Bipolar Disorder
Table of Contents
Formerly, it was considered that bipolar disorder (BD) is a manic depression. Nowadays, the disorder is referred to as a severe mental illness that provokes the patient for life-threatening behavior, destruction of personal relationships and careers, as well as suicidal thoughts, especially if the disease is not treated. Bipolar disorder is a chronic recurrent mood disorder, characterized by the periods of elevated mood and depression. About 1-2% of the population suffer from this disorder (Merikangas et al., 2007). The consequences of BD are a significant financial cost for the health and society as a whole and the negative impact on the patients and their relatives: criminalization, disability, disruption of financial stability, ruined family relationships, poor health, and quality of life. Bipolar disorder is associated with significant deterioration in performance and an increased risk of suicide, namely 10-15% (Cavazzoni et al., 2007). Thus, timely detection and efficient treatment of patients with bipolar disorder can reduce their premature mortality and extend their life.
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Symptoms and Diagnostics
There are many problems in the bipolar disorder diagnosis. Many patients remain undiagnosed for a long period of time, namely up to ten years after the onset of symptoms prior to diagnosis (HealthyPlace.com, 2016). In this regard, more than 60% of patients do not receive proper treatment, or the treatment does not match the diagnosis or is ineffective (HealthyPlace.com, 2016). There are screening and diagnostic scales for the disorder detection, and its criteria are described in the DSM-5.
Bipolar and related disorders are identified as a separate category in the DSM-5. Bipolar disorder might be characterized by different types of episodes (manic, depressive, and mixed) and various degrees of severity (mild, moderate, and severe). The most important criterion of the disorder and belonging to the bipolar spectrum is the presence of manic, hypomanic or mixed episodes of any degree of severity. The Young Mania Rating Scale is applied to determine the severity of mania (Tohen et al., 2015).
According to DSM-5, there are three degrees of severity of mania: mild, moderate, and severe (American Psychiatric Association, 2013). Mild severity is marked with mood elevation within a few days, hypersexuality, reduced need for sleep, and absent-mindedness (American Psychiatric Association, 2013). Sometimes irritability, rude behavior, and hostility may be observed instead of elevated mood.
Moderate severity is characterized by considerable elation, hyperactivity, and sleeplessness (American Psychiatric Association, 2013). The euphoric mood is frequently interrupted by the periods of irritability, aggression, and depression. Regular social inhibition is being lost. The patient cannot focus the attention due to the expressed distractibility (American Psychiatric Association, 2013). During some episodes of mania, the patient can be irritable, aggressive, and suspicious.
Severe cases of the disorder are characterized by uncontrollable psychomotor agitation (American Psychiatric Association, 2013). High self-esteem and ideas of grandeur can develop into delirium while irritability and suspiciousness can develop into delusion of persecution. Patients may have racing thoughts and incomprehensible speech (American Psychiatric Association, 2013). The most frequent delusions are erotomania and delusions of grandeur and persecution. Delusions or hallucinations can be either mood-congruent or mood-incongruent. Mood-congruent delusions include neutral delusions and hallucinations in the form of ‘voices’ that talk with patients about events without expressing emotions (American Psychiatric Association, 2013).
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Epidemiology
Up to the 1970s, bipolar disorder was perceived as a rare disease (0.5% of the population) with a typical and favorable prognosis that is easy to diagnose and treat (Yildiz, Ruiz, & Nemeroff, 2015). However, BD is one of the global challenges of the 21st century due to the epidemiological data obtained in a study of mood disorders. It happened because the original idea of the BD low prevalence was rejected.
According to the international studies conducted over the last 30 years of the 20th century, the probability of bipolar disorder development throughout life is about 1%, which is comparable to the prevalence of schizophrenia (Miklowitz & Cicchetti, 2010). However, these data were incomplete (Miklowitz & Cicchetti, 2010). Some epidemiological studies found that the prevalence of BD is several times higher than expected 1% of the population. For example, the US National Comorbidity Survey Replication proved that the prevalence of the disorder is 3.9% for bipolar I disorder and 2.6% for bipolar II disorder (Kessler et al., 2005). It was also found that patients diagnosed with bipolar disorder are much more likely to have comorbid mental health and physical disorders like alcoholism, drug addiction, and anxiety (Kessler et al., 2005).
Further analysis of data from the same study showed that the prevalence of BD showed that lifetime and 12-month prevalence estimates are “1.0% and 0.6% for bipolar I disorder, 1.1% and 0.8% for bipolar II disorder, and 2.4% and 1.4% for the subthreshold borderline personality disorder” (Merikangas et al., 2007). The latter concept describes patients with episodes of depression and hypomania symptoms, which are insufficient for the diagnosis of bipolar II disorder. In addition, about 0.5% of patients suffer from cyclothymia and 0.1% of them suffer from recurrent episodes of mania throughout the life (Fountoulakis, 2015). Thus, it was found that the cumulative incidence of disorders united in the bipolar spectrum may reach a total population of 5% (Fountoulakis, 2015).
Treatment
The most important aspect in the treatment of bipolar disorder is to choose the right treatment regimen and strictly adhere to it. Thereby, the change of mood and related symptoms will be stabilized. Treatment of bipolar disorder must necessarily take place as a combination of medical and psychological treatment is the best option for the control of disease. Usually, the first medicine a psychiatrist prescribes is lithium. This medication stabilizes mood and prevents the development of symptoms. Other medicines include valproate and carbamazepine. If the patient has insomnia, the doctor prescribes such medications as clonazepam and lorazepam, which, however, are prescribed only in the first stage of the disorder in order to avoid addiction. Moreover, psychotherapy is recommended in conjunction with medical treatment. It is important that relatives and friends of a patient who suffer from the bipolar disorder treat the burden of disease with understanding and help the patient adapt to normal life more quickly.
Prognosis
Only 25% reach a completely normalized mood and recover the skills of everyday life during the first year after treatment (Yatham & Maj, 2011). The rate of recurrence is approximately 50% within one year due to failure to comply with the regimen of mood stabilizers and poor patient awareness of the chronic nature of the disease (Yatham & Maj, 2011). Up to 90% of patients with identified episodes of mood disorders have repeated exacerbation; up to 35-50% of them become disabled; 30% of them have a continuous illness course (Yatham & Maj, 2011).
Social Implications
The damage caused by bipolar disorder to society is commensurate with that of the depression, because patients are maladjusted in the professional, social, and family life, and have an increased risk of suicide. According to the World Health Report, bipolar disorder is the sixth-leading cause of disability (Yatham & Maj, 2011). Unemployment can reach 57% in the first six months of BD and 75% after two years of the disorder (Yatham & Maj, 2011). Bipolar disorder patients often become criminalized, making up to 10% of the prisoners’ population (Yatham & Maj, 2011).
The BD consequences include frequent job change, relocation, divorce, bankruptcy, hypersexuality, and the risk of contracting sexually transmitted infections. In addition, bipolar disorder is fraught with the highest risk of suicide. The suicide rate among patients suffering from bipolar disorder reaches 11-15%, which is 15-22 times higher than the average number in the population (Kearney & Trull, 2014). Finally, patients suffering from bipolar disorder lose nine years of life expectancy, fourteen years of ability to work, and twelve years of good health, primarily, due to suicide and comorbid medical illnesses (Kearney & Trull, 2014).
Conclusion
Thus, the following significant effects of bipolar disorder have been revealed: increased mortality, mainly due to suicides; disturbances in professional, family and social, and life; serious health problems. Pharmacotherapy with mood stabilizers together with psychotherapy can improve the condition of patients as well as contribute to overcoming the negative effects of the disorder.
