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First General Meeting
In our first general meeting, we talked about Dissociative Amnesia, which was the mental disorder that gained the most votes on Clubs and Societies Day. However, that wasn't the only event for the day.

Friday, November 6, 2009

Bipolar Disorder

Symptoms of bipolar disorder
People with bipolar disorder experience both depression and periods of mania (Benneth, 2006).
What is Depression and Mania?
Depression
According to World Health Organization (WHO), depression is a common mental disorder that presents with depressed mood. DSM-IV-TR defines a major depressive episode presence for at least two weeks (Benneth, 2006).
The following are the symptoms in depression:
• Loss of interest or pleasure
• Feelings of guilt or low self worth
• Disturbed sleep or appetite
• Low energy
• Poor concentration.

Mania
According to DSM-IV-TR, mania involves at least three of the following:
• Inflated self-esteem
• Decreased need for sleep
• More talkativeness than usual or pressure to keep talking
• Flight of ideas or the experience that thoughts are racing
• Distractibility
• Increase activity or psychomotor agitation
• Excessive engagement in high-risk activities

There are two types of bipolar disorder as described in DSM-IV-TR
Bipolar disorder I
• Occurrence of depression and mania are experience by individuals alternately (Benneth, 2006).
• Whereby, some people may experience multiple episode of depression or mania with a period of “normality” between the gaps (Benneth, 2006).
• Besides, there are some people may experience both episode depression and mania in a day (Benneth, 2006).
Bipolar Disorder II
• Occurrence of depression is dominated (Benneth, 2006).
• Episode of mania is NOT experienced by the individual (Benneth, 2006).
• Individual with this disorder may swing between episodes of hypomania and severe depression (Benneth, 2006).

Hypomania: A raise in daily activities which beyond the normal but not as extreme as mania.

Causes for bipolar disorder

Genetic Factor
When talking about biological causes, the first issue is whether bipolar disorder can be inherited. This question has been researched through multiple family, adoption and twin studies. In families of persons with bipolar disorder, first-degree relatives (parents, children, siblings) are more likely to have a mood disorder than the relatives of those who do not have bipolar disorder. Studies of twins indicate that if one twin has a mood disorder, an identical twin is about three times more likely than a fraternal twin to have a mood disorder as well. In bipolar disorder specifically, the concordance rate (when both twins have the disorder) is 80 percent for identical twins, as compared to only 16 percent for fraternal twins. (Identical twins occur when one fertilized egg splits in two, so they share the same genetic material; fraternal twins come from separate fertilized eggs, so the mixtures of genetic material are different.) There is overwhelming evidence that bipolar disorder can be inherited and that there is a genetic vulnerability to developing the illness.

Neurotransmitters
However, exactly what is inherited? The neurotransmitter system has received a great deal of attention as a possible cause of bipolar disorder. Researchers have known for decades that a link exists between neurotransmitters and mood disorders, because drugs which alter these transmitters also relieve mood disorders. Some studies suggest that a low or high level of a specific neurotransmitter such asserotonin, norepinephrine or dopamine is the cause. Other studies indicate that an imbalance of these substances is the problem, i.e., that a specific level of a neurotransmitter is not as important as its amount in relation to the other neurotransmitters. Still other studies have found evidence that a change in the sensitivity of the receptors on nerve cells may be the issue. In short, researchers are quite certain that the neurotransmitter system is at least part of the cause of bipolar disorder, but further research is still needed to define its exact role.

Stress Triggers

These can range from a death in the family to the loss of a job, from the birth of a child to a move. It can be pretty much anything, but it cannot be precisely defined, since one person's stress may be another person's piece of cake. With that in mind, research has found that stressful life events can lead to the onset of symptoms in bipolar disorder. However, once the disorder is triggered and progresses, "it seems to develop a life of its own." Once the cycle begins, psychological and/or biological processes take over and keep the illness active.

Putting it all together
When we look for the cause of bipolar disorder, the best explanation according to the research available at this time is what is termed the "Diathesis-Stress Model." The worddiathesis means, in simplified terms, a physical condition that make a person more than usually susceptible to certain diseases. Thus the Diathesis-Stress Model says that each person inherits certain physical vulnerabilities to problems that may or may not appear depending on what stresses occur in his or her life(4). Durand and Barlow define this model as a theory "that both an inherited tendency and specific stressful conditions are required to produce a disorder."

So the bottom line, according to today's thinking, is that if you are manic depressive, you were born with the possibility of developing this disorder, and something in your life set it off.

Treatments for bipolar
Pharmacotherapy 3 types of medication:
Antidepressant
Antidepressant was first introduced in the 1950s (Butcher, Mineka & Hooley, 2010). It is known then, as monoamine oxidase inhibitors (MAOIs) (Butcher, Mineka & Hooley, 2010). Just as the name suggested, it inhibits enzyme monoamine oxidase from working and without this enzyme, norepinphrine and serotonin would not breakdown (Butcher, Mineka & Hooley, 2010). However, there is a deadly risk in taking this drug. It reacts with food that contains amino acid tyramine (e.g. red wine, salami) (Butcher, Mineka & Hooley, 2010). From 1960s to 1990s, tricyclic antidepressant was used (Butcher, Mineka & Hooley, 2010). It increases the neurotransmission of norepinephrine and serotonin (Butcher, Mineka & Hooley, 2010). However, there is only a 50 percent that this medication might work (Butcher, Mineka & Hooley, 2010). Besides that, its side effects are very unpleasant to some of the patients (e.g. dry mouth, constipation, sexual dysfunction) (Butcher, Mineka & Hooley, 2010). Because of the side effects of the two medications, selective serotonin reuptake inhibitor (SSRIs) was introduced (Butcher, Mineka & Hooley, 2010). It has lesser side effect compare to tricyclic antidepressant but, its effectiveness is the no better than tricyclic antidepressant (Butcher, Mineka & Hooley, 2010). For bipolar disorders, the antidepressant only treats its depressive symptoms. Thus, it has to be paired with other treatments to treat its manic symptoms.
Lithium and mood stabilizers
Lithium is a widely use treatment for bipolar disorder as it deals with the manic and depressive symptoms (Butcher, Mineka & Hooley, 2010). It helps to avoid recurrent episodes of manic and depression. However, not all of the patients have the same effect (Butcher, Mineka & Hooley, 2010). Only one-third of patients react to the treatment (Butcher, Mineka & Hooley, 2010). Plus, there are negative side effects as well, such as, weight gain, lethargy, cognitive slowing, decreased motor coordination and gastroinstestinal difficulties (Butcher, Mineka & Hooley, 2010). Patients that do not react towards lithium will be given anticonvulsants, for example, carbamazepine, divalproex and valproate (Butcher, Mineka & Hooley, 2010).
Antipsychotics drugs
Patients that show symptoms of hallucinations and delusions will be given antipsychotic drugs as well to treat the psychosis symptoms (Butcher, Mineka & Hooley, 2010).


Biological Treatments
Electroconvulsive Therapy (ECT)
Only patients with severe bipolar disorder where drugs have no effects will be given this treatment option (Butcher, Mineka & Hooley, 2010). Electrical current will be delivered to the patients’ brain in which it will cause brain seizures (Hoeksema, 2004). However, it causes a decrease in patients’ cognitive performance (Hoeksema, 2004). Furthermore, the patient may have a high percentage in relapse (Hoeksema, 2004).
Transcranial Magnetic Stimulation (TMS)
Intense pulsating magnetic field is delivered briefly to the cortex to encourage electrical activity in the brain (Butcher, Mineka & Hooley, 2010). There will be no pain and it takes only 2 to 6 weeks for a positive result (Butcher, Mineka & Hooley, 2010). It is better than ECT as the treatment does not decrease cognitive performance and it may even increase its performance (Butcher, Mineka & Hooley, 2010).
Bright Light Therapy
This therapy is used for seasonal affective disorders; however, study has shown that this therapy is effective against depression (Butcher, Mineka & Hooley, 2010). The therapy changes the brightness of the environment such as by letting in sunlight to the room or use artificial light (Butcher, Mineka & Hooley, 2010). This will help to change the circadian rhythm of the patient (Butcher, Mineka & Hooley, 2010). Once again, these biological treatments are only effective against the depressive symptoms (Butcher, Mineka & Hooley, 2010). These treatments would be paired with other treatments that deal with bipolar (Butcher, Mineka & Hooley, 2010).

Psychotherapy
Cognitive-Behavioural Therapy
The main function of the therapy is to defy the autonomic thoughts that the patient has (Butcher, Mineka & Hooley, 2010). For example, the therapist might ask the patient to challenge their idea of being worthless. For bipolar disorder, it has to be paired with medication to enhance its effectiveness (Butcher, Mineka & Hooley, 2010). There is another type of CBT known as mindfulness based cognitive therapy (Butcher, Mineka & Hooley, 2010). This therapy focuses on the acceptance or the awareness of the autonomic thoughts of the patient (Butcher, Mineka & Hooley, 2010). This therapy is effective on patients with between episodes (Butcher, Mineka & Hooley, 2010).
Interpersonal Therapy
Interpersonal therapy focuses on the interpersonal relationship issues that the patients have (Butcher, Mineka & Hooley, 2010). It helps the patient to be more understandable towards their communication styles and why they failed in adapting the situation (Butcher, Mineka & Hooley, 2010). Bipolar patients would be treated by having a stabilize interactions with other people (Butcher, Mineka & Hooley, 2010).
Family and Marriage Therapy
In this therapy, family members are a very important aspect (Butcher, Mineka & Hooley, 2010). Family members would be educated with patients’ disorders and what intervention should be used to help the patients (Butcher, Mineka & Hooley, 2010). This would help the patients’ family member to be more understanding and to prevent any negative views or perspectives of the family members towards the patient (Butcher, Mineka & Hooley, 2010).


References

Bennett. P. (2006). Abnormal and Clinical Psychology; An Introductory Textbook. Butcher, J.N., Mineka, S. & Hooley, J.M. (2010). Abnormal Psychology (14th ed.). Boston: Allyn and Bacon. Hoeksema, S.N. (2004). Abnormal Psychology (3rd ed.). New York: McGraw Hill. England: McGraw-Hill education, Open University Press. Read. K., 2007, http://bipolar.about.com/cs/bpbasics/a/what_causes_bp.htm, retrieved at 29 October 2009. Bennett. P., 2006, Abnormal and Clinical Psychology, Open University Press, New York: United States. Ge