Bipolar illness is a mental disease that is defined by unusual emotional changes such as ‘lows’ (depressive episode) and ‘highs’ (Hypomanic or manic episodes). During depression, people with bipolar disorder may feel sad, guilty and lose pleasure or interest in most activities. In contrast, when their moods shift to hypomania or mania, they may feel very happy, creative, full of energy, more talkative, and friendly. Regardless, such an elevated mood among people with bipolar disorder is short-lived and difficult to maintain as such individuals cannot follow a plan. Such unusual mood swings adversely affect an individual’s activity, sleep, behavior, energy, judgment, social relationships, and other aspects of life.
The signs and symptoms of bipolar disorder vary among individuals. For instance, in some, the symptoms may last for several months or years, while others may experience emotional highs and lows concurrently or in quick succession (De Girolamo, McGorry, and Sartorius, 2019). There are several forms of this mental illness, which include type I, cyclothymic, and type II bipolar, respectively. Although most researchers have not identified any single cause of the bipolar disorder, they believe that several risk factors include genetics, environmental factors, and differences in brain structure. Diagnosis is primarily done using a criteria set out in the DSM-5 whereby one must have symptoms lasting for at least a week or less if they were severe enough to require medical attention(Shah, Grover, and Rao, 2017). Although there is no known sure way of preventing the illness, recent research reveals that early intervention and treatment can help manage the symptoms associated with bipolar disease, thereby preventing it from worsening. The primary treatment options for this disorder include psychotherapy, medication, electroconvulsive therapy, and lifestyle remedies. This paper aims to discuss the prevalence, causes and risk factors, signs and symptoms, types, diagnosis, and the available treatment options of bipolar disorder.
Prevalence of Bipolar Disorder
Based on Our World in Data, approximately 46 million people (0.55% males and 0.65% females) worldwide have bipolar disorder. According to Dattani, Ritchie, and Roser (2018), the U.S. is recognized as the country reporting the highest cases of bipolar type I (1%), with nearly 2.8% of U.S adults being diagnosed with the bipolar disorder each year with a similar prevalence rate being recorded in both males and female (2.9 and 2.8 % respectively). Dattani, Ritchie, and Roser (2018) reveal that the prevalence rate of this mental disorder is highest (4.7%) among individuals aged between 18 to 29 years (with nearly 2.9% of adolescents suffering from the disorder with 2.6% reporting severe impairments) followed by those aged between 30 to 45 years old (3.5%) and finally people aged above 60 years old recording the lowest rates (0.7%).
Several studies have explored the prevalence rates of bipolar disorder based on some socio-demographic factors such as occupation level, income, and socio-economic status. Some evidence reveals that the prevalence rate of this illness is higher among unemployed people and those with low income. Conversely, some studies have revealed that people with higher creativity, socio-economic status, and occupational level are at a high risk of suffering from bipolar disorder. However, such interactions cannot be ruled out due to the small sample size used in these studies (De Girolamo, McGorry, and Sartorius, 2019).
Causes and Risk Factors of Bipolar Disorder
Although the precise cause of this mental illness is not known, several risk factors are associated with bipolar disorder. These include genetics, environmental factors, and biological differences. In terms of differences in brain structure, some types of scans that provide detailed images of the brain may reveal specific physical changes associated with bipolar disorder. However, little is known on how these structural differences in the brain influence the diagnosis and treatment of bipolar disorder (Vieta et al., 2018). The risk of having bipolar disorder is higher among individuals who have a first-degree relative with this illness, such as parents or siblings than those who do not have family members suffering from the illness. According to Vieta et al. (2018), this genetic risk factor is primarily attributed to the multiple nucleotide polymorphisms in the genetic coding of the brain-derived neurotrophic factor associated with this mental illness.
Several environmental factors are associated with bipolar disorder. First, stressful events such as early childbirth, divorce, disability, or the loss of a loved one may trigger a depressive or manic episode, leading affected individuals to develop bipolar disorder. Emotional abuse, such as maltreatment during one’s early childhood, is also believed to trigger the development of bipolar disorder later on in the affected individual’s life. Besides, bipolar disorder patients with a history of childhood maltreatment have been reported to indicate poor bipolar treatment outcomes characterized by more frequent and severe mood episodes (Shan, Grover, and Rao, 2017). Another environmental factor that is a risk factor for bipolar disorder is substance abuse. Frequent misuse of substances such as cannabis, sedatives, opioids, cocaine, and alcohol has been identified as a risk factor for developing psychotic disorders and bipolar mental illness.
Major Signs of Bipolar Mental Illness
People with bipolar mental illness often go through periods of extreme emotions, changes in behavior, sleep patterns, activity, individual judgment, and other aspects of life without realizing their detrimental effects. Such mood episodes may last for a day or even more extended periods, such as several weeks or even a year. The signs and symptoms of this mental illness are classified into two; manic or hypomanic episodes (emotional high) and depressive episodes (emotional low). Manic episodes are more severe and result in more noticeable difficulties in performing social activities at work or school and difficulties in initiating and maintaining social relationships. Such episodes may trigger psychosis, thereby leading to hospitalization.
On the other hand, hypomanic episodes comprise less intense manic symptoms that persist for at least four days in a row rather than a week. They do not cause noticeable problems in an individual’s day-to-day activities or daily functioning. Manic episodes comprise symptoms such as loss of appetite, being talkative about many unrelated things, racing thoughts, increased energy or activity, impaired judgment distraction, and feeling euphoric. On the other hand, a depressive episode is characterized by symptoms that result in noticeable difficulty in performing day-to-day activities at work or school and maintaining social relationships with other people. These symptoms include feeling sad, hopeless, or desperate, difficulties focusing, irritability, eating less or more, being anxious about minor issues, extreme fatigue, feelings of guilt, suicidal thoughts, and loss of pleasure or interest in most activities.
If a manic or depressive episode becomes intense among individuals with bipolar disorder, they may experience psychosis. In other words, they may enter a phase where they cannot differentiate between reality and fantasy. As such, psychosis symptoms during a manic episode may include hallucinations and delusions whereby individuals see or hear things that are not there in real life or believe they possess special powers or rankings in society which is not the actual case. On the other hand, psychosis symptoms during a depressive episode may include believing that one is broke, ruined, or has committed a serious crime. In some instances, individuals may experience the symptoms of both manic and depressive episodes concurrently. Such an episode is known to have mixed features. In this regard, individuals in a period with mixed features may experience symptoms such as feeling extremely sad and hopeless while at the same time feeling euphoric or energetic.
Types of Bipolar Disorder
Bipolar disorder is classified into three major types; bipolar I, cyclothymic and bipolar II. Type I is characterized by manic episodes that are persistent for at least a week or symptoms of the same that are extremely severe and require immediate medical attention. This type of bipolar disorder is also characterized by depressive episodes with symptoms lasting for at least 14days. In some instances, people with bipolar I disorder may experience mixed feature episodes or a neutral mood. Diagnosis for this type of mental illness requires an individual to have experienced at least a single manic episode or a major depressive episode with at least five of its main symptoms.
Bipolar type II is characterized by hypomanic periods, with depression being the most dominant state. Individuals with bipolar II Disorder may feel happy and show increased energy and activity levels, but their mood may not be stable, and they may sink into depression. Sometimes, people think of this type of illness as a milder version. However, this is not the case. According to Vieta et al. (2018), individuals with bipolar type II may encounter depression more frequently due to their vulnerability to other mental illnesses like substance use and anxiety disorders compared to those with bipolar type I. Diagnosis of bipolar type II requires one to have experienced at least a single hypomanic episode, one or more depressive episodes, no alternative diagnosis to explain the unusual mood swings. People with this type of disorder often resume their usual functioning between episodes. Also, they often seek first treatment after experiencing a major depressive episode since hypomanic episodes are characterized by the extreme pleasure that facilitates a significant increase in their performance at school or work.
Cyclothymic bipolar disorder is often described as a milder form of this mental illness characterized by frequently occurring hypomanic and depressive episodes with less intense symptoms than the type I and II bipolar disorders. Diagnosis of cyclothymic bipolar disorder requires one to have reported at least two years (1yr in children) or many hypomanic and depressive episodes with less intense symptoms than a major depression (De Girolamo, McGorry, and Sartorius, 2019).
Medical Diagnosis of Bipolar Mental Illness
Diagnosis of this mental condition is done primarily using a criteria set out in the DSM-5. The process involves the following steps:
- Comprehensive assessment of respective patients and their caregivers.
- Assessment of patient’s medical history with relevant information about the type of the first episode, duration and intensity of periods, presence or absence of agitation, suicidal behavior and periodic variation in symptoms occurrence, and the presence of mixed or rapid cycling.
- Assessment of patient’s history on precipitating factors at the onset of the illness such as psychosocial stressors or other biological disturbances.
- Physical assessment including measuring and recording the patient’s body mass index (BMI), weight, and blood pressure.
- Cognitive state assessment.
- Formulating the diagnosis based on the criteria set out in the DSM-5.
- Differential diagnosis and eliminating the possibility of a secondary disorder.
- Assessing patient on the risk of any suicidal behavior such as suicidal thoughts or plans, past attempts to commit suicide, history of completed suicide in the family line, psychotic symptoms in the form of intense hallucinations, anxiety, and substance misuse disorders.
- Factors to be assessed in the current episode such as the severity of signs and symptoms, comorbid mental and physical conditions such as the risk of harm to others or self, anxiety, and substance misuse disorders.
- History of previous treatment methods used, duration and patient’s response to the same, associated side effects, and the main reasons for termination.
- Basic tests such as electrocardiogram, haemogram, blood and urine tests to examine the blood sugar level, lipids level, liver, and renal functions.
- Assessing caregivers to gather and record information regarding what they know about the disorder, including its treatment options, beliefs, and attitudes about the same, its effect on their personal and social well-being in terms of being a financial burden, and stigmatization.
- Evaluating the patient on their response to current treatment that is underway, ease of access, associated side effects, and their adherence to the same.
Warning Signs that Indicate When One should Seek Medical Attention
Despite the unusual mood swings associated with this mental illness, people with bipolar disorder barely recognize the impact of these disruptions on their individual lives and their friends and family. At first, one may enjoy feelings of increased activity, energy levels, and pleasure, but this will eventually be followed by an emotional crash that will make you feel depressed and maybe leave you with financial or relationship problems. Hence, it is crucial to recognize that bipolar disorder does not go away on its own. Thus, if anyone realizes that they have manic or depressive symptoms, including suicidal ideations, behavior, and plans, they should confide in a close friend or relative to support them in seeking immediate medical attention from a medical professional.
Treatment Options for Bipolar Mental Illness
Although there is no precise cure for this mental condition, several treatment options for this mental illness are available. These include medication, psychotherapy, lifestyle remedies, and electroconvulsive therapy. Certain drugs are administered to bipolar disorder patients to help stabilize their mood and the symptoms associated with the illness. These include mood stabilizers like lithium and lamotrigine, antidepressants such as bupropion and tricyclic, first and second-generation antipsychotics, anticonvulsants to ease off manic symptoms, and drugs to aid with anxiety and insomnia. Some of these drugs have side effects that affect individuals differently. Thus, patients should consult with their doctors before taking or withdrawing any of these medications.
Psychotherapy can also be used to treat bipolar disorder effectively. It may involve various approaches such as cognitive behavioral therapy family-focused and interpersonal social rhythm therapies to provide guidance, support, and education to bipolar disorder patients and their families. Besides, such approaches can help people with this type of mental illness identify the first signs of an episode or trigger factors like stress and employ appropriate mechanisms to manage the same. Also, psychotherapy can help patients learn how to engage the support and help of their friends and family members.
Some lifestyle remedies can help in mood stabilization and relieve the symptoms of bipolar disorder. For example, engaging in regular exercises such as yoga, swimming, weightlifting, and cycling, maintaining a balanced and healthy diet, establishing and maintaining a routine such as regular sleep patterns to avoid insomnia, creating a life chart to record daily life events, and mood changes among others. The last treatment option is electroconvulsive disorder. It refers to a simulation procedure on the brain to help relieve the severe signs associated with bipolar disorder. It is done through several sessions that take several weeks to complete. It is often done under anesthesia precisely when physiotherapy and medication prove ineffective or unsafe for a bipolar disorder patient.
References
Dattani, S., Ritchie H., & Roser, M. (2018). Prevalence of Mental Health and Substance Use Disorders. Our World in Data. Retrieved from https://ourworldindata.org/mental-health#bipolar-disorder
De Girolamo, G., McGorry, P. D., & Sartorius, N. (Eds.). (2019). Age of Onset of Mental
Disorders: Etiopathogenetic and Treatment Implications. Springer International Publishing.
Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for the Management of the Bipolar Disorder. Indian Journal of Psychiatry, 59(Suppl. 1), S51.
Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., & Suppes, T. (2018). Early Intervention in Bipolar Disorder. American Journal of Psychiatry, 175(5), 411-426.
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