Bipolar Disorder, which is referred to as manic depression is a mental illness that results in lengthened periods of depression as well as elevations in the mood of the patient. The elevations in the mood are significant, where they are clinically referred to as mania or hypomania, while the reference depends on the severity of elevation or depending on the presence of psychosis ( Baker et al., 2014) . In the mania phase, the patient has a characteristic behavior of feeling abnormally energetic, happy and sometimes the patient is irritable. The mania phase leads the patients to make poor thoughts out of decisions in relation to the consequences of such decisions. The manic phases also lead to the reduction in sleep with associated symptoms of insomnia. In the phases of depression, the patient may often cry and have a negative outlook on living. The patient may have poor eye contact with peers, which may lead to isolation. Such patients have high risks of suicide, where it is greater than 10% for patients with over 20 years of suffering, while less self harm may occur among the 20-40 percent of the patients. Bipolar disorder is characteristically divided into two types depending with the phase of infection ( Geddes & Miklowitz, 2013) . The two types if disorders are the bipolar 1 and bipolar 11 disorders, which arise as a result of the mania phase and the hypomania phase respectively. The pathophysiology of the disease is linked to the reduction on the volume of the specific areas in the hippocampus. This paper takes an analysis of the bipolar disorders.
Bipolar 1 Disorder
Bipolar 1 disorder is the type one bipolar disorder, which is characterized by a bipolar spectrum associated with the occurrence of manic or mixed episodes. The patients diagnosed with the type one bipolar disorder have more depressive episodes, where they experience the hippomanic stage before proceeding to the maniac stage ( Craddock & Sklar, 2013) . The type one bipolar disorder is in conformation with the classical concept of the manic-depressive disorder, which is characterized by psychosis in the wake of the mood episodes.
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Psychosis is a condition of psychological abnormality, where the patient loses the contact with reality. The patients with this abnormal condition of the mind often exhibit the changes in personality and the thought disorder ( Baker et al., 2014) . The severity of the abnormal condition will determine the symptoms depicted by the patient, where it is often accompanied with unusual behavior that is bizarre. Patients may also have difficulties in social interaction and they are likely to have an impaired system in carrying out the daily life activities. Psychosis is the major abnormality that is associated with type one bipolar disorder, which is a view of a psychiatric disorder that is diagnosed through exclusion.
In the wake of diagnosis of the psychosis, there are no evident signs of it being a psychiatric disorder up to the time when other known causes are determined through medical and laboratory testing. The testing is recommended with the exclusion of other central nervous system disorders and injuries to the brain as well as the psychoactive substances for the full conclusion of the condition as being psychosis ( Craddock & Sklar, 2013) . Bipolar 1 disorder gives the requirement that an individual experiences full manic or mixed manic episodes, which is the major variation with the type-two bipolar disorder, where a patient will be subject to less severe manic episodes.
Bipolar 1 disorder is diagnosed through a clinical course that is characterized by the confirmation of the existence of the manic or mixed episodes. Individuals with type-one bipolar disorder have a single or multiple major depressive episodes. A single episode of mania is sufficient for the confirmation of the diagnostic procedure for the type-one bipolar disorder. In this case, the patient will or will not have the history of major depressive disorder ( Baker et al., 2014) . For the conclusion to be made in association with the type-one bipolar disorder, there are exclusions that should be made in the course of diagnosis. For instance, there should be exclusions on the mood disorder as a result of the effects of medication, coupled with other somatic treatments for the depression ( Geddes & Miklowitz, 2013) . Drug abuse should also be excluded or exposure to toxins as well as the mood disorder resulting from general medical procedures, which may resemble the bipolar 1 disorder.
Bipolar II Disorder
Bipolar II disorder is also known as type two bipolar, where it is the characteristic form of a single or multiple episodes of hypomania as well as a major episode of depression ( Whitton eta l., 2015) . Hypomania is a phase that is less severe as compared to the mania phase, where it is the characteristic form of persistence in disinhibition and pervasive elevated euphorisms. Hypomania is distinct from the mania phase in that the latter is rid of the psychosis phase. The characteristics of the mania phase are that the patient will feel extremely energetic, talkative and more confident than usual, while the hypomania is a situation where the patient will feel to be productive mixed with the feeling of anxiety ( Geddes & Miklowitz, 2013) . The hypomania phase can become troublesome if the patient is allowed to engage in risky or inadvisable behavior.
The type two bipolar presents more than frequent depressive disorders that alternate with shorter periods of well being as compared to type-one bipolar ( Craddock & Sklar, 2013) . The cause of type two bipolar is chronic, where it is associated with more frequent circles as compared to the type one bipolar. The type two bipolar has the highest risk of suicide as compared to the type one bipolar. Event though type one bipolar is considered to have severe consequences, the both bipolar disorders have equally severe burdens ( Baker et al., 2014) . Type two bipolar has a difficulty in its diagnosis procedure. Most of the patients are known to seek help especially when depressed. The hypomania symptoms are not easily discovered since they are attributed to the personality, where they may be as well be mistaken for the high functioning behavior or some form of normal anxiety.
Causes of Bipolar Disorders
There is a variation in the causes of the bipolar disorders, where they range from the nature of the individual, while the exact mechanism that underlies the causal agents is unclear. Almost 70% of the causes of bipolar disorders are associated with the genetic factors, where the development of the disorders is associated with the hereditary component of the patient ( Baker et al., 2014) . There has been a heritability spectrum for bipolar, which is estimated at 0.71 twin studies, which has led to the conclusion of the genetic contribution in the infection of the bipolar disorders. Other factors that have been proved to be contributory to the infection of bipolar disorder are the environmental factors such as the child upbringing, although they are of little significance.
Behavioral genetics has proved that the regions within chromosomes and the candidate genes are highly associated with the susceptibility of the bipolar disorder, where each gene is believed to exert a mild to moderate effect ( Craddock & Sklar, 2013) . The percentage of bipolar risk is higher among the first degree relatives especially among those infected with the disease as compared to the other people belonging to the general population. It is thus evident that the environmental factors will lead to susceptibility to the disease as a result of the changes in the genetic content of a person.
How Bipolar Affects the Elderly
Whether A Person With Bipolar Is More Likely To Develop Dementia
Bipolar disorder is linked to a range of psychological issues including mood swings. Risk-taking and euphoria can be caused by mania to a level that is very dangerous or can sometimes manifest in other ways such as extreme irritation accompanied by the patient lashing out at others (Mitchell et al., 2016). Depression makes one feel horrible and worthless or desperation and hopeless and may lead to a risk of committing suicide. These are the core symptoms of bipolar but there are other subtle symptoms known as cognitive impairments that is manifested through problems with decision making, thought processing, attention, and memory. These bipolar effects of cognitive impairments are further linked to other mental symptoms of illness know as dementia (Mitchell et al., 2016).
Therefore, it is evident that elderly people with bipolar disorder have a high chance of developing dementia (Mitchell et al., 2016). A majority of the elderly people lose cognitive function as their age advance. It is rare to find elderly people without cognitive impairments such as forgetting recent events, appointments, and names. Studies indicate that about 20% of people aged 65 years and above some degree of cognitive impairment. Globally, it is approximated that close to 36 million people live with dementia with the figure expected to double in the next 20 years. This problem in the elderly is associated with certain disorders or diseases such as brain tumor, vascular disease, alcoholism, head injury, stroke, Alzheimer’s disease, Huntington’s disease, Parkinson’s disease, and stroke among others. Each of the disorder or disease mentioned above has a unique risk of causing serious cognitive impairments (Mitchell et al., 2016).
Based on the analysis above, it’s now official that bipolar disorder is really linked to dementia (Gerhard et al., 2015). A majority of people diagnosed with dementia have bipolar disorder in later life as opposed to the general population. Some of the patients diagnosed with dementia develop the disease in their earlier life with others showing the symptoms in their middle-age as opposed to their sixties whilst a few people develop these problems in their eighties (Gerhard et al., 2015). This risk tent to increase the affected people’s episodes when depressive or manic. There is scanty information explaining why we have an increase in the risk because the study findings linking bipolar and dementia surfaced in one and half decades back which is a short period of time in field of research. Thus, we it shall take more time to establish the exact relationship between the two.
The Difficulties That the Elderly Face In Dealing with Bipolar
According to Granek et al. (2016), people of all ages as mentioned earlier can be affected by bipolar disorder including older adults. However, a majority of the affected people are above 65 years. Caring for elderly diagnosed with bipolar squarely lies with the family members such as adult children and spouses. Thus, the family members should be aware of the difficulties the patients diagnosed with bipolar disorder have including manic episodes and depression manifested in irritability and agitation. Those aged 60 years and above have severe problems like psychosis, hyperactivity, confusion, and distractibility. For such patients, they tend to have either rapid cycling form of bipolar disorder demonstrated through mania and frequent depression episodes or both. Therefore, these elderly are normally in a state of irritable depression whilst others, like it was mentioned earlier, show significant transformations in cognitive functioning encompassing issues related to problem-solving, perception, judgment, and memory among others (Granek et al., 2016).
Prevention and Treatment of Bipolar Disorders
The attention of preventing the bipolar disorders is focused on the reduction of the levels of stress within the childhood adversity as well as the families under conflict. Although stress is not the causal agent for the bipolar disease, it is known to increase the vulnerability of the individuals with the genetic makeup towards infection. Other related life activities that have been known to fuel and not proved to cause the bipolar disorder are drugs such as cannabis, where subjects are advised to control the use ( Geddes & Miklowitz, 2013) . On the other hand, there are a number of medications that are sued in response to the bipolar disorder. Lithium is the most effective form of medication that has been proved to work for patients diagnosed with the mania and hypomania phases of bipolar disorder ( Craddock & Sklar, 2013) . Lithium is known to reduce the suicide risks, self harm and death among the people suffering from high levels of depression resulting from bipolar disorders. There are also other anticonvulsants that are used in response to the effects of bipolar disorder. These include carbamazepine and sodium valproate.
The Effects of Bipolar On the Medication Used To Treat a Person with Dementia or the Elderly
Traditionally, bipolar and dementia were regarded two different clinical entities but the recent clinical and preclinical data in elderly people indicates that they have a high connection. Bipolar and dementia disorders exhibit varying irregularities in functional brain neuroimaging. Although the design of "dorsal" hypoactivity and "ventral" hyperactivity in brain emotional paths is largely evident in bipolar disorder, it has not been revealed in dementia (Mast et al., 2016). Regarding the treatment of the two, memantine and acetylcholinesterase inhibitors are used in treating patients showing symptoms of cognitive impairments in dementia. They are also to improve psychological and behavioral symptoms that manifest throughout the course of dementia. According to Mast et al. (2016), antidepressants, anticonvulsants, lithium, and antipsychotics are effective in managing cases of acute bipolar disorder episodes of younger adults. Currently, there is no empirical or evidence-based data supporting their use in treating elderly bipolar patients (Mast et al., 2016).
However, it is possible that the efficacy of antipsychotics and anticonvulsants is superior in treating cases of acute bipolar episodes manifested in elderly people. Unfortunately, the two categories of medications are linked to significant adverse effects. Research findings indicate that elderly bipolar patients in their maintenance phase can effectively be treated through continuation of agents for acute episodes (Mast et al., 2016). Elderly bipolar patients with cognitive symptoms are yet to get an appropriate treatment because studies are underway to find a reliable treatment for such cases. Besides, controversies still surround the therapeutic value of psychotropics other than memantine and cholinesterase inhibitors in dementia because of their connection to certain side effects (Mast et al., 2016). The latest research about the use of lithium in dementia is hoped to provide more information regarding the association of elderly bipolar disorder and dementia. Despite the fact chances are high that dementia can be prevented by lithium treatment, none of the current clinical studies support this claim. The clarity in the value of lithium treatment in the prevention of dementia as well as the preventive significance of intervention measures against the two disorders’ vascular risk factors remain unclear and shall be established in the coming prospective studies.
Bipolar disorders are thus characterized by the reduction in the volume of the specific areas in the hippocampus. The two major types of bipolar disorders are the type one and type two bipolar. The classification is dependent upon the severity of the infection. Type one bipolar is the most severe, where it is associated with the maniac phase of bipolar disorder, while type two bipolar is associated with the hypomania phase of bipolar disorder. Both phases are associated with elevation in the mood, while the patients may portray symptoms of depression. The mania phase makes the patient to feel extremely energetic and irritable, while the hypomania stage is associated with high levels of depression.
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