Illness and Disease Management: Bipolar Disorder essay

Bipolar disorder is a problem that attracts attention of experts all over the world. This pathology is one of the most serious diseases, and is a complex diagnostic and therapeutic challenge even for experienced physicians. Thus, the main purposes of this paper are to explore bipolar disorder from different perspectives, and to understand its pathology and origins, dwelling specifically on the possible ways of its treatment.

Definition of the Bipolar Disorder

Bipolar disorder was previously known as a manic-depressive disorder, or manic psychosis. This is an acute affective disorder or mood disorder, characterized by abrupt mood swings. Berk et al (2008) mentioned that this mental illness, which may be accompanied not only by affective state, but also by the destruction of relationships and careers, and by suicidal tendencies (in the case of absence of adequate treatment), is a complex condition in which mania causes insomnia that may last for several days, hallucinations, nervous breakdowns, disorientation and paranoia attacks.

Pathology and Origins of Bipolar Disorder

Currently there is no a strictly proven theory about the causes of the disorder. It is believed that all depends on the level of concentration of certain brain chemicals. Mania develops in patients, when their level becomes too high, as well as depression develops in patients when their level falls too low. As a result, observing pathology and origins of the disorder, it is necessary to mention that bipolar disorder is a complex genetic disease. Mood swings that occur in this disease can range from severe bouts of clinical depression or manic behavior to the state of excessive euphoria. These mood swings can occur both in light and in the most complex forms, and last for several minutes or hours. If these differences occur frequently, such condition is called repetitive cycle.

People diagnosed with bipolar disorder confuse thoughts along with the mood swings. They have many difficulties in perceiving the world and functioning in society. Manic depression violates the normal feelings and thoughts, provokes inappropriate behavior, undermines the foundations of rational thinking, and often destroys the desire and will to live. This disease, being organic in nature, runs as a psychological disorder in practice; it is unique in its ability to fascinate and bring pleasure, but the consequences of this pleasure may cause intolerable suffering and often lead to suicide.

Symptoms of this disease are strictly individual. While only a few symptoms can be seen in some patients, then the large number of symptoms leading to the loss of ability to live and work normally is observed in the rest group of patients. It is a fact that quite often, bipolar disorder cannot be diagnosed, and people have to suffer for years before being correctly diagnosed and beginning appropriate treatment. Bipolar disorder as well as diabetes or heart disease is a chronic disease that should be carefully monitored throughout the life.

Presenting Symptoms and Diagnostic Tests

Like other mental illnesses, bipolar disorder cannot be diagnosed by using physiological methods, such as blood tests or brain scans. Thus, the diagnosis of bipolar disorder is usually made on the basis of symptomatic pictures, medical history, and, if possible, a family history. A doctor may conduct laboratory studies to rule out the possibility of the presence of other serious diseases that affect mood.

Generalizing the information about bipolar disorder, it is necessary to note that bipolar disorder is poorly diagnosed. On average, the correct diagnosis of bipolar affective disorder takes eight years since the patient starts to search the problem of the own condition. The frequency of recurrences in bipolar affective disorder in most patients is 1-2 episodes in 1-2 years. However, there are people who experience mood swings several times a day.

As it was previously said, bipolar disorder causes sudden mood swings – from a very excited and / or irritable to a minor and hopeless-helpless, and then returns to its original state, often with some (short or long) periods of normal mood in between. Such alternation of moods is often accompanied by significant changes in energy and behavior. The periods of the excited state and the passive state are called ‘episodes of mania and depression’.

Signs and various symptoms of mania (or manic episode) include:

• Activity, increased energy and restlessness;
• The incredible excitement, too much elated or euphoric mood;
• Heightened irritability;
• Disorder of thinking and fast-paced conversation, jumping from one idea to another;
• Distractibility, inability to concentrate;
• Decreased need for sleep;
• Unjustified confidence in the own capacities and abilities;
• Inadequate assessment of the situation;
• Wastefulness, extravagance;
• An extended period when the behavior is very different from the normal;
• Increased sexual activity;
• The consumption of drugs, particularly cocaine, alcohol and drugs for insomnia;
• Provocative, intrusive or aggressive behavior;
• The denial of the fact that something is wrong.

Manic episode is diagnosed if the excited state, accompanied by three or more symptoms, lasts for the most part of the day, nearly every day for a week or longer. The presence of four additional symptoms is important for the purpose to make a definitive diagnosis in the state of irritation.

Signs and symptoms of depression (or depressive episode) include:

• Continued state of sadness, anxiety or emptiness;
• Pessimism or various feelings of hopelessness;
• Feelings of guilt, helplessness or sense of worthlessness;
• Loss of interest or pleasure from those activities that previously brought pleasure, including sex;
• Decreased energy, feeling of constant fatigue or ‘inhibition’;
• Problems with concentration, difficulties in remembering or making decisions;
• Restlessness or irritability;
• Increased sleepiness or insomnia;
• Changes in appetite and / or unintentional loss or weight gain;
• Chronic pain or other persistent symptoms of the illness, not resulting from physical illness or injury;
• Constant thoughts of death or suicide, suicide attempts.

Depressive episode is usually diagnosed if five or more symptoms occur throughout most part of the day, nearly every day for two weeks or more.

However, symptoms of mania and depression can be observed in some patients simultaneously. This condition is called a mixed bipolar disorder. In this type of bipolar disorder symptoms often include agitation, sleep disturbance, significant changes in appetite, psychosis, suicidal thoughts. The patient is in the state of sadness and hopelessness, but at the same time he feels an extraordinary burst of energy.

Treatment

Owing a correctly matched treatment, medicine can stabilize the mood swings and other symptoms of disorder in most patients who suffer from bipolar disorder (even in the toughest of its forms). Taking into account the fact that bipolar disorder occurs with a recurrence, preventive treatment is not only pointed, but strongly recommended. The treatment which combines medication and psychotherapy is the best way to keep the disease under control. According to Steinkuller and Rheineck (2009), “typically, pharmacological treatments are essential for managing bipolar disorder; however, medication alone is often inadequate to restore and maintain physical health and quality of life”.

Observing medical treatment, it is possible to note that medications play a key role in helping people with bipolar disorder. They allow patients to live a stable, active life. Lithium and other mood stabilizers can smooth out the sharp change of mood episodes. Patients with severe manic phases can also take anti-psychotic drugs. Antidepressants may be prescribed during episodes of depression. Also doctors recommend their patients not to stop taking drugs in the period between attacks, in order to reduce the risk of disease recurrence.

Hatchett (2010) stated that “bipolar disorder is thought to be best treated with medication, principally mood stabilizers and atypical antipsychotics; counseling or psychotherapy is thought of as an adjunct treatment”. Thus, besides medication, doctors recommend their patients to use psychosocial methods, including certain forms of psychotherapy. Such methods help not only patients with bipolar disorder, but also their families to understand the specificity of the disease and obtain the necessary information. According to Griswold and Pessar (2000), the results showed that psychosocial therapy helps to stabilize mood, to reduce the number of hospitalizations and to improve livelihoods in different spheres of human activity.

Thinking about alternative methods of treatment, it is important to dwell on electroconvulsive therapy, which is used in cases where medication, psychosocial therapy, or combination of them do not have the desired effect, or have too slow effect in relieving severe symptoms such as psychosis or suicidal symptoms. The use of electroconvulsive therapy may also help during acute episodes, when the patient’s physical condition (including pregnancy) does not allow the use of drugs. Electroconvulsive therapy is highly effective in treating severe depression, mania and / or mixed episodes. The possibility of long-term memory problems as a result of electroconvulsive therapy, which has recently been a serious cause for concern, is now significantly reduced due to the newest methods of electroconvulsive therapy. Nevertheless, it is necessary to discuss the ‘pros’ and ‘cons’ of the use of electroconvulsive therapy and other alternative methods of treatment with the patient and, if it is necessary, with the family members or friends beforehand.

Nursing Management

First of all, observing nursing management, it should be mentioned that only an experienced psychiatrist who specializes in diagnosing and treating this disease should advise the patient with bipolar disorder. Psychologists, social workers and mental health nurses in their turn help to ensure various aspects of treatment and care to patients and their families in mental clinics and other healthcare facilities. In addition, each participant of the treatment, including the patient and his family members, in order to cope with bipolar disorder, should strictly follow the schedule of medication, follow the manifestation of side effects, keep to the established daily order.

Conclusion

To sum up, we have observed bipolar disorder with all the necessary details in the body of this paper. We have understood that bipolar disorder is a mental disorder that is characterized by atypical change of mood, swings of energy and inability to function. The symptoms of bipolar disorder can lead to very serious consequences unlike normal mood swings, with their ups and downs that are inherent in everyone. Specific phases of disease can destroy personal relationships; affect the quality of work or school performance, and even lead to suicide. In such a way, a proper treatment is a very important component of life for all patients, the component which helps them to lead stable and productive lives.