Evidence from epidemiological and twin studies strongly suggests that bipolar disorder is a heritable illness. First-degree relatives of patients with bipolar disorder have significantly higher rates of mood disorder than do relatives of nonpsychiatrically ill comparison groups. However, the mode of inheritance remains unknown. In clinical practice, a family history of mood disorder, especially of bipolar disorder, provides strong corroborative evidence of the potential for a primary mood disorder in a patient with otherwise predominantly psychotic features. Likewise, the magnitude of the role played by environmental stressors, particularly early in the course of the illness, remains uncertain. However, there is growing evidence that environmental and lifestyle features can have an impact on severity and course of illness. Stressful life events, changes in sleep-wake schedule, and current alcohol or substance abuse may affect the course of illness and lengthen the time to recover.
Key Points About Bipolar Disorder
Criteria: Mania, at some time severe enough to compromise functioning. 90% of patients have periods of depression. A “manic episode” usually develops over several days, and 20% of manics have hallucinations and/or delusions.
Severe mania may be indistinguishable from an organi delirium. A person with Bipolar I Disorder usually has a difficult time concentrating, needs very little sleep, and may have inflated self-esteem. Often people with this disorder have also had at least one major depressive episode. A patient with Bipolar I Disorder may have severe depression but may present with mild depressive symptoms. Attacks are often separated by months or years, but cycling between depression and mania may occur over days or weeks.
Criteria: Bipolar II is diagnosed when a patient has Major Depression but also experiences a hypomanic episode (usually around the time of the depression) but never develops a full manic episode. Five to 10% of first-degree relatives with Bipolar develop the illness. Bipolar II Disorder is considered a a genetic disorder due to 70% concordance for identical twins. There is some evidence to suggest and abnormality on chromosome 11, but this is not clear at this time.
Individuals with this disorder, experience the first manic episode before age 30. Onset is usually rapid and resolves within two to four months. In addition, one or more periods of depression have usually occurred. Suicide is a major risk during depressive episodes. Legal difficulities or substance use are major risks during manic episodes.
Medical Treatment for Bipolar Disorder
Medication is commonly used in the treatment of bipolar disorder. Some regularly prescribed medications include.
Mood stabilizers: These medications stabilize a person’s mood in order to avoid the highs and lows typically associated with bipolar. Lithium is one example of a mood stabilizer. Lithium has potentially serious side effects, though; people taking this medication are encouraged to have their blood monitored regularly.
Anticonvulsants: These medications are typically used to treat seizures, but have been found to be effective in mood stabilization as well. Potential side effects of these medications include risk of suicidal thoughts and behaviors. People taking these medications should be closely monitored for new or worsening signs of depression.
Atypical antipsychotics: These medications are often used in the treatment of schizophrenia, but have also been found to be effective for treating bipolar (especially manic symptoms). Examples include Zyprexa (olanzapine), Abilify (aripiprazole), Seroquel (quetiapine), and Risperdal (risperidone).
Antidepressants: Antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) can be used to treat depressive symptoms of bipolar. However, use of these medications can cause a manic or hypomanic episode. For that reason, these medications are typically used in combination with a mood stabilizer.
Medical treatment of bipolar disorder also includes hospitalization in some cases. Hospitalization for the purpose of stabilization is typically brief. Hospitalization may be necessary if the following symptoms are present:
Thoughts of hurting self or others
Insomnia that persists for several days
Inability to care for oneself