Bipolar disorder formerly known as manic depression is a type of mood disorder characterized by manic and hypomanic and depressive episodes. Bipolar manic episodes involve long periods of sleeplessness, psychosis, hallucinations, paranoid rage and delusions of grandiose (Asherson et al. 2014 p. 1657). Bipolar disorder is an illness that is assumed to stem from an interaction of genetic and non-genetic factors. The episodes of altered moods involved in the disorder include mania or clinical depression with episodes of normal energy and moods in between episodes. The intensity of the moods varies from mild to extreme. Rapid cycling is the process where discrete mood episodes happen within a timeframe of four or more sessions per year. The process should however not be confused with frequent mood changes that happen in people with bipolar disorder or other mood disorders. Patients who experience manic episodes may have disturbances in thinking, distorted perceptions and impairment in social functioning (Asherson et al. 2014 p. 1657). Like in most mood disorders the causes are unknown. However research suggests that bipolar disorder involves alteration of brain function and genetic factors. The mood disorder normally occurs around the ages of 15-24 and continues for a lifetime. Diagnosis of mania is rarely diagnosed in children or adults over the age of 65. While some patients may present with mild symptoms others may have severe symptoms that impair their ability to live normally. Patients with the disorder experience relapses and remissions if left untreated. Most patients with severe symptoms might be hospitalized to keep them from risky behaviors. Bipolar I disorder is the most serious form of the disorder withy most of its patients experiencing at least one psychiatric hospitalization. The symptoms of mania in bipolar disorder involve inappropriate euphoria, irritability and social behavior. Patients experiencing manic episodes experience increased sexual desire, talking speed and significant energy levels. The Diagnostic and Statistical Manual of Mental Disorders, Fifth edition is the most recent version of classifying mental disorders such as bipolar disorder. In the DSM criteria bipolar is characterized into four; bipolar I disorder, bipolar II disorder, substance or medication induced bipolar and other specified bipolar and related disorder formerly known as not otherwise specified bipolar (NOS) (American Psychiatric Association, 2013. Bipolar I disorder is characterized by one or more manic and mixed episodes. Bipolar I disorder patients experience a period of abnormally and elevated moods, increased goal-oriented activity and high energy levels lasting not less than a week. According to the DSM, during the mood disturbance period the patients might experience the following; labored speech, increased activity, decreased need for sleep, delusions of grandiosity, distractibility and an increased need to experience pleasurable activity. Bipolar I disorder patients mostly experience significant impairment that is not caused by substance abuse or medical conditions. The DSM criteria categorizes a mixed episode as causing functional impairment and necessitates hospitalization. The mixed episode meets the standard for a manic and major depressive episode during a one week period (American Psychiatric Association, 2013). According to the DSM 5, bipolar II disorder patients have never had a full manic episode. Most of these patients experience at least one hypomanic episode and one major depressive episode. Bipolar II patients experience a period of abnormally elevated moods that last for more than four days and less than seven days (American Psychiatric Association, 2013). During the elevated mood period the patients might experience a decreased need for sleep and increased delusions of grandiose. Additionally the patients might experience racing thoughts, distractibility, labored speech and increased need to experience risky activity. The episodes in bipolar II patients are not severe enough to cause significant impairment. Substance or medication induced bipolar disorder is characterized by a persistent disturbance in moods with or without depressed mood that develops as a result of substance withdrawal or intoxication. The DSM 5 classifies other forms of bipolar as other specified bipolar and related disorder to encourage more research. The symptoms do not meet the criteria of bipolar I or bipolar II disorders. The criteria for diagnosis includes cyclothymia for less than two years, hypomania with the absence of major depressive episodes, short duration manic episodes and a major depressive episode (American Psychiatric Association, 2013). The paper will focus on the historical context of bipolar, cause, treatment, prevention, cross-cultural perspective and biblical worldview of the disorder.
Historical Context
Bipolar disorder is an exceedingly researched neurological disorder that traces its beginnings in 1 st century ancient Greece. The National Institute of Mental Health records that the disorder affects more than 4.5 percent of adults in the United States (Corrigan, Druss & Perlick, 2014 p. 37). Human beings have been trying to research the cause of bipolar and its treatments since ancient times. Aretaeus of Cappadocia started the procedure of recording the signs of the disorder as early as the 1 st century in Greece. He established a link between depression and mania but his notes went unnoticed for several centuries. Mood could be described as a changing expression of emotion. The extremities in the mood spectrum are highlighted in the two states of mania being the highest and melancholia (depression) being the lowest (. Ancient Greeks and Romans were mainly accountable for the words mania and melancholia (Corrigan, Druss, Perlick, 2014 p. 37). The mood extremities have been highly documented in human history. Nineteenth century contemporaries Baillarger and Falret noted the two extremities of mood disorder but their accuracy was debated. However the cycling mood concept was accepted before the end of the 19 th century. Falret published an article in 1851 that detailed individuals alternating between severe depression and manic excitement. The article was considered the pioneering published diagnosis of bipolar disorder. Jean-Pierre Falret noted the genetic link in causality of bipolar disorder; medical professionals still support the theory today. In the 20 th century the history of bipolar revolutionized with the discoveries of Emil Kraepelin a German psychiatrist who diverted from Sigmund Freud’s theory which formulated that the environment and the control of desires takes part in the development of mental illnesses. Kraepelin was the first scientist to research and study about mental illnesses (Corrigan, Druss & Perlick 2014 p. 37) . Manic Depressive Insanity and Paranoia published by Kraepelin in 1921 described the contrast between manic-depressive and praecox currently referred to as schizophrenia. Kraepelin’s classification system is the foundation of classification systems used today. In the late 20 th century the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) published the term bipolar. Bipolar means two poles which symbolize the two opposite moods of mania and depression. The DSM is currently in its fifth publication and is considered the main diagnostic tool for professionals.
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Cause of the Illness
The source of bipolar disorder is not entirely known but genetic, environmental and neurochemical components combine to play a role in the trigger and development of bipolar disorder (Marangoni et al. 2016 p. 165). More than half of patients with the bipolar disorder have a relative with the mood disorder therefore raising the issue of genetic factors. Research conducted on twins indicated that if one of them has a bipolar disorder it raises the risk of up to 70 percent for the other twin to be diagnosed (Asherson et al. 2014 p. 1657). However data on the genetic link of bipolar disorder is inconclusive. Bipolar disorder is primarily a biological disorder that happens in the brain and is caused by the alteration of neurotransmitters such as serotonin and norepinephrine. Since it is a biological disorder it may activate on its own or influenced by external factors. A traumatic life event may cause a mood disorder in a person with genetic disposition for bipolar disorder. Unhealthy lifestyles, alcohol abuse and hormonal imbalances could trigger episodes. Bipolar disorder is diagnosed in patients at early ages; some environmental factors can be attributed to the early age of onset. Substance abuse is not primarily a cause of bipolar disorder but its use can aggravate the symptoms (Bond & Anderson 2015 p. 349). Medications such as antidepressants can activate a manic episode in individuals who are vulnerable to bipolar disorder. A depressive episode can change into a manic episode when a patient takes antidepressants. Anti-manic drugs should be taken to prevent from a manic episode since they protect from antidepressant-induced mania. Certain medications mimic the symptoms of a manic episode; they include appetite suppressants (Stovall et al. 2016). Other substances that trigger manic episodes include illicit drugs such as cocaine, amphetamines and ecstasy. Excessive doses of appetite suppressants and cold preparations could cause manic-like episodes. Nonpsychiatric medications such as thyroid issues and corticosteroids cause manic like episodes.
Treatment
The treatment for bipolar disorder include mood stabilizers to manage episodes of mania or hypomania. Examples of mood stabilizers include valproic acid, divalproex sodium, lithium, lamotrigine and carbamazepine. A medical care provider could also recommend antipsychotics such as olanzapine, risperidone, ziprasidone, cariprazine, quetiapine, lurasidone and asenapine. Antidepressants are also prescribed for bipolar I and II patients. However antidepressants tend to trigger manic episodes therefore they need to be prescribed along with mood stabilizers or antipsychotics (Fountoulakis et al. 2017 p. 196). Research suggest that patients who have experienced manic episodes have higher chances of getting better with mood stabilizers and antipsychotic therapy over the next six months. Antipsychotics and mood stabilizers are advantageous to treat manic episodes since they can be instantly introduced, adjusted and bring the manic state in control in under 24 to 72 hours. Antipsychotic medication have been used to treat acute manic-depression episodes. Research indicates that antipsychotic agents have potential anti-manic properties (Fountoulakis et al. 2017 p. 196) The introduction of second generation antipsychotics has been useful since they do not seem to worsen depression for bipolar patients. Other treatment options for bipolar patients include psychotherapy, treatment programs, substance abuse treatment and self-management strategies. Cognitive behavior therapy a form of psychotherapy is sometimes recommended by a psychiatric care provider to determine the negative, unhealthy behaviors and replace them with positive ones. Social rhythm therapy can also be used to create a consistent routine for better mood management (Fountoulakis et al. 2017 p. 197). Many patients with bipolar disorder also have substance abuse problems. Drugs actually trigger mania and depression. Therefore threating substance abuse issues could help ease mania and depression symptoms. Outpatient treatment programs for bipolar patients could be very beneficial. Self-management treatment therapies such as healthy lifestyles, maintaining regular schedules and joining support groups could help manage bipolar symptoms. Most bipolar patients use a combination of treatment therapies for the successful management of bipolar disorder and manic symptoms. Psychiatric care providers mostly adjust treatments from time to time to keep symptoms and side effects of medication at bay.
Prevention
Knowing bipolar symptoms is key in the prevention of recurrent episodes. Based on current research concerning the cause of bipolar it is challenging to predict its onset. However individuals at risk of bipolar disorder due to hereditary factors could do certain things to be aware of the symptoms. Mood changes can often be perceived before its onset therefore talking to other family members already affected by bipolar may help a prospective patient identify the trigger for mood changes. The best prevention strategy for individuals who have already experienced mania is to stay on medication to avoid relapses. Most individuals know certain indicators that signal full blown manic episodes such as alterations in moods, sexual interest, energy, sleep, motivation and concentration. Some of the best ways of managing a manic episode include maintaining stable schedules and sleep patterns, setting realistic goals, refraining from alcohol, and staying away from stressful situation. Maintaining a regular schedule such as eating meals at regular periods, physical exercises, and meditation could help put manic episodes at bay (Bond & Anderson 2015 p. 350). Maintaining stable sleep patterns helps balance chemicals in the body therefore preventing mood alterations. Refraining from stressful situations helps keep manic and depressive situations at bay. Counselling helps prevent manic and depressive episodes, group, family and individual counseling (Bond & Anderson 2015 p. 350). Individual counselling is a one-on-one session with a therapist where the patient is educated on the disorder, methods of identifying warning signs and strategies to manage stress. Family counselling involves the entire family especially is one member has the disorder, family members are educated on how to recognize warning signs. It might feel like a good idea to stop medication during a manic episode since the symptoms might feel exhilarating however it is important to continue treatment to avoid taking risks. Keeping track of moods is a good method of managing manic episodes.
Cross-cultural Issues
Some cultures have social structures that promote better mental health than others. Effective cross-cultural interaction is important in the diagnosis and management of individuals with mental illnesses. In cultures such as African, Hispanic, African American having bipolar disorder is considered a weakness. Most people with the disorder are considered crazy and weak; the weakness is derived from the fact they cannot handle their problems. Only 36 percent of Hispanics and African-Americans receive treatment for mental health conditions such as bipolar disorder (Corrigan, Druss & Perlick, 2014 p. 37). Compared to whites, only half of the minorities are diagnosed and treated for mood disorders such as bipolar disorder. Individual from cultures who are more sensitive to mental illnesses stay in treatment and have better outcomes with mental illnesses. Some forms of treatment are not culturally sensitive therefore therapists should strive to be respectful when addressing clients from different cultures. Terms like depression invoke sensitivity among individuals from certain cultures. Using less weighty words such as stress and sadness can contribute to a successful initial connection between a client and therapist (Corrigan, Druss & Patrick, 2014 p. 37). Subconscious stereotype among therapists prevents many individuals from minority culture to seek treatment for illnesses such as bipolar disorder since most cultures believe that therapist trick them to talk about their problems. Talking about problems is considered a sign of weakness hence the reluctance to seek professional help can be understood. The way individuals perceive cure is highly influenced by cultural beliefs. Asians, African-Americans and Hispanics often believe that a mental illness could be treated through willpower rather than seeking psychological help. Asian and Hispanics are more likely to believe that mental health is maintained through self-control and avoiding negative thoughts.
Biblical Worldview
The best reference of bipolar disorder that can be found in the bible is in James 1. If any of you lack wisdom, let him ask of God, that giveth to all men liberally, and upbraideth not; and it shall be given him. But let him ask in faith, nothing wavering. For he that wavereth is like a wave of the sea driven with the wind and tossed. For let not that man think that he shall receive any thing of the Lord. A double-minded man is unstable in all his ways (James 1:5-8). Bipolar literally refers to two poles; the term gives a picture of a disorder that because mood swings that alternate between two opposites. The bible however refers to bipolar disorder as double mindedness which leaves an individual unstable (Ting, 2014) The passage continues to give bipolar patients a foundation for dealing with the illness. The passage suggests that an individual has to trust Christ as their Savior as a management strategy for the disorder. The understanding to deal with bipolar disorder is derived from the Holy Spirit. A bipolar patient must accept God’s word and apply it to all situations. The passage suggests that whenever an individual feels depressed or euphoric a Christian should focus on putting Christ in control of their thoughts. Bipolar disorder often cause destructive behavior especially when a patient experiences manic episodes. For such situations the bible prescribes that a believer focuses on allowing Christ control every thought (2 Corinthians 10:3-6).
Conclusion
Bipolar disorder formerly known as manic depression is a form of major mood disorder characterized by manic and hypomanic and depressive episodes. The mood disorder normally appears between the ages of 15-24 and persists through a lifetime but it can be managed with the correct treatment. In the DSM criteria bipolar is characterized into four; bipolar I disorder, bipolar II disorder, substance or medication induced bipolar and other specified bipolar and related disorder formerly known as not otherwise specified bipolar (NOS). Bipolar I disorder patients experience a period of abnormally and elevated moods, increased goal-oriented activity and high energy levels lasting not less than a week. Bipolar II disorder patients have never had a full manic episode, most of these patients have had at least one hypomanic episode and one key depressive episode. Substance or medication induced bipolar disorder is characterized by a persistent disturbance in moods with or without depressed mood that develops as a result of substance withdrawal or intoxication. DSM 5 classifies other forms of bipolar as other specified bipolar and related disorder to encourage more research. Bipolar disorder is among the most investigated mental illnesses and its research can be traced back to Ancient Greece first century. Ancient Greeks and Romans were mainly responsible for the words mania and melancholia, the two main states that characterize the disorder. Jean-Pierre Falret issued an article in 1851 that detailed individuals alternating between severe depression and manic excitement. He also discovered the genetic link in causality of bipolar disorder; medical professionals still support the theory today. In the 20 th century the history of bipolar revolutionized with the discoveries of Emil Kraepelin a German psychiatrist. Manic Depressive Insanity and Paranoia published by Kraepelin in 1921 described the contrast between manic-depressive and praecox currently known as schizophrenia. In the late 20 th century the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) published the term bipolar that marked the beginning of research that has revolutionized the treatment of the disorder. Genetic, environmental and neurochemical components combine to take part in the onset and development of bipolar disorder. More than half of patients with bipolar disorder have a relative with the mood disorder therefore raising the issue of genetic factors. Research conducted on twins indicated that if one twin has bipolar disorder it raises the risk of up to 70 percent for the other twin to be diagnosed. The treatment for bipolar disorder involves mood stabilizers, antipsychotics, antidepressants, psychotherapy, treatment programs, substance abuse treatment and self-management strategies. The best prevention strategy for individuals who have already experienced mania is to stay on medication to avoid relapses and knowing the symptoms of manic and depressive episodes. Counseling sessions with a licensed therapists could help patients and family members accept their diagnosis and know warning signs. The perception of individuals towards mental illness and its cure is highly influenced by cultural beliefs. Asians, African-Americans and Hispanics often believe that a mental illness could be treated through willpower rather than seeking professional help. In cultures such as African, Hispanic, African American having bipolar disorder is considered a weakness. The best reference to bipolar disorder is found in James 1:5-8. The bible verse refers to bipolar as double mindedness however it continues to give patients hope that if they trust in Christ they can manage their illness. The understanding to deal with bipolar disorder is derived from the Holy Spirit.
References
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