Bipolar II is a mood-related disorder with a high changing frequency between maniac and depression characteristics. Diagnostic criteria for bipolar II is fixed at one hypomanic episode that is followed by a severe depressive episode. The disorder is among the most common cause of disability in the world. McIntyre and Calabrese (2019) report that the global annual prevalence rate is 0.8 percent while the lifetime prevalence rate is 1.1 percent. Occurrences with shorter and less severe symptoms are estimated at 6 percent with over 90 percent of patients experiencing recurring episodes. Prevalence is equal in both genders and also shows no correlation with races (McIntyre & Calabrese, 2019). This paper reviews major symptoms and discusses the individual, family and societal challenges caused by bipolar II. Additionally, potential causes and current diagnostic and treatment procedures are discussed.
Symptoms of Bipolar II Disorder
MacQueen and Young (2001) note that the most distinct symptom of bipolar II disorder that sets it apart from unipolar disorder is the susceptibility to suicide. Studies indicate that the risk and frequency of suicide are higher in bipolar II than in other subtypes. One such study was conducted to determine the lifetime frequencies at which bipolar I, II, and unipolar depression patients attempted suicide. The results from the study indicated that the disorder with the least number of suicidal attempts was unipolar depression. Bipolar II disorder had 24 percent of its patients experiencing suicidal attempts while 17 percent of bipolar I had similar attempts (MacQueen & Young 2, 001).
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A related study by Sublette et al. (2009), attempts to determine the relationship between substance use disorders and the high rate of suicidal attempts in bipolar II. The study aimed to identify if the suicidal character in bipolar II is an independent symptom or a factor of substance abuse. In their study, a sample of 42 adults is assessed. The sample is a mixture of both patients with a history of drug abuse and those without any history of using drugs. Methods used for data collection in this study included an analysis of the psychiatric history of patients, scheduled laboratory analysis and physical body examination. After an exploratory analysis of the findings, it was concluded that there lacked any correlation between substance abuse and suicide attempts among patients with bipolar II. The case was dissimilar in bipolar I patients which indicated substance abuse as the main factor towards suicidal attempts (Sublette et al., 2009). Suicidal ideas, attempts, and executions are, therefore, major symptoms in bipolar II patients.
The expression of mania is a symptom characterized by episodes of euphoria, hyperactivity, and delusions. Mania is common in both bipolar I and II patients. MacQueen and Young (2001) suggest that the intensity of mania is a symptom that varies more with families than with bipolar subtypes. A study by Kato, Kunugi, Nanko, and Kato (2000) confirms MacQueen and Young’s hypothesis on the intensities of mania. In their study, the four researchers examine the possibility of a relationship between bipolar and the 5178 polymorphism carried by a mitochondrial deoxyribonucleic acid. 145 patients take part in this study, with 184 more being used as controls. The results of this study indicated that the presence of a genotype related to the severity of mania was higher among both bipolar I and II patients who had a family history of bipolar. They concluded that 5178 polymorphism, which is carried in the DNA, is responsible for the different levels of brain energy metabolism thus a direct link to intensity of mania (Kato, Kunugi, Nanko, & Kato, 2000).
However, the tendency towards the expression of mania in bipolar II patients is distinguishable from other bipolar subtypes. Patients with bipolar II conditions show higher frequencies of depression than patients with bipolar I (MacQueen & Young, 2001). A similar concept is shared in Vieta et al.’s study in their quest to identify features that distinguish bipolar I and II patients. In their study, 38 patients were monitored by different independent researchers and their findings tallied. Their results indicate that bipolar II patients had a remarkably higher number of depression and hypomanic episodes than bipolar I patients. They concluded that the severity of mania was higher in bipolar I than bipolar II but the frequency of the episodes was higher in bipolar II (Vieta et al., 1997).
In addition to the frequent mania expressions, bipolar II patients also show deficits in several cognitive features. They have a poor working and verbal memory with slow verbal learning ability. Additionally, the speed at which they process information is significantly slow. They also have difficulty in sustaining attention and their ability to coordinate sense and motion is abnormally lower than in healthy persons. Unlike in the severity of maniac expressions, the severity of cognitive features is similar in both bipolar I and II patients (Bora, Yücel, Pantelis, & Berk, 2010).
The aforementioned cognitive deficiencies also come along with medical and psychiatric comorbid conditions. Medical conditions such as cardiovascular diseases, diabetes, high blood pressure, and obesity have been found to have a high prevalence in bipolar II patients than in the general public. McIntyre and Calabrese (2019) indicate that 94.6 percent of bipolar II patients have one or more of these medical conditions. In addition to the medical conditions are psychiatric comorbidities which have been found in approximately 90 percent of patients with bipolar II disorder. Psychiatric related conditions include anxiety, unhealthy eating habits, and substance abuse (McIntyre & Calabrese, 2019).
Impact of Bipolar II Disorder on the Individual, Family, and Society
Bipolar II disorder has socioeconomic and psychosocial impacts on the patients, their families, and society. The negative socio-economic impacts of bipolar II are divided into direct and indirect impacts. Direct impacts arise from the medical bills accrued. This cost mostly affects patients and their immediate families. The substantial amount of family income channeled towards medical bills derails personal and family activities that would have been used in economic activities. Governments also feel these direct impacts through the payment of state-funded medical bills. Indirect socioeconomic impacts are caused by the reduced productivity arising from valuable time spent in the hospital. This is evident from a McIntyre and Calabrese’s (2019) report from a life-chart database that indicates 5.2 months of bipolar II patients are spent under depression. Bipolar II patients also spent 43% of their time ill. Patients in employment are also less productive at their workplace due to absenteeism caused by the disorder.
Psychosocial impacts are mostly burdened on family members and caregivers in their quest to offer protection and care. Bipolar II patients have an annual rate of attempted suicide at 3.9% and the rate of completed suicide at 1.4% (McIntyre & Calabrese, 2019). Family members and caregivers are, therefore, in constant fear of the possibility of these patients committing suicide. Patients may also be subjected to stigma and discrimination due to the unsocial symptoms of the disorder.
Potential Causes
Bipolar II has genetically, biological and environmental causes. In most patients, it takes a combination of more than one factor to suffer from the disorder. In genetics, the disorder is passed down to the offspring via a mitochondrial deoxyribonucleic acid. Biological causes arise from imbalances in chemicals within the brain or hormones within the body system. The imbalances trigger depression or maniac expressions and frequent recurrences may lead to bipolar disorder II. Environmental factors are those which persons are exposed to in their surroundings. They include mental stress and traumatizing experiences. Environmental factors mostly act as bipolar II triggers to persons who genetically harbor the disorder.
Diagnosis and Treatment
Misdiagnosis is common in bipolar II patients due to the different medical comorbidities related to the disorder. Accurate diagnosis within the first year of the disorder is only achieved in 20 percent of the patients. The mean delay time of diagnosis is between five to ten years (McIntyre & Calabrese, 2019).
Accurate diagnosis and timely treatment of bipolar II is essential since the severity of the disease increases rapidly with time. The first advisable line of action is the treatment of the most pronounced symptom at the time of diagnosis. Maniac expressions are treated by the administration of mood stabilizers such as lithium and lamotrigine. Symptoms of depression can be treated by the administration of fluoxetine and olanzapine in a combined dose. Cariprazine and quetiapine are efficient in treating both mania and depression symptoms. Current guidelines contraindicate the administration of antidepressants due to their clinical inefficiency. Medical conditions related to the disorder, such as hypertension and obesity should be managed and treated individually (McIntyre & Calabrese, 2019).
McIntyre and Calabrese (2019) give caution on potential drug-drug interactions in bipolar II patients. Due to numerous complications related to bipolar II, treatment of the entire list of symptoms and ailments results in a complex procedure with different medications. This may give rise to an interaction between drugs thus potentially harmful to patients. Side effects resulting from treatment should also be monitored and managed. Examples of side effects are obesity caused by antipsychotic drugs and renal toxicity caused by lithium.
References
Bora, E., Yücel, M., Pantelis, C., & Berk, M. (2010). Meta-analytic review of neurocognition in bipolar II disorder. Acta Psychiatrica Scandinavica , 123 (3), 165-174. doi:10.1111/j.1600-0447.2010.01638.x
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
Vieta, E., Gastó, C., Colom, F., Otero, A., Nieto, E., & Vallejo, J. (1997). Differential features between bipolar I and bipolar II disorder. Biological Psychiatry , 42 (1), 249S. doi:10.1016/s0006-3223(97)87945-0
