INTRODUCTION

This paper will be looking at bipolar disorder, the causes, symptoms, diagnosis and treatment of this disorder will be briefly explained in the paper as well as the manner in which the society view this disorder.

Bipolar is described as a mood disorder by many books and journal articles.

According to Weiten (2010), mood disorders are a class of disorders marked by emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social, and thought processes. Mood disorders can also be explained as disorders of depression and elation, resulting in outward effects of depression and mania; which is severe enough to impair normal functioning in the absence of a clearly identifiable stressor (Burke, Austin, Bezuidenhout, Botha, Du Plessis, Du Plessis, et al, 2012).

Bipolar is a chronic, common and recurring medical disorder that is characterized by the episodes of mania, depression (Martinowhich, Scholoesser & Manji, 2009), and hypomanic episodes (Butcher, Mineka, & Hooley, 2010). Manic episode is a period of unrealistically heightened euphoria, extreme restlessness, and excessive activity which is characterised by disorganised behaviour and impaired judgement (Nevid, Rathus, & Greene, 2011); whereas hypomania is a period where one feels persistently elevated, expansive and irritable; and it can last for up to four days (Burke, et al., 2012). A depressive episode is when the person experiences feelings of hopelessness, irritability and is socially withdrawn; they usually experience slow thought processes and tiredness (Weiten, 2010).

Causes

Both Martinowhich, Scholoesser and Manji (2009) and Burke, et al. (2012) agree that the main cause of bipolar disorder is the person’s genes. Louw and Edwards (1997) states that genes are carriers of hereditary characteristics whilst Burke, et al. (2012) states that genes responsible for debilitating bipolar disorders are selected despite being a danger as they confer important adaptive advantages such as abilities for language and creativity. So either way both these writers tell us that genes can play a massive role in causing bipolar to people. Even though bipolar has a strong genetic basis, there are other factors that can cause this disorder. Stress and life events also develop the illness as people may face stresses that are greater than their ability to cope in life. Therefore people may become stressed when they feel they have no control over the stress in their lives and then start developing manic episodes.when people cannot sleep or their sleep patterns become irregular manic episodes may be triggered especially if that person is at risk of having bipolar disorder, and also to those that already have the disorder (Burton, 2009).

People who have bipolar disorder and yet abuse drugs and alcohol are more likely to develop the disorder earlier, they are also more likely to be admitted to a psychiatric hospital (Burton, 2009). Medication such as antidepressants, steroids, appetite suppressants, caffeine, and steroids can trigger depressive and manic episodes. Also, during pregnancy and the period after giving birth, women with bipolar have about twice the risk of developing an episode of elevated or depressed mood (Burton, 2009). According to Burton (2009), the changes of the seasons can also trigger this illness, as manic episodes are most likely to occur in summer and spring. Bipolar disorder is also associated with a chemical imbalance in the brain (The Depression and Anxiety Group, 2000). Excess excitatory of neurotransmitters, the chemical messengers in the brain, causes the symptoms of mania (Burton, 2009).

Symptoms

Symptoms of bipolar can be divided into manic, depressive, and psychotic symptoms. Manic episodes usually begin abruptly over a period of days, and can go up to an average of four months if there is no treatment (Burton, 2009). Main features of a person in a manic episode are hyperactivity, talkativeness, flight of ideas, inflamed self-esteem, and reduced need for sleep, distractibility, and high risk behaviour without regarding the consequences (Louw & Edwards, 1997). Psychotic symptoms can include hallucinations and delusions (Burton, 2009). Hallucinations are sensory perceptions occurring in the absence of a real, external stimulus; while delusions are false beliefs that are maintained even though they are out of touch with reality (Weiten, 2010).  During hypomania, the mood is elevated, expansive, or irritable, but in contrast to mania, there are no psychotic features (Burton, 2009). During a depressive episode, one may feel sadness, lack of interest, lack of enjoyment, and fatigue. One may also have poor concentration, poor motivation and energy, poor self- esteem and self-confidence, sleep disturbances, loss of weight and appetite, and retardation of speech and movements (Burton, 2009).

The most disabling episodes are those that include symptoms of both mania and depression, known as mixed episodes (The Depression and Anxiety Group, 2000). This combination of manic activation and depressed mood is referred to as agitated depression which predisposes to illicit drug misuse and attempted suicide (Burton, 2009). Bipolar disorders can also be separated into bipolar I and bipolar II (The Depression and Anxiety Group, 2000). Bipolar I disorder is when a person experiences manic or mixed episodes and almost always has depression as well (The Depression and Anxiety Group, 2000). Even though the person may be only showing signs of manic symptoms, it is assumed that a bipolar disorder exists and that a depressive episode will eventually occur (Butcher, Mineka, & Hooley, 2010).

According to The Depression and Anxiety Group (2000), bipolar II disorder is when a person has only hypomanic and depressive episodes, not full manic or mixed episodes, and is usually hard to recognise as hypomania may seem normal.

Diagnosis

In order for a patient to be treated well a proper diagnosis of the disorder needs to be done. The diagnosis of bipolar is based on the symptoms that the patient has, the symptoms that you see without even considering blood tests or brain scans. The Classification of Disease System (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorder (DSM) are the two major classification systems that are used to diagnose disorders (Butcher, Mineka, & Hooley, 2010). The ICD-10 provides clinical descriptions and diagnostic criteria; it is based on scientific literature and international consultation and consensus (Burton, 2009). The DSM specifies what subtypes of mental disorders are currently recognised and provides a set of defining criteria for each.

Burton (2009) states that if a person is suspected to have symptoms of bipolar disorder, they must meet the certain agreed criteria listed in the diagnostic manuals. The person should be in a period of abnormally and persistently elevated, expansive, or irritable mood lasting for at least one week. During this period of mood disturbance, one needs to have three or more of these symptoms present to a significant degree: grandiosity, decreased need for sleep, more talkative than usual, flight of ideas, distractibility, agitation in goal-directed activity, and involvement in risky behaviour (Burton, 2009). The symptoms of the person should not meet criteria for a mixed episode, but the symptoms should be sufficiently severe to cause marked impairment in occupational or social functioning (Burton, 2009). Burton (2009) also stresses that the person diagnosed should not have symptoms that are due to substances or general medication condition.

It is very important to remove conditions that can be seen as the bipolar disorder so that a firm diagnosis can be made. Conditions that can be seen as bipolar can include drug use, schizophrenia, schizoaffective disorders, severe depression, psychotic disorders, personality disorders, attention-deficit hyperactivity disorder, organic brain disease, infectious diseases affecting the brain, head injury, endocrine disorders, and medications like antidepressants, steroids and L-dopa (Burton, 2009).

Treatment

There are many ways to treat bipolar and it all differs from the causes and how much it has grown. Therefore the choice of medication in bipolar disorder is determined by the current symptoms that the patient has, and so manic and depressive episodes are also treated differently. People who are going through mania are at risk of harming themselves, and antipsychotic medication is usually used to treat them (Burton, 2009). Antipsychotic medication is fast-acting and effective, but relatively high doses are required as it does not protect against future depressive episodes, antipsychotic medications are also effective for treating mania as it blocks the effect of dopamine in the certain parts of the brain (Burton, 2009). Dopamine is a neurotransmitter that plays a role in important functions like voluntary movement, attention, and learning. Though the antipsychotics assist in this way, they may also cause side effects like muscle stiffness, restlessness, drowsiness, and other side effects (The Depression and Anxiety Group, 2000).

Mood stabilizers can be used to control the symptoms of bipolar disorder. Mood stabilizers are used to improve symptoms during acute manic, hypomanic, and mixed episodes; they may also reduce symptoms of depression (The Depression and Anxiety Group, 2000). Mood stabilizers include lithium, valproate, lamotrigine, and carbamazepine. Mood stabilizers are used to prevent further relapses of both mania and depression, and sometimes also in short term mania and hypomania (Burton, 2009). If one mood stabilizer is not working, a substitute one can always be used, or a combination of two medications at manageable dosages (The Depression and Anxiety Group, 2000).

Another crucial treatment is the psychological and social interventions. To ensure that the person with bipolar is receiving medication; a member of a mental health-care team needs to review the person. The care plan may involve a number of psychosocial measures, including patient and family education, cognitive behavioural therapy, illness self-management, self- help groups, and social and vocational skills training (Burton, 2009). Cognitive behavioural therapy focuses on identifying and correcting thinking errors associated with behaviours that occur in depression (Burton, 2009). One can also reduce the minor mood swings and stresses that sometimes lead to more severe episodes by maintaining a stable sleep pattern, maintaining a regular pattern of activity, not using alcohol and illicit drugs, getting support from friends and family, reducing stress at work, and reducing the everyday amount of caffeine. Developing a wellness lifestyle assists with managing stress and also for physical health and quality of life (Burton, 2009). Eating a balanced diet, exercising, avoiding excessive caffeine and alcohol, using therapy and educational materials to improve self- esteem, enhancing life with activities that makes one feel good, having a safe and peaceful living space, peer counsel, and finding individuality outside of the bipolar disorder are some of the things that aid one to enhance their lives (Burton, 2009; The Depression and Anxiety Group, 2000).

In bipolar disorders, the most common treatment used for depressive episodes is the antidepressants. Antidepressants are the medications taken to eliminate the symptoms of depression (Louw & Edwards, 1997). They usually take a few weeks to begin showing effects and can sometimes cause problems in this illness by pushing the mood too high (The Depression and Anxiety Group, 2000). Antidepressants such as fluoxetine, paroxetine, sertraline, and citalopram prevent the reuptake of the chemical messenger serotonin in the brain (Burton, 2009). In other rare cases, the depressive episode is so severe that electroconvulsive therapy is indicated (Burton, 2009). Electroconvulsive therapy (ECT) has been demonstrated to be safe and effective in the treatment of mood symptoms that are severe and unresponsive to medication (Burton, 2009). ECT is explained by Burton (2009) as a potentially life-saving treatment, and the benefits and the risks need to be weighed up in each case. Although ECT can be effective, it can leave side effects of the anaesthetic, headaches, muscle aches and nausea (Burton, 2009). The effectiveness of ECT in extreme cases of both depression and mania makes it the best choice for many suicidal individuals (The Depression and Anxiety Group, 2000).

Contextualized issues

One of the major problems that are associated with bipolar disorder usually influences the recovering processes of the sufferers. Burton (2009) explains that these problems can create a very bad cycle of alienation and discrimination that hinders progress to recovery by promoting social isolation, stress, depression, alcohol and drug misuse, unemployment, homelessness, and institutionalization. Some people suffering from bipolar are very anxious of the problems that they find it difficult to accept that they have the illness. Attitudes and behaviours that contribute to the problems are subtle and may include speaking to people with bipolar as if they are children , talking about them as if they are not in the room, and failing to grant them sufficient independence and responsibility (Burton, 2009). People with bipolar disorder find it hard disclosing about their illness once they have been diagnosed because of these derogatory terms such as ‘maniac’ or ‘psycho’, it reminds the victims that their behaviour is different from the others and develop a fear of the pain and shame of being called by names (Burton, 2009).