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Bipolar Disorder

Symptoms, causes, diagnosis and treatment of Bipolar Disorder. 

Bipolar disorder which is formerly known as Manic Depression, is a mental health condition in which someone's mood swings in an extreme way that emotional highs (mania or hypo-mania) and lows are counted as depression. When someone becomes depressed, he or she may feel sad, dejected or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypo-mania (less extreme than mania) that person may feel euphoric, full of energy or unusually irritable.
These mood swings can reflect into sleeping pattern, energy activity, behaviour, judgment and the thinking and reasoning abilities. Events or cycles of mood swings may occur rarely or multiple times in a week, month or year. While most of the people will experience some emotional symptoms between those events, some may not experience any at all.

Although bipolar disorder is a life long situation, in which an individual can manage mood swings and other symptoms by following a treatment plan. In most of the cases, bipolar disorder is treated with certain medications and psychological counselling (psychotherapy).

Symptoms of Bipolar Disorder.

There are several types of bipolar and related disorders. They may include mania or hypo-mania and depression. Symptom can cause sudden or unpredictable changes in mood and behaviour resulting in significant distress and difficulty in life.

Bipolar I Disorder - If someone had at least one manic event that may be followed or preceded by hypo-manic or major depressive episodes. In some cases, mania may have trigger a break from reality ( psychosis ).

Bipolar II Disorder - You have had at least one depressive event and at least one hypomanic event but you have never had a manic episode .

Cyclothymic disorder - You have had at least two years or one year in children and teenagers of many episodes of hypo-mania symptoms and periods of depressive symptoms ( though less severe than major depression ).

Other Types - These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition such as Cushing's diseases , multiple sclerosis or stroke.

Bipolar II disorder is not a lighter form of Bipolar I disorder, but a separate diagnosis. On the other hand, manic episodes of Bipolar I disorder can be severe and dangerous, individuals who are suffering from Bipolar II disorder can be depressed for longer periods, which can cause significant impairment.
Although Bipolar disorder can occur at any age or stage of life, typically it's diagnosed in the teenage years or early twenties. Symptoms can vary from individuals to individual and symptoms may vary over time.

Mania and hypo-mania
Mania and hypo-mania are two different and distinct types of events but they have the same symptoms. Mania is more serious and severe than hypo-mania and causes more noticeable at work places. School and social activities as well as it creates difficulties for all sorts of relationships.
Mania may also trigger a break from reality ( psychosis ) and it requires proper hospitalization. Both a manic and a hypo-manic episode includes three or more types symptoms :-

1)  Abnormally upbeat , jumpy or wired. 
2) Increased activity energy or agitation.
3) Exaggerated sense of well being and self-confidence ( Euphoria ).
4) Decreased need for sleep.
5) Unusual talkativeness.
6) Racing thinking and thoughtfulness
7) Distractibility.
8) Poor decision making for example going on buying sprees taking sexual risks or making foolish investments.

Major depressive episode - A major depressive episode includes symptoms that are serious and severe enough cause noticeable tough conditions in daily activities such as work, school , college , social activities or relationships . An episode includes five or more of these symptoms are as follows :

1) Depressed mood such as feeling sad , empty , dejected , hopeless or fearful ( especially in children and teens , depressed mood can appear as irritability )
2) Marked loss of interest or feeling no happiness , zeal , pleasure in almost all activities.
3) It can be either insomnia or sleeping too much
4) It can be either restlessness or slowed behaviour .
5) Fatigue or loss of energy can take place.
6) Feelings of worthlessness or excessive or inappropriate guilt.
7) It can show decrease in ability to think or concentrate or indecisiveness.

Other features of Bipolar Disorder - Signs and symptoms of Bipolar I and Bipolar II disorders may include other characteristics like as anxious, distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, Bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in Children and Teens - Symptoms of Bipolar Disorder can be difficult to identify in children and teens due to their varying behaviour. It's often hard to tell whether these are normal fluctuations, the results of stress, pressure or trauma, or signs of a mental health problem other than Bipolar Disorder.
Children and teens may have distinct major depressive or manic or hypo-manic episodes, but the pattern of episodes can vary from that of adults with Bipolar Disorder. And moods can rapidly shift during the episodes. Some children may have periods without mood symptoms between episodes.
The most prominent signs of Bipolar Disorder in children and teenagers may include severe mood fluctuations that are different from their usual mood fluctuations.

When to see a doctor ? - Despite the mood extremes, people with Bipolar Disorder often don't recognize how much their emotional instability disturbs and disrupts their lives and the lives of their loved ones and don't getting the treatment and medication they need.
And if you are like some people with Bipolar Disorder, you may enjoy the feelings of Euphoria and episodes of being more productive. However, this Euphoria is always followed by an emotional crash that can leave you depressed and tensed, worn out and perhaps mostly in legal, financial or relationship troubles. If you have any symptoms of depression or mania, consult your doctor or mental health expert. Bipolar Disorder doesn't get better on its own, it needs proper treatment.
Getting treatment from an experienced mental health expert with experience in Bipolar Disorder can help you to get your symptoms under control.

When to get an emergency help ? - Suicidal thoughts and behaviours are common among people who have Bipolar Disorder. If you have thoughts of hurting yourself, just call the local emergency number immediately or you can go to an emergency centre or confide in a trusted relative or friend.
If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person.

Causes of Bipolar Disorder are as follows : The exact causes of Bipolar Disorder is unknown but several factors cannot be undermined and they may be involved such as -:

Biological Differences - People with Bipolar Disorder appear to have physical changes in their brains. The importance of these changes is still uncertain and unknown but may eventually help pin point causes.

Genetics - Bipolar Disorder is more common in people who have a first degree relative, for example, a sibling or parent, with the conditions. Researchers are trying to find genes that may be involved in causing Bipolar Disorder.

Risk factors - Factors that may increase the risk of developing Bipolar Disorder or act as a trigger for the first episode include under these situations -
1) Having a first degree relative such as parent or sibling with Bipolar Disorder.

2) Alcohol or drug abuse.

3) Periods of high stress, such as the death of a loved one or any other traumatic event.

Complications related to Bipolar Disorder are as follows - Left untreated Bipolar Disorder can result in serious problems that affect every part of your life such as :-
1) Problems related to drug and alcohol use.

2) Suicidal thoughts or suicide attempts.

3) Legal or financial problems.

4) Damaged or broken relationships.

5) Poor work or school performance.

Co-occurring situations of Bipolar Disorder are as follows - If you have Bipolar Disorder, you may have another health conditions that requires to be treated along with Bipolar Disorder. Some conditions can worsen Bipolar Disorder symptoms or make treatment less successful. Some of the examples can be included as follows -
1) Anxiety disorders.

2) Eating disorders.

3) Attention Deficit/Hyperactivity Disorder (ADHD).

4) Alcohol or drug problems.

5) Physical health problems such as heart disease, thyroid problems, headaches or obesity.

Preventive measures for Bipolar Disorder are as follows - As it is rightly said prevention is better than cure. But there is no sure way to prevent Bipolar Disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent Bipolar Disorder or other mental health conditions from getting it worsening.

If you have been diagnosed with Bipolar Disorder some strategies can help in preventing minor symptoms from becoming full blown episodes of mania or depression.

Pay attention to warning signs - Addressing symptoms as early as only can prevent episodes from getting worse. You may have identified a pattern to your Bipolar episodes and what triggers them. Consulting your doctor is the best option if you are feeling that you are falling into an episode of depression or mania. Tell your family members or friends in watching for warning signs.

Avoid drugs and alcohol - Using recreational drugs or alcohol can worsen your symptoms and make them more likely to return.

Take your medications exactly as directed by the doctor - You may be tempted to stop treatment but don't. Stopping or leaving the medication or reducing your dose on your own may cause withdrawal effects or your symptom may worsen or return completely.

Diagnosis of Bipolar Disorder are as follows : To determine or confirm if you have Bipolar Disorder, you can include following evaluations by your Doctor or Mental Health Expert :
Physical Examination - Your doctor has to conduct lab test and physical examination for identification about any problems that could be causing your symptoms.

Psychiatric assessment - Your conductor may refer you to consult a psychiatrist, who will take care about your thoughts, feelings and behaviour patterns. You can also do a self assessment by filling psychological questionnaire. Your family members and friends may be called for providing information about your symptoms.

Mood Charting - You may be asked to keep a daily record of your moods, thinking, thoughts, sleeping patterns and other factors that could help with diagnosis and finding the right treatment.

Criteria for Bipolar Disorder are as follows : Your mental health expert may compare your symptoms with the criteria for Bipolar Disorder and other disorders.
Diagnosis in Children - Although diagnosis of children and teenagers with Bipolar Disorder includes the same criteria used in cases for adults, symptoms in children and teen often have different patterns and they may differ from adults and may not fit neatly into the diagnostic categories.
Children who have Bipolar Disorder are frequently also diagnosed with other mental health issues such as Attention Deficit/Hyperactivity Disorder (ADHD) or behavioural problems, which can make diagnosis more complicated. Referring to a child psychiatrist with experience in Bipolar Disorder is recommended. 

Treatment of Bipolar Disorder are as follows - Treatment is best guided by a medical doctor who is specialized in diagnosing and treating mental health conditions. Psychiatrist who is skilled in treating Bipolar Disorder and related disorders.You may have a treatment team which includes a psychologist, psychiatric nurse and social worker skilled in mental health conditions.
Bipolar Disorder is a lifelong condition. The treatment is directed at managing symptoms. It all depends on your needs, treatment may include the following things -

Medication - Often, you will need to start medication right away to balance your moods.

Complete and continued treatment - Bipolar Disorder requires lifelong treatment with proper medication, even during periods when you feel better. Persons 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.

Day treatment programs - Your doctor may recommend a day treatment program. These programs provide the full support and complete counselling you need when you get the symptoms under control.

Substance Abuse Treatment - If you have problems with alcohol or drugs, you will also need substance abuse treatment. Otherwise, it can be very difficult to treat Bipolar Disorder.

Hospitalization - Your doctor can ask you to hospitalize if you are behaving dangerously or you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can keep you calm and safe and stabilize your mood whether you are having a manic or major depressive episode.
The primary treatments for Bipolar Disorder include medical and psychological counselling session (Pyschotherapy) to control symptoms, and also may include education and support groups.

Medications of Bipolar Disorder are as follows - There are number of medications used to treat Bipolar Disorder. The types and doses of medications on your particular symptoms. Medications may include the following :

1) Mood stabilizers - For stabilizing moods, you will need medication to control manic or hypo-manic episodes. Examples of mood stabilizers include Lithium (Lithobid), Valporic Acid (Depakene), Divalproex Sodium (Depakote), Carbamazepine (Tegretol Equetro) and Lamotrigine (Lamictal).

2) Antipsychotics - If any symptoms of depression or mania is persisting in spite of treatment with other medications, adding an antipsychotic drug medications, such as, Olanzapine (Zyprexa), Risperidone (Risperdal), Quetiapine (Seroquel), Aripiprazole (Abilify), Ziprasidone (Geodon), Lurasidone (Latuda) or Asenapine (Saphris) may help you. Your doctor may prescribe some of these medications alone or along with a mood stabilizer, according to your situation.

3) Antidepressant - Antipsychotic - The medication of Symbax combines the antidepressant Fluoxetine and the antipsychotic Olanzapine. It works as a depression treatment and a mood stabilizer.

4) Anti-anxiety medications - Benodiazepines may help to curb anxiety and improve sleep, but they are usually used on a short term basis.

Finding the right medication - The main challenge is to find the right medication or medications for you will likely take some trial and error. If one doesn't work well for you, you can try others several for you.
This process takes time and have a good patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your psychiatrist can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted according to your symptoms change.

Side effects - There are no major side effects of medication, but mild side effects of medication, but mild side effects often improve as you find the right medication and doses that works for you, and your body adjusts to the medications. Talk to your doctor or mental health expert if you are facing bothersome side effects.
Don't make changes or stop taking your medication on your own. If you are stopping your medication you may experience withdrawal effects or your symptoms may get worsen or return drastically. You may become very depressed, feeling suicidal or go into a manic or hypo-manic episode. If you think you need to make a change in medication, always consult your doctor.

Medications and Pregnancy - A number of medications for Bipolar Disorder can be associated with birth defects and it can pass through breast feeding to your body. Certain medication such as, Valproic Acid and Divalproex Sodium must be avoided during pregnancy. Also birth control medications may lose their effectiveness when taken along with certain Bipolar Disorder medications.
You can discuss treatment options with your doctor before you become pregnant, if possible. If you are taking medications to treat your Bipolar Disorder and thinking of pregnancy talk to your doctor right now.

Psychotherapy - Psychotherapy is a vital part of medication in Bipolar Disorder treatment and it can be provided in individual, family or group settings. Several types of psychotherapy are there and they can be helpful. These include :

Interpersonal and Social Rhythm Therapy (IPSRT) - IPSRT focuses on the stabilization of daily rhythms such as, talking, walking, eating and sleeping. A consistent routine allows for better mood management. People with Bipolar Disorder may benefit from establishing a daily routine for sleep, diet and exercise.

Cognitive Behavioural Therapy (CBT) - The focus of CBT is to identify unhealthy, negative beliefs and behaviours in an individual and replacing them with healthy and positive ones. CBT can help identify what triggers your Bipolar Disorder episodes. You can also learn effective strategies to manage stress and to cope with upsetting situations.

Psychoeducation - Learning about Bipolar Disorder (psychoeducation) can help you to cope up and your loved ones to 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 the treatment.

Family Focused Therapy - Family care, support and deep communication can help you to stick with your treatment plan and help your loved ones and yourself to recognize and manage warning signs of mood swings.

Other treatment options - Depending on the need, other treatments may be added to your depression therapy. During the medication of Electro-convulsive Therapy (ECT), electrical currents are passed through the Brain, intentionally triggering a brief seizure. ECT seems to cause changes in chemistry of Brain that can reverse symptoms of certain mental illnesses. ECT may be an option which can be tried for Bipolar Disorder treatment if you don't get better with regular medications, and can't take antidepressants for health reasons such as pregnancy or at high risks of suicide.

Trans-cranial magnetic stimulation (TMS) is being investigated as another therapy for those who haven't responded well to antidepressants.

Treatment in children and teenagers - Treatment for children and teenagers who are suffering from Bipolar Disorder are often prescribed the same types of medications as those used in cases regarding adults. There has been less research done on the safety and effectiveness of Bipolar medications in children than in adults, so treatment decisions are usually based on adult research.

Psychotherapy for children and teenagers with Bipolar Disorder - Initial and long term therapy can help keep symptoms away from returning back. Psychotherapy can help children and teens manage their daily routines, developing coping skills, addressing and learning to face difficulties, resolving social problems, and helping to strengthen family bonds and good communication. And if any requirement arises it can help in treating substance abuse problems in older children and teens with Bipolar Disorder.

Psycho-education for children and teenagers with Bipolar Disorder - Psycho-education can be included for learning the symptoms of Bipolar Disorder and it can also help in determining how they differ from behaviour related to your child's developmental age, the situation and appropriate cultural behaviour. We have to understand about the Bipolar Disorder can also be helping and supporting your child.

Support and guidance for children and teenagers with Bipolar Disorder - Working with teachers and school counsellors can encourage support from family and friends will help in identifying services and encourage success.

Lifestyle and home remedies in Bipolar Disorder - You will probably need to make certain changes in lifestyle to stop cycles of behaviour that worsen your Bipolar Disorder. Here are some steps which can be followed :

Quit drinking and using recreational drugs - One of the biggest concerns with Bipolar Disorder is the negative consequences of risk taking behaviour and alcohol or drug abuse. First, you have to try to quit drinking or taking drugs, but if you fail sought out someone's help to quit .

Form healthy relationships - Try to make good and healthy relations with other people. Surround yourself among positive people and your family members and friends can support you and raise an alarm if you are in vulnerable position due to mood shifts.

Create a healthy routine - Try to fix a regular routine for sleeping, eating and sessions of physical activity can help you in balancing your moods. Consult your doctor before starting any exercise programme. Always eat a balance and nutritious and healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping just have a talk with your doctor or mental health expert about what you can do further.

Check first before taking other medications - Call your doctor before you take new medication prescribed by another doctor or any over the counter supplements. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you are taking for Bipolar Disorder.

Consider keeping a mood chart - Recording your daily moods, treatments, sleeping pattern and feelings may help you to identify triggers effective treatment options and when treatment has to be adjusted according to requirements.

Alternative medicines - There is not much research done on alternative or complimentary medicines and sometimes they are called integrative medicines for Bipolar Disorder. Most of the studies have done majorly on depression, so it is not very clear how these non- traditional approaches work for Bipolar Disorder.
If you choose to try alternative or complimentary medicine in addition to your doctor recommended treatment, you have to these precautions first.

Don't stop taking prescribed medications and skip therapy session - Using an alternative or complimentary medicine is not a substitute for regular medical care when it comes to Bipolar Disorder.

Be honest with your doctors, counsellors and mental health experts - Tell them exactly which alternative or complimentary treatment you are taking or thinking to use.

Be aware of potential dangers - Alternative and complimentary products are not meant to use them as regulated the way prescription drugs are working. Just because they are natural, does not they are safe. Before using alternative or complimentary medicine, always consult to your doctor about the risks including possible serious interactions with medications.

Coping and support in Bipolar Disorder - Coping and supporting with Bipolar Disorder can be challenging and tough to handle. Here are some strategies that can help you towards coping and supporting in Bipolar Disorder :

1) Learn about Bipolar Disorder - Complete and correct education about your situation can empower you and encourage you to stick to your treatment plan and recognize mood changes. Always educate your family members and friends about what stage you are going through.

2) Stay focused on your goals - Learning about the management of Bipolar Disorder can take time. For learning, always be motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and can regain your old charm and rectify other problems caused by your mood swings.

3) Join a support group - Support groups for people suffering from Bipolar Disorder can help you to connect to others facing similar challenges and problems and share your experiences and get others' too.

4) Find healthy outlets - Always explore healthy way to channelize your energy such as daily activities, hobbies, exercise and recreational measures.

5) Learn ways to relax and manage stress - Yoga, Tai Chi, massage, meditation, spiritual meetings, religious symposium can be helpful in relaxation.

How to prepare for the appointment ? You can start by visiting your primary or family doctor or even a psychiatrist. You may want to take a family member or friend along to your appointment, if possible for support take and to help remember information.

What you can do before the appointment ? Before your appointment with doctor, just make a list of following :

1) Any symptoms you have had - Just mention what are the reasons or symptoms seems to unrelated to the reason for the appointment.

2) Key personal information - It will include any major stress or recent changes in your life.

3) All medications - It will include all vitamins, supplements, herbs or other medicines you are taking and about the exact dosages.

Questions to ask your doctor ? Some questions you can ask to doctor may include the following -

1) Do I have a Bipolar Disorder ?

2) Are there any other possible causes for my symptoms ?

3) What kinds of tests will I need ?

4) What treatments are available ?

5) Which treatment you recommend for me ?

6) What side effects are possible  with that treatment ?

7) What are the alternatives to the primary approach that you are suggesting ?

8) I have these other health conditions. How can I best manage these conditions together ?

9) Should I see a psychiatrist or other mental health expert ?

10) Is there a generic alternative to the medicine you are prescribing ?

11) Are there any brochures or other printed material that I can have ?

12) What websites do you recommend for me ?

What to expect from your doctor ? Your doctor likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask the following questions :

1) When did you or your loved ones first begin to noticing your symptoms ?

2) How frequently do your moods change ?

3) Do you ever have suicidal thoughts when you are feeling down ?

4) Do your symptoms interfere with your daily life or relationships ?

5) Do you have any blood relatives with Bipolar Disorder or depression ?

6) What other mental or physical health conditions do you have ?

7) Do you drink alcohol, smoke cigarettes or use any recreational drugs ?

8) How much do you sleep at night ?

9) Do you go through periods when you take risks that you would not normally take such as unsafe sexual intercourse or unwise, spontaneous financial decisions ?

10) What, if anything seems to improve your symptoms ?

11) What, if anything appears to worsen your symptoms ?

Source :
www.mayoclinic.org     


  
   

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