Bipolar Disorder
Bipolar Disorder
Introduction
Bipolar disorder is a psychological disorder in which individual experiences erratic mood swings. In one instance, an individual could be happy while in the next instance he portrays maniac tendencies that can lead to depression. An individual with bipolar disorder is unpredictable hence difficult to handle. Bipolar disorder affects men and women from the age of 15-26 years with the prevalence rate standing at 5.9% of the entire UU adult population. The precise cause of the conditions remains unclear to medical professionals. However, there is a tendency to inherit the condition if one parents had it. Medical professionals categorize bipolar disorder into three categories. Type one bipolar disorder involves an individual having one manic episode and a series of major depressions. Individuals with type two bipolar, on the other hand, never experience a full mania episode (Scott, & Kinderman, 2006).
Instead, they experience instances of high energy and impulsiveness which alternate with periods of depression. The third type is mild bipolar in which an individual experience minimal mood swings. Unfortunately, the mild nature of their conditions tends to be confused simply as depression hence the risk of incorrect medical care. Statistics from the National institute of mental health indicate that approximately 2.6% of US adult population acquires bipolar disorder every year. Out of this percentage, 82.9% of the cases are severe and require medical intervention. With regards to treatment of bipolar disorder, only 49% bother to seek treatment.
Statistics also indicate that out of those seeking treatment only 39% of them receive minimal treatment for their condition (Nusslock & Abramson, 2009). The key to management of bipolar disorder is early detection and management of triggers that can lead to an attack. Treatment strategies such as Cognitive-Behavioral Therapy (CBT) have proven effective in the management of the medical condition. Bipolar disorder occurs when a patient is faced with a situation that leads to the adoption of an attitude that determines appropriate behavior. CBT helps patient enhance their quality of life, have a positive approach when facing different situation and detect situations that can lead to an attack.
Psychological Theories of Bipolar Disorder
Riedell (2011) discusses the bio-psychological theory of behaviorism when discussing bipolar disorder. The theory of behaviorism relies on the principle of learning and stipulates that learning principles and elicit and affect attitudes, they can reinforce behaviors and can prompt the direction of behavior. When discussing the theory of behaviorism, the concept of basic behavioral repertoires (BBR) arises. There are three types of BBR, emotional-motivational (e-m), sensory-motor (s-m) and language-cognitive (l-c). The behavior that a patient portrays is thus regulated by the three types of BBR process which in turn constituted his personality. Riddel further states that the individual differences in the BBR process means that individual will have differing emotional responses to different situations. According to behavioral theory, an individual’s situational factors interact with BBR’s to produce psychopathology symptoms such as bipolar disorder.
Furham, A. & Anthony, E. (2010) review various lay theories relating to the cause and treatment of bipolar disorder. In a study involving 170 participants, a mean response indicated that minority of people recognized bipolar disorder significantly less than depression. The minimal recognition of bipolar disorder is due to the fact that the prevalence of the condition is not as high as depression and schizophrenia. There is a correlation between the familiarities of a condition with the prevalence rates. A mental condition that is prevalent such as depression is commonly known compared to a mental condition such as bipolar disorder. There is also a common theory that bipolar disorder occurs due to neurochemical malfunction in the brain. Medical researchers are yet to prove if there is a relation between the disorder and brain function. According to (Furham & Anthony (2010) other mental conditions such as depression have been found to have relations to the function of the brain. The key to determining the cause of bipolar disorder thus lies in the ability to investigate the chemical basis of the disorder.
Biopsychological Causes of Bipolar Disorder
Scientists are unaware of the exact trigger of bipolar disorder. The exact trigger of bipolar disorder is unknown. However, psychologists suggest that the mental condition is a combination of genetics and neurochemical reaction. The genetics and neurochemical reactions await an environmental trigger which results to manic attacks and depression.
In relation to genetics, bipolar disorder appears to run in families. In a study by Cataldo, & Cohen, (2010) approximately 50% of individuals with bipolar disorder have a family member with a similar condition. Such mental disorders are not necessarily bipolar disorder but any other mental condition such as schizophrenia or depression. An individual born in a family where one of the parents has a mental condition such as bipolar disorder is 5 times likely to get the same condition as his parents. Individuals with bipolar disorder have various common traits and experiences. For instance, if a mother got her first maniac episode at the age of 15, it is likely that the son (with bipolar disorder), will experience his first attack approximately the same age. The prevalence of the condition in genetics is also evident in a situation where there are fraternal twins. Though different, one twin has a 25% of acquiring the diseases if his twin has it. In the situation of identical twins, the risk of suffering from bipolar disorder is higher as the identical twins share the same genetic component (Nusslock & Abramson, 2009).
Bipolar disorder can also occur as a result of neurochemical reactions in the brain. According to a study by the national Institute of mental Health, high or low levels of neurotransmitter such as serotonin or dopamine can trigger bipolar disorder. These brain chemicals are response for stress response and an individual’s thinking abilities. For individuals with bipolar disorder, the binding sites in the brain chemicals are quite dense compared to the binding sites for an individual without bipolar disorder.
A dense binding site means that the individual with bipolar may react more strongly than another person without the mental condition. An abnormal brain cell structure can also lead to erratic mood swings, a characteristic of bipolar disorder. In a study by Cataldo & Cohen, (2010) individuals with bipolar disorder have decreased mitochondrial activities, which alters energy metabolism. The study which involved postmortem, genetic, brain imaging which indicated that mitochondria’s located in the brain differed in size and distribution compared to the brain of an individual without bipolar disorder. An alteration of an individual’s nerve cell receptor can also lead to the activation of the disorder.
Research also indicates that there is a close relation between the occurrence of bipolar disorder and hormone imbalance. Fluctuating hormones can trigger mood swings, which can trigger mood disorders. However, fluctuation of hormones is common especially in women. It is only when the fluctuations are erratic that concern for mood disorder can be considered. The severity of the mood swing can also be a determinant of whether the hormonal fluctuation is ordinarily or not. Bipolar disorder mood fluctuation results to drastic changes in moods. For instance from extremely happy to extremely irritable for no clear reason.
Cognitive-Behavioral Therapy in Treatment of Bipolar Disorder
Cognitive-Behavioral Therapy (CBT) is a common therapy treatment for the management of mental conditions like depression and unipolar. Treatment of bipolar depression is based on the cognitive process of the individuals. Reviewing previous research Nusslock & Abramson (2009) indicates that cognitive profiles presented a viable predictor of relapse of bipolar disorder in individuals after a period of 12 months. Cognitive factors interact with negative events to trigger increased depressive symptoms hence increase in the occurrence of a manic episode. CBT in the treatment of bipolar disorder revolves around three main aspects. First is medication adherence where the patients are educated on the need to take their medication as stipulated by health care professionals. Educating the patient also involves informing them of the toxicity levels of the medication, and the side effects.
Side effects can be mild or severe. If sever, the patient may tend halt the medication intake. The patient must be familiar with the expected side effects so that he knows how to handle them. It is vital to inform a patient of the positive effects of the drugs e.g. it can stabilize the mood of the patients. Positive effects of medication motivate the patient to take the drug as stipulated by the health care provider. Medical adherence provides patients with appropriate behavioral strategies to help them adhere to the doctors instructions. The second aspect pertaining use of CBT in treatment of bipolar disorder focuses on biased or dysfunctional thinking. The patient must be introduced to the idea that negative thoughts influence his emotions. The patient must strive to monitor his thoughts, and aim to have positive thoughts that will not trigger negative emotions (Zaretsky, & Parikh, 2008).
One way that patients can boost their thoughts is through increased positive thoughts which aim to improve patients self esteem. When a bipolar disorder patient manages his thoughts, he can preempt a bipolar episode. The last aspect of treating bipolar disorder involves facilitation of psychosocial adjustments that guarantee that the patient can handle different situations he may face. The clinicians thus strive to teach the patient effective problem solving and behavioral skills so as to manage psychosocial stressors.
According to Nusslock & Abramson (2009) previous students by psychologists such as Fava and Patelis-Siotis have proven that CBT is an effective biopsychological approach to treat bipolar disorder. Other than the maniac attacks, CBT also assists in the management of depression caused by bipolar disorder. CBT effectively minimizes the risk of depressive and manic attacks by over 30months. CBT also reduces the risk of subsyndromal symptoms, which increases the chances of relapse for patient recovering from bipolar disorder.
Effectiveness of CBT in Managing Bipolar Disorder
Cognitive-behavioral therapy for purposes of treating bipolar disorder is an additional intervention that is needed in the treatment of mental disorders. CBT emphasizes on changing the cognitive process of the patients to be more optimistic that pessimistic. According to Nusslock & Abramson (2009) alternative intervention strategies in the management of bipolar disorder have proven to be ineffective. 50% of patients recovering from bipolar disorder experience relapse. CBT is psycho educational in nature hence enabling the patient make life changes that involve cognitive and behavioral modification. In most instances, over-reliance on medication for the management of bipolar disorder is not always effective in curtailing the mental condition. Medication is used to control the mood swings that the patient may experience. A life changing approach such as CBT is vital in ensuring that the patient finds a lasting solution to the condition.
Nusslock & Abramson (2009) indicates that CBT helps to increase compliance in terms of medication and life changes. It also helps enhance a patient’s quality of life and functioning such that the individual is able to manage stressors that can trigger mania attacks and depression. CBT strategies also help the patient make early prediction of bipolar disorder symptoms. Early detection enables the patient to minimize the effect of the attacks if they occur. Early detection also enables the patient to adopt effective aversion strategies to prevent an attack.
Interpersonal and Social Rhythm Therapy
Other than CBT, there are other treatment strategies that clinicians and psychologists utilize. According to a study by Hlastala, & McClellan, (2010) interpersonal and social Rhythm therapy (IPSRT) is a psychotherapy procedure that is also used in the treatment of bipolar disorder. The clinician works, with the patient, to determine the routines of the patient’s life.
The aim of determining these routines is so that the patient can adopt a regular pattern when handling issues and problems in life. Increasing regularity in daily behaviors minimizes disruption of circadian rhythms that may trigger bipolar disorder. The clinician thus works with the patient to understand the importance of maintaining a routine in activities such as eating and sleeping to keep manic attacks at bay (Furham, & Anthony, 2010). After the patient’s daily routine has been identified, the clinician strives to help the patient keep the routines consistent and overcome situations hat may interfere with these routines hence triggering variation of emotions. The clinicians also educate the patient on the need to track their moods.
Conclusion
The successful management of bipolar disorder involves medication, lifestyle changes and psychotherapy. There are several intervention strategies that clinicians can adopts to manage bipolar disorder. One of them is the Cognitive behavioral Therapy (CBT). CBT is an effective approach in the management of bipolar disorder as it helps a patient improve, how he thinks, acts and views the situation around him. With change of perception, the patient avoids destructive mood swings that trigger the neurotransmitter resulting to unmanageable mood swings. The functionality of the treatment of bipolar disorder is based on the ideology that thoughts cause feelings and subsequent behavioral reactions. CBT thus provides an ideal tool involving the management of symptoms of depression and mood swings so as to prevent a relapse. However, research indicates that CBT therapy over short periods of time is ineffective especially for individuals that have had frequents episodes of mania attacks and depression. There is also need to research further on the cognitive processes involved in bipolar disorder. It is by understanding the underlying cognitive processes that an elaborate CBT intervention can be formulated. CBT helps patient enhance their quality of life, have a positive approach when facing different situation and detect situations that can lead to an attack.
Reference
Cataldo, a. & Cohen, B. (2010). Abnormalities in mitochondrial structure in cells from patients with bipolar disorder. American journal of pathology. Vol. 177(2); 575-585
Furham, A. & Anthony, E. (2010). Lay theories of bipolar Disorder: causes, manifestation and cures. International journal of social psychiatry. Vol. 56 (3); 255-269
Hlastala, S. & McClellan, J. (2010). Interpersonal and social rhythm therapy for adolescents with bipolar disorder. Journal of depression and anxiety. Vol. 27(5): 457-464
Nusslock, R. & Abramson, L. (2009). Psychosocial Intervention for bipolar disorder: perspective form the behavioral approach system (BAS) theory. Journal of clinical psychology. Vol. 1 (16):449-469
Riedel, H. & Heiby, E. (2011). Psychological behaviorism theory of bipolar disorder. The psychological record. Vol. 51: 507-532
Scott, J. & Kinderman, P. (2006). Cognitive-behavioral therapy for severe and recurrent bipolar disorders. The British journal of psychiatry. 188:313-320
Zaretsky, a. & Parikh, S. (2008). Is cognitive-behavioral therapy more effective that psychoeducation in bipolar disorder. Canadian journal of psychiatry. Vol. 53(7); 441-448
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