Bi-Polar Disorder - Review of Types, Treatment Options, and Professional Attitudes
Bi-Polar Disorder - Types & Treatments
Bipolar disorder is a psychological mood disorder characterized by extreme mood swings, from manic to depressed that interfere with daily life (WebMD, 2013). Whereas the cause of bipolar disorder remains unknown, it is believed to have genetic factors (WebMD, 2013). Bipolar disorders can be divided into one of five different sub-types (WebMD, 2013). Individuals with bipolar disorder experience numerous symptoms ranging from euphoria to despair (WebMD, 2013). These symptoms recur at different intervals, depending on the classification and the individual (WebMD, 2013). Although bipolar disorder can make daily life more challenging early detection and proper care can offer some relief (WebMD, 2013). Treatment options include cognitive, pharmacological, and alternative treatments which will all be discussed in more detail. There are differences in opinions in different medical teams concerning what treatments are the most effective (Cooke, Bowskill, Clatworthy, LeSeve, Rank, Parham & Horne, 2012). Individual perceptions of appropriate treatment plans for bipolar disorder can be changed with education and proper training.
Individuals with bipolar disorder suffer from extended periods of extreme mood states that not only affect one’s ability to function in society but can also affect attitudes, behaviors, and energy levels. People suffering from these symptoms may have problems with personal relationships, work performance, and performance at school (Nemade & Dombreck, 2009).
There are five different types of bipolar disorder. The five types are bipolar I, bipolar II, cyclothymic disorder, mixed bipolar, and rapid-cycling bipolar disorder (WebMD, 2013). While there are some differences between them, they all are characterized by occurrences of mania and depression (WebMD, 2013). Patients with bipolar I have experienced at least one episode of unusually high mood elevation, which led to atypical behaviors that caused disruption to his or her life (WebMD, 2013). Patients with bipolar 11, on the other hand, experience a cycle of moods, between high and low episodes, but never reach a full manic episode (WebMD, 2013). In patients with rapid cycling bipolar, which is 10% to 20% of those diagnosed with bipolar disorder, the cycle recurs at least four times a year (WebMD, 2013). Mixed bipolar disorder is different from the others in that the highs and lows are experienced at the same time or in a quick sequence (WebMD, 2013). Cyclothymia is a mild form of bipolar. Individuals with this type of bipolar experience the same symptoms, but at a less severe level (WebMD, 2013).
Bipolar moods range from mania to depression. During the manic stage individuals may experience feelings of grandiosity, increased energy, hyperactivity, euphoria, and believe that he or she can accomplish anything (Nemade & Dombreck, 2009). He or she may experience rapid thoughts, require less sleep, speak quickly – almost tripping over words in an effort to get them out – and be easily distracted (Nemade & Dombreck, 2009). When in a manic state individuals may also engage in risky behavior, dangerous activities, act impulsively, and demonstrate poor judgment (Nemade & Dombreck, 2009). In the depressed stage, he or she may seem lethargic, lack self-esteem, and exhibit a negative attitude about life in general (Nemade & Dombreck, 2009). While in a manic state, he or she may believe anything can be accomplished, in the depressed stage the opposite it true that nothing can be accomplished (Nemade & Dombreck, 2009). Individuals in the down phase of bipolar disorder are likely to lose interest in favorite activities, feel exhausted no matter how much or how little sleep they get, and seem very unhappy and distraught (Nemade & Dombreck, 2009). During this stage there may be times when he or she feels angry and can get mad easily as well as experience feelings of guilt, annoyance, irritation, and hopelessness (Nemade & Dombreck, 2009).
Treatment options for bipolar disorder include medication, therapy, and proper diet and exercise (WebMD, 2013). While all treatment plans include medication, psychotherapy can help individuals with bipolar cope with the symptoms and effect it can have on relationships, work, and school (WebMD, 2013). Bipolar disorder cannot be cured and prescribed medications will need to be taken throughout the lifetime (WebMD, 2013). Mania is normally treated with antipsychotics and mood stabilizers and depression may be treated with these types of medication as well as an anticonvulsant and antidepressants (WebMD, 2013). Most times a combination of medications is used to control the symptoms as well as some of the side effects from the medications themselves (WebMD, 2013). While home remedies will not work on their own to control bipolar symptoms, they may reduce occurrences or lesson the severity of some of the symptoms (WebMD, 2013).
While medications will help to control the symptoms associated with bipolar disorder psychotherapy can help patients work through some of the issues that arise, understand the condition better, and stay on track with medications (WebMD, 2013). It can also help build confidence and improve self-image (WebMD, 2013). Treatment options in psychotherapy include behavioral therapy, cognitive therapy, interpersonal therapy, social rhythm therapy, support groups, and education (WebMD, 2013). Each of these options focuses on a different characteristic of the disorder (WebMD, 2013). For example behavior therapy focusses on changing behaviors that cause stress, cognitive therapy focusses on understanding and changing the way one thinks during changes of mood (WebMD, 2013). On the other hand interpersonal therapy helps work through relationship issues associated with the disorder and social rhythm therapy assists in the development and maintenance of daily routines that can help keep patients on track (WebMD, 2013). Both support groups and education are helpful in that they help individuals, friends, and family, learn about the condition and find ways to cope with the challenges (WebMD, 2013).
According to Simon et al. (2005) 50% of individuals diagnosed with bipolar disorder receive no active treatment. More than half of the patients either stop taking medications or take them sporadically and rarely are there follow-up visits or and kind of monitoring to ensure compliance (Simon et al., 2005). In this study more than 400 patients were assigned to continue usual care or usual care plus a care management program that included assessment, telephone monitoring, care planning, and attendance in a psychoeducational program (Simon et al, 2005). Blind quarterly assessments were given to all of the patients to track week to week levels of depression and mania (Simon et al, 2005). Those who were assigned to the treatment group showed a significant reduction in mania ratings, and one-third less occurrences of manic episodes (Simon et al, 2005). While the depression scores did not vary dramatically, the treatment group did show a decrease in depression ratings over time (Simon et al, 2005). According to this study including a systematic care program as part of the therapy for bipolar disorder will decrease the risk of manic episodes (Simon et al, 2005).
There are many pharmacological treatment options for bipolar disorder. Managing manic and depressive episodes in bipolar disorder requires long-term treatment as well as acute interventions to reduce or prevent relapse (Sajatovic, Madhusoodanan, Fuller, Aulakh, & Keaton, 2005). Since around the 1960s Lithium has been used to treat bipolar episodes, but there is a high rate of non-responsiveness (Sajatovic et al, 2005). When a response was needed quickly, or a patient was non-responsive to Lithium, neuroleptics like chlorpromazine and haloperidol were used (Sajatovic et al, 2005). Because neuroleptics caused movement disorders there use was limited (Sajatovic et al, 2005).
One of the newer options is Risperidone, which is an antipsychotic. It has been approved to use as a short-term treatment, either on its own or with Lithium or Valproate, for severe manic episodes and has been reported to be an effective long-term option (Sajatovic et al, 2005). Research has shown it to be both tolerable and effective during the manic stage (Sajatovic et al, 2005).
According to Chou (2011) half of all bipolar patients who have experienced a reduction of symptoms while under the best possible conditions will have a recurrence within two years. For those individuals who do not respond to typical treatment plans, combining Lithium, lamotrigine, or quetiapine may be an option;, however it may take a while to determine to correct combination and dosage (Chou, 2011).
Although there is not a designated approved diet or exercise plan for those with bipolar disorder, it is essential that wise choices are made to ensure that a healthy weight is maintained to avoid other medical issues (WebMD, 2013). Even though avoiding eating excessive saturated fats and foods high in carbohydrates will not affect bipolar symptoms, it will reduce the chance of obesity, heart disease, and diabetes (WebMD, 2013). Eating a balanced diet that includes plenty of fruits, vegetables, legumes, lean meats, low-fat dairy, cold-water fish, eggs, soy products, nuts, and seeds can help prevent other diseases and maintain good general health (WebMD, 2013). Other suggestions include regular exercise, which has been shown to elevate mood and improve sleep, take up relaxing activities like yoga or meditation to avoid stress, do not use alcohol, drugs, or caffeine, set and stick to a schedule (WebMD, 2013).
According to McNamara, Nandagopal, Strakowski, and DelBello (2010) omega-3 fatty acids have neurotropic and neuroprotective properties that have been found to be both safe and effective in the treatment of bipolar symptoms in both children and adolescents. Children with an increased risk of developing mania, including those with a first-degree relative who has been diagnosed with a mood disorder, have been physically or sexually abused, or experienced other psychosocial stressors could be treated with safe interventions. These treatments include increased omega-3 fatty acids and family-focused therapy during the early stages prior to using pharmacological agents that have been shown to have adverse side effects. Studies have shown that a reduction of lifetime occurrence rates of bipolar disorder is connected to increased intake of omega-3 fatty acid from fish/seafood.
Taking a dietary supplement with omega-3 fatty acids for two to three months has been shown to reduce the severity of depression in adults diagnosed with bipolar disorder (McNamara, 2010). Recent studies have also found that long-term use of dietary omega-3 fatty acid (EPA plus DHA) therapy can reduce the severity of symptoms in adolescence diagnosed with bipolar disorder (McNamara, 2010). In one trial children from eight to 12 were given the Children's Depression Rating Scale (CDRS) and either a placebo or 600 mg/day of EPA plus 400 mg DHA 200 mg for four months (McNamara, 2010). While none of the scores for the children treated with the placebo changed significantly, over 70% of the children who received the omega-3 fatty acid had a 50% reduction in scores on the CDRS with little or mild side effects (McNamara, 2010). The results were sustained over the length of the trial to (McNamara, 2010).
Contemporary Attitudes about Bipolar Treatment
According to Cooke et al., (2012) there is a difference in opinion about the use of prescribing medications in the treatment of bipolar disorder between members of different mental health teams, including occupational therapists, psychiatric nurses, psychiatrists, social workers, support workers. Not surprisingly psychiatrists were found to have the most confidence in the use of prescribed medications for treating those with bipolar disorder as well as the least amount of concern for possible side effects (Cooke et al, 2012). As psychiatrists were also found to be more willing (71% versus 35%) than those in other fields to take the medications if ever diagnosed with a condition that required them this finding is consistent (Cooke et al, 2012). Many patents with bipolar disorder are not consistent concerning adherence to taking the prescribed medications (Cooke et al, 2012). This could in part be due interactions with other members of the treatment team who may not feel as strongly about the need for prescribed medications in the treatment of bipolar disorder (Cooke et al, 2012).
The training for some medical fields downplay the need of medication or consider them to be a last resort (Cooke et al, 2012). Many medical professionals feel that psychotherapy or maintaining a healthy lifestyle are better treatment options as there are no side effects associated with them compared to prescribed medications (Cooke et al, 2012). Additional training could alleviate this issue and improve understanding of the need for a combination of medication and other therapies to treat effectively the symptoms associated with bipolar disorder (Cooke et al, 2012).
Suggested Approach to Treating Bipolar Disorder
Based on education and personal experience with an individual with bipolar disorder my recommendation for treatment would include a combination of all treatments options listed above. Proper medication, or combinations of medications, is essential to allow individuals to function in society on a daily basis. Psychotherapy gives individuals the opportunity to discuss feelings, emotions, and challenges related to having bipolar disorder. It also gives the therapist the opportunity to regulate compliance with the care program and monitor medication use. Education on the disease, for both the patient and close friends and family will help develop a strong support group around the patient which should improve compliance. Living a healthy lifestyle that includes a healthy diet, exercise, getting enough sleep, and avoiding alcohol and drugs will reduce the chance of developing other medical problems and could decrease the likelihood of manic or depressive episodes from occurring.
Bipolar disorder is a condition that leads to extreme fluctuations in mood (WebMD, 2013). While everyone may experience ups and downs, with bipolar disorder the mood swings happen more frequently, last longer, are more intense, and interfere with daily life (WebMD, 2013). The symptoms can be controlled with medication, but the disorder itself cannot be cured (WebMD, 2013). Treatment options include pharmacological, psychotherapy, and making healthy lifestyle choices (WebMD, 2013). Not all medical practitioners agree on the importance of prescribing medications to combat the symptoms associated with bipolar disorder, which could be a result of different training programs and priorities (Cooke et al, 2012). Although individual perceptions of appropriate treatment plans for bipolar disorder differ, they can be changed with continued education and proper training. Bipolar disorder is not an easy condition to live with, but with proper treatment individuals with the condition can live happy and productive lives.
Benazzi, F. (2007). Bipolar II Disorder: Epidemiology, Diagnosis and Management. CNS Drugs, 21(9), 727.
Chou, J. C., M.D. (2011). Treatment-resistant bipolar disorder. Psychiatric Times, 28(7), 58-63. Retrieved from http://search.proquest.com/docview/883611657?accountid=458
Cooke, J., Bowskill, R., Clatworthy, J., LeSeve, P., Rank, T., Parham, R., & Horne, R. (2012). Health professionals' beliefs about medication for bipolar disorder. The Journal of Mental Health Training, Education, and Practice, 7(1), 4-8. doi:http://dx.doi.org/10.1108/17556221211230543
McNamara, R. K., Nandagopal, J. J., Strakowski, S. M., & DelBello, M. P. (2010). Preventative strategies for early-onset bipolar disorder. CNS Drugs, 24(12), 983-96. doi:http://dx.doi.org/10.2165/11539700-000000000-00000
Nemade, B. & Dombreck, M. (2009). Introduction to Bipolar Disorder and Mood Disorders. Retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=11191&cn=4
Sajatovic, M., Madhusoodanan, S., Fuller, M. A., Aulakh, L., & Keaton, D. B. (2005). Risperidone for bipolar disorders. Expert Review of Neurotherapeutics, 5(2), 177-87. doi:http://dx.doi.org/10.1586/14737126.96.36.199
Simon, G. E., Ludman, E. J., UnÜtzer, J., Bauer, M. S., Operskalski, B., & Rutter, C. (2005). Randomized trial of a population-based care program for people with bipolar disorder. Psychological Medicine, 35(1), 13-24. Retrieved from http://search.proquest.com/docview/204492751?accountid=458
WebMD. (2013). Bipolar Disorder. Retrieved from http://www.webmd.com/bipolar-disorder/default.htm