Within the unique discipline of physiological psychology, psychologists work to examine the intricate relationship between biology and behavior. They aim to assimilate psychological states with particular regard for brain chemistry and the nervous system. This has led psychologists to study a wide variety of conditions, including neurological, psychological, and neuropsychological disorders. One such disorder is Bipolar Disorder. The focus of this paper will discuss the dynamics of Bipolar Disorder from an analytical, historical, and physiological standpoint in an attempt to understand what takes place in the brain of sufferers and how it impacts their resulting behavior.
Bipolar Disorder, previously known as “manic-depressive disorder,” dates back many centuries. The indication of a distinct connection between bipolar extremes, melancholy, and mania, can be traced back to the time of the Ancient Greeks. In particular, Aretaeus of Cappadocia, a physician, and philosopher during the first century AD. However, it wasn’t until around the 19th century that Bipolar Disorder garnered its name. In 1854, Jean-Pierre Falret and Jules Baillarger individually provided explanations of the disorder to an Academic journal in Paris (Burton, 2012). Falret termed the illness “folie circulaire (‘circular insanity’)” whereas Baillarger termed it “Folie a double forme (‘dual-form insanity’)” (Burton, 2012, para. 3).
Moreover, Falret proposed that the disorder had a sound genetic foundation, which was later supported by research. German Psychiatrist Emil Kraepelin examined the natural progression of the disorder and discovered that it was marked by moderately symptom-free periods. Because of this, he termed the illness, ‘manic-depressive psychosis.’ He described it in contrast to schizophrenia and maintained that manic-depressive psychosis had an intervallic development and a gentler ending (Burton, 2012). Ultimately, Bipolar Disorder garnered its name because it was believed to be less defaming than its older counterpart ‘manic-depressive disorder.’
Bipolar Disorder is a psychological disorder that afflicts about 2.6% of the general population (NAMI, 2013). This disorder impacts individuals’ mood and is quite frequently described as cycles of elevated energy, elation and irritability, and insomnia trailed by periods of depression. This is a disorder that has accrued a substantial amount of attention, and this attention has been mounting just as quickly as its diagnosis, particularly in children and adolescents. Nierengarten (2015, p. 34) disclosed that there had been a “40-fold increase” in this disorders diagnosis in children between 1995 and 2003. Such statistics are sobering and beg the question of whether or not there has been a considerable percentage of misdiagnosis.
The diagnosis of bipolar disorder is not as clear-cut as performing a body scan or administering a blood test. In truth, tests such as these cannot identify BP but can be beneficial in excluding other possible illnesses. Perspicuity, precision, and objectivity of diagnostic practice are critical in experts’ aptitude to examine and handle mental health illnesses adequately. Furthermore, bipolar disorder is typically diagnosed under four primary subtypes: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Not Otherwise Specified (BP-NOS).
Although criteria for a BP diagnosis has altered over the years, the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) bases its identification on illnesses based on the existence of specified symptoms that occur for a specific amount of time. Moreover, mania is the primary ingredient in diagnosis. Without the manifestation of mania over a certain period, patients would just be considered to have ‘Depressive Disorder.’ Also, the type of bipolar that one is diagnosed with is contingent upon the pattern and duration of both manic and depressive episodes that the patient is experiencing or has experienced.
There are myriad physical and psychological signs and symptoms for BP. Some of which include: elevated mood, grandiosity, being more talkative, increase in energy and/or goal-directed activity, decreased need for sleep, irritability (Koukopoulos & Sani, 2014), insomnia, depressed mood, lack of interest in everyday activities, notable weight gain or loss, feelings of worthlessness/helplessness, inability to think or concentrate, low self-esteem, etc. (Bressert, 2013). Lastly, while this is just a general list of signs and symptoms, to be identified as BP in any of the specified subsets, patients must meet the aforementioned criteria.
Concerning the choice of topic, the selection of bipolar disorder mainly derives from a personal interest of its functions. Many families across civilizations encounter this illness, including my own. With a mother who is afflicted, there was a deep-seated compulsion to understand its ins and outs. However, as an individual who endeavors to one day work closely with children in a future profession, an understanding of this illness could greatly assist me in meeting the needs of every one of my pupils in the most effective way imaginable. And that brings us to the question of who is affected by this disorder.
Research has indicated that BP affects men and women alike. In general, the inception of BP is usually discovered in people in their early 20s; however, this disorder is becoming ever-more prevalent in children and adolescents. Although BP does not discriminate against regions or ethnicities, lower socioeconomic status may be marginally associated with higher percentages of bipolar disorder (Hafeman et al., 2013). Ultimately, it is a mental condition that can impact just about anyone regardless of geographic location.
In a perfect world, everyone would experience feelings and moods with a sort of normal consistency. Perhaps something even akin to the ebbs and flows of the ocean on a calm day. Unfortunately, such a world does not exist, especially for those who suffer from bipolar disorder. Those with BP endure drastic shifts in emotional states, and these shifts last for longer periods of time compared to those who are not afflicted by the illness. Sufferers are literally on an emotional rollercoaster, being catapulted heavenward only to be propelled straight back down into the dark abyss just as quickly as the climb skyward. These dramatic variations in mood have seemingly little to no real explanation, yet they exist. It is important to note that one of the significant distinctions between normal emotions and BP is that those with the condition are incapable of handling everyday goings-on. Thus, identifying mood states is crucial to treatment.
When patients experience a manic episode, they may endure elevated mood, euphoria, irritability, and aggression, lack of concentration, a vast decrease in the need for sleep, a higher sense of self-esteem, flight of ideas, extreme engagement in pleasurable activities, etc. (Bressert, 2013). Patients who experience depressive episodes may endure a profound loss of interest in daily events, negative thoughts that may or may not lead to talks of suicide and death, low self-esteem, feelings of worthlessness and hopelessness, insomnia, lack of concentration, significant weight loss or weight gain, etc. (Bressert, 2013). Those with Bipolar disorder experience major shifts back and forth between the manic and depressive spectrum. However, depending on what side of the spectrum they fall under the most, determines what subtype of the disorder they harness.
As stated previously, Bipolar disorder is generally diagnosed under four subtypes: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder Not Otherwise Specified (BP-NOS). Individuals diagnosed under Bipolar I often endure one or more periods of mania. Depression is not required for diagnosis; however, most patients will experience periods of both depression and mania. For a diagnosis to be valid, a patient must experience manic and/or mixed episodes that persist for a minimum of seven days or be so ruthless that the patient demands hospitalization. Bipolar II is diagnosed when a patient principally suffers depressive spells alternating back and forth with hypomanic bouts. However, an essential element in this diagnosis is that patients never fully endure a full manic attack. Cyclothymia indicates a prolonged unbalanced emotional state. Patients with this diagnosis suffer hypomania and minor depression for a minimum of two years. A person with this diagnosis may experience intervals of “normal” mood; however, these episodes are short-lived and are recorded to last less than eight weeks. Finally, BP-NOS is established when an individual does not meet the standards for bipolar I, II, or cyclothymia but has suffered from episodes of abnormal mood elevation (NAMI, 2015).
From an epidemiological perspective, BP ranked as the 12th most popular moderately to brutally debilitating illness worldwide for all age groups, with 4 percent impacting the U.S. alone (Price & Marzani-Nissen, 2012). Bipolar has no preference when it comes to race, gender, geographic location, or ethnicity. Furthermore, while this disorder is typically discovered in adolescents and young adults, recent studies have revealed that its onset can occur even in early childhood. Children as young as preschool age have been reported to have BP; however, it should be noted that symptoms and signs do not always present themselves in the same way, and treatments vary dramatically depending on the child and their response to treatment interventions.
Furthermore, bipolar disorder is significantly different compared to other conditions (e.g., diabetes, cholesterol, blood pressure, etc.) and therefore long-term treatment is vital to patients’ health and well-being. Proper diagnosis and subsequent treatment enable patients to lead healthy, successful, and productive lives. The treatment helps with reducing the severity and regularity of occurrences, and enables patients to gain more control over their mood swings and associated problems. When left untreated, bipolar disorder just escalates. Over time, patients will begin to endure even more shifts in mood state, more brutal than when they were first diagnosed, and they will have more severe depressive episodes and less manic attacks. This can cause major issues in all areas of a person’s life: academic, personal, professional, social, etc. Thus, treatment is a necessary component in maintaining control of symptoms, and there are many avenues to get help.
If patients first seek help through their primary care doctors, a physical examination is often given, followed by a multitude of laboratory tests. This is done so doctors can rule out all other possible causes for reported symptoms. If a physical cause is eliminated, doctors will then refer patients to specialists (psychiatrists and/or psychologists) for further examination. Once patients see a mental health professional, they are typically diagnosed based on the criteria found within the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders. However, they also give psychological evaluations. There are no blood tests or brain scans for bipolar disorder (Martin, 2013). Once BP has been established, it is important to come up with a treatment plan to control symptoms. This can be achieved through therapeutic alliance. As stated by the APA (2010, p. 14), “Establishing and maintaining a supportive and therapeutic relationship is critical to the proper understanding and management of an individual patient."
Moreover, repeated psychological evaluations are also used in ongoing management. This is to ensure that if any adjustments need to be made in treatment, they can be carried out in an effective and timely manner. Additionally, while there is still no cure for BP, research is ongoing, and genetic breakthroughs seem to be at the forefront for better detection and future treatments.
Although the cause of bipolar has yet to be wholly known, there are some factors that are linked to its inception. As mentioned briefly, genetics plays a role in the development of bipolar. Statistics allude that children with a bipolar parent(s) have a 4 to 15 percent possibility of also acquiring the disorder, whereas children of parents that do not suffer from the disorder only have a 0 to 2 chance (Price & Marzani-Nissen, 2012, p. 485). It is a disorder that runs in families and is passed down through generations. The environment also has a role in the establishment of bipolar. For those with a genetic predisposition for this disorder, primary and/or stressful life events may trigger an episode; however, it should be noted that the stress alone is not causation.
Moreover, the choice of lifestyle can also provoke the onset of this illness. Drug and alcohol use can both trigger mood episodes and worsen the preexisting illness by inhibiting treatment though these are not the only factors implicated in the onset of BP.
Another recognized factor that can impact those with BP involves medication, both prescription and non-prescription. Medications can also elicit manic episodes. Thus, depressive episodes have to be treated with great care in patients who have also exhibited manic spells. A chemical imbalance is another dynamic that is believed to “cause” BP. A final consideration for causation that has been bounced around is viruses and/or other infectious agents. However, the research that has been conducted to connect viruses/other infectious agents with clinical, genetic, and epidemiologic aspects of this illness have welded primarily negative results (Yolken & Torrey, 1995). Nevertheless, there are always reasons for optimism whilst seeking a cure.
Furthermore, there are several shifts in neurotransmitter and hormone operations that have been linked to bipolar disorder. For example, above normal levels of cortisol have been linked to the disorder, as well as thyroid abnormalities (Wilson, 2013). Moreover, irregularities in serotonin, norepinephrine, and dopamine have been connected in the cause of bipolar disorder as well. While norepinephrine activity upsurges, serotonin activity diminishes. Additionally, very little of the heritability of BP can be explicated by common polymorphisms (19) (Vieta, 2014). However, two genes seem to be the soundest contenders from genome-wide association investigations, “the ANK3, a gene involved in the function of voltage-gated sodium channels), and the CACNA1C, a gene encoding a protein that is part of a voltage-dependent calcium channel (20, 21)” (Vieta, 2014, p. 323). The X chromosome also plays a role in the development of BP.
In addition, there are several shifts in neurotransmitter and hormone operations that have been linked to bipolar disorder. For example, above normal levels of cortisol have been linked to the disorder, as well as thyroid abnormalities (Wilson, 2013). Moreover, irregularities in serotonin, norepinephrine, and dopamine have been connected in the cause of bipolar disorder as well. While norepinephrine activity upsurges, serotonin activity diminishes. Additionally, very little of the heritability of BP can be explicated by common polymorphisms (19) (Vieta, 2014). However, two genes seem to be the soundest contenders from genome-wide association investigations, “the ANK3, a gene involved in the function of voltage-gated sodium channels), and the CACNA1C, a gene encoding a protein that is part of a voltage-dependent calcium channel (20, 21)” (Vieta, 2014, p. 323). The X chromosome also plays a role in the development of BP.
In this last section, we will examine treatment options as well as future areas of research. The leading pharmacological treatment for bipolar disorder is lithium. This is a drug that is designed to control manic symptoms. It is often coupled with antidepressants (Wilson, 2013). While this is a common treatment, it should be noted that not all people respond similarly to the same medications. Therefore, sometimes there are patients that have to try out numerous medications before finding the right combination to help with their symptoms. Non-pharmacological treatment is often used in conjunction with medication treatment. This kind of therapy includes numerous kinds of psychotherapy (aka talk therapy), which works to help patients gain control of their lives and their behavior. Examples of such therapies include cognitive behavioral therapy, dialectical behavior, psychoeducational therapy, family-focused therapy, and a multitude of others (Turner, 2013).
Additionally, when these forms of therapy do not work, some patients try electroconvulsive therapy, more commonly referred to as “shock therapy.” Patients may also try more natural forms of relief, such as herbal supplements (Turner, 2013). Additionally, although there is no scientific literature to support it, Yoga has also been considered in the treatment and alleviation of symptoms (particularly anxiety) associated with BP.
With the multitude of treatment options, it is essential to understand the types of healthcare providers who administer treatments. In general, patients see their primary healthcare doctors at the outset before being referred to a psychiatrist and/or psychologist. Psychiatrists can administer medications, whereas psychologists conduct psychotherapy. Thus patients with bipolar disorder tend to see a combination of healthcare professionals. Moreover, similar to the kind of healthcare providers, patients can receive assistance in a wealth of settings. Those with severe bipolar symptoms may receive support in a hospital, while others can get treatment through outpatient facilities. There are some special cases where home treatment is applicable; however, this condition is generally treated in primary care settings.
Regarding future areas of research, further genetic investigation looks promising concerning more detailed diagnoses, advanced treatments, and a possible antidote. Scientists are garnering a more profound knowledge of what role genetics plays in bipolar disorder, and there is a possibility that with this growing knowledge they are on the cusp of identifying some of the biological systems that play a part in the onset of this condition. As maintained by Scutti (2013, para. 5), “The association between genotype and phenotype for psychiatric disorders is clearly complex. The key point is that most cases of bipolar disorder involve the interplay of several genes or more complex genetic mechanisms, together with the effects of the environment, and chance.” Knowing this, future research for bipolar disorder should primarily focus on genetic studies in order to reveal the intricate biological apparatuses entangled in bipolar disorder. This would greatly improve how treatments are considered and administered. In addition to genetic factors, even though there does not seem to be any impending pharmacological innovations in the treatment for BP, as more studies are conducted, perhaps psychoanalysts in future generations can better merge scientific and human understanding through a closer examination of environmental and social factors.
In conclusion, through an analytical, historical, and physiological lens, we can see how the onset and progression of Bipolar disorder are influenced by a multitude of factors. It is a psychological disorder that afflicts approximately 2.6 percent of the population and is growing in number almost daily. This disorder impacts mood and is described as periods of increased energy, euphoria, and cantankerousness, plus insomnia with subsequent episodes of depression. Long-term treatment is crucial to the overall health and well-being of patients, and a failure to do so can result in more severe symptoms. Through continued research and study, it is entirely possible that future psychoanalysts will be able to combine scientific and human understanding in such a way that will ensure enhanced treatment and better-quality diagnosis. Such a revolution is imperative to treating future generations.
References
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