Bipolar Disorder, Its Symptoms and Indicators

Mood is the changing expression of emotion and can be described as a spectrum describing how the various expressions of human happiness and sadness may be experienced. The outermost ends of this spectrum highlight two states, the lowest low, melancholia, and the highest high, mania. These mood extremes have been studied and documented repeatedly in human history, it was first studied and described by Hippocrates. Nineteenth century contemporaries Falret and Baillarger described two forms of an extreme mood disorder, with the validity and accuracy of both debated. Regardless, the concept of a cycling mood disease was highly discussed and the concept was accepted before the end of the 19th century. Kraepelin then described “manic depressive insanity” and gave a description of a full range of mood dysfunction which included single episodes of mania or depression or a complement of many episodes of each. It was this concept which was incorporated into the first DSM and carried out until DSM-III, in which the description of episodic mood dysfunction was used to build a diagnosis of bipolar disorder.

The first attempt to categorize and standardize mental illness in DSM-I (1952) classified manic-depression as a psychotic disorder, “characterized by a varying degree of personality integration and a failure to test and evaluate correctly external reality in various spheres”. “Manic depressive reaction” details symptoms of mania true to the diagnosis today, severe mood swings and a tendency to remit and recur. However, earlier psychotic features of illusions, delusions and hallucinations where also listed as possible additions to the diagnosis which are now known to be only a minor section of the wider disease. This diagnosis approaches more closely the Kraeplinian understanding of manic-depressive insanity, and the dominant mood presentation of a patient would be described using the specific type.

Three types were detailed: manic, depressed and other. The manic type details what is most similar to the modern definition of mania, “elation or irritability, with overtalkativeness, flight of ideas, and increased motor activity”, with depression only present in fleeting episodes. The depressed type resembled what is now Major Depressive Disorder, “outstanding depression of mood and with mental and motor retardation and inhibition; in some cases there is much uneasiness and apprehension. Perplexity, stupor or agitation may be prominent symptoms”. It is only in the other type in which mixed states or cycling is characterized as a feature, “marked mixtures of the cardinal manifestations of the above two phases (mixed type), or those cases where continuous alternation of the two phases occur (circular type)”. These classifications allow for cases which do not easily fit into a primary manic or primary depressive description to be typed; however, the modern understanding of bipolar with a primary characteristic of cycling between mania and depression is not a fundamental component of the major disorder. In addition, the mixed state is mentioned but again was not fully characterized.

Understanding Bipolar Disorder

Bipolar disorders are characterized by an unpredictable behavior, resulting in depressive, hypomanic or manic episodes alternating with span of normal states. A multi-parametric approach can be followed to diagnose mood states by analyzing information coming from different physiological signals and from the changes in voice and behavior

Bipolar disorder is a mood disorder that presents with symptoms of cycling between periods of extreme excitement (mania) and sadness; it is hereditary and often linked to brain injury. Between one and two percent of all Australians suffer from bipolar disorder, although in many the symptoms are mild and have limited impact on functioning (Mitchell, 2013; Kulkarni et al., 2012). For those with severe cases, symptoms can impact all major life areas, including work, school, and interpersonal and community relationships.

The three subcategories are organized by increasing severity of bipolar disorder. The first subcategory is Bipolar 1 Disorder. The main symptom of Bipolar I Disorder is an increase in manic mood swings which generally affects daily activities such as work, school, or family. Manic mood swings commonly cause effects such as extreme optimism, aggressive behavior, agitation/irritation, loss of sleep, abuse of drugs/alcohol, or delusion. The second category is Bipolar II Disorder. In this subcategory, people endure depressive mood swings including emotions of sadness, anger, happiness, anxiety, guilt, irritability, and suicidal thoughts. The final subcategory of bipolar disorder is Cylothymia which is the least severe form of bipolar disorder, but does include highs and lows of depression. Other symptoms of bipolar disorder include mood swings over a period of a few years, days, or hours varying on season change, as well as psychosis (hallucinations/delusions).

Symptoms of the disease are behavioral, with limited and disputed indications of change of brain activity during certain mood episodes. Bullock, Murray and Meyer (2017), in a study of the effects of environmental factors on bipolar mood episodes, found that few clear physiological tests exist. Further, there are not consistent environmental factors beyond a slight correlation with increased environment temperature that would predict when mood changes might occur. Periods of extreme mood can last anywhere from a few hours to weeks at a time, making differentiation between symptoms and the patient’s normal functioning even more difficult, particularly in early stages of the disease.

In this disease as observed, there is no fixed pattern for the dramatic episodes of elevated and low moods. Someone may feel the same mood (depressed or manic) several times before changing to the opposite mood for an extended period of time. How serious it becomes varies from individual to individual and with time it can also alter, becoming more or less serious.

Symptoms of mania ('the highs'):

• Excessive happiness, hope, and excitement
• Sudden shift from being joyful to being irritable, angry, and hostile
• Restlessness
• Rapid speech and poor concentration
• Increased energy and less need for sleep
• Unusually high sex drive
• Making grand and unrealistic plans
• Showing poor judgment
• Drug and alcohol abuse
• Becoming more impulsive.

During depressive periods ('the lows'), a person with bipolar disorder may have:

• Sadness
• Loss of energy
• Feelings of hopelessness or worthlessness
• Not enjoying things they once liked
• Trouble concentrating
• Uncontrollable crying
• Trouble making decisions
• Irritability
• Needing more sleep
• Insomnia
• Appetite changes that make them loose or gain weight
• Thoughts of death or suicide
• Attempting suicide.
• Psychological indicator

People with bipolar disorder may also have another health to treat along with bipolar disorder. Some circumstances can render symptoms of bipolar disorder worse or less effective in therapy. Examples include the following:

• Anxiety disorders
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Alcohol or drug abuse
• Physical health problems, such as heart disease, thyroid problems, headaches or obesity.

Researchers have noted that in the households of those with bipolar disorders mood, anxiety and psychotic disorders happen more frequently than in the general population. Studies of identical twins, which all share the same genes, show that variables other than genes, such as extremely stressful events, also play a part in precipitating bipolar disorder.

Research into cognitive styles suggests evidence for unstable self-esteem and elevated positive self-appraisal in BD. Prospectively, low explicit self-esteem appears to predict increased risk of both mania and depression in individuals diagnosed with BD. We have also observed low and unstable explicit self-esteem in teenage offspring of bipolar parents. Although these phenomena seem to be specifically associated with the presence of depressive symptoms, there is some evidence that manic symptoms in high-risk teenagers are associated with low implicit self-esteem.

It was discovered through observation that patients with bipolar disorder have trouble coping and become suicidal. Suicide in a depressive or mixed episode is more probable to happen.

1. Illicit drugs such as cocaine, “designer drugs” such as Ecstasy and amphetamines.
2. Excessive doses of certain over-the-counter drugs, including appetite suppressants and cold preparations.
3. Non-psychiatric medications, such as medicine for thyroid problems and corticosteroids like prednisone.
4. Excessive caffeine (moderate amounts of caffeine are fine).

If a person is vulnerable to bipolar disorder, stress, frequent use of stimulants or alcohol, and lack of sleep may prompt onset of the disorder. Certain medications also may set off a depressive or manic episode.

Social Indicator

Bipolar disorder develops usually when people are in late adolescence or young adulthood. It has been observed that bipolar disorder can happen earlier in childhood but the chances are low. Bipolar disorder can run in families.

Men and women are equally likely to get it.. Women are more probable to go through 'rapid cycling,' than males, which has four or more separate episodes of mood within a year. Women also tend to spend more time depressed than men with bipolar disorder. Reports show that individuals with bipolar disorder often experience overall poor quality of life and life functioning. We also found that females had lower quality of life than males. Patients who were married, living as married, divorced, or separated had worse functional impairment compared with patients who were single or never married.

Social disadvantage was significantly associated with worse functioning and symptoms, but unexpectedly only marginally associated with quality of life. The multivariate models suggested that depression and irritability together were the strongest indicators of poor quality of life and functioning in individuals with bipolar disorder. Consistent with prior studies patients with greater clinical severity (i.e., total, depression, anxiety, irritability) had lower quality of life, patients with greater manic severity reported marginally better quality of life. No association was found between manic severity and functioning, consistent with the literature, and mania was not associated with social disadvantage.

Many people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder.

Biological approach towards bipolar disorder explain the impact and roots of the disorder “The biological approach looks for its roots of mental disorder in the brain’s circuitry”.

The present observation is that this is a predominantly neurobiological disease that arises in a particular portion of the brain and is caused by a malfunction of certain brain chemicals (which happens in both the brain and body). In — serotonin, dopamine, and noradrenaline — three particular brain chemicals were attracted. It can be predisposed and activated unexpectedly as a neurobiological illness or it can be caused by stressors in life.

Conclusion

This essay have explored bipolar disorder, its characterization, categories, symptoms, and major indicators. Bipolar disorder is mainly a biological disease occurring in a particular brain region owing to the dysfunction in the brain of certain neurotransmitters or chemical messengers. Neurotransmitters such as norepinephrine, serotonin, and likely many others may be involved in these chemicals. It may lie dormant and be activated on its own as a biological disease, or it may be caused by external variables such as psychological stress and social conditions.