Bipolar Disorder: Causes, Effects, and Treatments

            The most significant factor in the completion of a differential diagnosis that results in the identification of Bipolar I affective disorder is the presence of fluctuations between periods of mania and major depressive episodes (Durand & Barlow, 2007), most frequently known as mood swings or described as cycling.

           The specific exact cause, or etiology, of most serious mental illness is not able to be conclusively identified, however it is important to note that, as with most medical illnesses as well, there is a strong correlation between the predisposition toward the illness and the complex interaction of biological, psychological, and socio-cultural factors (U.S. Department of Health and Human Services, 1999.). The role of the environment in the development of Bipolar disorder has been, to date, focused on “loss as the cause of depression in biologically vulnerable individuals” (Boyd, 2002. p.431.), with the more common acceptance that individual or combined environmental factors are more likely to impact upon the timing of a particular exacerbation of the disorder, rather than to exist as the cause of the disorder itself. To state this simply, a stressor such as the death of a loved one, divorce, parenting issues, financial concerns and others may critically influence an individual’s mood and behavior, and may, through a variety of complex interplays, result in an exacerbation or instability, or even the first episode of treatment, but these stressors contribute to, rather than cause the disorder.

                   The ways in which the environment might influence Bipolar I disorder are almost too numerous to count. Impaired sleep, however, is one highly significant environmental influence on this disorder. A change in a work schedule which requires an alteration in sleep patters, such as a shift worker who is required to move between days and nights may appear to be a relatively benign factor for many, but the regulation of sleep patterns and circadian rhythms has been linked to biochemical abnormalities that affect mood and “artificially induced sleep deprivation is known to alleviate depression or precipitate mania in some bipolar patients” (Boyd, 2002. p. 431).  The impaired sleep can be viewed as both a symptom and an influencing agent in light of a manic episode, and I feel that this can be summed this up by simply stating that the lack of sleep for several days is almost always present in a true manic episode, and we have to consider that no matter how we try to figure out which came first, the chicken or the egg (the mania or the insomnia) the bottom line is they have to be viewed as a sort of pathological partnership.

                   The treatment of Bipolar disorder historically has involved everything from insulin shock therapy and electroconvulsive therapy (ECT) and a wide variety of pharmacological measures including mood stabilizers, antidepressants and antipsychotic medications. The use of psychotropic medications may continue to be the first treatment of choice in order to stabilize acute symptoms, and achieve ongoing stability, but there is increasing awareness of the fact that the addition of psychosocial treatment, used in combination with the front-line pharmaceutical measures, plays a vital role in not only reducing acute symptoms, but perhaps even more importantly in the areas of relapse prevention and the achievement of long term stability (Miklowitz & Otto, 2006).

                  Supplementing the traditional medication regiment with the addition of treatment strategies that are focused toward education for both the diagnosed individual and family members can have positive outcomes in all areas that reflect on the risk and the affects of relapse, such as medication compliance, goals for healthy living, emotional support and early intervention. “Family interventions for bipolar disorder are psycho-educational

in orientation, meaning that families (spouses, parents) and patients are taught to recognize the signs and symptoms of bipolar disorder, develop strategies for intervening early with new episodes, and assure consistency with medication regimens” (Miklowitz, 2007.).

                          Family focused treatment, or FFT as described above, is just one of the many types of psychosocial treatment currently in use for Bipolar disorder. Cognitive Behavioral Therapy (CBT) is a therapeutic process by which individuals are taught to play close attention to their thought processes and cognitive errors, and to deliberately replace those negative thoughts with less depressive and more realistic internal statements (Durand & Barlow, 2007)Interpersonal psychotherapy (IPT) is a goal driven therapeutic modality and revolves around the resolution of conflicts within pre-existing relationships, and the development of the necessary skills to form new ones (Durand & Barlow, 2007). Interpersonal and Social Rhythm Therapy (IPSRT) is another psychosocial treatment used with bipolar disorder, and focuses on the results that life stressors have upon an individual’s social and sleep patterns. (Miklowitz & Otto, 2006)..

                The alliance of the family in supporting an individual in this endeavor is critical, as it is not uncommon for a family member, particularly a parent, to have a strong resistance to the idea that their beloved child has been diagnosed as mentally ill. A parent saying “you don’t need that pill, you are fine” can be a much more powerful statement than all of the others (psychiatrist, nursing staff, peers, court system) combined.)

                        Non-acceptance of adequate and consistent long-term medical management and frequent noncompliance contribute to the high risk of unfavorable outcome(s) in bipolar disorder” (Huxley, Parikh and Baldessarini, 2000), and one highly effective means of increasing both acceptance and compliance is to educate not only the patient, but all available means of support, such as parents, spouses and significant others.

                 The combination of a variety of treatment measures lends itself to the potential for the most stability of the person suffering from Bipolar disorder. Medications work, therapy is helpful, support is necessary, but it is education and awareness that is the keystone that holds the entire treatment plan together, and it is with these collective tools that the individual with Bipolar disorder can live a life, not free from the disorder itself, but with the highest likelihood of the fewest negative consequences associated with the illness.

 References

Boyd, M.A. (2002). Psychiatric nursing: contemporary practice. 2cd. Ed. Lippincott, Williams & Willkins, Inc. Philadelphia:PA.

Durand, V., & Barlow, D. (2007).Essentials of abnormal psychology.. Special Edition for Kaplan University. Thomson Wadsworth. Mason:OH.

Huxley, N., Parikh, S., & Baldessarini, R. (2000, September). Effectiveness of Psychosocial Treatments in Bipolar Disorder: State of the Evidence. Harvard Review of Psychiatry, 8(3), 126. Retrieved April 12, 2008, from Academic Search Premier database.

Miklowitz, D. (2007, August). The Role of the Family in the Course and Treatment of Bipolar Disorder. Current Directions in Psychological Science, 16(4), 192-196. Retrieved April 12, 2008, from Academic Search Premier database.

Miklowitz, D., & Otto, M. (2006, Summer). New Psychosocial Interventions for Bipolar Disorder: A Review of Literature and Introduction of the Systematic Treatment Enhancement Program. Journal of Cognitive Psychotherapy, 20(2), 215-230. Retrieved April 12, 2008, from Academic Search Premier database.

U.S. Department of Health and Human Services. (1999). Mental health : A

            report of the surgeon general- executive summary. Retrieved April 10, 2008           from http://www.surgeongeneral.gov/library/mentalhealth/home.html