CASE STUDY

PROJECT 2

(ILOILO DOCTORS’ COLLEGE)

Name : Angeli Macampo

Year and Section : BS Psychology- III
Submitted to : Maria Corazon A.
Jardiolin, Md, DSBPP, FPPA
 CONFIDENTIAL
The following Case Study Report is intended as a communication between professionals. This
report includes private information that is likely to be misenterpreted by those without
private necessary training. Authorization for use to this report is limited to the examinee and
their deignated consultants/guardian.

ANGELI MACAMPO
Psychology Student
Iloilo Doctors’ College
South Fundidor Molo, Iloilo City

IDENTIFYING DATA
Name : Kitkat
Age : 18 years old
Marital Status : Single
Sex : Female
Occupation : Not yet working
Language : English
Ethnic Background : Asian
Religion : Catholic
Current Living Situation : Has a child/Middle class

1. Case History

Chief Complaint :

I ask her if what brings her to the doctor and she answered me in a very short length
which is
“because of my emotions”
“it’s hard for me to breath”
“im suffering too much anxiety”

History of Present Illness :

About her present illness history it triggers more because her family has a favoritism
like her dad likes her sister even more that’s what she feel and also she mention that
her illness affect her life as a student. She handle her anxieties with the use of
centraline medication. This medication is a multivitamin product used to treat or
prevent vitamin deficiency due to poor diet, certain illnesses, or during pregnancy.
Vitamins are important building blocks of the body and help keep you in good health
and she takes quetiapine is a tablets may be used as part of a treatment program to
treat bipolar disorder and schizophrenia in children and teenagers. Quetiapine is in a
class of medications called atypical antipsychotics. It works by changing the activity
of certain natural substances in the brain.
 Precipitating Factors :

Her illness trigger more when she is mad about something or people around her
makes her mad, and also when she feel so bad inside that makes her sometimes
want to end her life.

Past Illness :

 Psychiatric :

The hospital name where she consult before was at Western (mandurriao) she have
a session every 2 weeks or if she feels okay it’s enough if she meet her doctor once a
month. Her doctor is Dr. Ingles and Dr. Chen. Their treatment for her is that she
should write a journal then read it infront of them and also they are doing a talk
everytime she meet her doctors.

 Medical :

Her Medical history is that she still keep in taking centraline , Quetiapine and
risperidone to make her feel better and can sleep peacefully without thinking
anything.

 Alcohol and other substance History :

She drinks alcohol ocassionally since her parents doesn’t allow her to drink a lot.

Family History :

In her family medical illness history her cousin and father suffered from depression.
About the family history of alcohol’ her father is alcoholic that triggers her
depression. Her family doesn’t have a family tradition. I ask her if she can determine
her family’s insight or attitude towards her illness and she said :
 Father : Starting to accept the fact the she has depression.
 Mother and Sister : Understand what she feels and understand the illness that
she’s suffering.

About her attitude to her family she is trying her bet to understand them. Sometimes
if her father is too much and treat her too much she think about suicide and try to
slash her arms.
For their living her dad owns a shop where they get all their needs and
medication. Her siblings are currently studying and and her personality is more
similar to her younger sister. She said that she can tell her secrets and everything
about what’s going on in her life. She is also open to her sister about her problems
that she’s been struggling to.
 Connecting Pedigree Symbols

 Married Couple
Andrea Kirby
Pineda Pineda

 Siblings
Andrea Kirby
Pineda Pineda

Keye Rain Andrie

Andrea Pineda Pineda
Pineda

Personal History :

A. Prenatal and Perinatal :

About her prenatal and perinatal her mom gives her birth without any complications.
She has a normal birth process.

B. Early Adulthood :

At the age of 3 years old she stated that her father is always drunk and her mom
treats her nicely. She starts walking when she was 1 year old.

C. Middle Childhood :

In the age off 3-11 years old she already have a lot of friends birth school and home
like she is friend with anyone on her neighborhood. At this age she didn’t experience
any kind of trauma.
D. Late Childhood :

In her late childhood she said that she already knows her talent which she can draw
and her puberty through adolescence she didn’t have any crush yet as what she said.

E. Adulthood :

 Occupational History :

She don’t have any job experience but if ever she said that she’s given a chance she
will accept and have the job.

 Marital and Relationship History :

In her past history when she was 16 years old she had a boyfriend and they had a 2
years relationship but her boyfriend abuse her physically, emotionally and mentally.
Their 2 years relationship give them a baby. His boyfriend before go with every
session she has on her psychiatry. Right now his boyfriend left and her boyfriends
family gives her allowance for their baby that is with her.

 Military History :

She don’t have any military history.

 Educational History :

She is not studying right now because she need to take good care of her baby. She
also stated that she is still undecided about what course she will take if she will start
going to school again.
 Religion :

She is raise and born catholic

 Social Activity :

She is not sociable she said she better have a time for herself than other people. She
is a introvert type of person. She just talk if she is comfortable with that person.

 Current Living Situation :

Her current living situation is in middle class average since her father owns a shop.
Which is already enough for their daily needs and her medication.

 Legal History :

She don’t have any legal history.

F. Sexual History :

Her sexual history happened when she was drunk and that happened that they have
a baby she stated that it’s was out of control when it happened.

G. Fantacies and Dreams :

About her dreams and her fantacies she said that she don’t have one for the mean
time but all she dream of is to be a good mom to her baby and be a good role model
to her when her baby grew up.

H. Value :

She stated about her value of right and wrong is that if she’s is right she will fight for
it but if she’s wrong she said that she should learn from her mistakes and take it as a
life lesson.

2. Mental Status Examination

I. Appearance (observed)

During the interview she is wearing simple shirt and shorts. Her hair is into ponytail
and she is smiling the whole time while we’re doing the interview.

II. Behavior (observed)

I just noticed that her behavior is kinda insulting because she keep on looking and
checking her phone as a interviewer it feels like she is not interested on the
interview’ but she is still trying her best to answer all my questions.

III. Attitude (observed)

She have a sassy attitude but respectful towards me. She’s using a respectful words
and terms if she’s answering my questions. Her mood is congruent and very calming
but she gives me one answer every question that needs me to ask further question
just to get the real point of her answers. She’s also kinda suspicious during the
interview.

IV. Level of Consciousness (observed)

She’ is not paying attention towards my questions. Base on my observation her level
of conciousness is at survival. It feels like she doesn’t have idea what’s going on
between the interview and she just answer undecided. She is also confused about
her anwers.
V. Orientation (inquired)

The orientation went like :

“What is your name?”
“How old are you?”
“How can you describe what is happening right now?”
“Do you have any idea what is this all about?”

VI. Speech and Language (observed)

A. Quantity : I observed that the way she speaks is more on paucity. I can’y barely
get her answer in just one question. She’s anwering me in hiligaynon.
B. Rate : she is pressured on what I ask to her. Like when I ask her about her
relationship her expression look so pressured on the way she answered me.
C. Tone : The way she speak is at the low and weak voice as if I forced her to answer
all my question.

VII. Mood (inquired)

She stated that her mood was angry because of her child. She said that if her child
starts to cry it makes her illness triggered. Also during interview when I ask her “how
are you feeling right now?” she said she is fine because she have time to unwind.

VIII. Affect (observed)

She feel uncomfortable towards me even though she said she is ready and fine but
still I cann see in her eyes that she’s not widely open towards my questions.
Fluctuations : Nothing change or breakdown happened during the interview. She still
act normally from the start to the end.
Range : Her range was in restricted since as I stated she’s not comfortable to share
all of it during the interview.
Intensity : She’ was into blunted affect. Her determination to tell me her answers are
weaken.
Quality : I can see base on her reaction on the interview that she feel anxious to
answer the question. It feels like she’s worried if she said something bad or private.

IX. Thought Process/Form (observed/inquired)

I observed that she’s in tangential speech. She shows lack of focus and never
returning to the initial topic of the conversation. She is gives me irrelevant details
that shows a poor result.

X. Thought Content (observed/inquired)

The thought content of the patient went like this :

* “What do you think about when you are sad/angry?” She said she have different
negative thoughts when she is angry or sad. She will just go in her room and she will
cry and wants to be alone.
* “What’s been on your mind lately?” She stated that she just want to spend time
with her child.
* “Are you worried/scared/frightened about something or other?” In this question
she answered me that she is scared if her illness will atttack her again. She is also
scared that if that happens it will affect her c hild and her family.
In my total observation about her thoughts and content she is honestly giving
me a normal thoughts at that moment she didn’t have any bad thoughts about
herself.

XI. Suicidality and Homicidality (inquired)

* “Do you ever feel that life isn’t worth living? Or that you would just as soon be
dead?” When I asked her this she immidiately said yes. She commit suicide because
of too much stress on her studies and her relationship.

* “Have you ever thought of doing away with yourself? If so, how?” She commited
suicide by drinking shampoo , drowning herself, and he cut her wrist using blade.

No homicidal thoughts mentioned and happened.

XII. Insight and Judgment (observed/inquired)

My observation about her is that she doesn’t have any idea what is happening
between the interview. She is clueless about the possible question that will be given
to her.

XIII. Attention Span (observed/inquired)

XIV. Memory (observed/inquired)

A. Recent Memory – Possible questions for patient:

* “What is my name?” - She answered “ Manang Angel” then she smiled.
* “What medications did you take today?” she stated that she stopped taking
medication for long time now because she already feels better.
* “What time was your appointment with me for today?” She answered me in right
time which is 4-5pm.

XV. Intellectual Functioning (observed/inquired)

Based on my observation about her intellectual functioning. She’ doesn’t have any
huge value for herself or any interest she relies more on her emotions and feelings
than focusing on her intellectual knowledge.
 Beck's Depression Inventory
This depression inventory can be self-scored. The scoring scale is at the end of the
questionnaire.
1.
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.

2.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.

3.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.

4.
0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.

5.
0 I don't feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.

6.
0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.

7.
0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8.
0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.

9.
0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.

10.
0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even though I want to.

11.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.

12.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.

13.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can't make decisions at all anymore.

14.
0 I don't feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look
unattractive
3 I believe that I look ugly.

15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.

16.
0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.

17.
0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.

18.
0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.

19.
0 I haven't lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.

20.
0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches, pains, upset stomach, or
constipation.
2 I am very worried about physical problems and it's hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.

21.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.

INTERPRETING THE BECK DEPRESSION INVENTORY Now that you have completed the
questionnaire, add up the score for each of the twenty-one questions by counting
the number to the right of each question you marked. The highest possible total for
the whole test would be sixty-three. This would mean you circled number three on
all twenty-one questions. Since the lowest possible score for each question is zero,
the lowest possible score for the test would be zero.
This would mean you circles zero on each question. You can evaluate your
depression according to the Table below.
Total Score : 10 : These ups and downs are considered normal

1-10____________________These ups and downs are considered normal

11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression over
40__________________Extreme depressio
3. Essential Features to include timeline of onset of symptoms
It was shown and said above that she has bipolar disorder she also said that during
the interview. The timeline onset of her symptoms started 3 years ago year 2018 and
she takes centraline for, this medication is a multivitamin product used to treat or
prevent vitamin deficiency due to poor diet, certain illnesses, or during pregnancy,
Quetiapine Quetiapine tablets may be used as part of a treatment program to treat
bipolar disorder and schizophrenia in children and teenagers. Quetiapine is in a class
of medications called atypical antipsychotics. It works by changing the activity of
certain natural substances in the brain and risperidone Risperidone is used to treat
certain mental/mood disorders (such as schizophrenia, bipolar disorder, irritability
associated with autistic disorder). This medication can help you to think clearly and
take part in everyday life. Risperidone belongs to a class of drugs called atypical
antipsychotics.
The essential features of bipolar disorder according to the DSM-V The bipolar
disorder criteria represent the modern understanding of the classic manic-
depressive disorder or affective psychosis described in the nineteenth century,
differing from that classic description only to the extent that neither psychosis nor
the lifetime experience of a major depressive episode is a requirement. However,
the vast majority of individuals whose symptoms meet the criteria for a fully
syndromal manic episode also experience major depressive episodes during the
course of their lives. The essential features of bipolar disorders are cyclical mood
disorders including distinct sustained periods of mood elevation. Mood elevation is
critical in differentiation from unipolar disorders, specifically major depressive
disorder, recurrent type. Bipolar disorders are classified in a number of ways. One
diagnostic system is described in the Diagnostic and statistical manual of mental
disorders, fourth edition, text revision (DSM-IV-TR), which is United States based;
another is described in the International statistical classification of diseases and
related health problems, 10th revision (ICD-10), which is World Health Organization
and predominantly European based. Although these diagnostic classifications have
similarities, there are several differences in their detail. Here we refer to the DSM-IV-
TR1 criteria, unless otherwise specified. Bipolar Disorder is treated with three main
classes of medication: mood stabilizers, antipsychotics, and, while their safety and
effectiveness for the condition are sometimes controversial, antidepressants. Typically,
treatment entails a combination of at least one mood-stabilizing drug and/or atypical
antipsychotic, plus psychotherapy. The most widely used drugs for the treatment
of bipolar disorder include lithium carbonate and valproic acid (also known
as Depakote or generically as divalproex). Lithium carbonate can be remarkably
effective in reducing mania, although doctors still do not know precisely how it works.
Lithium (Eskalith, Lithobid) may also prevent recurrence of depression, but its value
seems greater against mania than depression; therefore, it is often given in conjunction
with other medicines known to have greater value for depression symptoms,
sometimes including antidepressants.
Primary Diagnosis with basis
To be diagnosed with bipolar disorder, she must have experienced at least one
episode of mania or hypomania. So she said that she became and irratable and easy
to get pissed. To be considered mania, the elevated, expansive, or irritable mood
must last for at least one week and be present most of the day, nearly every day.
Firstly, a doctor may perform a physical evaluation to rule out any other conditions
that may be causing symptoms. If no other illnesses are present, the doctor will
conduct a comprehensive mental health evaluation to assess the patient’s symptoms
in accordance with the specific criteria from the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be
diagnosed with bipolar disorder, a person must have experienced at least one
episode of mania or hypomania. To be considered mania, the elevated, expansive, or
irritable mood must last for at least one week and be present most of the day, nearly
every day. To be considered hypomania, the mood must last at least four
consecutive days and be present most of the day, almost every day. During this
period, three or more of the following symptoms must be present and represent a
significant change from usual behavior: 1) Inflated self-esteem or grandiosity
2)Decreased need for sleep 3) Increased talkativeness 4) Racing thoughts. Distracted
easily Increase in goal-directed activity or psychomotor agitation Engaging in
activities that hold the potential for painful consequences, e.g., unrestrained buying
sprees. The depressive side of bipolar disorder is characterized by a major depressive
episode resulting in depressed mood or loss of interest or pleasure in life. The DSM-5
states that a person must experience five or more of the following symptoms in two
weeks to be diagnosed with a major depressive episode: 1) Depressed mood most of
the day, nearly every day 2) Loss of interest or pleasure in all, or almost all, activities
3) Significant weight loss or decrease or increase in appetite 4) Engaging in
purposeless movements, such as pacing the room 5) Fatigue or loss of energy 6)
Feelings of worthlessness or guilt 7) Diminished ability to think or concentrate, or
indecisiveness 8) Recurrent thoughts of death, recurrent suicidal ideation without a
specific plan, or a suicide attempt. Bipolar disorder, formerly called manic
depression, is a mental health condition that causes extreme mood swings that
include emotional highs (mania or hypomania) and lows (depression). When you
become depressed, you may feel sad or hopeless and lose interest or pleasure in
most activities. When you become depressed, you may feel sad or hopeless and lose
interest or pleasure in most activities. When your mood shifts to mania or
hypomania (less extreme than mania), you may feel euphoric, full of energy or
unusually irritable. These mood swings can affect sleep, energy, activity, judgment,
behavior and the ability to think clearly. Episodes of mood swings may occur rarely
or multiple times a year. While most people will experience some emotional
symptoms between episodes, some may not experience any. Although bipolar
disorder is a lifelong condition, you can manage your mood swings and other
symptoms by following a treatment plan. In most cases, bipolar disorder is treated
with medications and psychological counseling (psychotherapy).
4. Differential Diagnosis :
Major depressive disorder. According to the DSM V Major depressive disorder may
also be accompanied by hypomanie or manic symptoms ( fewer symptoms or for a
shorter duration than required for mania or hypomania). When the individual
presents in an episode of major depression, one must depend on corroborating
history regarding past episodes of mania or hypomania. Symptoms of irritability may
be associated with either major depressive disorder or bipolar disorder, adding to
diagnostic complexity. Sadness is a natural part of the human experience. People
may feel sad or depressed when a loved one passes away or when they’re going
through a life challenge, such as a divorce or serious illness. These feelings are
normally short-lived. When someone experiences persistent and intense feelings of
sadness for extended periods of time, then they may have a mood disorder such as
major depressive disorder MDD, also referred to as clinical depression, is a
significant medical condition that can affect many areas of your life. It impacts mood
and behavior as well as various physical functions, such as appetite and sleep MDD is
one of the most common mental health conditions in the United States. Data
suggests that more than 7 percent of U.S. adults experienced a major depressive
episode in 2017. Some people with MDD never seek treatment. However, most
people with the disorder can learn to cope and function with treatment.
Medications, psychotherapy, and other methods can effectively treat people with
MDD and help them manage their symptoms. The diagnosis of major depressive
disorder is based on the person's reported experiences and a mental status
examination. There is no laboratory test for the disorder, but testing may be done to
rule out physical conditions that can cause similar symptoms. Those with major
depressive disorder are typically treated with counseling and antidepressant
medication. Medication appears to be effective, but the effect may only be
significant in the most severely [Link] of counseling used include cognitive
behavioral therapy (CBT) and interpersonal therapy, and electroconvulsive
therapy (ECT) may be considered if other measures are not effective. Hospitalization
may be necessary in cases with a risk of harm to self and may occasionally
occur against a person's [Link] most common time of onset is in a person's 20s
and 30s, with females affected about twice as often as males. Major depressive
disorder affected approximately 163 million people (2% of the world's population) in
2017. The disorder causes the second-most years lived with disability, after lower
back pain. Depression (major depressive disorder) is a common and serious medical
illness that negatively affects how you feel, the way you think and how you act.
Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss
of interest in activities you once enjoyed. It can lead to a variety of emotional and
physical problems and can decrease your ability to function at work and at home.
Depression affects an estimated one in 15 adults in any given year. And one in six
people will experience depression at some time in their life. Depression can occur at
any time, but on average, first appears during the late teens to mid-20s. Women are
more likely than men to experience depression. Some studies show that one-third of
women will experience a major depressive episode in their lifetime.
Generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or other
anxiety disorders. These disorders need to be considered in the differential diagnosis
as either the primary disorder or, in some cases, a comorbid disorder. A careful
history of symptoms is needed to differentiate generalized anxiety disorder from
bipolar disorder,as anxious ruminations may be mistaken for racing thoughts, and
efforts to minimize anxious feelings may be taken as impulsive behavior. Similarly,
symptoms of posttraumatic. Generalized Anxiety Disorder (GAD) is characterized by
persistent and excessive worry about a number of different things. People with GAD
may anticipate disaster and may be overly concerned about money, health, family,
work, or other issues. Individuals with GAD find it difficult to control their worry.
They may worry more than seems warranted about actual events or may expect the
worst even when there is no apparent reason for concern. GAD is diagnosed when a
person finds it difficult to control worry on more days than not for at least six
months and has three or more symptoms. This differentiates GAD from worry that
may be specific to a set stressor or for a more limited period of time. Women are
twice as likely to be affected. The disorder comes on gradually and can begin across
the life cycle, though the risk is highest between childhood and middle age. Although
the exact cause of GAD is unknown, there is evidence that biological factors, family
background, and life experiences, particularly stressful ones, play a role. Sometimes
just the thought of getting through the day produces anxiety. People with GAD don’t
know how to stop the worry cycle and feel it is beyond their control, even though
they usually realize that their anxiety is more intense than the situation warrants. All
anxiety disorders may relate to a difficulty tolerating uncertainty and therefore many
people with GAD try to plan or control situations. Many people believe worry
prevents bad things from happening so they view it is risky to give up worry. At
times, people can struggle with physical symptoms such as stomachaches and
headaches. When their anxiety level is mild to moderate or with treatment, people
with GAD can function socially, have full and meaningful lives, and be gainfully
employed. Many with GAD may avoid situations because they have the disorder or
they may not take advantage of opportunities due to their worry (social situations,
travel, promotions, etc). Some people can have difficulty carrying out the simplest
daily activities when their anxiety is severe. Anxiety is a common symptom of many
mental health conditions, like depression and various phobias. GAD is different from
these conditions in several ways. People with depression may occasionally feel
anxious, and people who have a phobia worry about one particular thing. Occasional
anxiety is a normal part of life. You might worry about things like health, money, or
family problems. But people with generalized anxiety disorder (GAD) feel extremely
worried or feel nervous about these and other things even when there is little or no
reason to worry about them. People with GAD find it difficult to control their anxiety
and stay focused on daily tasks. The good news is that GAD is treatable. Call your
doctor to talk about your symptoms so that you can feel better. Everyone gets
anxious sometimes, but if your worries and fears are so constant that they interfere
with your ability to function and relax, you may have generalized anxiety disorder
(GAD). GAD is a common anxiety disorder that involves constant and chronic
worrying, nervousness, and tension. This anxiety is less intense than a panic attack,
but much longer lasting, making normal life difficult and relaxation impossible.
Stress disorder need to be differentiated from bipolar disorder. It is helpful to assess
the episodic nature of the symptoms described, as well as to consider symptom
triggers, in making this differential diagnosis. Posttraumatic stress disorder (PTSD) is
a psychiatric disorder that may occur in people who have experienced or witnessed a
traumatic event such as a natural disaster, a serious accident, a terrorist act,
war/combat, or rape or who have been threatened with death, sexual violence or
serious injury. PTSD has been known by many names in the past, such as “shell
shock” during the years of World War I and “combat fatigue” after World War II, but
PTSD does not just happen to combat veterans. PTSD can occur in all people, of any
ethnicity, nationality or culture, and at any age. People with PTSD have intense,
disturbing thoughts and feelings related to their experience that last long after the
traumatic event has ended. They may relive the event through flashbacks or
nightmares; they may feel sadness, fear or anger; and they may feel detached or
estranged from other people. People with PTSD may avoid situations or people that
remind them of the traumatic event, and they may have strong negative reactions to
something as ordinary as a loud noise or an accidental touch. A diagnosis of PTSD
requires exposure to an upsetting traumatic event. However, the exposure could be
indirect rather than first hand. For example, PTSD could occur in an individual
learning about the violent death of a close family or friend. It can also occur as a
result of repeated exposure to horrible details of trauma such as police officers
exposed to details of child abuse cases. The following are the symptoms and
diagnosis of PSTD : 1. [Link]: Intrusive thoughts such as repeated, involuntary
memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may
be so vivid that people feel they are re-living the traumatic experience or seeing it
before their eyes. 2. Avoidance: Avoiding reminders of the traumatic event may
include avoiding people, places, activities, objects and situations that may trigger
distressing memories. People may try to avoid remembering or thinking about the
traumatic event. They may resist talking about what happened or how they feel
about it. 3. Alterations in cognition and mood: Inability to remember important
aspects of the traumatic evet, negative thoughts and feelings leading to ongoing and
distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”);
distorted thoughts about the cause or consequences of the event leading to wrongly
blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest
in activities previously enjoyed; feeling detached or estranged from others; or being
unable to exprience positive emotions (a void of happiness or satisfation). 4.
Alterations in arousal and reactivity: Arousal and reactive symptoms may include
being irritable and having angry outbursts; behaving recklessly or in a self-
destructive way; being overly watchful of one's surroundings in a suspecting way;
being easily startled; or having problems concentrating or sleeping
Substance/medication-induced bipolar disorder. Substance use disorders may
manifest with [Link]-induced manic symptoms that must be
distinguished from bipolar I disorder; response to mood stabilizers during a
substance/medication- induced mania may not necessarily be diagnostic for bipolar
disorder. There may be substantial overlap in view of the tendency for individuals
with bipolar I disorder to overuse substances during an episode. A primary diagnosis
of bipolar disorder must be established based on symptoms that remain once
substances are no longer being used.
Personality disorders. Personality disorders such as borderline personality disorder
may have substantial symptomatic overlap with bipolar disorders, since mood lability
and impulsivity are common in both conditions. Symptoms must represent a distinct
episode, and the noticeable increase over baseline required for the diagnosis of
bipolar disorder must be present. A diagnosis of a personality disorder should not be
made during anuntreated mood episode. Personality disorders are a group of mental
health conditions that are characterized by inflexible and unhealthy patterns of
thinking, feeling, and behaving. These inner experiences and behaviors often differ
from the expectations of the culture in which someone lives. People with personality
disorders usually have a hard time getting along with others and dealing with
everyday problems in the ways that are expected by a cultural group. They
commonly believe that their way of thinking and behaving is completely normal.
However, they tend to have a view of the world that is quite different than others. As
a result, they may find it difficult to participate in social, educational, and family
activities. They may also make people with personality disorders feel isolated, which
can contribute to depression and anxiety. The cause of personality disorders isn’t
known. However, it is believed that they may be triggered by genetic and
environmental influences, most prominently childhood trauma. Personality disorders
tend to emerge in the teenage years or early adulthood. The symptoms vary
depending on the specific type of personality disorder. Treatment typically includes
talk therapy and medication. Personality disorders are a type of mental illness in
which a person’s thought patterns and behaviors cause them distress. Often, people
with a personality disorder experience inflexible thoughts that impair their ability to
adapt to stress, problem-solve, or engage in healthy relationships with [Link]
signs and symptoms of many personality disorders can overlap each other, though
each specific type usually involves a defining feature. Personality disorders are
characterized by an enduring collection of behavioral patterns often associated with
considerable personal, social, and occupational disruption. Personality disorders are
also inflexible and pervasive across many situations, largely due to the fact that such
behavior may be ego-syntonic (i.e. the patterns are consistent with the ego
integrity of the individual) and are therefore perceived to be appropriate by that
individual. In addition, people with personality disorders often lack insight into their
condition and so refrain from seeking treatment. This behavior can result in
maladaptive coping skills and may lead to personal problems that induce extreme
anxiety, distress, or depression and result in impaired psychosocial functioning.
These behavior patterns are typically recognized by adolescence, the beginning of
adulthood or sometimes even childhood and often have a pervasive negative impact
on the quality of life. While emerging treatments, such as dialectical behavior
therapy, have demonstrated efficacy in treating personality disorders, such
as borderline personality disorder,personality disorders are associated with
considerable stigma in popular and clinical discourse alike. Despite various
methodological schemas designed to categorize personality disorders, many issues
occur with classifying a personality disorder because the theory and diagnosis of
such disorders occur within prevailing cultural expectations; thus, their validity is
contested by some experts on the basis of inevitable subjectivity.
5. Case Discussion : (should include the ff : )
A. Etiology : Bipolar disorder has garnered increasing attention as many argue that
rates of bipolar disorder are skyrocketing and the definition of the classic bipolar
disorder phenotype should be expanded, especially among children and adolescents.
Understanding the psychosocial etiologies of bipolar disorder across the lifespan is
critically important, and Alloy and colleagues’ (2009) scholarly review makes an
important contribution. Given the debate and controversy surrounding the
description, diagnosis, and phenotype of bipolar disorder, having an accurate,
reliable, and valid classification for definition, diagnosis, and assessment is critical for
explicating potential etiology. Likewise, advanced understanding of etiology,
especially when grounded in basic psychological science as Alloy and colleagues’
review is, can importantly inform clinical phenomenology, course, assessment, and
intervention. In summary, there is an essential interplay among description,
classification, assessment, etiology, and intervention, such that a deeper
understanding of all these areas is necessary for advancing an empirically based
practice of assessment and intervention. Factors that may increase the risk of
developing bipolar disorder or act as a trigger for the first episode include: Having a
first-degree relative, such as a parent or sibling, with bipolar disorder. Periods of high
stress, such as the death of a loved one or other traumatic event. Drug or alcohol
abuse. The exact cause of bipolar disorder is unknown, but several factors may be
involved, such as: Biological differences. People with bipolar disorder appear to have
physical changes in their brains. The significance of these changes is still uncertain
but may eventually help pinpoint causes and for the risk facors of bipolar disorder
Factors that may increase the risk of developing bipolar disorder or act as a trigger
for the first episode include: 1) Having a first-degree relative, such as a parent or
sibling, with bipolar disorder 2) Periods of high stress, such as the death of a loved
one or other traumatic event and 3) Drug or alcohol abuse. Most people experience
mood changes at some time, but those related to bipolar disorder are more intense
than regular mood changes, and other symptoms can occur. Some people
experience psychosis, which can include delusions, hallucinations, and paranoia,
Between episodes, the person’s mood may be stable for months or years, especially
if they are following a treatment plan. Treatment enables many people with bipolar
disorder to work, study, and live a full and productive life. However, when treatment
helps a person feel better, they may stop taking their medication. Then, the
symptoms can return. Some aspects of bipolar disorder can make a person feel
good. During an elevated mood, they may find they are more sociable, talkative,
and creative. However, an elevated mood is unlikely to persist. Even if it does, it may
be hard to sustain attention or follow through with plans. This can make it difficult to
follow a project through to the end. According to some research : symptoms vary
between individuals. For some people, an episode can last for several months or
years. Others may experience “highs” and “lows” at the same time or in quick
succession. In “rapid cycling” bipolar disorder, the person will have four or
more episodes within a year. She is honestly the cause of bipolar I. In other findings,
researchers report that first-degree relatives of a person diagnosed with bipolar I or II
disorder are at an increased risk for major depression when compared to first-degree
relatives of those with no history of bipolar disorder.
B. Genetics : Bipolar disorder is more common in people who have a first-degree
relative, such as a sibling or parent, with the condition. Researchers are trying to find
genes that may be involved in causing bipolar disorder. Bipolar disorder is frequently
inherited, with genetic factors accounting for approximately 80% of the cause of the
condition. Bipolar disorder is the most likely psychiatric disorder to be passed down
from family. If one parent has bipolar disorder, there's a 10% chance that their child
will develop the illness. Bipolar disorder is a common, complex genetic disorder, but
the mode of transmission remains to be discovered. Many researchers assume that
common genomic variants carry some risk for manifesting the disease. The research
community has celebrated the first genome-wide significant associations between
common single nucleotide polymorphisms (SNPs) and bipolar disorder. Currently,
attempts are under way to translate these findings into clinical practice, genetic
counseling, and predictive testing. However, some experts remain cautious. After all,
common variants explain only a very small percentage of the genetic risk, and
functional consequences of the discovered SNPs are inconclusive. Furthermore, the
associated SNPs are not disease specific, and the majority of individuals with a “risk”
allele are healthy. On the other hand, population-based genome-wide studies in
psychiatric disorders have rediscovered rare structural variants and mutations in
genes, which were previously known to cause genetic syndromes and monogenic
Mendelian disorders. In many Mendelian syndromes, psychiatric symptoms are
prevalent. Although these conditions do not fit the classic description of any specific
psychiatric disorder, they often show nonspecific psychiatric symptoms that cross
diagnostic boundaries, including intellectual disability, behavioral abnormalities,
mood disorders, anxiety disorders, attention deficit, impulse control deficit, and
psychosis. Although testing for chromosomal disorders and monogenic Mendelian
disorders is well established, testing for common variants is still controversial. The
standard concept of genetic testing includes at least three broad criteria that need to
be fulfilled before new genetic tests should be introduced: analytical validity, clinical
validity, and clinical utility. These criteria are currently not fulfilled for common
genomic variants in psychiatric disorders. Further work is clearly needed. Bipolar
disorder (BD) is one of the most heritable mental illnesses, but the elucidation of its
genetic basis has proven to be a very challenging endeavor. Genome-Wide
Association Studies (GWAS) have transformed our understanding of BD, providing
the first reproducible evidence of specific genetic markers and a highly polygenic
architecture that overlaps with that of schizophrenia, major depression, and other
disorders. Clinicians have always known that bipolar disorder tends to run in families
but recent advances in molecular genetics now provide the tools needed to identify
genes influencing susceptibility. Although psychiatric and behavioural traits
represent, perhaps, the greatest challenge to molecular investigation of complex
genetic disorders, they also offer arguably the greatest potential reward. Identifying
susceptibility genes for bipolar disorder will pinpoint biochemical pathways involved
in pathogenesis, facilitate development of more effective, better targeted
treatments, and offer opportunities for improving the validity of psychiatric diagnosis
and classification. In this review article, we start by briefly considering
methodological issues involved in genetic studies of bipolar disorder. We will then
review the formal evidence that genes are involved in influencing susceptibility to
bipolar disorder.
C. Biochemical Factors : Biological traits: Research suggests that imbalances
in neurotransmitters or hormones that affect the brain may play a role.
Environmental factors: Life events, such as abuse, mental stress, a “significant loss,”
or another traumatic event, may trigger an initial episode in a susceptible person.
There are a number of brain chemical messenger systems that have been implicated
in bipolar disorder, certainly dopamine is one. Dopamine, of course, has been
implicated in schizophrenia which is characterized by psychosis, when people have
hallucinations or delusions and kind of lose touch with reality. An important thing to
know is that people with bipolar disorder can also become psychotic, either when
they’re manic, in which case they tend to have very grandiose sorts of delusions, or
when they’re depressed in which case they tend to feel extremely badly about
themselves and think that terrible things are happening in the world. Given that
people with bipolar disorder can sometimes become psychotic, its not surprising that
dopamine has also been implicated in bipolar disorder. Of course, one pole of
bipolar disorder is depression, and we know that serotonin has a good bit to do with
the brain mechanisms of depression, so that has also been implicated in bipolar
disorder. Recently there has been more interest in glutamate which is the major
excitatory neurotransmitter; the one that makes the neurons fire. For example,
there’s some preliminary data using Riluzole, which is a medication which damps
down glutamate, using that to try to treat bipolar disorder. So chances are that there
are a number of neurotransmitter systems that are involved in bipolar disorder. It
probably ultimately may be hard to find one thats not we would say, and the issue is
putting all the pieces of the puzzle together.
D. Neuro/psychopathology : The disorder is heritable and appears to share
susceptibility genes with schizophrenia. It is characterized by dysregulation in the
dopamine and serotonin systems and by pathology in the brain systems involved in
regulating emotion. Psychosocial stressors, notably life events and familial expressed
emotion, significantly influence the course of the illness in the context of these
vulnerabilities. Findings of randomized clinical trials indicate that psychosocial
interventions enhance long-term outcomes when added to pharmacotherapy. Much
remains to be clarified about the interactive contributions of genetic,
neurobiological, and psychosocial factors to the course of the disorder, and the
moderators and mediators of treatment effects. The purpose of this chapter is to
review current research on the diagnosis, epidemiology, course, etiology, and
treatment of bipolar disorder (BD). BD has traditionally been viewed as a purely
biologically based group of disorders, but BD episodes are best understood within a
biopsychosocial framework. That is, recurrences of mania or depression are a result
of the mutually influential interactions between genes, neural pathways, and
socioenvironmental influences. We place special emphasis on new findings regarding
the prognostic effects of psychosocial variables. By extension, effective treatments
for BD usually involve psychosocial treatment in combination with pharmacotherapy.
In a separate section, we address the interactions of biological and psychosocial risk
factors in the course of the illness. Current pharmacological and psychological
treatments are then reviewed. Finally, we give recommendations for future research
on etiology and treatment. Diagnostic criteria specify that mania must last at least
one week or require hospitalization. Manic symptoms include irritability or euphoria
along with symptoms such as decreased need for sleep, grandiose ideas, impulsive
behavior, increased talkativeness, racing thoughts, flight of ideas, increased activity,
and distractibility. Mixed episodes include manic symptoms and simultaneous
depressive symptoms lasting for at least one week. Most, but certainly not all,
people with BD I experience periods of depression. According to some research
various neuropathological findings have been reported in bipolar disorder (BD).
However, it is unclear which findings are well established. To address this gap, we
carried out a systematic review of the literature. Like other ‘functional’ psychiatric
disorders, bipolar disorder (BD) lacks any diagnostic neuropathology of the kind
which characterises and defines the dementias, but this does not mean that BD has
no morphological correlates. Magnetic resonance imaging (MRI) studies show small
but robust differences in the volumes of some brain structures, notably decreases in
hippocampus, amygdala and thalamus, and reduced cortical thickness . There is also
increasing evidence for white matter decrements with anatomical and functional
dysconnectivity of specific pathways and circuits. Presumably these neuroimaging
findings are reflected in alterations at the histological and cellular level. However, a
review covering the period up to 1999 noted the remarkable lack of data. The
literature at that time comprised only nine publications. Vawter and colleagues drew
attention to some preliminary findings, notably a report of decreased glial density in
the subgenual anterior cingulate cortex in BD and major depressive disorder , and a
pilot study describing decreased interneuron density in the hippocampal CA2
subfield .
E. Psychosocial and Psychoanalytic theories : Like the disorder itself, empirical and
theoretical work on bipolar disorder has bseesawedQ back and forth between
psychological and biological conceptualizations. Despite the early pioneering work of
Kraepelin (1921) emphasizing the psychosocial context of the disorder, conceptions
of bipolar disorder as a genetically based, biological illness dominated over the past
century. Family, twin, and adoption studies suggesting that bipolar disorder has a
strong genetic predisposition (Goodwin & Jamison, 1990; Nurnberger & Gershon,
1992) and pharmacotherapy trials indicating the effectiveness of lithium and
anticonvulsive drugs in controlling the cycling of bipolar disorder (e.g., Keck &
McElroy, 1996) shifted the focus to the disorder’s biological underpinnings.
However, in the past decade and a half, there has been resurgence of interest in the
role of psychosocial processes in the onset, course, expression, and treatment of
bipolar spectrum disorders. This swing of the seesaw back again toward the inclusion
of psychosocial factors in bipolarity research is largely attributable to researchers’
dual recognition that genetic and biological processes are unable to fully account for
differences in the expression, timing, and polarity of symptoms (O’Connell, 1986)
and that lithium’s and other drugs’ prophylactic effects are limited. In fact, a 1990
NIMH workshop report (Prien & Potter, 1990) called for further exploration of the
impact that psychosocial factors have on the course of bipolar disorder as well as the
development of psychosocial treatments as an adjunct to pharmacotherapy. Given
that bipolar disorder is often a severe, recurrent, or unremitting illness with
significant impairment including alcohol abuse, suicide, divorce, and erratic work
history population of the world population (Kleinman et al., 2003), an understanding
of the role of psychosocial factors in the onset, course, expression, and treatment of
this disorder has great importance. Psychosocial treatment studies provide findings
relevant to demonstrating that a psychosocial risk factor causally affects the course
or expression of bipolar disorder. Given that ethical concerns would prohibit the
manipulation of psychosocial variables to induce bipolar symptomatology, treatment
studies that manipulate psychosocial variables by attempting to reduce their effects
provide the most powerful means of testing the causal significance of psychosocial
risk factors. Consequently, we review the findings of three types of psychosocial
treatments for bipolar disorder that were developed specifically to remediate the
impact of putative environmental and cognitive risk factors. However, the majority
of psychosocial intervention studies for bipolar disorder share several common
limitations that make it difficult to conclude with any certainty that the manipulation
of the psychosocial risk factor is the mechanism underlying any therapeutic change.
Typically, these psychosocial interventions differ from the comparison or control
therapy not only in their focus on the psychosocial variable of interest, but also on
nonspecific therapeutic factors such as therapist allegiance, expectancy of success by
both therapist and bipolar patient, and amount of clinical attention received by the
patient. Thus, therapeutic improvement may be attributable to these nonspecific
factors rather than to amelioration of the psychosocial risk factor of interest.
Moreover, to demonstrate the potential causal significance of a psychosocial risk
factor, it would also be necessary for treatment studies to demonstrate that this risk
factor has actually changed as a result of the intervention. Few of the psychosocial
treatment studies on bipolar disorder conducted to date examine the mechanisms of
change.
[Link] subtype & : The following are the clinical subtypes of bipolar disorder :
1. Bipolar I and II : All types of bipolar disorder are characterized by episodes of
extreme mood. The highs are known as manic episodes. The lows are known as
depressive episodes. The main difference between bipolar 1 and bipolar 2 disorders
lies in the severity of the manic episodes caused by each type. A person with bipolar
1 will experience a full manic episode, while a person with bipolar 2 will experience
only a hypomanic episode (a period that’s less severe than a full manic episode). A
person with bipolar 1 may or may not experience a major depressive episode, while
a person with bipolar 2 will experience a major depressive episode.
The Bipolar I ou must have had at least one manic episode to be diagnosed
with bipolar 1 disorder. A person with bipolar 1 disorder may or may not have a
major depressive episode. The symptoms of a manic episode may be so severe that
you require hospital care. Manic episodes are usually characterized by the
following: : 1) exceptional energy 2) restlessness 3) trouble concentrating 4) feelings
of euphoria (extreme happiness) 5) risky behaviors 6) poor sleep. The symptoms of a
manic episode tend to be so obvious and intrusive that there’s little doubt that
something is wrong.
The Bipolar II Bipolar 2 disorder involves a major depressive episode lasting at least
two weeks and at least one hypomanic episode (a period that’s less severe than a
full-blown manic episode). People with bipolar 2 typically don’t experience manic
episodes intense enough to require hospitalization. Bipolar 2 is sometimes
misdiagnosed as depression, as depressive symptoms may be the major symptom at
the time the person seeks medical attention. When there are no manic episodes to
suggest bipolar disorder, the depressive symptoms become the focus. Rapid-cycling is
a term that describes having four or more mood episodes within a 12-month period.
Episodes must last for some minimum number of days in order to be considered distinct
episodes. Some people also experience changes in polarity from high to low or vice-
versa within a single week, or even within a single day, meaning that the full symptom
profile that defines distinct, separate episodes may not be present (for example, the
person may not have a decreased need for sleep). Sometimes called "ultra-rapid"
cycling, there is debate within psychiatry as to whether this phenomenon is a valid or
well-established feature in bipolar disorder. A pattern of rapid cycling can occur at any
time in the course of illness, although some researchers believe that it may be more
common at later points in the lifetime duration of illness. Women appear more likely
than men to have rapid cycling. A rapid-cycling pattern increases risk for severe
depression and suicide attempts. Antidepressants may sometimes be associated with
triggering or prolonging periods of rapid cycling. However, that theory is controversial
and is still being studied. The "Mixed features" refers to the occurrence of simultaneous
symptoms of opposite mood polarities during manic, hypomanic or depressive episodes.
It's marked by high energy, sleeplessness, and racing thoughts. At the same time, the
person may feel hopeless, despairing, irritable, and suicidal. From the DSM- 5 The
bipolar I disorder criteria represent the modern understanding of the classic manic-
depressive disorder or affective psychosis described in the nineteenth century,
differing from that classic description only to the extent that neither psychosis nor
the lifetime experience of a major depressive episode is a requirement. However,
the vast majority of individuals whose symptoms meet the criteria for a fully
syndromal manic episode also experience major depressive episodes during the
course of their lives. Bipolar II disorder, requiring the lifetime experience of at least
one episode of major depression and at least one hypomanie episode, is no longer
thought to be a "milder" condition than bipolar I disorder, largely because of the
amount of time individuals with this condition spend in depression and because the
instability of mood experienced by individuals with bipolar II disorder is typically
accompanied by serious impairment in work and social functioning.
2. Mania : A manic episode is more than just a feeling of elation, high energy,
or being distracted. During a manic episode, the mania is so intense that it can
interfere with your daily activities. It’s difficult to redirect someone in a manic
episode toward a calmer, more reasonable state. People who are in the manic phase
of bipolar disorder can make some very irrational decisions, such as spending large
amounts of money that they can’t afford to spend. They may also engage in high-risk
behaviors, such as sexual indiscretions despite being in a committed relationship. An
episode can’t be officially deemed manic if it’s caused by outside influences such as
alcohol, drugs, or another health condition. Manic episodes last at least seven days.
An individual experiencing a manic episode may experience: 1) Feelings of euphoria
2) Less need for sleep 3) Increased sexual desire 4) Hallucinations or delusions 5)
Marked increase in energy and ; During a manic episode, individuals may engage
in risky or reckless behavior. For example, someone may indulge in risky sexual
behavior, spend excessive amounts of money, or make impulsive decisions. It's
important to note that experiencing mania does not automatically mean a person
will become violent or dangerous. In the manic phase of bipolar disorder, it's
common to experience feelings of heightened energy, creativity, and euphoria. If
you're experiencing a manic episode, you may talk a mile a minute, sleep very little,
and be hyperactive. You may also feel like you're all-powerful, invincible, or destined
for greatness. In the manic phase of bipolar disorder, it’s common to experience
feelings of heightened energy, creativity, and euphoria. If you’re experiencing a
manic episode, you may talk a mile a minute, sleep very little, and be hyperactive.
You may also feel like you’re all-powerful, invincible, or destined for greatness. But
while mania feels good at first, it has a tendency to spiral out of control. You may
behave recklessly during a manic episode: gambling away your savings, engaging in
inappropriate sexual activity, or making foolish business investments, for example.
You may also become angry, irritable, and aggressive picking fights, lashing out when
others don’t go along with your plans, and blaming anyone who criticizes your
behavior. Some people even become delusional or start hearing voices. Mania and
hypomania are phases of bipolar disorder characterized by elevated "highs" in mood
and behavior that are in stark contrast to the depressive "lows" of the emotional
cycle. Mania is a facet of type I bipolar disorder in which the mood state is
abnormally heightened and accompanied by hyperactivity and a reduced need for
sleep. By contrast, hypomania (often described as "mania-light") is a type II bipolar
disorder which neither has the range nor severity of symptoms that classic mania
has. If left untreated, bipolar mania can spin out the control and affect your ability to
function on a daily basis. Recognizing the symptoms is the first step toward seeking
the appropriate treatment and care.
 3. Hypomania : In DSM-5 A. distinct period of abnormally and persistently
elevated, expansive, or irritable mood and abnormally and persistently increased
activity or energy, lasting at least 4 consecutive days and present most of the day,
nearly every day.
B. During the period of mood disturbance and increased energy and activity, three
(or more) of the following symptoms (four if the mood is only irritable) have
persisted, represent a noticeable change from usual behavior, and have been
present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful conse
quences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or
foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is
uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or
occupational functioning or to necessitate hospitalization. If there are psychotic
features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication, other treatment). A hypomanic episode is a period of
mania that’s less severe than a full-blown manic episode. Though less severe than a
manic episode, a hypomanic phase is still an event in which your behavior differs
from your normal state. The differences will be extreme enough that people around
you may notice that something is wrong. Officially, a hypomanic episode isn’t
considered hypomania if it’s influenced by drugs or alcohol. An individual
experiencing a hypomanic episode may experience similar symptoms but their
functioning won't be markedly impaired. Many individuals who experience
hypomania associated with bipolar II enjoy the increased energy and decreased need
for sleep. An episode of hypomania does not escalate to a point that a person needs
hospitalization, which may happen with a person experiencing mania especially if he
or she is becoming a danger to others and/or themselves. Hypomania is an
abnormally revved-up state of mind that affects your mood, thoughts, and behavior,
and is a potential symptom of bipolar disorder, particularly type II. A hypomanic
episode commonly manifests with unusual gaiety, excitement, flamboyance, or
irritability, along with potential secondary characteristics like restlessness, extreme
talkativeness, increased distractibility, reduced need for sleep, and intense focus on
a single activity. Diagnosing hypomania depends on the presence of a combination of
key symptoms and features. There must be a persistent and abnormally
elevated, expansive, or irritable mood, accompanied by unusually increased activity
and energy for most of the day over at least four days.
 4. Depression : Depression in DSM-5 A. Five (or more) of the following
symptoms have been present during the same 2-week period and represent a
change from previous functioning; at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical
condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjec
tive report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g.,
appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly every
day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others; not
merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delu
sional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (ei
ther by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupa
tional, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or
another medical condition.
Depressive symptoms in someone with bipolar disorder are like those of
someone with clinical depression. They may include extended periods of sadness
and hopelessness. You may also experience a loss of interest in people you once
enjoyed spending time with and activities you used to like. Other symptoms include:
1) tiredness 2) irritability 3) trouble concentrating 4) changes in sleeping habits 5)
changes in eating habits 6) thoughts of suicide.
Note: Criteria A-C constitute a major depressive episode. Major depressive episodes
are common in bipolar I disorder but are not required for the diagnosis of bipolar I
disorder.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a
natural disaster, a serious medical illness or disability) may include the feelings of
intensesadness, rumination about the loss, insomnia, poor appetite, and weight loss
noted in Criterion A, which may resemble a depressive episode. Although such
symptoms may be understandable or considered appropriate to the loss, the
presence of a major depressive episode in addition to the normal response to a
significant loss should also be carefully considered. This decision inevitably requires
the exercise of clinical judgment based on the individual’s history and the cultural
norms for the expression of distress in the context of loss.
G. Researches of the Psychiatric Disorders : In Philippine journal Statistics on
depression and bipolar disorder among Filipinos are in the Philippines and had the
highest incidence of depression in Southeast Asia.
Here are some of the journal regarding bipolar disorder : 1. Overview of
Lithium’s use : a nationwide survey - Lithium is considered the gold standard
treatment for bipolar disorder (BD). Current clinical guidelines and scientific
evidence support its use as a first-line treatment in BD. However, over the last two
decades, there has been a downward tendency in lithium's use in several developed
countries. Based on a nationwide survey, this study's objective is to analyze in a large
sample of psychiatrists relevant issues of the use of lithium salts in BD. There are
also given methods : Methods : Data were collected through an anonymous survey
sent by email among 500 psychiatrists who belong to a National Society of Psychiatry
(Spanish Society of Biological Psychiatry). The survey is a self-administered
questionnaire consisting of 21 items on the most key aspects of lithium's use
(indication, dosage, monitoring, and information for patients). In Conclusions : From
the results of the present study, it can be concluded that the use of lithium in Spain
is in line with the recommendations of the main international clinical guidelines and
current scientific literature. The first reason not to prescribe lithium in our country is
the perception of its adverse effects and not the aspects related to its practical use
or its effectiveness. Considering that BD is a chronic disease with a typical onset in
adolescence, the low rate of prescription of lithium salts in patients under 18 must
be thoroughly studied. For the Introduction of this journal : In addition to its mood-
stabilizing properties, lithium has a distinctive, independent, and proven anti-suicide
action This is a relevant quality in BD since up to 15% of patients diagnosed with BD
die by suicide. In fact, a systematic review and meta-analysis showed that treatment
with lithium among people with mood disorders could reduce the risk of death and
suicide up to 60% compared to placebo. Remarkable neuroprotective and antiviral
properties have also been attributed to lithium. It slows brain aging and reduces the
risk of dementia by almost 50% in patients with BD. It could also attenuate the
cognitive and functional decline in patients (without BD) with mild cognitive
impairment . Moreover, the use of lithium has recently been proposed as a potential
treatment for CoViD-19 . Despite the undeniable evidence in favor of its application
in BD, a descendent tendency in the use of lithium has been noticed in the US and in
numerous European countries . In several of them, it has changed from being the
most prescribed drug to the least one, even behind the controversial
antidepressants. . The emergence of new effective drugs for BD, such as second-
generation antipsychotics and certain antiepileptics, has overturned the prescription
pattern of BD. The absence of pharmaceutical marketing, the toxic perception of its
adverse effects, the slow onset of action and the need for venipuncture monitoring
are some of the possible causes of this declining trend . Neither the main clinical
guidelines nor current scientific literature supports the idea of replacing lithium with
other drugs.
6. Treatment Plan and Management : The treatment plan for bipolar disorder goes
this way : Medications may include: Mood stabilizers. You'll typically need mood-
stabilizing medication to control manic or hypomanic episodes. Examples of mood
stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium
(Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
Lithium. Lithium is the first-line choice for preventing mood instability and treating
mania. This agent is successful in treating aggressive behavior during acute manic
episodes, and it is also the most successful long-term treatment for bipolar disorder.
The following are the treatment for bipolar disorder : Treatment is best
guided by a medical doctor who specializes in diagnosing and treating mental health
conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You
may have a treatment team that also includes a psychologist, social worker and
psychiatric nurse. Bipolar disorder is a lifelong condition. Treatment is directed at
managing symptoms. Depending on your needs, treatment may include: 1)
Medications. Often, you'll need to start taking medications to balance your moods
right away. 2) Continued treatment. Bipolar disorder requires lifelong treatment
with medications, even during periods when you feel better. People who skip
maintenance treatment are at high risk of a relapse of symptoms or having minor
mood changes turn into full-blown mania or depression. 3) Day treatment
programs. Your doctor may recommend a day treatment program. These programs
provide the support and counseling you need while you get symptoms under control.
4) Substance abuse treatment. If you have problems with alcohol or drugs, you'll
also need substance abuse treatment. Otherwise, it can be very difficult to manage
bipolar disorder. 5) Hospitalization. Your doctor may recommend hospitalization if
you're behaving dangerously, you feel suicidal or you become detached from reality
(psychotic). Getting psychiatric treatment at a hospital can help keep you calm and
safe and stabilize your mood, whether you're having a manic or major depressive
episode. The primary treatments for bipolar disorder include medications and
psychological counseling (psychotherapy) to control symptoms, and also may include
education and support groups. Finding the right treatment : Finding the right
medication or medications for you will likely take some trial and error. If one doesn't
work well for you, there are several others to try. This process requires patience, as
some medications need weeks to months to take full effect. Generally only one
medication is changed at a time so that your doctor can identify which medications
work to relieve your symptoms with the least bothersome side effects. Medications
also may need to be adjusted as your symptoms change. Lifestyle and home
remedies : You'll probably need to make lifestyle changes to stop cycles of behavior
that worsen your bipolar disorder. Here are some steps to take: 1) Quit drinking or
using recreational drugs. One of the biggest concerns with bipolar disorder is the
negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if
you have trouble quitting on your own. 2) Form healthy relationships. Surround
yourself with people who are a positive influence. Friends and family members can
provide support and help you watch for warning signs of mood shifts. 3) Create a
healthy routine. Having a regular routine for sleeping, eating and physical activity
can help balance your moods. Check with your doctor before starting any exercise
program. Eat a healthy diet. If you take lithium, talk with your doctor about
appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or
mental health professional about what you can do. 4) Check first before taking other
medications. Call the doctor who's treating you for bipolar disorder before you take
medications prescribed by another doctor or any over-the-counter supplements or
medications. Sometimes other medications trigger episodes of depression or mania
or may interfere with medications you're taking for bipolar disorder. 5) Consider
keeping a mood chart. Keeping a record of your daily moods, treatments, sleep,
activities and feelings may help identify triggers, effective treatment options and
when treatment needs to be adjusted. For the Management of Bipolar Disorder :
Bipolar disorder is a chronic illness that causes periodic shifts in mood through
episodes of dysthymia, depression, hypomania, and mania. There are two major
types of bipolar disorder: bipolar I disorder, which is characterized by the presence
of at least one acute manic episode, and bipolar II disorder, which is typified by
hypomania and longer depressive episodes and is sometimes misdiagnosed as major
depressive disorder. Pharmacotherapeutic options include lithium, anticonvulsants,
antipsychotics, and antidepressants. Pharmacists play a role in ensuring proper
dosing regimens, checking for drug interactions, and monitoring for potential drug
toxicity. When counseling patients, pharmacists should review optimal
administration times and potential side effects to make certain that the patient has a
comprehensive understanding of how to manage symptoms. Bipolar disorder is a
chronic illness that causes periodic shifts in mood through episodes of dysthymia,
depression, hypomania, and mania. There are two major types of bipolar disorder.
Bipolar I disorder (BD I) involves the presence of at least one acute manic episode,
whereas bipolar II disorder (BD II) is characterized by hypomania and longer
depressive episodes. Because it involves longer depressive episodes, BD II is
sometimes misdiagnosed as major depressive disorder (MDD). It is estimated that
patients with BD I are depressed for a maximum of 3 weeks for every week of
hypomania, whereas patients with BD II are depressed for 37 weeks for every week
of hypomania.1 Patients who are misdiagnosed with MDD and are accordingly
prescribed antidepressants are at heightened risk for a rapid switch to
mania.2 Pharmacists can help patients develop a thorough history of their mood
episodes so that an accurate diagnosis of the patient’s psychiatric disorder can be
made. Lithium is the first-line choice for preventing mood instability and treating
mania. This agent is successful in treating aggressive behavior during acute manic
episodes, and it is also the most successful long-term treatment for bipolar disorder.
Lithium is effective as monotherapy in the depressive phase, with approximately
60% to 80% of patients demonstrating an improvement in symptoms. Depressive
symptoms may require up to 6 to 8 weeks of continuous treatment for
improvement, so if a patient’s depressive symptoms require a short onset of
response, lithium should be administered with antidepressants or other mood
stabilizers. The most commonly reported initial side effects associated with lithium
include gastrointestinal upset (nausea, vomiting, diarrhea), intention tremor of the
hand, polyuria, and polydipsia. Patients taking lithium who show symptoms of
confusion, ataxia, or slurred speech may be experiencing lithium toxicity and require
medical attention. More severe effects associated with long-term use of lithium
include leukocytosis, hypothyroidism, weight gain, acne, nephropathy, and cardiac-
rhythm disturbances.
[Link] Management and Psychotherapy : In Alternative management There
isn't much research on alternative or complementary medicine sometimes called
integrative medicine and bipolar disorder. Most of the studies are on major
depression, so it isn't clear how these nontraditional approaches work for bipolar
disorder. If you choose to use alternative or complementary medicine in addition to
your physician-recommended treatment, take some precautions first: 1) Don't stop
taking your prescribed medications or skip therapy sessions. Alternative or
complementary medicine is not a substitute for regular medical care when it comes
to treating bipolar disorder. 2) Be honest with your doctors and mental health
professionals. Tell them exactly which alternative or complementary treatments you
use or would like to try. 3) Be aware of potential dangers. Alternative and
complementary products aren't regulated the way prescription drugs are. Just
because it's natural doesn't mean it's safe. Before using alternative or
complementary medicine, talk to your doctor about the risks, including possible
serious interactions with medications. Some people with bipolar disorder have
reported that using alternative treatments provides relief from symptoms. Scientific
evidence supports many of the benefits in treating depression. But the effectiveness
in treating bipolar disorder requires more research. Always check with your doctor
before starting any alternative treatments. Supplements and therapies may interact
with your medication and cause unintended side effects. Alternative treatments
shouldn’t replace traditional treatments or medications. Some people have reported
feeling increased benefits when combining the two together. Example the Fish oil :
Fish oil and fish are common sources of two of the three main types of omega-3 fatty
acids: 1) eicosapentaenoic acid (EPA) 2) docosahexaenoic acid (DHA). These fatty
acids may affect the chemicals in your brain associated with mood disorders. Bipolar
disorder seems to be less common in countries where people consume fish and fish
oil. People with depression also tend to have lower levels of omega-3 fatty acids in
their blood. Omega-3 fatty acids may help: 1) reduce irritability and aggression 2)
maintain mood stability 3) reduce depression symptoms 4) improve brain function.
You can take fish oil supplements to help reach this daily amount. However, fish oil
supplements may have side effects that include: 1) nausea 2) heartburn 3) stomach
pain 4) bloating 5) belching 6) diarrhea. While the Psychotherapy can also be part of
Bipolar treatment : Psychotherapy is a vital part of bipolar disorder treatment and
can be provided in individual, family or group settings. Several types of therapy may
be helpful. These include: 1) Interpersonal and social rhythm therapy (IPSRT). IPSRT
focuses on the stabilization of daily rhythms, such as sleeping, waking and
mealtimes. A consistent routine allows for better mood management. People with
bipolar disorder may benefit from establishing a daily routine for sleep, diet and
exercise. 2) Cognitive behavioral therapy (CBT). The focus is identifying unhealthy,
negative beliefs and behaviors and replacing them with healthy, positive ones. CBT
can help identify what triggers your bipolar episodes. You also learn effective
strategies to manage stress and to cope with upsetting situations. 3)
Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you
and your loved ones understand the condition. Knowing what's going on can help
you get the best support, identify issues, make a plan to prevent relapse and stick
with treatment. 4) Family-focused therapy. Family support and communication can
help you stick with your treatment plan and help you and your loved ones recognize
and manage warning signs of mood swings. Psychotherapy, or "talk" therapy, is an
important part of treatment for bipolar disorder. During therapy, you can discuss
feelings, thoughts, and behaviors that cause you problems. Talk therapy
can help you understand and hopefully master any problems that hurt your ability to
function well in your life and career. Psychotherapy. Initial and long-term therapy
can help keep symptoms from returning. Psychotherapy can help children and teens
manage their routines, develop coping skills, address learning difficulties, resolve
social problems, and help strengthen family bonds and communication. And, if
needed, it can help treat substance abuse problems common in older children and
teens with bipolar disorder. The types of psychotherapy used to treat bipolar
disorder include: 1) Behavioral therapy. This focuses on behaviors that decrease
stress. 2) Cognitive therapy. This type of approach involves learning to identify and
modify the patterns of thinking that accompany mood shifts. 3) Interpersonal
therapy. This involves relationships and aims to reduce strains that the illness may
place upon them. 4) Social rhythm therapy. This helps you develop and maintain a
normal sleep schedule and more predictable daily routines. Support groups also help
people with bipolar disorder. You receive encouragement, learn coping skills, and
share concerns. You may feel less isolated as a result. Family members and friends
may also benefit from a support group. They can gain a better understanding of the
illness, share their concerns, and learn how to best support loved ones with bipolar
disorder. Education is another integral part of treatment for you and your family.
People with bipolar disorder (and their families) often benefit from learning about
the disorder its symptoms, early signs of an episode, and types of treatment. This
type of education can also help to come up with a plan in case your insight or ability
to see you system is compromised. person to person, together with a psychiatrist you
can identify what behavior changes signal the onset of an episode for you. It may be
needing less sleep to feel rested, buying things you can’t afford or don't need, or
becoming suddenly involved in religion or new activities and interests. 1) Adapt. This
can help you avoid embarrassing behavior during manic episodes and set realistic goals
for treatment. Your doctor can help you prepare for possible future episodes and
manage fear about having more. A key part of adapting is to understand the types of
stressors that might increase the risk for manic or depressive episodes and the lifestyle
changes that can reduce them. 2) Maintain a regular sleep pattern. Go to bed and wake
up around the same times each day. Changes in sleep can disrupt the normal
functioning of brain circuits involved in the processing of emotions, potentially triggering
mood episodes. 3) Do not use alcohol or street drugs. These substances can trigger or
mimic mood episodes. They can also interfere with the effectiveness of medication. For
many people with bipolar disorder, there is risk of having other psychiatric problems.
Typically, these are alcohol and drug abuse, an anxiety disorder, an eating disorder, or a
personality disorder. An estimated 60% of all people with bipolar disorder have drug or
alcohol problems. Drug abuse can mimic the symptoms of depression or mania, making
it important to treat substance abuse problems in order to make an accurate diagnosis
of bipolar or other mood disorders. Here are the role of psychotherapy in bipolar
disorder : Non-adherence to medication is a major cause of relapse in bipolar
disorder. The factors involved in non-adherence are multifaceted and occur at the
individual, service delivery, and illness levels.
Individual factors of illness acceptance, beliefs and level of understanding of the
disorder, and fear of the role of medication all affect adherence. Treatment
complexity and tolerability issues also contribute to non-adherence. This is further
compounded by some patients “chasing” the elevated mood pole; those with a
predominance of mania are more likely to be non-adherent. Lack of knowledge
about the disorder and the reason for taking medication, and misinformation leading
to inaccurate beliefs and fears about medication are risk factors for non-adherence
in bipolar disorder. Psychoeducation combined with a collaborative alliance between
the clinician and the patient can help to reduce these risks. Understanding the
patient’s beliefs about the disorder and its treatment can facilitate targeted
intervention to improve adherence. Interventions such as simplifying the treatment
regimen and building in reminders (eg, a diary) or cues (eg, link to brushing teeth)
can also be helpful: a recent study of 140 people with bipolar disorder found a
strong factor in poor adherence was forgetting to take medication. Barriers to care
can occur at a system and service delivery level, at which greater barriers are
associated with more non-adherence. Issues of access, convenience and cost all
affect engagement with treatment. At an illness level, psychiatric comorbidities are
also associated with reduced medication adherence. Predictably, comorbid
substance misuse predicts non-adherence, and is associated with a worse
outcome and an increased risk of suicidality. A recent trial of a 12-session, group-
based cognitive behaviour therapy (CBT) program for people with bipolar disorder
and comorbid substance misuse showed promising trends in reducing substance
misuse and bipolar relapse compared with group-based counselling for substance
misuse alone. Although there are distinct theoretical approaches to the psychosocial
treatment of bipolar disorder, there is a blurring of boundaries between them, with
a number of shared components. Overall, they differ more in their emphasis, rather
than in their unique elements. A meta-analysis of psychosocial interventions for
bipolar disorder showed no evidence to suggest superiority of any specific type of
therapeutic approach, perhaps due to the extent to which their content
overlapped. At the individual level, however, particular psychosocial needs should be
identified, and treatment individualised as far as possible. As with medication, there
is no single psychosocial tool that every patient will find useful. Primary components
of psychoeducation include information about: the illness and the role of
medication; regulation of biological rhythms (eg, the sleep wake cycle); identification
of illness triggers; personal illness profiles (eg, identification of prodromes); and
relapse prevention plans. Other elements encompass risk behaviour, including
substance misuse, stress management and problem-solving strategies. The number
of sessions involved in psychoeducation programs varies, from five sessions in the
first phase of the Life Goals Program to 21 in another group-based psychoeducation
program. Psychoeducation can significantly reduce relapse and improve functioning,
over and beyond improving medication adherence. Recently published 5-year
outcomes of group-based psychoeducation show enduring benefits, with fewer
episodes of illness and higher levels of functioning, in comparison to non-structured
group meetings. Behavioural strategies focus on responding to triggers and mood
changes; these include strategies to increase activity levels when the patient is
lethargic and depressed, and strategies to assist the patient to set small manageable
goals.
7. Psychodynamic Foundation, prevention and prognosis : The psychodynamic
formulation of bipolar disorder is :psychodynamic group therapy for bipolar patients
led to improvement in depressive, but not manic symptoms, and recommended that
this form of treatment should be considered as adjunctive to psychopharmacologic
management of acute bipolar illness. Depression secondary to medical illness is an
appropriate diagnosis when the physiological effects of the illness on the brain
directly result in depressive symptoms. Several medical disorders are associated with
depressive symptoms in this way. Occult hypothyroidism exemplifies disorders in
which recognition and treatment of the underlying condition may alleviate
depression symptoms. In addition to organic causes of depression in the medically ill,
other relevant factors to consider and explore with patients include: the meaning of
the illness to the patient, the patient's causal attributions about illness, distorted
cognitions or maladaptive behavioral responses to illness, coping mechanisms, and
strengths or weaknesses which may be imbedded in patients' premorbid personality
traits and style. When rapid improvement of depressive symptoms is the goal,
psychostimulants have been useful in patients with advanced cancer. The suggestion
that antidepressants increase the risk of cancer has been refuted.
1. Predisposing Factor in Bipolar Disorder : Factors that may increase the risk of
developing bipolar disorder or act as a trigger for the first episode include: Having a
first-degree relative, such as a parent or sibling, with bipolar disorder. Periods of
high stress, such as the death of a loved one or other traumatic event. Drug
or alcohol abuse. In DSM-5 Environmental. Bipolar disorder is more common in high-
income than in low-income countries (1.4 vs. 0.7%). Separated, divorced, or
widowed individuals have higher rates of bipolar I disorder than do individuals who
are married or have never been married, but the direction of the association is
unclear. Genetic and physiological. A family history of bipolar disorder is one of the
strongest and most consistent risk factors for bipolar disorders. There is an average
10-fold increased risk among adult relatives of individuals with bipolar I and bipolar
II disorders. Magnitude of risk increases with degree of kinship. Schizophrenia and
bipolar disorder likely share a genetic origin, reflected in familial co-aggregation of
schizophrenia and bipolar disorder. Course modifiers. After an individual has a manic
episode with psychotic features, subsequent manic episodes are more likely to
include psychotic features. Incomplete inter episode recovery is more common
when the current episode is accompanied by mood incongruent psychotic features.
[Link] Factors of Bipolar Disorder : What are the possible risk factors for
bipolar disorder? No one single risk factor means you’ll develop bipolar disorder.
Scientists believe that multiple risk factors work together to trigger the illness. More
research needs to be done to pin down the specific risk factors and causes.
Genetics : Bipolar disorder tends to run in families. Children with a parent or sibling
with the disorder have a higher chance of developing it than those without affected
family members. Identical twins don’t have the same risk of developing the illness.
It’s likely that genes and environment work together in the development of bipolar
disorder.
Environment : Sometimes a stressful event or major life change triggers a person’s
bipolar disorder. Examples of possible triggers include the onset of a medical
problem or the loss of a loved one. This kind of event can bring about a manic or
depressive episode in people with bipolar disorder.
Drug abuse might trigger bipolar disorder. An estimated 60 percent of individuals
with bipolar disorder are dependent on drugs or alcohol. People with seasonal
depression or anxiety disorders may also be at risk for developing bipolar disorder.
Brain structure : Functional magnetic resonance imaging (fMRI) and positron
emission technology (PET) are two types of scans that can provide images of the
brain. Certain findings on brain scans may be associated with bipolar disorder. More
research is needed to see how these findings specifically impact bipolar disorder and
what this means for treatment and diagnosis.
[Link] factors of Bipolar Disorder : Stressful events or circumstances in a
person’s life, such as, family conflicts, employment difficulties, bereavement, or even
positive events, such as getting married, having children, moving house, etc, can
place extra demands on the person, leading to them feeling stressed, frustrated,
anxious, sad, etc. The occurrence of bipolar disorder can thus be explained as an
interaction of the 3 above factors. A person who is genetically and/or biologically
vulnerable may not necessarily develop bipolar disorder. These vulnerabilities are
affected by how they cope with stressors in their life. For example, a person who has
a family history of diabetes may not develop diabetes if they are careful with they
eat and have enough exercise. This brings us to a discussion on protective and risk
factors. A risk factor is something that will increase the chances of a person who is
already vulnerable becoming ill. Examples of risk factors are: poor or maladaptive
coping strategies, alcohol or drug use, irregular daily routines, interpersonal
conflicts, stressful events, etc. Protective factors, on the other hand, are those that
can help to prevent a vulnerable person from becoming ill. Protective factors include
good coping strategies, good social support networks, effective communication and
problem solving skills, etc. It is when the risk factors outweigh the protective factors,
that the chances of developing the disorder are high. This principle applies when
considering the risk of recurrence as well.
[Link] Factors of Bipolar Disorder : Patients with bipolar I fare worse than
patients with a major depression. Within the first two years after the initial episode,
40-50% of patients experience another manic attack. Often, the cycling
between depression and mania accelerates with increasing age. In DSM-5 Patients
with bipolar I fare worse than patients with a major depression. Within the first two
years after the initial episode, patients experience another manic attack. Often, the
cycling between depression and mania accelerates with increasing age. Factors
suggesting a worse prognosis include: 1) Impairment of occupational functioning 2)
Alcohol abuse 3) Psychotic features 4) Depressive features between periods of mania
and depression 5) Male sex .Factors suggesting a better prognosis include: 1)
Shorter duration of manic phases 2) Later age of onset 3) No psychotic symptoms 4)
Few medical problems. Although there is no cure for bipolar disorder, it is a highly
treatable disease. According to the National Advisory Mental Health Council,
the treatment success rate for bipolar disorder is a remarkable 80 percent. Suicide is
the number one cause of premature death among people with bipolar disorder, with
15 percent to 17 percent taking their own lives as a result of negative symptoms that
come from untreated illness. The extreme depression can result from lack of
treatment are the usual culprits in these cases. Suicides rates can be compared to
those of the general population, which are somewhere around one percent.