Overview
Bipolar disorder is a critical mental health condition often characterized by the occurrence of deep, prolonged and profound depression, which accompanied by the alternating episodes of excessively elevated at least one manic(irritable mood) and/or mixed-manic. Essentially, the disorder is a brain disorder that often results into irregular shift in one’s mood, energy as well as activity level and ability to carry out daily activities. Bipolar disorder tends to express itself in episodes of irregular pattern changes in one’s energy level, mood and thinking. The disorder is also often linked to significant mortality risk, with about 25% of those diagnosed with the disorder attempting suicide and 11 percent completing. In most cases, bipolar disorder begins or develops during teen years or early years of adulthood. However, occasionally the disorder can manifest in children.
Everyone often experiences ups and downs; however, bipolar patients are different. They often experience extreme ranges of mood changes. Thus, bipolar disorder is also referred to as manic depressive disorder ( Comes et al., 2017). Mania is often characterized by pressured speech, heightened libido, less sleep, severe thought disturbance with or without episodes of psychosis and reckless behavior. Between depressive and manic occurrences, patients with bipolar disorder usually experience episodes of greater functionality. In the intervals between the occurring episodes, most bipolar patients often recover back to their normal state of well-being. Therefore, bipolar disorder can be described as a ‘‘cyclic ‘‘ or periodic disorder , with its patients cycling up into episodes of manic(irritable mood) or /and mixed-manic , then afterwards returning to normal self, and cycling “down “into a rather depressive period from which they as well eventually more or less recover.
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Unluckily, despite the availability of effective pharmacological and non pharmacological treatment, bipolar remains a lifelong challenge. The long-course of bipolar disorder still remains marked by regular relapses and recurrences including subsyndromal symptoms ( Maaser et al., 2018 ). As a result, globally, bipolar disorder is a leading cause of disability. It is also highly associated with a suicide rates and still remains a major public health challenge.
Effects of Bipolar disorder on the brain
Studies suggest that bipolar disorder tend to have effects on the cognitive functioning of the brain. Cognitive changes are often seen when the individuals seem to be either manic or depressed. These have been seen in research studies of sustained attention, verbal learning as well as executive functioning. The evidence from these studies have established that there trait cognitive abnormalities in patients with bipolar, although it is possible that these effects are often exacerbated by the various medications prescribed to patients and also the duration of the disorder ( Alves et al., 2018) . One study carried out to compare both depressed individuals and euthymic bipolar patients showed changes in regional cerebral blood flow (rCBF) in both target groups in multiple brain regions. , another study carried out on depressed, manic and euthymic persons found a trait abnormality in the brain, in the prefontal cortex. Further an fMRI study that aimed at comparing euthymic individuals to controls also established that changes that occur in limbic as well as visual cortex may often represent trait abnormalities that occur in the brain functioning ( Comes et al., 2017) . Data from neurocognitive research show widespread impairments that occur in attentional, emotional and executive brain function during manic episodes of bipolar disorder.
Causes of Bipolar Disorder
Although bipolar disorder is among the most common mental disorders affect a large population of patients, there is still no exact cause linked to the disorder. However, research suggests that a combination of various factors may contribute to one developing the disorder ( Comes et al., 2017) . They include genetic factors, environmental as well as neurochemical factors.
Genetic Factors
Bipolar disorder associated with genes. According to Comes et al. (2017); Maaser et al. (2018) and Grande et al. (2016), about half of patients with bipolar disorder have at least one family suffering from depression, extreme anxiety or any other mood disorder, an individual with at least one parent suffering from bipolar disorder has about 15 to 25 percent chance of developing or having the disorder. Similarly, an individual with non-identical twin suffering from the disorder has a 25 percent chance of exhibiting the illness, just the same chance as if both of their parents have the disorder. An individual with an identical twin that suffers from the condition, have a greater possibility of getting the disorder about an eightfold greater chance than a nonidentical twin.
Family Studies
Research shows that bipolar disorders tend to run into families. Comes et al. (2017) emphasizes that f irst degree relatives of individuals with bipolar disorders are about 7 more times to develop the disorder compared to the general population. Remarkably, Grande et al. (2016), point out that children born of a parent with bipolar disorder have a 50 percent chance of developing another major psychiatric disorder such as depression. Maaser et al. (2018 ) add that one longitudinal study indicated that sub threshold episodes of manic or hypomanic increased one’s risk in developing subsequent manic, hypomanic or even mixed episodes in children born of parent with bipolar disorder. Maaser et al. (2018 ) further point out that unipolar is normally one the most common type of mood disorder found in families of bipolar probands.
Twin Studies
Twins who are nurtured together typically share the same environment; however monozygotic twins have similar genes, while Dizy Gotic twins share about 50 percent of their genes ( Comes et al., 2017) . Twin studies thus tend to compare the existing concordance rates in both Dizy Gotic and Monozygotic twins. Correspondingly, the concordance rate is the proportion of twin pairs whereby the co-twins who are affected by the disorder or to the proportion of twin-pairs who are both affected. According to Comes et al. (2017), s tudies have further shown that a concordance of about 3390 percent for bipolar disorder in monozygotic twins. This is because identical twins share 100 percent of their genetic DNA.
Adoption Studies
Adoption studies give a different approach to differentiating both genetic and environmental aspects in familial transmission. According to Grande et al. (2016), further studies carried out utilizing a number of experimental designs such as the adoptee, which utilizes proband strategy. In proband strategy, the probands with from mood disorder and were initially adopted at birth are identified. Through this approach, nature is differentiated from nurture ( Comes et al., 2017) . From there, the rates psychiatric disorders are then identified in both biological and adoptive parents. Several adoption research studies establish that a common nurturing environment is rather not the only aspect that contributes to development of bipolar disorder in families ( Solé et al., 2017) . Offspring with biological parents suffering bipolar disorder often remain at a higher risk of developing the disorder, even when they are nurtured in an adopted home with parents without the disorder.
Linkage Studies
Many linkage researches of bipolar disorder have shown numerous chromosomal regions. Apparently, bipolar disorder and more specifically bipolar type 1, carries a key genetic constituent, with the linkage of the ANK3, clock as well as CACNAIC genes ( Solé et al., 2017) . Thus, the evidence showing a genetic role as it appears in bipolar disorder tends to take several forms.
Neurochemical Factors
There are three major brain chemicals that have been constantly associated with bipolar disorders. They included noradrenalin also referred to as norepinenephrine, dopamine and serotonin. Norepinenephrine together with 5 hydroxytrytamin (serotonin) are often associated with Psychiatric mood disorder such as bipolar depression. Serotonin on the other hand, is linked to numerous body functions such as appetite, sexual desire, memory, sleep and learning. Biochemical imbalance is also more likely to occur in the brain, increasing someone’s risk to experience mood episodes.
Recent theory has shown that bipolar disorder is highly linked to abnormal levels of serotonin chemicals in the one’s brain ( Alves et al., 2018) . Apparently, serotonin acts as one of the neurotransmitter in one’s brain, and it strongly influences one’s mood changes. As a result, an imbalance of serotonin is thought to occur as a result of irregular hormone production in the body or certain neurotransmitter, which tends to act a massager between connecting nerves cell ( Alves et al., 2018) . In addition, new research shows that stress hormone may often alter the way gene operate, allowing illness like bipolar disorder to surface.
Brain imaging studies have further facilitated in the study of factors that trigger bipolar disorders as well as other mental disorders. New brain-imaging procedures allow scientists to take pictures of the brain at work, to observe its structure including its activity, without the need of undergoing surgery. These techniques entail resonance magnetic resonance imaging (MRI), functional magnetic resonance imaging (FMRI) and Position Emission Tomography (PET).
Environmental Factors
A life event triggers an occurrence of mood episode in an individual having a genetic disposition for psychiatric disorder. Even without existing genetic factors, hormonal problems, altered health behaviors, drug abuse or even alcohol can trigger the onset of an episode ( Alves et al., 2018) . . Among individuals with a higher of developing bipolar disorder, the disorder is appearing at significantly early ages than imagined. The apparent upsurge in earlier onsets may be linked to the poor diagnosis in the past ( Solé et al., 2017) . Similarly, the change in the age of occurrence may be due to social as well as environmental aspects that are poorly understood.
Overall Grande et al. (2016) affirm that studies showing live occurrences have indicated patients with bipolar often experience previous heightened stressful life events before experiencing their first onset of mood episodes. Furthermore, more studies have established that negative life events often precede the occurrence of depressive episodes, manic or hypomanic of bipolar patients ( Maaser et al., 2018 ). Most studies have shown that from 20 percent to 60 percent of individuals with bipolar disorder may experience at least a single stressful experience rated as independent of their existing behavior in the previous 1 to 3 month before the onset of a mood disorder ( Solé et al., 2017) . Moreover, psychosocial stressors are linked to frequent relapses in bipolar individuals.
Although individual behaviors such a substance abuse is not singularly associated with the onset of the disorder, it can negatively impact the disorder by slowing down the recovery. Alcoholism or use of tranquillizers is more likely to trigger a more severe depressive episode ( Alves et al., 2018) . Notwithstanding this, individuals with Bipolar disorder normally find it beneficial to identify various ways of managing stress and so do those without the disorder. Though not a major cause, seasonal factors tend to play a significant role in the occurrence of the disorder.
Symptoms
Symptoms of bipolar disorder often vary among individuals. A patient with bipolar disorder may exhibit manic, depressive or mixed episodes. The mixed episodes are usually marked by both manic as well as depressive episodes ( Maaser et al., 2018 ). Moreover, these mood episodes may result to symptoms that may last a week to two weeks or even longer. During the occurrence an episode, the bipolar sympto12`ms may occur most of the day. Similarly, mood episode are often intense ( Grande et al., 2016) . The emotions are intense and they typically accompanied by changes in behavior, energy levels and even apparent activity level easily noticeable to others.
The table summarizes the key symptoms associated with both depressive and manic episodes in bipolar patients;
| Symptoms of depressive episode | Symptoms of a manic episode |
| Feeling extremely irritable or elated and high | Feeling extremely anxious or sad |
| Being more active than usual | Being restless or inactive |
| Having unsettled thoughts | Having trouble paying attention, distractibility or making decisions |
| Feeling of unwanted, less important and talented | Feeling worthless, suicidal and hopeless |
| Thinking one can carry out all tasks at once without help or getting tired | Inability to carry out even simple tasks |
| Increased sex drive and excessive appetite for things such as food, alcohol among others | Lack of interest or drive in almost all activities |
| Talking fast about many different things at the same things | Talking very slowly, with feelings of forgetfulness |
| Decreased sleep | Having sleeplessness or excessive sleep |
Notable, some individuals tend to experience milder symptoms of bipolar disorder than others ( Maaser et al., 2018 ). For instance, hypomanic episodes may make one feel great and become very productive, making them feel like nothing is wrong. On the contrary, Alves et al. (2018) explain that family and close friends may notice the apparent changes in both mood and activity level that is different from the norm and afterwards severe depression may occur after the mild hypomanic episodes.
Treatment and Management of Bipolar Disorder
Pharmacological Treatment
Bipolar disorders medications are prescribed by a psychiatrists o patients diagnosed with the disorder. However, Alves et al. (2018) point out that not all pharmacological medications resonate well with all the patients, it is therefore important to keep a daily chart of mood episodes, sleep patterns, and life events among others to help track the psychiatrist track the episodes and make changes where necessary.
Some of the pharmacological medications used to treat bipolar disorder include the mood stabilizers, atypical antipsychotic medications and antidepressants.
The Antidepressants Medications
The antidepressant drugs in conjunction with the mood stabilizers are often used to treat depressive episodes in bipolar patients. Like any other drugs, antidepressants may result in some effective in bipolar patients, these include ( Solé et al., 2017) ;
The antidepressants such as Lithium are normally prescribed for treating occurring symptoms. The drugs may result to mild negative effects, however, these effects in most cases normally goes way within a few days. The effects entail;
Mild headaches which do not last long
Sleep problems; which often occur only during the first few weeks, they also do not last long. To help minimize the effects, the doctor can sometimes reduce the medication dose or change the time the patients takes the medicine.
Sexual appetite; the medication can sex drive in both men and women.
Heightened nausea which often disappears within a few days.
Increased agitation
Effects on the brain
Studies show that antidepressant drugs may have some side effects on structural brain changes in bipolar patients. The changes are however limited to cortical layers and other key regions ( Alves et al., 2018) . Changes in the hippocampus and amygdala have been seen in bipolar patients with mood extreme mood disorders.
Atypical Antipsychotic Medications
Atypical antipsychotic are among effective drugs used in treating bipolar disorder. Grande et al. (2016) explain that the medications are often taken along with other medications. They include Olanzapine (Zyprexa, Aripiprazole (Abilify), Risperidone (Risperdal), Quetiapine (Seroquel) and ziprasidone (Geodon).
Atypical antipsychotic medications may have some side effects on the patient. The medications tend to trigger increased weight gain which is caused by the changes in one’s metabolism. As a result, the doctor should regularly monitor the patient’s glucose levels, weight as well as lipid levels ( Maaser et al., 2018 ). With long term use, the drugs may often cause tardive dyskinesia condition (TD). The condition tends to affect muscle movement especially around the mouth. A patient with tardive dyskinesia is unable to control these muscles ( Maaser et al., 2018 ). The effect can range from mild to severe, and it is not also curable. However, Solé et al. (2017) expound that some individuals with condition may partially or even recover when they stop taking the atypical antipsychotic drugs. Other effects linked to the drugs include;
Triggering feelings of drowsiness
Blurred vision
Menstrual challenges in women
Increased sun sensitivity
Rapid heartbeats
Skin rashes
Effects on the brain
Anti psychotic drugs tend to have an effect on the structural brain changes. The changes include reduced brain volume, increased striatum size, heightened density of the glial cells found in the prefrontal cortex, reduced gray matter in the parietal lobe and increased number of synapses ( Maaser et al., 2018 ) .
3) Mood Stabilizers
These are normally the first choice of medications when treating Bipolar Disorder. Generally, patients suffering from bipolar disorder are put on these medications for years ( Alves et al., 2018) . Apart from Lithium, most of the mood stabilizers are anticonvulsant. They are typically used to manage moods as well as treat any occurring seizures ( Grande et al., 2016) . They include Valproic acid or divalproex sodium (Depakote), Lithium, gabapentin (Neurontin), lamotrigine (Lamictal) and oxcarbazepine (Trileptal) among others.
Like many other bipolar medications, mood stabilizers may cause some side effects in patients. These side effects may include
Thyroid malfunction; Lithium treatments have been shown to trigger low thyroid levels in some patients, especially women. The hypothyroidism can often lead to changes in energy levels or even frequent mood episodes. It thus important to monitor carefully the patient, to ensure the thyroid levels are kept in check.
Increased levels of testosterone; Valproic acid has been associated with elevated testosterone in teenage girls resulting to polycystic ovary syndrome in young women. The condition is known to cause cysts in ovary tubes, hence resulting to a disrupted menstrual cycle.
Effects on the brain
It should also be distinguished that some of the medications, specifically lithium, may result in cognitive deficits especially in tests carried out on verbal memory. Although it still remain uncertain how the cognitive deficits are reflected in existing functional chain in brain activation ( Alves et al., 2018) .
Non pharmacological treatment
Psychotherapy
One of the most common non-pharmacological treatments is psychotherapy. Over years, the talk therapy has been used in the effective treatment in bipolar patients ( Alves et al., 2018) . The therapy gives education, guidance and as well as support to both the patients and their families. Examples of psychotherapy medications include ( Grande et al., 2016) ;
Psychoeducation; this aims at teaching patients about the illness and its treatment. through this treatment, the patient are able t recognize signs of relapse so as to promptly seek medical intervention before a full-blown episode takes place, normally, it is carried in groups.
Family-focused therapy; this therapy seeks to improve family coping strategies especially during the onset of new episodes. It helps the patient and family members build good communication and problem-solving skills.
Cognitive behavioral therapy; this helps patients to adopt better behavior patterns and avoid negative and harmful thoughts.
Interpersonal and social rhythm therapy; this seeks to enhance good relationships in patients experiencing bipolar disorders ( Maaser et al., 2018 ). The therapy also aims at helping patients develop better daily routines that protect them against manic episodes.
Conclusion
Bipolar disorder is basically a brain disorder that often results in extreme mood changes, energy as well as one’s ability to function properly. The factors linked to onset of bipolar disorder include environmental factors, genetic factors and neurochemical factors. Patients with bipolar disorder exhibit a number of symptoms which may range from unsettled thoughts, anxiety, extreme active/inactive, suicidal thoughts, indecisiveness, feeling of worthlessness, increased sexual desire /decreased sexual appetite and lack of interest or increased interest in everything at once among others. A number of medications are often used in the treatment bipolar disorder by psychiatrists. They include mood stabilizers, anti-psychotic and antidepressant medications. Although research have found that pharmacological treatments are key in managing bipolar disorder, other studies have shown that psychosocial interventions such as psychotherapy can significantly augment the clinical improvement. Moreover, the complexity of the disorder often renders any single approach inadequate to manage and treat the multifaceted disorder. Though these therapeutic may result into one or two negative effects, bipolar patients can benefit from an integrated psychosocial and mood stabilizers, together with close monitoring from the doctors to help ease the effects of the side effects.
References
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