Bipolar disorder is a mental disease commonly known as a manic-depressive disorder that frequently affects young adults. Even for psychiatrists it is a complex psychiatric disorder to manage because it has comorbid disorders and many episodes coupled with non-responsiveness to treatment. Bipolar disorder is a significant health problem, and the diagnosis process occurs several years after the onset. However, the comorbid complexities are more common and do not easily respond to treatment. This analysis will focus on the factors that complicate bipolar treatment such as comorbid disorders, non-adherence to treatment, depression, and mixed mania. This study aims to evaluate the epidemiology, assessment, etiology, and management of bipolar disorder.
With estimates of lifetime prevalence, bipolar scale disorders are a significant community health problem associated with high mortality risk. About 25% of the bipolar patients are known to have attempted suicide at one time in their lives, and another 11% of patients succumb to suicide as a result (Allardyce, 2018). Moreover, another cause of high rates of jailing for bipolar patients is service structure and inadequate treatment. According to the National Collaborating Centre for Mental Health (UK, 2018), bipolar depression cases are under treated and the patients who suffer from such symptoms over nearly 12 years amount to 31%.
The first Bipolar (I) onset is at the age of 18 while the second Bipolar (II) begins at the age of 22 years. According to Post et al. (2017), onset is between the ages of 18 through to 44 years, and with increased rates between 18 and 34 years exceeding those between the age of 35 and 55 years. Allardyce, (2018); Kristensen, Nierenberg, & Ostergaard, (2018), note that more than half of the patients with bipolar disorder do not pursue professional care for more than five years. Moreover, accurate diagnosis is not done up to an average of 8 years from when they first seek a cure. Therefore, bipolar disorder has been linked inconsistently with socio-demographic aspects, and although both genders are similarly affected by bipolar, conversely, bipolar II is more prevalent in women with no clear links between home location, socioeconomic rank, race, or ethnicity. However, there are increased cases of bipolar disorder patients among unmarried individuals (Kristensen, Nierenberg, & Ostergaard, 2018).
Economic analysis of the illness includes indirect costs arising from mortality and direct treatment expenses. Similarly, bipolar disorder is a lifetime disorder, and the misdiagnosis can lead to mistreatment and exorbitant costs. Additionally, late diagnosis, inadequate presentation, and under treatment influence the increased costs of treatment (Goodwin et al., 2016). Bipolar disorder and epilepsy could share some factors of pathophysiology because manic and depressive symptoms are evident in patients with seizures and several antiepileptic drugs used in prophylactic and acute treatment are effectively used to treat bipolar disorder. However, estimation of the age of onset of bipolar disorder is difficult to define accurately because of the long periods of untreated illness, when symptoms can be apparent or nascent without the patients accessing adequate medication, which is used in the evaluation of the onset in many studies. Similarly, there are no explicit modes of a certain clinical course or presentation of bipolar depending on the age of onset with higher rates of medical or psychiatric comorbidities such as the vascular disease or suicidality in later onset mania. Accordingly, more research has focused on investigating the rates of bipolar based on sociodemographic variables with inconsistent results and findings. However, evidence points out that there are higher rates of bipolar disorder in unmarried, unemployed, and low-income earners although the social distraction caused by severe mental illnesses cannot be ruled out (Grunze et al. 2018). Conversely, other findings on the level of creativity as well as higher socioeconomic status are associated with increased risk of bipolar, which is inverse to that of schizophrenia and unipolar depression. Consequently, there is emerging evidence for the association between increased rates of bipolar and urban environments. Kristensen, Nierenberg, & Ostergaard, (2018), state that there is a strong association between the incidence of psychotic bipolar and urban residence and no clear association of bipolar without psychosis.
Etiology and Pathophysiology
The current research has subdivided the illness into two form however, depression predominates bipolar II although the mania is milder than in bipolar I. Moreover, the imaging studies that are emerging across medical research may help to shed some light with regard to bipolar disorders. Particularly, epidemiological evidence from studies of concordance in fraternal and identical twins indicates that affective bipolar disorders are heritable (Goodwin et al., 2016). Consequently, the morbid risk for families with bipolar disorder depending on the diagnosis procedure used and the similarity of the disorder is between 3% to 15 % for bipolar disorder, and 4% to 25 % for the unipolar disorder (Allardyce, 2018).Therefore, it is unclear if phenotype (mood disorders) is the most appropriate indicator of a genetic etiology. Subsequently, counselling can be an effective method of dealing with the family and patients concerns.
A large number of neuroimaging and neuroanatomical studies are underway to assess and learn more about bipolar disorder, with temporal and lesions in the frontal lobes being more associated with bipolar disorder (Post et al., 2017). Moreover, there are two crucial biochemical models regarding bipolar disorder. Bipolar II is milder than Bipolar I although they have a separate diagnosis procedures. Therefore, individuals with bipolar II may experience longer periods of depression while those with bipolar I have dangerous and severe episodes.
By definition, the episodes are characterized by hypomania, mania, mixed episodes, and depression. Moreover, patients with bipolar I disorder have single episodes of mania. Similarly, those with bipolar II can experience hypomanic and depressive episodes. Other signs and symptoms include psychosis, melancholy, anxious distress and the timing of the diagnostic labels such as rapid cycling (Grunze et al. 2018). Accordingly, increased reasons for the epidemiological studies on the bipolar spectrum are more sophisticated detection and systematic sampling of patients with bipolar I or II symptoms (Parker et al., 2018).
Bipolar differential diagnosis is quite complex and extensive. First, the presentation of patients is similar to psychotic and mood disorders including schizoaffective disorder, major depression, and schizophrenia (Allardyce, 2018). Additionally, bipolar disorder symptoms of truancy, recklessness, impulsivity, and antisocial conduct are not exclusive versus substance abuse, attention to hyperactivity, and personality disorders. Similarly, the affiliation between personality and affective disease should be considered while diagnosing bipolar disorder (Post et al., 2017). Therefore, bipolar disorder should be considered on prospective predictions of bipolar I disorder with acute onset of depression in the differential diagnosis. These predictions of the onset of bipolar II disorder include high substance abuse, mood lability, racing thoughts, and psychosocial functioning (Post et al., 2017). Moreover, bipolar patients have sudden change of mood and attitude towards other people, and they have antisocial behavior which affects the way they interact.
Bipolar Disorder Management
Therapeutic alliance is essential for management and understanding of bipolar disorder, as well as identifying recurrence of the illness and assessing the psychosocial stressors. Therefore, patients require therapeutic education consistently regarding treatment options, the illness, and its impact on social and family relationships. Bipolar patients do not recognize that they need treatment or how much their emotional instability impacts on their lives and the lives of the family members and friends. Consequently, they tend to experience euphoria followed by emotional crashes and a cycle of increased productivity. The patients should be guided on the best medical solutions, although it is difficult to identify them in their early stages. Acute treatment can be administered between 0 and eight weeks with continued administration for up to six months and followed by maintenance procedures and attention to the patient’s natural history and side effects.
Selection of medication can be based partially on the medication factors during the severe episode with an emphasis on the patient’s side effects and the illness history (Kristensen, Nierenberg, & Ostergaard, 2018). However, many several medications are needed for bipolar patients and rational combinations that are crucial in preventing relapse and avoiding exacerbations. Combinations therapy may have multiple advantages compared to long-term mono-therapy, and is increasingly gaining popularity in the treatment of bipolar disorders. Several factors and possible relationships between personality and bipolar disorder have been considered, considering that the criteria for borderline personality disorder hypomania overlap (Parker et al., 2018).
Bipolar disorder is involved with mood discourses and instability. The behavior of bipolar disorder manifestations are complex and mediated by a chain of interconnected neural circuits. Thus, the brain system receives much of the treatment attention in the research studies and experiments. However, current research is trying to assess the cause of the illness, and some studies have suggested that life stress could be a leading cause. Similarly, bipolar disorder has a higher prevalence rate among unmarried people, and those that live secluded from most social gatherings as well as people in the lower-income status. With the right therapeutic procedures, bipolar I and Bipolar II can be effectively managed, although patients may have difficult leading a normal life. However, it is difficult to tell if the illness is controllable especially during onset when the sighs and behaviors are dangerously high. Additionally, it is at the onset of the disease where patients are more likely to be jailed or punished in crime related actions as a result of the illness.
Managing bipolar disorder has been a challenge even for psychiatrists because it has severe multiple episodes, comorbid disorders and associated with non-adherence to treatment. Bipolar disorder is a significant health problem, and the diagnosis process occurs several years after the onset. Moreover, guidelines for the medical practitioners and patients are available bipolar I and Bipolar II, and other depressive episodes. Additionally, some psychosocial and pharmacologic treatments are under research in randomized trials. Therefore, bipolar disorder should be adequately assessed, and clearly evaluated for diagnosis and treatment. More research on the causes and development of the disease need to be conducted in future to help both the patients and practitioners to deal with the illness.
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Goodwin, G. M., Haddad, P. M., Ferrier, I. N., Aronson, J. K., Barnes, T. R. H., Cipriani, A., … & Holmes, E. A. (2016). Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 30(6), 495-553.
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National Collaborating Centre for Mental Health (UK. (2018). Bipolar disorder: The NICE guideline on the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. British Psychological Society.
Parker, W. F., Gorges, R. J., Gao, Y. N., Zhang, Y., Hur, K., & Gibbons, R. D. (2018). Association Between Groundwater Lithium and the Diagnosis of Bipolar Disorder and Dementia in the United States. JAMA Psychiatry.
Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Rowe, M., … & Nolen, W. A. (2017). More childhood-onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neuroscience & Biobehavioral Reviews, 74, 204-213.