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Bipolar disorder (previously known as '''manic depression''') is a Diagnostic Category describing a Class of Mood Disorders where the person experiences states or episodes of Depression and/or Mania , Hypomania , and/or Mixed States . It is considered to be a Disability . The difference between bipolar disorder and unipolar disorder (also called Major Depression ), for the purpose of this introduction, is that bipolar disorder involves "energized" or "activated" mood states in addition to depressed mood states. The duration and intensity of these mood states varies widely among people with the illness. The fluctuating component of this illness is called "cycling" from one mood state to another at varying rates. Cycling, another word for Mood Swings , causes varying levels of impairment. For most individuals with bipolar disorder, the condition is Disabling and the individual has some difficulty Functioning . ETIOLOGY OR CAUSES The causes of bipolar disorder can be divided into biological and psychological explanations. Husseini K. Manji M.D. of the U.S. National Institute of Mental Health (NIMH) states that at their most basic level, the bipolar disorders involve problems in brain structure and function. He stated that these structural changes respond very well to treatment with Lithium and Valproate in a University of California, Los Angeles Neuropsychiatric Institute (NPI) Grand Rounds Talk given in 2003 (requires Real Player and a high-speed internet connection). Bipolar disorders are polygenic (involving many genes), so typical symptoms differ significantly from person to person, even among twins with the disorder. This is why people respond uniquely from one another to the same medications. Brain structural abnormalities may lead to feelings of Anxiety and lower stress resilience early in the course of the illness. When faced with very stressful, major life events, many individuals have their first major depression. Conversely, when an individual accomplishes a major achievement they may have their first manic episode. It is becoming increasingly clear that bipolar and unipolar mood disorders are biologically related illnesses, because individuals with both mood disorders tend to share a strong Family History of Bipolar Spectrum disorders. Individuals with late-adolescent/early adult onset of the disorder will very likely have experienced childhood anxiety and depression. It is intriguing that, according to Joseph Calabrese of Case Western Reserve University , childhood forms of the disorder may be easier to treat than adult forms of the illness. (See his University of California, Los Angeles NPI Grand Rounds Talk on rapid-cycling in October 2003.) Anxiety Disorders , bipolar disorder, clinical depression, Eating Disorders , Premenstrual Dysphoric Disorder , Postpartum Depression , Postpartum Psychosis and/or Schizophrenia are usually part of the patient's family history. This kind of "predisposed" family history creates a genetic vulnerability which can significantly increase the likelihood of developing the disorder. Genetics and Risk PsychEducation.org Robert Post M.D. of the U.S. NIMH proposed the "kindling" theory Link and reference involving kindling theory which asserts that people who are genetically predisposed toward bipolar disorder experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, the mood episode starts (and becomes recurrent) by itself. As with nearly all psychiatric or psychological phenomena, the etiology of bipolar disorder is thought to include a complex interplay between genetic vulnerability and Environmental events (stressful life events, major achievements, difficult relationships with family and/or significant others, drug use and other physical and social phenomena). Moreover, since the presence of bipolar disorder among identical twins (who share 100% of their DNA ) is about 50% to 80% (depending on how well the disorder is defined), some Environmental factors must be at play. Antidepressant medications and stimulants (e.g. Adderall or Methamphetamine ) can cause hypomania, mania and mixed states. When a patient with a history of manic episodes requires an antidepressant because of a serious depression, the doctor needs to be very careful, prescribing a low dose and closely monitoring the patient for any signs of a mood shift toward the mixed or manic side of the spectrum. Seasonality or exposure to daylight also affects mood in bipolar disorder. In untreated individuals, the bipolar cycle tends towards mania in the mid-to-late-summer, followed by depression in autumn and winter (due to decreasing natural light). TWO PERSONAL DESCRIPTIONS OF THE BIPOLAR EXPERIENCE The following is a quote from a successfully treated individual with bipolar disorder (from the U.S. National Institute Of Mental Health ): :Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness which is biological yet looks and feels psychological, one that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide. I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate of having the friends, colleagues, and family that I do.National Institute of Mental Health NIMH information In her book, ''Touched With Fire'', Kay Redfield Jamison , Ph.D. , writes: :The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness," to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously Suicidal . Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture. HISTORY OF THE BIPOLAR DISORDERS Varying moods and energy levels have been a part of the human experience since time immemorial. The words Depression (previously melancholia) and Mania have their etymologies in Ancient Greek. The word melancholia is derived from ‘melas’, meaning black, and ‘chole’, meaning bile, indicative of the term’s origins in pre- {Link without Title} ] humoral theories (Malhi and Yatham 2004). Within the humoral theories, mania was viewed as arising from an excess of yellow bile (Mondimore 1999), or a mixture of black and yellow bile (Akiskal 2004). The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the Roman physician Caelius Aurelianus, including the Greek word ‘ania’, meaning to produce great mental anguish, and ‘manos’, meaning relaxed or loose, which would contextually approximate to an excessive relaxing of the mind or soul (Angst and Marneros 2001). There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic poetry and mythologies (Angst and Marneros 2001). The idea of a relationship between mania and melancholia can be traced back to at least the 2nd century AD. Soranus of Ephedrus (98-177 AD) described mania and melancholia as distinct diseases with separate aetiologies; however, he acknowledged that “many others consider melancholia a form of the disease of mania” (Cited in Mondimore 2005 p.49). The earliest written descriptions of a relationship between mania and melancholia are attributed to Arataeus of Cappadocia. Arataeus was an eclectic medical philosopher who lived in Alexandria somewhere between 30 and 150 AD (Roccatagliata 1986; Akiskal 1996). Arataeus is recognized as having authored most of the surviving texts referring to a unified concept of manic-depressive illness, viewing both melancholia and mania as having a common origin in ‘black bile’ (Akiskal 1996; Marneros 2001). The contemporary psychiatric conceptualisation of manic-depressive illness is typically traced back to the 1850s. Marneros (2001) describes the concepts emerging out of this period as the “rebirth of bipolarity in the modern era”. On January 31st 1854, Jules Baillarger described to the French Imperial Academy of Medicine a biphasic mental illness causing recurrent oscillations between mania and depression. Two weeks later, on the 14th February 1854, Jean-Pierre Falret presented a description to the Academy on what was essentially the same disorder. This illness was designated folie circulaire (‘circular insanity’) by Falret, and folie à double forme (‘dual-form insanity’) by Baillarger (Sedler 1983). , bipolar disorder, became popular only recently and some individuals prefer the older term because it provides a better description of a continually changing illness. A NEW EPIDEMIOLOGY : BIPOLAR SPECTRUM DISORDER Clinical depression and bipolar disorder are currently classified as separate illnesses, but psychiatry is increasingly viewing them as part of an overlapping spectrum that also includes anxiety and psychosis. According to Hagop Akiskal, M.D. , at the one end of the spectrum is schizobipolar disorder and at the other end is unipolar depression (recurrent or not recurrent) with the anxiety disorders present across the spectrum. Also included in this view is premenstrual dysphoric disorder, postpartum depression and postpartum psychosis. This view helps to explain why many people who have the illness do not have first-degree relatives with clear-cut "bipolar disorder", but who have family members with a history of these other disorders. |
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