Bipolar disorder: Difference between revisions
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{{redirect|Manic depression}} |
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{{Infobox Disease | |
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Name = Bipolar disorder | |
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Image = | |
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Caption = | |
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DiseasesDB = 7812 | |
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ICD10 = {{ICD10|F|31||f|30}} | |
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ICD9 = {{ICD9|296.80}} | |
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ICDO = | |
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OMIM = 125480 | |
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OMIM_mult = {{OMIM2|309200}} | |
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MedlinePlus = 001528 | |
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eMedicineSubj = med | |
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eMedicineTopic = 229 | |
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MeshID = D001714 | |
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}} |
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'''Bipolar disorder''' is a [[Classification of mental disorders|psychiatric diagnosis]] that describes a category of [[mood disorders]] defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as [[mania]] or, if milder, [[hypomania]]. Individuals who experience manic episodes also commonly experience [[depressive]] episodes or symptoms, or [[mixed episodes]] in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of "normal" [[Mood (psychology)|mood]], but in some individuals, depression and mania may rapidly alternate, known as [[Bipolar disorder#Rapid cycling|rapid cycling]]. Extreme manic episodes can sometimes lead to [[psychotic]] symptoms such as [[delusions]] and [[hallucinations]]. The disorder has been subdivided into [[bipolar I]], [[bipolar II]], [[cyclothymia]], and other types, based on the nature and severity of mood episodes experienced; the range is often described as the [[bipolar spectrum]]. |
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Data from the United States on [[lifetime prevalence]] vary but indicate a rate of around 1 percent for Bipolar I, 0.5 to 1 percent for Bipolar II or cyclothymia, and between 2 and 5 percent for subthreshold cases meeting some but not all criteria. The onset of full symptoms generally occurs in late adolescence or young adulthood. Diagnosis is based on the person's self-reported experiences, as well as observed behavior. Episodes of abnormality are associated with distress and disruption, and an elevated risk of [[suicide]], especially during depressive episodes. In some cases it can be a devastating long-lasting disorder. In some cases, however, it has been associated with creativity, goal striving and positive achievements.<ref> http://linkinghub.elsevier.com/retrieve/pii/S0165032702004627 </ref> |
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Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizer medications, and sometimes other psychiatric drugs. Psychotherapy also has a role, often when there has been some recovery of stability. In serious cases in which there is a risk of harm to oneself or others [[involuntary commitment]] may be used; these cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with [[social stigma]], [[stereotypes]] and [[prejudice]] against individuals with a diagnosis of bipolar disorder.<ref>http://www.mental-health-matters.com/articles/article.php?artID=1176</ref> |
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Also called '''manic depression''' or '''bipolar affective disorder''', the current term "bipolar" is of fairly recent origin and refers to the cycling between high and low episodes (poles). A relationship between mania and [[melancholia]] had long been observed, although the basis of the current conceptualisation can be traced back to French psychiatrists in the 1850s. The term "manic-depressive illness" or psychosis was coined by German psychiatrist [[Emil Kraepelin]] in the late nineteenth century, originally referring to all kinds of mood disorder. German psychiatrist [[Karl Leonhard]] split the classification again in 1957, employing the terms unipolar disorder ([[Major depressive disorder]]) and bipolar disorder. |
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==Signs and symptoms== |
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Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and abnormally depressed states for a period of time in a way that interferes with functioning. Bipolar disorder has been estimated to affect more than 5 million Americans—about 3 out of every 100 adults.<ref>{{cite journal |last=Kessler |first=RC |coauthors=Chiu WT, Demler O, Walters EE |title= Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R) |journal=Arch Gen Psychiat |volume=6 |pages=617–27 |year=2005 |pmid=15939839 |url=http://archpsyc.ama-assn.org/cgi/content/full/62/6/617}}</ref> It is equally prevalent in men and women, and is found across all cultures and ethnic groups.<ref>Frederick K Goodwin and Kay R Jamison.''Manic-Depressive Illness'' Chapter 7, "Epidemiology". Oxford University Press, 1990. ISBN 0195039343.</ref> Not everyone's symptoms are the same, and there is no blood test to confirm the disorder. Scientists believe that bipolar disorder may be caused by chemical imbalances in the brain. Bipolar disorder can appear to be unipolar depression. Diagnosing bipolar disorder is difficult, even for mental health professionals. What distinguishes bipolar disorder from unipolar depression is that the affected person also experiences the "highs" of a manic phase. |
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===Major depressive episode=== |
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{{main|Major depressive episode}} |
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Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; [[depersonalization]]; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation.<ref name="Mayo-dsection2">{{cite web |url=http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=2 |title=Bipolar Disorder: Signs and symptoms |publisher=Mayo Clinic |accessdate= |format= |work= }}</ref> In severe cases, the individual may become [[psychotic]], a condition also known as severe bipolar depression with psychotic features. |
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===Manic episode=== |
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{{main|Mania}} |
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Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person's speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen", are "on a special mission", or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience [[psychosis]], or a break with reality, where thinking is affected along with mood.<ref>[http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-publication.shtml#pub2 NIMH · Bipolar Disorder · Complete Publication<!-- Bot generated title -->]</ref> Many people in a manic state experience severe [[anxiety]] and are very irritable (to the point of rage), while others are [[Euphoria (emotion)|euphoric]] and grandiose. |
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In order to be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM) a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required. According to the National Institute of Mental Health, "A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present."<ref>[http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-publication.shtml NIMH · Bipolar Disorder · Complete Publication<!-- Bot generated title -->]</ref> |
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===Hypomanic episode=== |
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{{main|Hypomanic episode}} |
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Hypomania is generally a mild to moderate level of mania, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Some people have increased creativity while others demonstrate poor judgment and irritability. These persons generally have increased energy and tend to become more active than usual. They do not, however, have [[delusions]] or hallucinations. Hypomania can be difficult to diagnose because it may masquerade as mere happiness, though it carries the same risks as mania. |
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Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.<ref>http://www.pueblo.gsa.gov/cic_text/health/bipolar/bipolar.htm</ref> |
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===Mixed affective episode=== |
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{{main|Mixed state (psychiatry)}} |
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In the context of bipolar disorder, a mixed state is a condition during which symptoms of [[mania]] and [[clinical depression]] occur simultaneously (for example, [[agitation (emotion)|agitation]], [[anxiety]], aggressiveness or belligerence, confusion, [[fatigue (physical)|fatigue]], impulsiveness, [[insomnia]], irritability, morbid and/or [[suicidal ideation]], [[panic]], [[paranoia]], persecutory delusions, pressured speech, [[racing thoughts]], restlessness, and [[Rage (emotion)|rage]]).<ref>{{cite web |url=http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=7 |title=Bipolar Disorder: Complications |accessdate= |format= |publisher=Mayo Clinic}}</ref> |
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==Diagnosis== |
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[[Image:PKDHypersonicDrop.jpg|thumb|Manic and depressive episodes, hallmarks of Bipolar Disorder, have been likened to a [[roller coaster]] ride.<ref>{{cite book |title=Riding the Roller Coaster: Living with Mood Disorders |author=Bergen M |year=1999 |publisher=Wood Lake Publishing Inc. |isbn=9781896836317}}</ref>]] |
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Diagnosis is based on the self-reported experiences of an individual as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a [[psychiatrist]], [[nurse]], [[social worker]], [[clinical psychologist]] or other clinician in a clinical assessment. There are lists of criteria for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's [[Diagnostic and Statistical Manual of Mental Disorders]], the current version being DSM-IV-TR, and the [[World Health Organization|World Health Organization's]] [[ICD|International Statistical Classification of Diseases and Related Health Problems]], currently the ICD-10. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions, as well as prevailing in research studies. |
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An initial assessment may include a physical exam by a physician. Although there are no biological tests which confirm bipolar disorder, tests may be carried out to exclude medical illnesses such as [[hypothyroidism|hypo-]] or [[hyperthyroidism]], metabolic disturbance, a systemic infection or chronic disease, and [[syphilis]] or [[HIV]] infection. An [[Electroencephalography|EEG]] may be used to exclude [[epilepsy]], and a [[Computed tomography|CT scan]] of the head to exclude brain lesions. Investigations are not generally repeated for relapse unless there is a specific ''medical'' indication. |
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There are several other mental disorders which may involve similar symptoms to bipolar disorder. These include [[schizophrenia]],<ref>{{cite journal |author=Pope HG |year=1983 |title=Distinguishing bipolar disorder from schizophrenia in clinical practice: guidelines and case reports |journal=Hospital and Community Psychiatry |volume=34|pages=322–28}}</ref> [[schizoaffective disorder]], drug intoxication, brief drug-induced psychosis, [[schizophreniform disorder]] and [[borderline personality disorder]]. Both borderline personality and bipolar disorder can involve what are referred to as "mood swings". In bipolar disorder, the term refers to the cyclic episodes of elevated and depressed mood which generally last weeks or months. The term in borderline personality refers to the marked [[Affective lability|lability]] and reactivity of mood, known as [[emotional dysregulation]], due to response to external psychosocial and intrapsychic stressors; these may arise or subside suddenly and dramatically and last for seconds, minutes, hours or days. A bipolar depression is generally more pervasive with sleep, appetite disturbance and nonreactive mood, whereas the mood in dysthymia of borderline personality remains markedly reactive and sleep disturbance not acute.<ref>Goodwin & Jamison. pp. 108–110.</ref> Some hold that borderline personality disorder represents a subthreshold form of mood disorder,<ref>{{cite journal |author=Akiskal HS, Yerevanian BI, Davis GC, King D, Lemmi H |title=The nosologic status of borderline personality: clinical and polysomnographic study |journal=Am J Psychiatry |volume=142 |issue=2 |pages=192–8 |year=1985 |month=February |pmid=3970243 |doi= |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=3970243}}</ref><ref>{{cite journal |author=Gunderson JG, Elliott GR |year=1985 |title=The interface between borderline personality disorder and affective disorder |journal=Am J Psychiatry |volume=142 |pages=277–288}}</ref> while others maintain the distinctness, though noting they often coexist.<ref>{{cite journal |last=McGlashan |first=TH | authorlink=Thomas McGlashan|year=1983 |title=The borderline syndrome:Is it a variant of schizophrenia or affective disorder? |journal=Arch Gen Psychiatry |volume=40 |pages=1319–1323}}</ref><ref>{{cite journal |author= Pope HG Jr, Jonas JM, Hudson JI, Cohen BM, Gunderson JG|year=1983 |title=The validity of DSM-III borderline personality disorder: A phenomenologic, family history, treatment response, and long term follow up study |journal= Arch Gen Psychiatry|volume=40 |pages=23–30}}</ref> |
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===Criteria and subtypes=== |
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{{main|Current diagnostic criteria for bipolar disorder}} |
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There is no clear consensus as to how many types of bipolar disorder exist.<ref> |
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{{cite journal |author=Akiskal HS, Benazzi F |
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| year = 2006 |
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| month = May |
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| title = The DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum |
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| journal = J Affect Disord. |
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| volume = 92 |
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| pages = 45–54 |
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| pmid = 16488021 |
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</ref> In [[DSM-IV-TR]] and [[ICD-10]], bipolar disorder is conceptualized as a [[Bipolar spectrum|spectrum]] of disorders occurring on a continuum. The DSM-IV-TR lists four types of mood disorders which fit into the bipolar categories: [[Bipolar I]], [[Bipolar II]], [[Cyclothymia]], and [[Bipolar Disorder NOS]] (Not Otherwise Specified). |
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====Bipolar I==== |
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In [[Bipolar I disorder]], an individual has experienced one or more [[manic episodes]] with or without major depressive episodes. For a diagnosis of Bipolar I disorder according to the [[DSM-IV-TR]], one or more manic or mixed episodes are required. A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs. |
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====Bipolar II==== |
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[[Bipolar II disorder]] is characterized by [[hypomanic]] episodes rather than actual [[manic episodes]], as well as at least one [[major depressive episode]]. There has never been a [[manic episode]] or a [[mixed episode]]. Hypomanic episodes do not go to the full extremes of mania (i.e. do not usually cause severe social or occupational impairment, and without [[psychosis]]), and this can make Bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression. For both Bipolar I and II, there are a number of specifiers that indicate the presentation and course of the disorder, including "chronic", "rapid cycling", "catatonic" and "melancholic". |
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====Cyclothymia==== |
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[[Cyclothymia]] involves a presence or history of hypomanic episodes with periods of [[Clinical depression|depression]] that do not meet criteria for major depressive episodes. A diagnosis of [[cyclothymia|Cyclothymic Disorder]] requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet ''full'' criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. |
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====Bipolar NOS==== |
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Bipolar Disorder Not Otherwise Specified is a catch-all diagnosis that is used to indicate bipolar illness that does not fit into the other diagnostic categories. If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified). |
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====Rapid cycling==== |
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Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.<ref> |
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</ref> |
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''Rapid cycling'', however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more episodes per year and is found in a significant fraction of individuals with bipolar disorder. The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period.<ref> |
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</ref> There are references that describe very rapid (ultra-rapid) or extremely rapid<ref> |
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}} |
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</ref> (ultra-ultra or [[ultradian]]) cycling. One definition of ultra-ultra rapid cycling is defining distinct shifts in mood within a 24–48-hour period. |
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===Challenges=== |
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The experiences and behaviors involved in bipolar disorder are often not understood by individuals or recognized by mental health professionals, so diagnosis may sometimes be delayed for 10 years or more.<ref>{{cite web|url=http://www.familyaware.org/expertprofiles/drghaemi4.asp|title=Bipolar Disorder: How long does it usually take for someone to be diagnosed for bipolar disorder?|author=S. Nassir Ghaemi|year=2001|accessdate = 2007-02-20}}</ref> That treatment lag is apparently not decreasing, even though there is now increased public awareness of this mental health condition in popular magazines and health websites. Despite this increased focus, individuals are still commonly misdiagnosed.<ref>{{cite web|title=Misdiagnosis of Bipolar Disorder|author=Roy H. Perlis|publication=American Journal of Managed Care|url=http://www.ajmc.com/Article.cfm?Menu=1&ID=2969|year=2005|accessdate = 2007-02-20}}</ref> An individual may appear simply depressed when they are seen by a health professional. This can result in misdiagnosis of [[Major Depressive Disorder]] and harmful treatments. Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32)<ref>[http://www.bipolarlab.com/hcl Hypomanic Check List Questionnaire (HCL-32)]</ref> have been developed to assist the quite often difficult detection of Bipolar II disorders. |
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It has been noted that the bipolar disorder diagnosis is officially characterised in historical terms such that, technically, anyone with a history of (hypo)mania and depression has bipolar disorder whatever their current or future functioning and vulnerability. This has been described as "an ethical and methodological issue", as it means no one can be considered as being recovered from bipolar disorder according to the official criteria. This is considered especially problematic given that brief hypomanic episodes are widespread among people generally and not necessarily associated with dysfunction.<ref name="Mansell2008"/> |
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Flux is the fundamental nature of bipolar disorder.<ref>[http://www.dbsalliance.org/site/PageServer?pagename=about_MDOverview Depression and Bipolar Support Alliance: About Mood Disorders<!-- Bot generated title -->]</ref> Individuals with the illness have continual changes in energy, [[mood]], thought, sleep, and activity. The [[diagnostic]] [[subtypes]] of bipolar disorder are thus static descriptions — snapshots, perhaps — of an illness in continual flux, with a great diversity of symptoms and varying degrees of severity. Individuals may stay in one subtype, or change into another, over the course of their illness.<ref>Goodwin & Jamison, 1990.</ref> The DSM V, to be published in 2012, will likely include further and more accurate sub-typing (Akiskal and Ghaemi, 2006{{which}}). |
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The diagnosis of bipolar disorder in children is particularly challenging, and controversial. Some who show some bipolar symptoms tend to have a rapid-cycling or mixed-cycling pattern that may not meet DSM-IV criteria.<ref name="Kranowitz, C.S. & Post, R., (1996)">Kranowitz, C.S. & Post, R., (1996). Ultra-rapid and ultradian cycling in bipolar affective illness. [[British Journal of Psychiatry]], 168, 314–323.</ref> In addition, it can be difficult to distinguish between age-appropriate restlessness, the fidgeting of children with [[ADHD]], and the purposeful busy activity of mania.<ref>Naomi A. Schapiro [http://www.medscape.com/viewarticle/504584_print Bipolar Disorders in Children and Adolescents] J Pediatr Health Care. 2005;19(3):131-141.</ref> Further complicating the diagnosis, is that abused or traumatized children can seem to have bipolar disorder when they are actually reacting to horrors in their lives.<ref>[http://www.boston.com/news/local/massachusetts/articles/2007/02/15/bipolar_labels_for_children_stir_concern/?page=2 Bipolar labels for children stir concern - The Boston Globe]</ref> |
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==Associated features== |
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Associated features are clinical phenomenon that often accompany the disorder, but are not part of the diagnostic criteria for the disorder. |
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===Cognitive functioning=== |
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[[Image:Cerebral lobes.png|thumb|Mild cognitive impairment in bipolar disorder is a controversial issue]] |
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So called [[cognitive deficit]]s in bipolar disorder are relatively mild and can only be detected by comparing performance in neuropsychological tests between groups of patients compared to those without the diagnosis.{{Fact|date=November 2008}} It should be stressed that although on ''average'' those with bipolar disorder perform worse in some tasks compared to controls, some patients will actually perform better than controls because of the large variation in test scores. |
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It has been concluded from recent reviews that most individuals who were diagnosed with bipolar disorder but who are [[euthymic]] (have not experienced major depression or (hypo)mania for some time) do not show neuropsychological deficits on most tests.<ref name="Mansell2008"/> Meta-analyses have indicated, by averaging the variable findings of many studies, impaired performance on some measures of sustained [[attention]], [[executive function]] and memory, in terms of group averages. The effects of subthreshold mood states and psychiatric medications appear to account for some of the association.<ref>Robinson LJ, Thompson JM, Gallagher P, Goswami U, Young AH, Ferrier IN, Moore PB. (2006) A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord. 2006 Jul;93(1-3):105-15. PMID 16677713</ref><ref>Torres IJ, Boudreau VG, Yatham LN. (2007) Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl. 2007;(434):17-26. PMID 17688459 (Note: The full text of this study discloses pharmaceutical company funding)</ref> |
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It is not known whether specific cognitive deficits are disorder-specific features of bipolar disorder.{{Fact|date=November 2008}} |
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===Creativity and accomplishment=== |
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[[Image:VanGogh-starry night ballance1.jpg|thumb|Some historians believe [[Vincent van Gogh]] suffered from Bipolar Disorder]] |
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{{main|Creativity and mental illness}} |
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While the disorder affects people differently, individuals with bipolar disorder during the manic phase tend to be much more outgoing and daring than individuals without bipolar disorder. The disorder is also found in a large number of people involved in the [[arts]].<ref name="Mad Geniouses">{{cite web | publisher =[[HowStuffWorks]]|title=Mad Genius | url= "http://people.howstuffworks.com/mad-genius3.htm" | accessdate=2008-09-08}}</ref> It is an ongoing question as to whether many creative [[genius]]es had bipolar disorder. Some studies have found a significant correlation between [[creativity]] and bipolar disorder. Though studies consistently show a positive correlation between the two, it is unclear in which direction the cause lies, or whether both conditions are caused by a third unknown factor. Temperament has been hypothesized to be one such factor.<ref name="santosa2006"> Santosa et al. Enhanced creativity in bipolar disorder patients: A controlled study. ''J Affect Disord.'' 2006 November 23; PMID 17126406. |
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</ref><ref name="rihmer2006"> |
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Rihmer et al. Creativity and mental illness. ''Psychiatr Hung.'' 2006;21(4):288–94. PMID 17170470. |
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</ref><ref name="nowakowska2006">Nowakowska et al. Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. ''J Affect Disord.'' 2005 Mar;85(1–2):207–15. PMID 15780691. |
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</ref> |
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A series of authors have described mania or hypomania as related to higher accomplishment, elevated achievement motivation and ambitious goal setting. One study indicated that greater-than-average striving for goals, and sometimes obtaining them, corresponded with mania.<ref>{{cite journal |author=Johnson SL |title=Mania and dysregulation in goal pursuit: a review |journal=Clin Psychol Rev |volume=25 |issue=2 |pages=241–62 |year=2005 |month=February |pmid=15642648 |doi=10.1016/j.cpr.2004.11.002 |url=}}</ref> |
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==Epidemiology== |
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The lifetime prevalence of bipolar disorder type I, which includes at least a lifetime manic episode, has generally been estimated at 2%.<ref name="Soldani2005">{{cite journal | first = Federico | last = Soldani | coauthors = Sullivan P. F. Pedersen N. L. | month = April | year = 2005 | title = Mania in the Swedish Twin Registry: criterion validity and prevalence | journal = Australian and New Zealand of Psychiatry | volume = 39 | issue = 4 | pages = 235–43 | pmid=15777359 | doi = 10.1111/j.1440–1614.2005.01559.x}}</ref> A reanalysis of data from the [[National Epidemiological Catchment Area]] survey in the United States, however, suggested that 0.8 percent experience a [[manic episode]] at least once (the diagnostic threshold for [[bipolar I]]) and 0.5 a [[hypomanic]] episode (the diagnostic threshold for bipolar II or cyclothymia). Including sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, an additional 5.1 percent of the population, adding up to a total of 6.4 percent, were classed as having a bipolar spectrum disorder.<ref name="Judd_and_Akiskal_2003">{{cite journal | first = Lewis L. | last = Judd | coauthors = Hagop S. Akiskal | month = January | year = 2003 | title = The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases | journal = Journal of Affective Disorders | volume = 73 | issue = 1–2 | pages = 123–31 | doi = 10.1016/S0165-0327(02)00332-4 |pmid=12507745 |url=http://linkinghub.elsevier.com/retrieve/pii/S0165032702003324}}</ref> A more recent analysis of data from a second US [[National Comorbidity Survey]] found that 1% met lifetime prevalence criteria for bipolar 1, 1.1% for bipolar II, and 2.4% for subthreshold symptoms.<ref>Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC. (2007) [http://archpsyc.ama-assn.org/cgi/content/full/64/5/543#REF-YOA60082-2 Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication] Arch Gen Psychiatry. May;64(5):543-52.</ref> There are conceptual and methodological limitations and variations in the findings. Prevalence studies of bipolar disorder are typically carried out by lay interviewers who follow fully structured/fixed interview schemes; responses to single items from such interviews may suffer limited validity. In addition, diagnosis and prevalence rates are dependent on whether a categorical or spectrum approach is used. Concerns have arisen about the potential for both underdiagnosis and overdiagnosis.<ref>Phelps, J. (2006) [http://www.psychiatrictimes.com/print.jhtml?articleID=191504355&url_prefix= Bipolar Disorder: Particle or Wave? DSM Categories or Spectrum Dimensions?] Psychiatric Times</ref> |
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Late adolescence and early adulthood are peak years for the onset of bipolar disorder.<ref name="Christie88">{{cite journal |author=Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ |year=1988 |title=Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults |journal=Am J Psychiatry |volume=145 |pages=971–975 |id= |url=http://www.ajp.psychiatryonline.org/cgi/content/abstract/145/8/971 (abstract) |accessdate = 2007-07-01 }}</ref><ref>Goodwin & Jamison. p. 121.</ref> These are critical periods in a young adult's social and vocational development, and they can be severely disrupted. |
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Major depressive disorder and bipolar disorder are currently classified as separate disorders. Some researchers increasingly view 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 bipolar type [[schizoaffective disorder]], and at the other end is recurrent [[unipolar depression]], 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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===Children=== |
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{{main|Bipolar disorder in children}} |
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Bipolar disorder in children has generally been considered very rare, and its diagnosis is controversial. Onset prior to age 10 has been found in an estimated 0.3% to 0.5% of bipolar patients, although some case reviews suggest higher figures.<ref>American Academy of Child and Adolescent Psychiatry (1997)[http://www.bpso.org/practice.htm Practice Parameters for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder]</ref> Nevertheless, findings indicate that the number of [[United States|American]] [[children]] and [[adolescents]] treated for bipolar disorder increased 40-fold from 1994 to 2003, and continues to increase. The data suggest that [[Physician|doctors]] had been more aggressively applying the [[diagnosis]] to children, rather than that the incidence of the [[disorder]] has increased. The study calculated the number of psychiatric visits increased from 20,000 in 1994 to 800,000 in 2003, or 1% of the [[population]] under age 20.<ref>[http://www.nytimes.com/2007/09/04/health/04psych.html?em&ex=1189051200&en=13c932cc4a338702&ei=5087%0A New York Times, Bipolar Illness Soars as a Diagnosis for the Young]</ref><ref>Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. (September 2007) "National trends in the outpatient diagnosis and treatment of bipolar disorder in youth," ''Archives of General Psychiatry''. 64(9):1032–9. PMID 17768268</ref> Assumptions regarding behavior, particularly in regard to diagnosing bipolar disorder, ADHD, and mania in children and adolescents, have raised considerable questions regarding unnecessary treatment, especially as antipsychotic drugs sometimes prescribed for the treatment of BD may increase risk to health including heart problems, diabetes, liver failure, and death.<ref>[http://www.usatoday.com/news/health/2006-05-01-atypical-drugs_x.htm USATODAY.com - New antipsychotic drugs carry risks for children]</ref> In addition a congressional investigation recently found that several of the research psychiatrists at the forefront of promoting the diagnosis and the use of unapproved antipsychotic drugs in children had been receiving millions of dollars in fees from pharmaceutical companies, much of which they did not disclose in their financial reporting.<ref>Harris, G. Carey, B. (2008) [http://www.nytimes.com/2008/06/08/us/08conflict.html?_r=2&hp=&pagewanted=all Researchers Fail to Reveal Full Drug] Pay New York Times, June 8</ref> |
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===Older age=== |
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There is a relative lack of knowledge about bipolar disorder in late life. There is evidence that it becomes less prevalent with age but nevertheless accounts for a similar percentage of psychiatric admissions; that older bipolar patients had first experienced symptoms at a later age; that later onset of mania is associated with more neurologic impairment; that substance abuse is considerably less common in older groups; and that there is probably a greater degree of variation in presentation and course, for instance individuals may develop new-onset mania associated with vascular changes, or become manic only after recurrent depressive episodes, or may have been diagnosed with bipolar disorder at an early age and still meet criteria. There is also some weak evidence that mania is less intense and there is a higher prevalence of mixed episodes, although there may be a reduced response to treatment. Overall there are likely more similarities than differences from younger adults.<ref>Depp CA, Jeste DV. (2004) [http://www3.interscience.wiley.com/journal/118809112/abstract Bipolar disorder in older adults: a critical review] Bipolar Disord. 2004 Oct;6(5):343-67.</ref> |
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==Causes== |
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The causes of bipolar disorder likely vary between individuals. [[Twin studies]] have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For Bipolar I, the (probandwise) [[Concordance (genetics)|concordance]] rates in modern studies have been consistently put at around 40% in [[monozygotic]] twins (same genes), compared to 0 to 10% in [[dizygotic]] twins.<ref name="Kieseppa_2004">{{cite journal |author=Kieseppä T, Partonen T, Haukka J, Kaprio J, Lönnqvist J |title=High concordance of bipolar I disorder in a nationwide sample of twins |journal=Am J Psychiatry |volume=161 |issue=10 |pages=1814–21 |year=2004 |month=October |pmid=15465978 |doi=10.1176/appi.ajp.161.10.1814 |url=}}</ref> A combination of bipolar I, II and [[cyclothymia]] produced concordance rates of 42% vs 11%, with a relatively lower ratio for bipolar II that likely reflects heterogeneity. The overall [[heritability]] of the bipolar spectrum has been put at 0.71.<ref name="Edvardsen2008">Edvardsen J, Torgersen S, Røysamb E, Lygren S, Skre I, Onstad S, Oien PA. (2008) Heritability of bipolar spectrum disorders. Unity or heterogeneity? J Affect Disord. 2008 Mar;106(3):229-40. PMID 17692389</ref> There is overlap with [[unipolar depression]] and if this is also counted in the co-twin the concordance with bipolar disorder rises to 67% (Mz) and 19% (Dz).<ref>{{Citation | last = McGuffin | first = P | last2 = Rijsdijk | first2 = F | last3 = Andrew | first3 = M | last4 = Sham | first4 = P | last5 = Katz | first5 = R | last6 = Cardno | first6 = A | title = The Heritability of Bipolar Affective Disorder and the Genetic Relationship to Unipolar Depression | journal = Archives of General Psychiatry | volume = 60 | issue = 5 | pages = 497–502 | year = 2003 | url = http://archpsyc.ama-assn.org/cgi/content/abstract/60/5/497 | doi = 10.1001/archpsyc.60.5.497 | pmid = 12742871}}</ref> The relatively low concordance between dizygotic twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes.<ref name="Edvardsen2008"/> |
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===Genetic=== |
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[[Image:DNA.png|thumb|Genetic influences are thought to be important in bipolar disorder]] |
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Genetic studies have suggested many [[chromosomal]] regions and [[candidate gene]]s appearing to relate to the development of bipolar disorder, but the results are not consistent and often not replicated.<ref>Kato, T. (2007). "Molecular genetics of bipolar disorder and depression." Psychiatry Clin Neurosci 61(1): 3-19. PMID 17239033</ref> Although the first [[genetic linkage]] finding for mania was in 1969,<ref>Reich, T., P. J. Clayton and G. Winokur (1969). "Family history studies-V The genetics of Mania." American Journal of Psychiatry l25: l358-1369.</ref> the linkage studies have been inconsistent.<ref name="Burmeister2008"/> (Genetic linkage studies may be followed by fine mapping searching for the phenomenon of linkage disequilibrium with a single gene, then DNA sequencing; using this approach causative DNA base pair changes have been reported for the genes P2RX7<ref>Barden N., Harvey M., Gagne B., Shink E., Tremblay M., Raymond C., Labbe M., Villeneuve A., Rochette D., Bordeleau L., Stadler H., Holsboer F., and Muller-Myhsok B. (2006). "Analysis of single nucleotide polymorphisms in genes in the chromosome 12Q24.31 region points to P2RX7 as a susceptibility gene to bipolar affective disorder." Am J Med Genet B Neuropsychiatr Genet.</ref> and TPH1{{Fact|date=November 2008}}). Recent meta-analyses of linkage studies detected either no significant genome-wide findings or, using a different methodology, only two genome-wide significant peaks, on chromosome 6q and on 8q21. Genome-wide [[genetic association|association]] studies have also not brought a consistent focus - each has identified new loci, while none of the previously identified loci were replicated.<ref name="Burmeister2008">Margit Burmeister, Melvin G. McInnis, & Sebastian Zöllner [http://www.nature.com/nrg/journal/v9/n7/abs/nrg2381.html Psychiatric genetics: progress amid controversy] Nature Reviews Genetics 9, 527-540 (July 2008) | doi:10.1038/nrg2381</ref> Findings did include a [[single nucleotide polymorphism]] in [[DGKH]];<ref name="Baum2008">Baum, A.E., et al. (2008). [http://www.nature.com/mp/journal/v13/n2/abs/4002012a.html A genome-wide association study implicates diacylglycerol kinase eta (DGKH) and several other genes in the etiology of bipolar disorder] Molecular Psychiatry, 13(2), 197-207. DOI: 10.1038/sj.mp.4002012</ref> a locus in a gene-rich region of high linkage disequilibrium (LD) on chromosome [[16p12]];<ref name="Burton2007">Burton, P.R., et al. (2007). [http://www.nature.com/nature/journal/v447/n7145/abs/nature05911.html Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls] Nature, 447(7145), 661-678. DOI: 10.1038/nature05911</ref> and a [[single nucleotide polymorphism]] in [[MYO5B]].<ref name="Sklar2008">Sklar, P., J. W. Smoller, J. Fan, M. A. Ferreira, R. H. Perlis, K. Chambert et al. (2008). [http://www.nature.com/mp/journal/v13/n6/abs/4002151a.html Whole-genome association study of bipolar disorder] Molecular Psychiatry DOI: 10.1038/sj.mp.4002151</ref> A comparison of these studies, combined with a new study, suggested an association with [[ANK3]] and [[CACNA1C]], thought to be related to calcium and sodium [[voltage-gated ion channel]]s.<ref name="Ferreira2008">Ferreira, M., M. O’Donovan, Y. A. Meng, A. Jones I, D. M. Ruderfer1, L. Jones et al. (2008) [http://www.nature.com/ng/journal/v40/n9/abs/ng.209.html Collaborative genome-wide association analysis supports a role for ANK3 and CACNA1C in bipolar disorder] Nature Genetics 40, 1056–1058</ref> Diverse findings point strongly to heterogeneity, with different genes being implicated in different families.<ref>Segurado R, Detera-Wadleigh SD, Levinson DF, Lewis CM, Gill M, Nurnberger JI Jr, Craddock N, et al. (2003) Genome Scan Meta-Analysis of Schizophrenia and Bipolar Disorder, Part III: Bipolar Disorder. Am J Hum Genet. 73, 49-62. PMID 12802785</ref> Numerous specific studies find various specific links.<ref>McQuillin, A., N. J. Bass, G. Kalsi, J. Lawrence, V. Puri, K. Choudhury, S. D. Detera-Wadleigh, D. Curtis and H. M. Gurling (2006). "Fine mapping of a susceptibility locus for bipolar and genetically related unipolar affective disorders, to a region containing the C21ORF29 and TRPM2 genes on chromosome 21q22.3." Mol Psychiatry 11(2): 134-142</ref><ref>Xu, C., F. Macciardi, P. P. Li, I. S. Yoon, R. G. Cooke, B. Hughes, S. V. Parikh, R. S. McIntyre, J. L. Kennedy and J. J. Warsh (2006). "Association of the putative susceptibility gene, transient receptor potential protein melastatin type 2, with bipolar disorder." Am J Med Genet B Neuropsychiatr Genet 141(1): 36-43.</ref><ref name="Barr2003">{{cite journal | author = Barrett TB, Hauger RL, Kennedy JL, Sadovnick AD, Remick RA, Keck PE, McElroy SL, Alexander M, Shaw SH, Kelsoe JR. | month = May | year = 2003 | title = Evidence that a single nucleotide polymorphism in the promoter of the G protein receptor kinase 3 gene is associated with bipolar disorder | journal = Molecular Psychiatry | volume = 8 | issue = 5 | pages = 546–57 | doi = 10.1038/sj.mp.4001268 | url = http://www.nature.com/mp/journal/v8/n5/abs/4001268a.html }}</ref><ref name="bipolar_assoc_1">{{cite journal |author=Zandi PP, Belmonte PL, Willour VL, ''et al'' |title=Association study of Wnt signaling pathway genes in bipolar disorder |journal=Arch. Gen. Psychiatry |volume=65 |issue=7 |pages=785–93 |year=2008 |month=July |pmid=18606951 |doi=10.1001/archpsyc.65.7.785 |url=http://archpsyc.ama-assn.org/cgi/content/full/65/7/785}}</ref><ref>{{cite web | author = Emma Young | year = 2006 | url = http://www.newscientist.com/article.ns?id=dn8572&feedId=online-news_rss20 | title = New gene linked to bipolar disorder | work = New Scientist | accessyear = 2006}}</ref> Advanced parental age has been linked to a somewhat increased chance of bipolar disorder in offspring, consistent with a hypothesis of increased new [[genetic mutations]].<ref>Frans, E., Sandin, S., Reichenberg, A., Lichtenstein, P., Langstrom, N., Hultman, C. (2008) [http://archpsyc.ama-assn.org/cgi/content/short/65/9/1034 Advancing Paternal Age and Bipolar Disorder] Arch Gen Psychiatry. 2008;65(9):1034-1040.</ref> A review seeking to identify the more consistent findings suggested several genes related to serotonin (SLC6A4 and TPH2), dopamine (DRD4 and SLC6A3), glutamate (DAOA and DTNBP1), and cell growth and/or maintenance pathways (NRG1, DISC1 and BDNF), although noting a high risk of false positives in the published literature. It was also suggested that individual genes are likely to have only a small effect and to be involved in some aspect related to the disorder (and a broad range of "normal" human behavior) rather than the disorder per se.<ref name="Serretti"/> |
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===Childhood precursors=== |
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Some limited long-term studies indicate that children who later receive a diagnosis of bipolar disorder may show subtle early traits such as subthreshold cyclical mood abnormalities, full major depressive episodes, and possibly [[ADHD]] with mood fluctuation. There may be hypersensitivity and irritability. There is some disagreement whether the experiences are necessarily fluctuating or may be chronic.<ref name="Miklowitz2008">David J. Miklowitz and Kiki D. Chan [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2504732 Prevention of Bipolar Disorder in At-Risk Children: Theoretical Assumptions and Empirical Foundations] Dev Psychopathol. Dev Psychopathol. 2008; 20(3): 881–897. doi: 10.1017/S0954579408000424.</ref> |
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===Life events and experiences=== |
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Evidence suggest that environmental factors play a significant role in the development and course of bipolar disorder, and that individual psychosocial variables may interact with genetic dispositions.<ref name="Serretti">Serretti A & Mandelli L. (2008) The genetics of bipolar disorder: genome 'hot regions,' genes, new potential candidates and future directions. Mol Psychiatry. 2008 Aug;13(8):742-71. PMID 18332878</ref> There is fairly consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, as they do for onsets and recurrences of unipolar depression.<ref name="Alloy2005"/> There have been repeated findings that between a third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated on average with earlier onset, a worse course, and more co-occurring disorders such as [[PTSD]].<ref>Gabriele S Leverich a, Robert M Post [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)68450-X/fulltext Course of bipolar illness after history of childhood trauma] The Lancet, Volume 367, Issue 9516, Pages 1040 - 1042, 1 April 2006 doi:10.1016/S0140-6736(06)68450-XCite</ref> The total number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without, particularly events stemming from a harsh environment rather than from the child's own behavior.<ref>Louisa D. Grandin, Lauren B. Alloy, Lyn Y. Abramson (2007) [http://www.atypon-link.com/GPI/doi/abs/10.1521/jscp.2007.26.4.460 Childhood Stressful Life Events and Bipolar Spectrum Disorders] Journal of Social and Clinical Psychology, 26 (4) pp460-478 doi: 10.1521/jscp.2007.26.4.460</ref> Early experiences of adversity and conflict are likely to make subsequent [[Developmental psychology|developmental challenges]] in adolescence more difficult, and are likely a potentiating factor in those at risk of developing bipolar disorder.<ref name="Miklowitz2008"/> |
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===Neural processes=== |
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[[Image:CADASIL.jpg|thumb|[[Hyperintensities]] (bright areas on MRI scans above) are 2.5 times more likely to occur in bipolar disorder]] |
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Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders. Some studies have found [[anatomical]] differences in areas such as the [[amygdala]],<ref>Strakowski, S.M., DelBello, M.P, Sax, K.W. et. al. (1999). "[http://archpsyc.ama-assn.org/cgi/content/full/56/3/254 Brain magnetic resonance imaging of structural abnormalities in bipolar disorder]," ''Archives of General Psychiatry'', 56:254–60.</ref> [[prefrontal cortex]]<ref>[http://www.neurotransmitter.net/bipolarpfc.html Prefrontal Cortex in Bipolar Disorder] Neurotransmitter.net.</ref> and [[hippocampus]]. However, despite 25 years of research involving more than 7000 MRI scans, studies continue to report conflicting findings and there remains considerable debate over the neuroscientific findings. Two fairly consistent abnormalities found in a [[meta-analysis]] of 98 [[MRI]] or [[Computed tomography|CT]] neuroimaging studies were that groups with bipolar disorder had [[lateral ventricles]] which were on average 17% larger than control groups, and were 2.5 times more likely to have deep white matter [[hyperintensities]]. Given the size of the meta-analysis, it was concluded that the relatively small number of significant findings was perhaps surprising, and that there may be genuinely limited structural change in bipolar disorder, or perhaps [[heterogeneity]] has obscured other differences. In addition, it was noted that averaged associations found at the level of multiple studies may not exist for an individual.<ref>Kempton, M.J., Geddes, J.R, Ettinger, U. et. al. (2008). "[http://archpsyc.ama-assn.org/cgi/content/short/65/9/1017 Meta-analysis, Database, and Meta-regression of 98 Structural Imaging Studies in Bipolar Disorder]," ''Archives of General Psychiatry'', 65:1017–1032 see also MRI database at [http://sites.google.com/site/bipolardatabase/ www.bipolardatabase.org].</ref> |
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The "kindling" theory asserts that people who are genetically predisposed toward bipolar disorder can experience a series of stressful events,<ref name="kindling">[http://www.bpinfo.net/kindling_theory.htm Link and reference involving kindling theory]</ref> each of which lowers the threshold at which mood changes occur. Eventually, a mood episode can start (and become recurrent) by itself. There is evidence of [[hypothalamic-pituitary-adrenal axis]] (HPA axis) abnormalities in bipolar disorder due to [[Stress (biological)|stress]].<ref>Brian Koehler, Ph.D., The International Society for the Psychological Treatment Of Schizophrenia and Other Psychoses, [http://www.isps-us.org/koehler/bipolar_stress.htm Bipolar Disorder, Stress, and the HPA Axis], 2005.</ref> |
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Recent research in Japan hypothesizes that dysfunctional [[mitochondria]] in the brain may play a role (Stork & Renshaw, 2005{{which}}). |
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Other recent research in implicates issues with a sodium ATPes pump,<ref>{{citebook|title=Focus on Bipolar Disorder Research|author=Malcomb R. Brown|coauthors=Michael R. Basso|pages=16|year=2004|publisher=[[Nova Science Publishers]]|isbn=978-1594540592}}</ref> causing cyclical periods of poor neuron firing (depression) and hyper sensitive neuron firing (mania). This may only apply for type one, but type two apparently results from a large confluence of factors.{{fact|date=February 2009}} |
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===Melatonin activity=== |
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It has been suggested that a hypersensitivity of the melatonin receptors in the eye could be a reliable indicator of bipolar disorder, in studies called a trait marker, as it is not dependent on state (mood, time, etc). In small studies, patients diagnosed as bipolar reliably showed a melatonin-receptor hypersensitivity to light during sleep, causing a rapid drop in sleeptime melatonin levels compared to controls.<ref name="pmid4003592">{{cite journal |author=Lewy AJ, Nurnberger JI, Wehr TA, ''et al'' |title=Supersensitivity to light: possible trait marker for manic-depressive illness |journal=Am J Psychiatry |volume=142 |issue=6 |pages=725–7 |year=1985 |month=June |pmid=4003592 |doi= |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=4003592}}</ref> Another study showed that drug-free, recovered, bipolar patients exhibited no hypersensitivity to light.<ref name="pmid1658841">{{cite journal |author=Whalley LJ, Perini T, Shering A, Bennie J |title=Melatonin response to bright light in recovered, drug-free, bipolar patients |journal=Psychiatry Res |volume=38 |issue=1 |pages=13–9 |year=1991 |month=July |pmid=1658841 |doi= |url=}}</ref> It has also been shown in humans that [[valproic acid]], a mood stabilizer, increases transcription of melatonin receptors<ref name="pmid16313512">{{cite journal |author=Castro LM, Gallant M, Niles LP |title=Novel targets for valproic acid: up-regulation of melatonin receptors and neurotrophic factors in C6 glioma cells |journal=J. Neurochem. |volume=95 |issue=5 |pages=1227–36 |year=2005 |month=December |pmid=16313512 |doi=10.1111/j.1471-4159.2005.03457.x |url=}}</ref> and decreases eye melatonin-receptor sensitivity in healthy volunteers<ref name="pmid15841104">{{cite journal |author=Hallam KT, Olver JS, Norman TR |title=Effect of sodium valproate on nocturnal melatonin sensitivity to light in healthy volunteers |journal=Neuropsychopharmacology |volume=30 |issue=7 |pages=1400–4 |year=2005 |month=July |pmid=15841104 |doi=10.1038/sj.npp.1300739 |url=}}</ref> while low-dose [[lithium]], another mood stabilizer, in healthy volunteers, decreases sensitivity to light when sleeping, but doesn't alter melatonin synthesis.<ref name="pmid15850501">{{cite journal |author=Hallam KT, Olver JS, Horgan JE, McGrath C, Norman TR |title=Low doses of lithium carbonate reduce melatonin light sensitivity in healthy volunteers |journal=Int. J. Neuropsychopharmacol. |volume=8 |issue=2 |pages=255–9 |year=2005 |month=June |pmid=15850501 |doi=10.1017/S1461145704004894 |url=}}</ref> The extent to which melatonin alterations may be a cause or effect of bipolar disorder are not fully known. |
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===Psychological processes=== |
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Psychological studies of bipolar disorder have examined the development of a wide range of both the core symptoms of psychomotor activation and related clusterings of depression/anxiety, increased [[hedonic]] tone, irritability/aggression and sometimes psychosis. The existing evidence has been described as patchy in terms of quality but converging in a consistent manner. The findings suggest that the period leading up to mania is often characterized by depression and anxiety at first, with isolated sub-clinical symptoms of mania such as increased energy and racing thoughts. The latter increase and lead to increased activity levels, the more so if there is disruption in [[circadian rhythms]] or goal attainment events. There is some indication that once mania has begun to develop, social [[stress (biological)|stressors]], including criticism from significant others, can further contribute. There are also indications that individuals may hold certain beliefs about [[self|themselves]], their internal states, and their [[social world]] (including striving to meet high standards despite it causing distress) that may make them vulnerable during changing mood states in the face of relevant life events. In addition, subtle frontal-temporal and subcortical difficulties in ''some'' individuals, related to planning, emotional regulation and attentional control, may play a role. Symptoms are often subthreshold and likely continuous with normal experience. Once (hypo)mania has developed, there is an overall increase in [[arousal|activation]] levels and [[impulsivity]]. Negative social reactions or advice may be taken less notice of, and a person may be more caught up in their own thoughts and interpretations, often along a theme of feeling criticised. There is some suggestion that the mood variation in bipolar disorder may not be cyclical as often assumed, nor completely random, but results from a complex interaction between internal and external variables unfolding over time; there is mixed evidence as to whether relevant life events are found more often in early than later episodes.<ref name="Mansell2008">Mansell, W. & Pedley, R. The ascent into mania: A review of psychological processes associated with the development of manic symptoms. Clinical Psychology Review, Volume 28, Issue 3, March 2008, Pages 494-520 PMID 17825463</ref> Many sufferers report inexplicably varied cyclical patterns, however.<ref> Manic-depressive illness FK Goodwin, KR Jamison - 1990 - Oxford University Press New York</ref> |
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==Treatment== |
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{{main|Treatment of bipolar disorder}} |
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There are a number of [[pharmacological]] and [[psychotherapeutic]] techniques used for Bipolar Disorder. Individuals may use [[self-help groups for mental health|self-help]] and pursue a personal [[Recovery model|recovery]] journey. |
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Hospitalization may occur, especially with manic episodes. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or [[involuntary commitment]]). Long-term inpatient stays are now less common due to [[deinstitutionalization]], although can still occur.<ref name="BeckerKilian2006">Becker T, Kilian R. (2006) Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care? ''[[Acta Psychiatrica Scandinavica]] Supplement'', 429, 9–16. PMID 16445476</ref> Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or [[Assertive Community Treatment]] team, supported employment and patient-led support groups.<ref>McGurk, SR, Mueser KT, Feldman K, Wolfe R, Pascaris A (2007). Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. ''Am J Psychiatry.'' Mar;164(3):437–41. PMID 17329468</ref> |
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===Medication=== |
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[[Image:Sodium-valproate-2D-skeletal.png|thumb|[[Sodium valproate]] is a common mood stabilizer]] |
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The mainstay of treatment is a mood stabilizer medication such as Lithium Carbonate or Lamotrigine. There is an evidence based review <ref>Geddes JR, Burgess S, Hawton K, et al. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004;161:217–22</ref><ref>Bauer, M.S. et al 2006, What Is a “Mood Stabilizer”? An Evidence-Based Response, Am J Psychiatry 2004; 161:3–18</ref>which shows these two drugs are the most effective. Lamotrigine has been found to be best for preventing depressions. ; these two drugs comprise several unrelated compounds which have been shown to be effective in preventing relapses of manic, or in the one case, depressive episodes. The first known and "gold standard" mood stabilizer is [[Lithium pharmacology|lithium]],<ref>Poolsup N, Li Wan Po A, de Oliveira IR. (2000) Systematic overview of lithium treatment in acute mania. ''J Clin Pharm Ther'' '''25''': 139–156 PMID: 10849192</ref> while almost as widely used is [[sodium valproate]],<ref name="Macr02">{{cite journal | author = Macritchie K, Geddes JR, Scott J, Haslam D, de Lima M, Goodwin G. | title = Valproate for acute mood episodes in bipolar disorder| journal = The Cochrane Database of Systematic Reviews | volume = | issue = 2 | pages = | publisher = John Wiley and Sons, Ltd. | year= 2002 | url = http://www.cochrane.org/reviews/en/ab004052.html (abstract) | doi = 10.1002/14651858.CD004052| id = ISSN 1464-780X}}</ref> also used as an [[anticonvulsant]]. Other anticonvulsants used in bipolar disorder include [[carbamazepine]], reportedly more effective in rapid cycling bipolar disorder, and [[lamotrigine]], which is the first anticonvulsant shown to be of benefit in bipolar depression.<ref>{{cite journal |author=Calabrese JR, Bowden CL, Sachs GS, Ascher JA, Monaghan E, Rudd GD |title=A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group |journal=J Clin Psychiatry |volume=60 |issue=2 |pages=79–88 |year=1999 |month=February |pmid=10084633 |doi= |url=}}</ref> |
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Treatment of the agitation in acute manic episodes has often required the use of [[antipsychotic]] medications, such as [[Quetiapine]], [[Olanzapine]] and [[Chlorpromazine]]. More recently, Olanzapine and Quetiapine have been approved as effective monotherapy for the maintenance of bipolar disorder.<ref name="Olanzapine_maintenance_therapy"> [http://www.zyprexa.com/common_pages/hcp_maintenance.jsp Now Approved: ZYPREXA for maintenance therapy for bipolar disorder.] Official Zyprexa Website.</ref> A head-to-head randomized control trial in 2005 has also shown olanzapine monotherapy to be as effective and safe as lithium in [[prophylaxis]].<ref name="Tohen_et_al_2005">{{cite journal |author=Tohen M, Greil W, Calabrese JR, ''et al'' |title=Olanzapine versus lithium in the maintenance treatment of bipolar disorder: a 12-month, randomized, double-blind, controlled clinical trial |journal=Am J Psychiatry |volume=162 |issue=7 |pages=1281–90 |year=2005 |month=July |pmid=15994710 |doi=10.1176/appi.ajp.162.7.1281 |url=}}</ref> |
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The use of antidepressants in bipolar disorder has been debated, with some studies reporting a worse outcome with their use triggering manic, hypomanic or mixed episodes, especially if no mood stabiliser is used. However, most mood stabilizers are of limited effectiveness in depressive episodes. Rapid cycling can be induced or made worse by [[antidepressant]]s, unless there is adjunctive treatment with a mood stabilizer.<ref>{{cite web|url=http://www.wpic.pitt.edu/stanley/1stbipconf/bipolar2.htm#trtref|title=Treatment of refractory and rapid-cycling bipolar disorder}}</ref><ref>Sachs, GS, MD, et al (2007) [http://content.nejm.org/cgi/content/abstract/356/17/1711 Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression] ''New England Journal of Medicine'', Volume 356:1711–1722 (Abstract).</ref> One large-scale study found that depression in bipolar disorder responds no better to an antidepressant with mood stabilizer than it does to a mood stabilizer alone.<ref>[http://goliath.ecnext.com/coms2/gi_0199-6442678/Bipolar-surprise-mood-disorder-endures.html Bipolar surprise: mood disorder endures antidepressant setback.] Science News, March 31, 2007, vol. 171, #13, p.196</ref> |
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Recent research indicates that triacetyluridine may help improve symptoms of bipolar disorder. <ref>http://www.epsychology.us/triacetyluridine-tau-decreases-depressive-symptoms-and-increases-brain-ph-in-bipolar-patients/</ref> |
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Also, Topamax (generic name [[topiramate]]) is an anticonvulsant often prescribed as a mood stabilizer. It is an [[off-label]] use when used to treat bipolar disorder. |
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== Alternative treatment == |
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===Psychosocial=== |
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[[Psychotherapy]] is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing [[prodromal]] symptoms before full-blown recurrence, and, practicing the factors that lead to maintenance of [[remission (medicine)|remission]]<ref>(Lam et al, 1999; Johnson & Leahy, 2004; Basco & Rush, 2005; Miklowitz & Goldstein, 1997; Frank, 2005.</ref> [[Cognitive behavioural therapy]], [[family therapy|family-focused therapy]], and [[psychoeducation]] have the most evidence for efficacy in regard to relapse prevention, while [[interpersonal and social rhythm therapy]] and cognitive-behavioural therapy appear the most effective in regard to residual depressive symptoms. Most studies have been based only on bipolar I, however, and treatment during the acute phase can be a particular challenge.<ref>Zaretsky AE, Rizvi S, & Parikh SV. (2007). [http://publications.cpa-apc.org/media.php?mid=343 How well do psychosocial interventions work in bipolar disorder?] Can J Psychiatry, Jan;52(1):14-21.</ref> Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a [[therapeutic alliance]] in support of [[recovery model|recovery]].<ref>Havens LL, Ghaemi SN. (2005) Existential despair and bipolar disorder: the therapeutic alliance as a mood stabilizer. Am J Psychother. 59(2):137-47 PMID 16170918</ref> |
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==Prognosis== |
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For many individuals with bipolar disorder a good [[prognosis]] results from good treatment, which, in turn, results from an accurate [[diagnosis]]. Because bipolar disorder continues to have a high rate of both under-diagnosis and [[misdiagnosis]], it is often difficult for individuals with the condition to receive timely and competent treatment. |
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Bipolar disorder can be a severely disabling medical condition. However, many individuals with bipolar disorder can live full and satisfying lives. Quite often, medication is needed to enable this. Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes. |
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Ultimately one's prognosis depends on many factors, several of which are within the control of the individual. Such factors may include: the right medicines, with the right dose of each; comprehensive knowledge of the disease and its effects; a positive relationship with a competent medical doctor and therapist; and good physical health, which includes exercise, nutrition, and a regulated stress level. |
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There are obviously other factors that lead to a good prognosis as well, such as being very aware of small changes in one's energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one's doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can assist them in predicting changes.<ref>{{citeweb|title=Introduction|url=http://www.cs.umd.edu/class/spring2004/cmsc434/teams/rise/Introduction.htm|publisher=cs.umd.edu|accessdate=2008-02-16}}</ref> |
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===Functioning=== |
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A recent 20-year prospective study on bipolar I and II found that functioning varied over time along a spectrum from good to fair to poor. During periods of [[major depression]] or mania (in BPI), functioning was on average poor, with depression being more persistently associated with disability than mania. Functioning between episodes was on average good - more or less normal. Subthreshold symptoms were generally still substantially impairing, however, except for hypomania (below or above threshold) which was associated with improved functioning.<ref>Judd Lewis L.; Aksikal Hagop S.; Schettler Pamela J. ; Endicott Jean; Leon Andrew C.; Solomon David A.; Coryell William; Maser Jack D.; Keller Martin B. (2005) [http://archpsyc.ama-assn.org/cgi/reprint/62/12/1322.pdf Psychosocial disability in the course of bipolar I and II disorders : A prospective, comparative, longitudinal study] Archives of General Psychiatry, vol. 62, no12, pp. 1322–1330 </ref> |
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Another study confirmed the seriousness of the disorder as "the standardized all-cause mortality ratio among patients with BD is increased approximately 2-fold." Bipolar disorder is currently regarded "as possibly the most costly category of mental disorders in the United States." |
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Episodes of abnormality are associated with distress and disruption, and an elevated risk of [[suicide]], especially during depressive episodes. |
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<ref> |
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{{Citation |
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| first2 = L |
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| last5 = Sparén |
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| title = Excess Mortality in Bipolar and Unipolar Disorder in Sweden |
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| journal = Archives of General Psychiatry |
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| volume = 58 |
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| issue = 9 |
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| pages = 844–850 |
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| year = 2001 |
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| url = http://archpsyc.ama-assn.org/cgi/content/abstract/58/9/844 |
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| doi = 10.1001/archpsyc.58.9.844 |
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| pmid = 11545667 |
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}} |
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</ref> |
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===Recovery=== |
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A naturalistic study from first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years. 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery.<ref>Tohen M, Zarate CA Jr, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ. (2003) [http://ajp.psychiatryonline.org/cgi/content/full/160/12/2099 The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence] Am J Psychiatry. 2003 Dec;160(12):2099-107.</ref> |
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===Recurrence=== |
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The following behaviors can lead to depressive or manic recurrence:{{Fact|date=November 2008}} |
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*Discontinuing or lowering one's dose of [[medication]], without consulting one's physician. |
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*Being under- or over-medicated. Generally, taking a lower dosage of a [[mood stabilizer]] can lead to relapse into mania. Taking a lower dosage of an [[antidepressant]], may cause the patient to relapse into depression, while higher doses can cause destabilization into mixed-states or mania. |
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*An inconsistent [[sleep]] schedule can destabilize the illness. Too much sleep (possibly caused by medication) can lead to depression, while too little sleep can lead to mixed states or mania. |
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*[[Caffeine]] can cause destabilization of mood toward irritability, [[dysphoria]], and mania. Anecdotal evidence seems to suggest that lower dosages of caffeine can have effects ranging from anti-depressant to [[mania]]-inducing. |
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*Inadequate [[stress management]] and poor lifestyle choices. If unmedicated, excessive stress can cause the individual to relapse. Medication raises the stress threshold somewhat, but too much stress still causes relapse. |
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*Often bipolar individuals are subject to [[self-medication]], the most common drugs being [[alcohol]], and [[cannabis (drug)|marijuana]]. Sometimes they may also turn to [[hard drugs]], which can cause the condition to worsen. Studies show that [[tobacco smoking]] induces a calming effect on most bipolar people, and a very high percentage suffering from the disorder smoke.<ref>[http://adam.about.com/reports/000066_3.htm Bipolar Disorder webpage from ADAM Illustrated Health Encyclopedia at About.com]</ref> |
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Recurrence can be managed by the sufferer with the help of a close friend, based on the occurrence of idiosyncratic prodromal events.<ref>{{cite journal |author=Perry A, Tarrier N, Morriss R, McCarthy E, Limb K |title=Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment |journal=BMJ |volume=318 |issue=7177 |pages=149–53 |year=1999 |month=January |pmid=9888904 |pmc=27688 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=9888904}}</ref> This theorizes that a close friend could notice which moods, activities, behaviours, thinking processes, or thoughts typically occur at the outset of bipolar episodes. They can then take planned steps to slow or reverse the onset of illness, or take action to prevent the episode from being damaging.<ref> Kelly, M., ''Bipolar and the Art of Roller-coaster Riding,'' Two Trees Media 2000, 2005</ref> These sensitivity triggers show some similarity to traits of a [[highly sensitive person]]. |
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===Mortality=== |
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"Mortality studies have documented an increase in all-cause mortality in patients with BD. A newly established and rapidly growing database indicates that mortality due to chronic medical disorders (eg, cardiovascular disease) is the single largest cause of premature and excess deaths in BD. The [[standardized mortality ratio]] from suicide in BD is estimated to be approximately 18 to 25, further emphasizing the lethality of the disorder."<ref name="MortBio_2006">{{cite web|title=Bipolar Disorder: Defining Remission and Selecting Treatment| author=Roger S. McIntyre, MD, Joanna K. Soczynska, and Jakub Konarski|publisher=Psychiatric Times, October 2006, Vol. XXIII, No. 11|url=http://www.psychiatrictimes.com/article/showArticle.jhtml?articleId=193400986}}</ref> |
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Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate in males and females with diagnosed bipolar disorder (0.4%) is 10 to more than 20 times that in the general population.<ref>{{cite web |url=http://www.postgradmed.com/issues/2005/02_05/comm_citrome.htm |title=Bipolar disorder is a potentially fatal disease |author=Leslie Citrome, MD, MPH; Joseph F. Goldberg, MD |accessdate= |format= |work= }}</ref> |
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Individuals with bipolar disorder may become [[suicidal]], especially during [[Mixed state (psychiatry)|mixed states]] such as [[dysphoric]] [[mania]] and [[agitated depression]].<ref>[http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=88445&Ausgabe=231392&ProduktNr=224276 Psychopathologic Correlates of Suicidal Ideation in Major Depressive Outpatients: Is It All Due to Unrecognized (Bipolar) Depressive Mixed States?<!-- Bot generated title -->]</ref> Persons suffering from Bipolar II have high rates of suicide compared to persons suffering from other mental health conditions, including Major Depression. Major Depressive episodes are part of the Bipolar II experience, and there is evidence that sufferers of this disorder spend proportionally much more of their life in the depressive phase of the illness than their counterparts with Bipolar I Disorder (Akiskal & Kessler, 2007{{which}}). |
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==History== |
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{{main|History of bipolar disorder}} |
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Varying moods and energy levels have been a part of the human experience since time immemorial. The words "[[melancholia]]" (an old word for [[depression (mood)|depression]]) and "mania" have their [[etymologies]] in [[Ancient Greek]]. The word melancholia is derived from ''melas''/μελας, meaning "black", and ''chole''/χολη, meaning "bile" or "gall",<ref name="Liddell 1980">{{cite book | author = [[Henry George Liddell|Liddell, Henry George]] and [[Robert Scott (philologist)|Robert Scott]] | year = 1980 | title = [[A Greek-English Lexicon]] (Abridged Edition) | publisher = [[Oxford University Press]] | location = United Kingdom | isbn = 0-19-910207-4}}</ref> indicative of the term’s origins in pre-[[Hippocrates|Hippocratic]] [[humoral]] theories. Within the humoral theories, mania was viewed as arising from an excess of [[yellow bile]], or a mixture of black and yellow bile. The [[linguistic]] origins of mania, however, are not so clear-cut. Several etymologies are proposed by the [[Ancient Rome|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 [[mythology|mythologies]] (Angst and Marneros 2001). |
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The idea of a relationship between mania and melancholia can be traced back to at least the 2nd century AD.{{Fact|date=October 2007}} [[Soranus (Greek Physician)|Soranus]] of Ephesus (98–177 AD) described mania and melancholia as distinct diseases with separate [[etiologies]];<ref>{{citeweb|title=Bipolar_disorders_beyond_major_depression_and_euphoric_mania|url=http://assets.cambridge.org/97805218/35176/excerpt/9780521835176_excerpt.pdf|publisher=cambridge.org|accessdate=2008-02-16|format=PDF}}</ref> however, he acknowledged that “many others consider melancholia a form of the disease of mania” (Cited in Mondimore 2005 p.49). |
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A clear understanding of bipolar disorder as a mental illness was recognized by early Chinese authors. The encyclopedist [[Gao Lian]] (c. 1583) describes the malady in his ''Eight Treatises on the Nurturing of Life'' (Ts'un-sheng pa-chien).<ref>http://www.nmh.gov.tw/nmh_web/english_version/exhibition/exhibition_s0703.cfm</ref> |
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The earliest written descriptions of a relationship between mania and melancholia are attributed to [[Aretaeus of Cappadocia]]. Aretaeus was an [[Eclectic medicine|eclectic]] medical philosopher who lived in [[Alexandria]] somewhere between 30 and 150 AD (Roccatagliata 1986{{which}}; Akiskal 1996{{which}}). Aretaeus 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{{which}}; Marneros 2001{{which}}). |
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[[Avicenna]], a [[Islamic medicine|Persian physician]] and [[Islamic psychology|psychological thinker]] who wrote ''[[The Canon of Medicine]]'' in 1025, identified bipolar disorder as a manic depressive [[psychosis]], which he clearly distinguished from other forms of [[madness]] (''Junun'') such as [[mania]], [[rabies]], and [[schizophrenia]] (''Junun Mufrit'' or severe madness).<ref name="Dening-57">{{Harvard reference |
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}}</ref> |
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[[Image:Emil Kraepelin.png|right|thumb|[[Emil Kraepelin]] (1856–1926) refined the concept of [[psychosis]].]] |
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The basis of the current conceptualisation of manic-depressive illness can be traced back to the 1850s; on January 31, 1854, [[Jules Baillarger]] described to the French Imperial [[Academy of Medicine]] a [[biphasic]] [[mental illness]] causing recurrent oscillations between mania and depression, which he termed ''folie à double forme'' (‘dual-form insanity’). Two weeks later, on February 14, 1854, [[Jean-Pierre Falret]] presented a description to the Academy on what was essentially the same disorder, and designated ''folie circulaire'' (‘circular [[insanity]]’) by him.(Sedler 1983) The two bitterly disputed as to who had been the first to conceptualise the condition. |
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These concepts were developed by the German [[psychiatrist]] [[Emil Kraepelin]] (1856–1926), who, using Kahbaum concept of [[cyclothymia]],<ref name="millon">{{cite book |
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| first = Theordore |
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| last = Millon |
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| year = 1996 |
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| title = Disorders of Personality: DSM-IV-TM and Beyond |
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| edition = |
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| publisher = John Wiley and Sons |
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| location = New York |
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| pages = 290 |
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| isbn= 0-471-01186-X }}</ref> categorized and studied the natural course of untreated bipolar patients. He coined the term ''manic depressive [[psychosis]]'', after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally.<ref>[[Emil Kraepelin|Kraepelin, Emil]] (1921) ''Manic-depressive Insanity and Paranoia'' ISBN 0-405-07441-7 </ref> |
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After [[World War II]], Dr. [[John Cade]], an Australian [[psychiatrist]], was investigating the effects of various compounds on veteran patients with manic depressive psychosis. In 1949, Cade discovered that [[lithium carbonate]] could be used as a successful treatment of manic depressive psychosis.<ref>{{cite journal |
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| author = Cade JF |title=Lithium salts in the treatment of psychotic excitement |journal=Med. J. Aust. |volume=2 |issue=10 |pages=349–52 |year=1949 |month=September |pmid=18142718 |doi= |url=http://www.who.int/docstore/bulletin/pdf/2000/issue4/classics.pdf|format=PDF}}</ref> Because there was a fear that table salt substitutes could lead to toxicity or death, Cade's findings did not immediately lead to treatments. In the 1950s, U.S. hospitals began experimenting with lithium on their patients. By the mid-'60s, reports started appearing in the medical literature regarding lithium's effectiveness. The U.S. Food and Drug Administration did not approve of lithium's use until 1970.<ref>{{cite journal |
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| author = Mitchell PB, Hadzi-Pavlovic D |title=Lithium treatment for bipolar disorder |
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| journal = Bull. World Health Organ. |volume=78 |issue=4 |pages=515–7 |year=2000 |pmid=10885179 |doi= |
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| url = http://www.who.int/docstore/bulletin/pdf/2000/issue4/classics.pdf|format=PDF}}</ref> |
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The term "manic-depressive ''reaction''" appeared in the first [[American Psychiatric Association]] Diagnostic Manual in 1952, influenced by the legacy of [[Adolf Meyer (psychiatrist)|Adolf Meyer]] who had introduced the paradigm illness as a reaction of biogenetic factors to psychological and social influences.<ref>Goodwin & Jamison. pp. 60–61.</ref> Subclassification of bipolar disorder was first proposed by German psychiatrist [[Karl Leonhard]] in 1957; he was also the first to introduce the terms ''bipolar'' (for those with mania) and ''unipolar'' (for those with depressive episodes only).<ref>Goodwin & Jamison. p62</ref> |
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In 1968, both the newly revised classification systems ICD-8 and DSM-II termed the condition "manic-depressive ''illness''" as biological thinking came to the fore.<ref>Goodwin & Jamison. p88</ref> |
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The current [[nosology]], bipolar disorder, became popular only recently, and some individuals prefer the older term because it provides a better description of a continually changing multi-dimensional illness.{{Fact|date=July 2007}} |
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[[Empirical]] and theoretical work on bipolar disorder has throughout history "[[seesaw]]ed" between psychological and biological ways of understanding. Despite the work of Kraepelin (1921) emphasizing the [[psychosocial]] context, conceptions of bipolar disorder as a genetically based illness dominated the 20th century. Since the 1990s, however, there has been a resurgence of interest and research in to the role of psychosocial processes.<ref name="Alloy2005">Alloy LB, Abramson LY, Urosevic S, Walshaw PD, Nusslock R, Neeren AM. (2005) The psychosocial context of bipolar disorder: environmental, cognitive, and developmental risk factors. Clin Psychol Rev. 2005 Dec;25(8):1043-75. PMID 16140445 </ref> |
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==Sociological and cultural aspects== |
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===Cultural references=== |
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{{see also|List of people affected by bipolar disorder}} |
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[[Kay Redfield Jamison]] is a clinical psychologist and Professor of Psychiatry at the Johns Hopkins University School of Medicine, who profiled her own bipolar disorder in her 1995 memoir ''[[An Unquiet Mind]]'',<ref name="unquiet">{{cite book|last=Jamison|first=Kay Redfield|title=An Unquiet Mind: A Memoir of Moods and Madness|publisher=Knopf.|location=New York|date=1995|isbn=0-330-34651-2}}</ref> and argued for a connection between bipolar disorder and artistic creativity in her 1993 book, ''[[Touched with Fire]]''.<ref>{{cite book|last=Jamison |first=Kay Redfield|title=Touched With Fire: Manic-Depressive Illness and the Artistic Temperament|publisher=The Free Press: Macmillian, Inc.|location=New York|date=1996|isbn=0-684-83183-X}}</ref> |
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Several films have portrayed characters with traits strongly suggestive of the diagnosis which have been the subject of discussion by psychiatrists and film experts alike. The 1993 film ''[[Mr. Jones (film)|Mr. Jones]]'' is a notable example, with [[Richard Gere]] playing a person who swings from a manic episode into a depressive phase and back again, spending time in a psychiatric hospital and displaying many of the features of the syndrome.<ref>{{cite book |title=Reel Psychiatry:Movie Portrayals of Psychiatric Conditions|author=Robinson DJ |year= |publisher=Rapid Psychler Press |location=Port Huron, Michigan |isbn=1-894328-07-8|pages=78–81}}</ref> Allie Fox, the character played by [[Harrison Ford]] in the 1986 movie ''[[The Mosquito Coast]]'', displays some features including recklessness, grandiosity, increased goal-directed activity and mood lability, as well as some paranoia.<ref>Robinson (''Reel Psychiatry:Movie Portrayals of Psychiatric Conditions''), p. 84-85</ref> |
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In the Australian TV drama Stingers, Gary Sweet played the role of Detective Luke Harris from season six, portraying him as having bipolar and how the paranoia he feels as a result of it interferes with his work. As research for the role Sweet visited a psychiatrist to learn about manic depression. He said that he left the sessions convinced he was one. |
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In the 1994 BBC Scotland television drama [[Takin' Over The Asylum| Takin' Over The Asylum]], [[David Tennant| David Tennant]] played Campbell Bain, a bi-polar aspiring DJ in a Glasgow psychiatric hospital. |
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In the NBC drama [[ER (TV series)|ER]], series of episodes follow [[Maura Tierney| Maura Tierney's]] [[Abby Lockhart]] character's relation with her bipolar mother Maggie<ref>[http://www.bestbuy.com/site/olspage.jsp?skuId=8315352&st=er+seventh+season&lp=1&type=product&cp=1&id=1622396 ER: The Complete Seventh Season [6 Discs / WS] - Widescreen Subtitle - DVD<!-- Bot generated title -->]</ref>, and later her brother, who had been misdiagnosed with depression, but who in fact had inherited BD from Maggie <ref>[http://www.bestbuy.com/site/olspage.jsp?id=1845407&skuId=8801497&type=product ER: Complete Ninth Season (6PC) / (WS DIG) - Widescreen - DVD<!-- Bot generated title -->]</ref>. |
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[[TV special]]s, for example the [[BBC]]'s ''The Secret Life of the Manic Depressive'',<ref>{{cite web|url=http://www.bbc.co.uk/health/tv_and_radio/secretlife_index.shtml|title=The Secret Life of the Manic Depressive|publisher=BBC|year=2006|accessdate = 2007-02-20}}</ref> MTV's ''[[True Life]]: I'm Bipolar'', talk shows, and public radio shows, and the greater willingness of public figures to discuss their own bipolar disorder, have focused on psychiatric conditions thereby raising public awareness. |
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==See also== |
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*[[Bipolar spectrum]] |
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*[[Bipolar disorders research]] |
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*[[Social Security Disability Insurance]] |
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==References== |
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{{reflist|2}} |
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===Cited texts=== |
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*{{cite book |author= Goodwin FK, Jamison KR|title= Manic-Depressive Illness |year= 1990|publisher= Oxford University Press|location=New York |isbn=0-19-503934-3}} |
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*{{cite book |author= Goodwin FK, Jamison KR|title= Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition |year= 2007|publisher=Oxford University Press|location=New York |isbn= 0-19-513579-2}} |
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==Further reading== |
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Other contemporary first-person accounts on this subject include |
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*Simon, Lizzie. 2002. ''Detour: My Bipolar Road Trip in 4-D''. New York: Simon and Schuster. ISBN 0-7434-4659-3. |
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*Behrman, Andy. 2002. ''Electroboy: A Memoir of Mania''. New York: Random House, 2002. ISBN 0-375-50358-7. |
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*Lovelace, David. 2008. ''[[Scattershot (book)|Scattershot: My Bipolar Family]]''. New York: Dutton Adult, 2008. ISBN 0-525-95078-8. |
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For readings regarding bipolar disorder in children, see: |
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*Raeburn, Paul. 2004. ''Acquainted with the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children''. |
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*Earley, Pete. ''Crazy''. 2006. New York: G. P. Putnam's Sons. ISBN 0-399-15313-6. A father's account of his son's bipolar disorder. |
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Classic works on this subject include |
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*[[Emil Kraepelin|Kraepelin, Emil]]. 1921. ''Manic-depressive Insanity and Paranoia'' ISBN 0-405-07441-7 (English translation of the original German from the earlier eighth edition of Kraepelin's textbook — now outdated, but a work of major historical importance). |
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*''Mind Over Mood: Cognitive Treatment Therapy Manual for Clients'' by Christine Padesky, Dennis Greenberger. ISBN 0-89862-128-3 |
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==External links== |
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* [http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml Bipolar Disorder overview] from the U.S. [[National Institute of Mental Health]] website |
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* [http://www.nice.org.uk/Guidance/CG38 NICE Bipolar Disorder clinical guidelines] from the U.K. [[National Institute for Health and Clinical Excellence]] website |
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*{{dmoz|Health/Mental_Health/Disorders/Mood/Bipolar_Disorder|Bipolar Disorder}} |
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{{Mental and behavioural disorders}} |
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[[Category:Mood disorders]] |
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[[af:Bipolêre gemoedsversteuring]] |
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[[ar:تعكر المزاج الثنائي القطب]] |
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[[bg:Биполярно разстройство]] |
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[[ca:Trastorn bipolar]] |
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[[cs:Bipolární afektivní porucha]] |
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[[cy:Anhwylder deubegwn]] |
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[[da:Bipolær affektiv sindslidelse]] |
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[[de:Bipolare Störung]] |
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[[et:Bipolaarne häire]] |
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[[el:Διπολική διαταραχή]] |
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[[es:Trastorno bipolar]] |
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[[eu:Desoreka bipolar]] |
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[[fa:اختلال دوقطبی]] |
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[[fr:Trouble bipolaire]] |
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[[gl:Trastorno bipolar]] |
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[[ko:조울증]] |
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[[hr:Bipolarni afektivni poremećaj]] |
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[[it:Psicosi maniaco-depressiva]] |
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[[he:הפרעה דו-קוטבית]] |
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[[lt:Maniakinė depresija]] |
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[[hu:Bipoláris zavar]] |
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[[mk:Биполарно растројство]] |
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[[nl:Bipolaire stoornis]] |
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[[ja:双極性障害]] |
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[[no:Bipolar lidelse]] |
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[[oc:Tresvirament bipolar]] |
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[[pl:Choroba afektywna dwubiegunowa]] |
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[[pt:Transtorno bipolar]] |
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[[ro:Tulburare bipolară]] |
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[[ru:Биполярное аффективное расстройство]] |
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[[simple:Bipolar disorder]] |
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[[sl:Bipolarna motnja]] |
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[[sr:Манично-депресивна психоза]] |
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[[fi:Kaksisuuntainen mielialahäiriö]] |
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[[sv:Bipolärt syndrom]] |
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[[tr:Bipolar bozukluk]] |
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[[uk:Біполярний афективний розлад]] |
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[[zh:躁鬱症]] |
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Revision as of 15:14, 5 March 2009
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