Bipolar disorder is a mental health condition characterized by frequencies of mood changes from depression to maniac symptoms. Bipolar is categorized into subtypes of unipolar depression, bipolar I and bipolar II. The differences between the two subtypes of bipolar depend on the severity and frequency of the depression and maniac symptoms. Bipolar I patients have more severe manic symptoms while bipolar II patients have less severe manic symptoms termed as hypomanic episodes. The severity, however, changes with depression symptoms with bipolar II patients experiencing more severe depression symptoms than bipolar I patients. Bipolar is globally considered as the most prone mental health disability. Annually, the percentage of persons who get diagnosed with bipolar disorder is approximately 0.8 with the figure rising beyond 1.1 percent on a lifetime bipolar diagnosis. Persons who experience shortened symptoms of depression and manic episodes that are categorized as less severe are estimated at 6 percent of the global population. 90 percent of those who experience less severe symptoms also experience recurring episodes (McIntyre & Calabrese, 2019). Both men and women show equal rates of prevalence, an indication that bipolar does not correlate with gender. Elaborate symptoms and treatment of bipolar disorder are herein discussed in this paper.
Symptoms of Bipolar Disorder
The most common symptom of bipolar disorder is the frequency to attempt or complete suicide. Both bipolar I and bipolar II patients show a high affinity to suicidal actions with bipolar II having a high rate of suicidal activities than bipolar I patients. The subtype with the least number of suicidal attempts and completion is the unipolar disorder. A study by MacQueen and Young (2001) conducted on patients suffering from the three subtypes indicated that 17 percent of bipolar I patients had attempted or completed suicide while 24 percent of bipolar II patients had attempted or completed suicide (MacQueen & Young, 2001).
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The next symptom of bipolar disorder is the expression of manic episodes in patients. Symptoms of mania include a demonstration of episodes of euphoria, increased physical activity, and experiences of delusions. Both bipolar I and bipolar II patients show episodes of mania. The intensity in which patients show symptoms of mania varies between bipolar I and II patients thus showing no correlation to any of the bipolar subtypes. However, there exists a relationship between the intensity of mania and family history, an indication that the severity of mania episodes might be genetically transmitted to offspring. Conclusive studies have indicated that patients who have a family history of bipolar disorder have a 5178 gene in the mitochondrial DNA (Kato, Kunugi, Nanko, & Kato, 2000). The presence of this gene in their DNA is responsible for the severity of expression of mania, which is higher in patients with family history than in patients of any bipolar subtype with no family history of the condition. There is however a difference in the frequency of expression of maniac symptoms among the bipolar subtypes. Bipolar II patients express the highest number of maniac symptoms than bipolar I and unipolar depression patients (Sublette et al., 2009).
Depression is also a major symptom of unipolar depression, bipolar I and bipolar II patients. It is defined as a continuous expression of extreme sadness and disinterest in daily human life activities. Short periods of sadness and disinterest in daily activities do not amount to depression. A depressed bipolar patient will show signs of extreme disinterest in normal activities such as cleaning, eating and watching television. Bipolar patients also show a reduced level of interest in their previous hobbies such as reading, taking walks, and participation in sporting activities. Depression may also lead to loss of sexual desire among couples and fluctuations in appetite. The appetite may elevate or may greatly reduce. Other signs of depression include changes in body mass, as a result of fluctuations in appetite. The patients may have increased or reduced weight which may also come as fluctuations between the two. Depressed patients also have fluctuations in sleeping patterns with others having reduced sleeping hours while others sleeping beyond their normal sleeping hours.
Bipolar patients also show increased episodes of agitation and restlessness, which may be categorized under their depressive mood. Additionally, the patients may show episodes of slowed speech while communicating and slowed movement. Fatigue is also common among bipolar patients. This may be as a result of the previous episode of hyperactivity that leads to loss of energy. The patients also have feelings of being worthless or feelings of guilt without any wrongdoing. The patients also experience difficulty in listening and making simple decisions. The severity of depression among bipolar patients is higher in women than in men. This is partially due to postpartum depression, suffered by women after childbirth.
Another bipolar symptom is cognitive incapability. Patients with bipolar disorder have a lower working memory than the average healthy person. Their verbal memory is also slower with most patients being unable to recall conversations made with a short period. The speed at which bipolar patients process audio and verbal information is also slower than that of a healthy person. The patients also have reduced levels of sustaining attention which is linked to their inability to concentrate and listen to verbal or audiovisual communication. The severity in which bipolar patients express the cognitive incapability is similar in both bipolar I and bipolar II patients (Kato, Kunugi, Nanko, & Kato, 2000).
Bipolar patients also suffer from other comorbid conditions which may be listed along as symptoms of bipolar conditions. The comorbid conditions frequently experienced include diseases of the heart such as cardiovascular disease. Cardiovascular conditions suffered by bipolar patients are linked to their unhealthy eating habits caused by fluctuations in moods and appetite. Bipolar patients also have a high prevalence of diabetes and hypertension. Obesity is also common in bipolar patients and is directly linked to an increased level of appetite as a symptom of depression.
Bipolar patients also show psychiatric related symptoms brought about by depression episodes. These symptoms include a shoe of anxiety and drug abuse and addiction. Drug abuse occurs when depressed bipolar patients use drugs in un-prescribed ways. The patients, often abuse drugs in an attempt to treat other symptoms related to bipolar disorder. An example is an abuse of hard drugs in an attempt to be active after suffering a sad episode linked to bipolar disorder. Since the symptoms of bipolar are recurring and prolonged, drug abuse among bipolar patients often leads to drug addiction. Drug addiction occurs when the patients are no longer able to stop using the drugs in the presence or absence of the episodes they attempt to treat.
Treatment
Bipolar patients often undergo misdiagnosis. This has been attributed to a high number of comorbid conditions suffered by these patients. The high number of comorbid conditions are also caused by the high number of depression symptoms suffered from bipolar disorder patients. Reports indicate that only 20 percent of bipolar patients had the condition accurately diagnosed within the first year of the illness. Averagely, a patient may suffer for five years before getting an accurate diagnosis of bipolar disorder (Sublette et al., 2009).
Accurate and timely diagnosis of bipolar disorder is vital since the condition often deteriorates with time. Upon diagnosis, the line of treatment often administered depends on the most pronounced symptoms at the time of diagnosis. Patients who show high levels of mania expressions are often treated by the administration of mood stabilizers. Mood stabilizers commonly used include lithium and lamotrigine.
I cases, where depression is the most pronounced symptom, administration of a combined dose of fluoxetine and olanzapine, is often recommended. Some medications have shown efficiency in their ability to treat both symptoms of depression and mania. The use of such medication, therefore, does not depend on the most pronounced symptoms. The multi-acting medication for both depression and mania includes cariprazine and quetiapine. The administration of antidepressants was common in bipolar patients who showed depression as the most pronounced symptom. However, there exist guidelines that currently contraindicate the prescription of antidepressants as a form of treatment among bipolar patients. The contraindication is due to the proven clinical inefficiency of antidepressants.
Notably, the other comorbid conditions in bipolar patients demand separate and specific medications. This implies that a bipolar patient who also suffers from hypertension requires an administration of the bipolar treatment along with a prescription of hypertension as a comorbid condition. A high number of comorbid conditions suffered implies that bipolar patients may have to cope with several medications in the same period. Caution should, therefore, be taken to avert possible drug-drug interactions or extreme side effects caused by multiple drugs (Sublette et al., 2009).
References
Kato, T., Kunugi, H., Nanko, S., & Kato, N. (2000). Association of bipolar disorder with the 5178 polymorphism in mitochondrial DNA. American Journal of Medical Genetics , 96 (2), 182-186. doi:10.1002/(sici)1096-8628(20000403)96:2<182::aid-ajmg12>3.3.co;2-h
MacQueen, G. M., & Young, L. T. (2001). Bipolar II disorder: Symptoms, course, and response to treatment. Psychiatric Services , 52 (3), 358-361. doi:10.1176/appi.ps.52.3.358
McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and unmet needs of a complex disorder. Current Medical Research and Opinion , 35 (11), 1993-2005. doi:10.1080/03007995.2019.1636017
Sublette, M. E., Carballo, J. J., Moreno, C., Galfalvy, H. C., Brent, D. A., Birmaher, B., … Oquendo, M. A. (2009). Substance use disorders and suicide attempts in bipolar subtypes. Journal of Psychiatric Research , 43 (3), 230-238. doi:10.1016/j.jpsychires.2008.05.001
