and 11 disorders. The DSM-5 diagnostic criteria inform this table.

The Population of Interest and Considerations

The population of interest, in this case, will be expectant women. This population set is ideal or favourable for analysis because of the risk associated with pregnancy and the increased prevalence of bipolar among women than men. Data indicates that for women, bipolar 1 disorder manifests in the early twenties and late teens of women. In expectant women, there is an increased risk of developing bipolar 1 disorder if the pregnancy is the first for the particular client (Nolen et al.,2020). Therefore the social determinants of health for women, in this case, are their physical condition; the prevalence of the first pregnancy. The other social health determinants for such women are age and historical background. As mentioned above, women in their early twenties and late teens are at risk of developing bipolar 1 disorder.

There are legal considerations when handling expectant women; an example is the emancipation status of the woman. The patient’s age matters because it helps determine the decision-maker during treatment. For minors in certain states, the law allows them to be the legal decision-makers when pregnant. In other states, the pregnancy exemption does not exist, and the surrogate decision maker would be the legal guardian (Shahrbabaki et al.,2020). The ethical consideration to be considered would revolve around the principle of autonomy. That is incorporating the patient’s desires in formulating treatment. The cultural consideration will be the genetic component of the disorder in the patients. In this case, a family history associated with a relative diagnosed with bipolar disorder increases the patient’s risk factor for developing bipolar.

Pharmacology of Bipolar 1 Disorder

There is no absolute treatment for bipolar 1 disorder; however, there are medications that can help manage the symptoms. In patients with less severe acute manic episodes, lithium is the recommended drug. The drug is FDA approved for the population of interest in this who are pregnant women (Misiak et al.,2020). The second-generation antipsychotic is used in behavioural control. The second generation antipsychotic drugs are often used in patients with severe manic episodes. Examples of these drugs are Clonazepam and lorazepam. The other alternative treatment for patients diagnosed with bipolar disorder 1 is subjecting the patient to cognitive behavioural therapy. This mode of treatment aims at preventing recurrent symptoms of mania. An indication is that cognitive behavioural therapy reduces the relapse rate among patients in recovery mode by treating underlying triggers of bipolar disorder.

Impact of the Medications

Lithium as a form of medication was approved by the FDA in 1970 as one of the recommended drugs for treating bipolar disorder. Lithium’s short-term side effects are dizziness and muscle weakness; long-term side effects are headache, acne, changes in the BMI index, and fatigue. In the lab, the practitioners would monitor lithium toxicity as the risk associated with prolonged drug use (Kessing et al.,2021). The purpose of monitoring lithium toxicity is to avoid adverse effects on the kidneys and thyroid glands.CBT is also an FDA approve course of treatment. The FDA approves various apps that are used in the treatment of underlying causes of bipolar 1. One of the side effects revolves around being physically drained because of the intensity of the sessions. For instance, exposure therapy is often overwhelming because it involves subjecting patients to their triggers. During exposure or assessment using the CBT-1, healthcare officials often monitor the abstract reasoning and memory of the patient. This is important to monitor because it informs the pharmacological course of action and other legal considerations, such as the emancipated state of the patient.

Examples of how to Write a Proper Prescription

Prescriptions 1

Name of patient; Birch Feronzi Martinez

Weight 87.4kg

Date; 6/28/2023

Medication Lithium Rx

300mg three times /day for 30 days

Refills; monthly

Signature

Prescription 2

Name of patient; Valdez Marinara

Weight; 76 kg

Date; 6/28/2023

Clonazepam 4mg 3 times a day for 30 days

Refills; once a month

Signature

Prescription 3

Name of the patient; Barouche Marylou

Weight; 90kgs

Date; 6/28/2023

Lithium 300mg 3 times daily

Atenolol 25 mg twice a day Refills; once a month

Signature

Conclusion

Bipolar 1 disorder can be described as a psychotic disorder. From the discussion above, it is evident that the condition does not have an absolute treatment. An indication that the condition is managed using a combination of modes of treatment. Examples used for the study are pharmacological treatment and behavioural treatment. The type of drugs being administered also relies on the severity of the symptoms; the main aim is to prevent relapse rates among those diagnosed with bipolar 1 disorder. The prevalence of the condition also revolves around risk factors associated with the condition, an example being first-time pregnancies, family history of bipolar, and age of the patients. In this regard, healthcare practitioners need to use standard diagnostic tools such as DSM-5 in diagnosing bipolar disorder because it will help differentiate bipolar and related disorders using the symptoms highlighted in the diagnostic tools.

References

Carter, A. E., & Regner, M. (2022). An adolescent with bipolar 1 disorder: A complex case with grey matter hyperintensities and parkinsonism symptoms. Psychiatry Research Case Reports, 1(2), 100079.

Kessing, L. V., González-Pinto, A., Fagiolini, A., Bechdolf, A., Reif, A., Yildiz, A., … & Vieta, E. (2021). DSM-5 and ICD-11 criteria for bipolar disorder: Implications for the prevalence of bipolar disorder and validity of the diagnosis–A narrative review from the ECNP bipolar disorders network. European Neuropsychopharmacology, 47, 54-61.

Misiak, B., Bartoli, F., Carra, G., Małecka, M., Samochowiec, J., Jarosz, K., … & Stańczykiewicz, B. (2020). Chemokine alterations in bipolar disorder: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 88, 870-877.

Nolen, W. A., Licht, R. W., Young, A. H., Malhi, G. S., Tohen, M., Vieta, E., … & ISBD/IGSLI Task Force on the treatment with lithium. (2019). What is the optimal serum level for lithium in maintaining bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar disorders, 21(5), 394-409.

Shahrbabaki, M. E., Sabouri, S., Sabahi, A., Barfeh, D., Divsalar, P., Esmailzadeh, M., & Ahmadi, A. (2020). The efficacy of probiotics for the treatment of bipolar disorder-type 1: a randomized, double-blind, placebo-controlled trial. Iranian Journal of Psychiatry, 15(1), 10.

Tchikrizov, V., Ladner, M. E., Caples, F. V., Morris, M., Spillers, H., Jordan, C. D., … & Vallender, E. J. (2023). Health disparities in the treatment of bipolar disorder. Personalized Medicine in Psychiatry, 37, 100101.