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Mental Health II
Group Assignment

Topic: Bipolar Disorder

BS PSYCHOLOGY
SEMESTER 6 A

Group Members
Javeria Noor 030
Eisha Isar 019
Zarish Javed 053
Ajer Atiq 004
Umer Rehman 036

FOUNADATION UNIVERSITY RWP

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Table of content:

1)What is Bipolar?

2)Types of Bipolar?

3)Symptoms of Bipolar

4)Causes of Bipolar

5) Differences from DSM 4 & 5

6) Diagnosis
a. Description
b. Diagnostic Criteria (DSM)
c. It's depression phase
d. When someone is Manic
e. What is mixed Episode
f. Bipolar 1 & Bipolar 2

7) Risk factors

8) Prognosis for Bipolar

9) Differential Diagnosis

10) Comorbidity

11) Cultural consideration

12) Case study

13) Treatment( Medication+ Therapy)

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1) WHAT IS BIPOLAR DISORDER?

Bipolar disorder, formerly referred to as manic depression, is a group of mental
disorders that result in rather extreme mood swings, ranging from excessively raised
highs (mania or hypomania episodes) to emotional lows (depressive episodes).

Bipolar disorder is a persistent, and sometimes severe, disruption of normal moods

that impairs a person’s ability to function, maintain relationships, work and make
sensible decisions.

People with Bipolar disorder can experience extreme happiness and vigor, as well as
bouts of extreme hopelessness, sadness and sluggishness. In between these periods,
they tend to feel normal. These highs and lows can be thought of as “two poles” of
mood, which is why its termed “bipolar disorder”.
Those who have been diagnosed with bipolar disorder have a wide range of emotions
and experiences that tend to differ a lot from person to person. The severity, duration,
and intervals between mood shifts can all be quite diverse. While for some people,
they may be able to carry on with their everyday tasks and social commitments as per
normal, for a lot of others, doing so may not necessarily be possible as their moods
and state interfere a lot with how they choose to conduct themselves through the day.

2) TYPES OF BIPOLAR DISORDER:

The diagnostic class “Bipolar and Related Disorders” describes disorders
characterized by marked fluctuations in mood, activity, and behavior. There are seven
primary diagnostic categories on the bipolar spectrum. The following are the
diagnostic categories of bipolar and related disorders set forth in the DSM-5:

1. Bipolar I Disorder:
Bipolar I disorder is diagnosed when a person experiences a manic episode. During a
manic episode, people with bipolar I disorder experience an extreme increase in
energy and may feel on top of the world or uncomfortably irritable in mood. Some
people with bipolar I disorder also experience depressive or hypomanic episodes, and
most people with bipolar I disorder also have periods of neutral mood.

2. Bipolar II Disorder:
A diagnosis of bipolar II disorder requires someone to have at least one major
depressive episode and at least one hypomanic episode. People return to their usual
functioning between episodes. People with bipolar II disorder often first seek
treatment as a result of their first depressive episode, since hypomanic episodes often
feel pleasurable and can even increase performance at work or school. People with
bipolar II disorder frequently have other mental illnesses such as an anxiety disorder
or substance use disorder, the latter of which can exacerbate symptoms of depression
or hypomania.

3. Cyclothymic Disorder:

Cyclothymic disorder is a milder form of bipolar disorder involving many "mood

swings," with hypomania and depressive symptoms that occur frequently. People
with cyclothymia experience emotional ups and downs but with less severe symptoms
than bipolar I or II disorder.

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Cyclothymic disorder symptoms include the following:

 For at least two years, many periods of hypomanic and depressive symptoms, but
the symptoms do not meet the criteria for hypomanic or depressive episode.
 During the two-year period, the symptoms (mood swings) have lasted for at least
half the time and have never stopped for more than two months.

4. Substance/Medication-Induced Bipolar and Related Disorder:

Substance/Medication-Induced Bipolar and Related Disorder is diagnosed when a

substance (alcohol, illicit drugs, or prescribed medication) causes manic/hypomanic
and/or depressive symptoms while an individual is using the substance or during a
withdrawal syndrome associated with the substance.

5. Bipolar and Related Disorder due to Another Medical Condition:

Bipolar and Related Disorder Due to Another Medical Condition is a mood
disorder diagnosis given when there is a prominent and persistent period of
abnormally elevated, expansive, or irritable mood and abnormally increased activity
or energy that is attributable to another medical condition. Medical conditions
commonly known to cause bipolar mania or hypomania include Cushing's
disease, multiple sclerosis, stroke, and traumatic brain injuries. In particular, for
Cushing's disease, once it is cured or in remission, the hypomania/mania typically will
not recur.

6. Other Specified Bipolar and Related Disorder:

Requires symptoms that do not meet the full criteria for any bipolar disorder but that
cause significant distress. This includes short-duration hypomanic episodes and major
depressive episodes, hypomanic episodes with insufficient symptoms or without
accompanying major depressive episodes, or short-duration cyclothymia.

7. Unspecified Bipolar and Related Disorder:

This disorder is similar to “other specified bipolar and related disorder” but is
diagnosed when the clinician chooses not to specify why symptoms do not meet
bipolar criteria.

Prevalence of Bipolar and Related Disorders Categories

12 Month Prevalence Male to

Female
Disorder In Internationall Ratio
U.S y
Bipolar I Disorder 0.6 0.0 – 0.6% 1.1:1
%
Bipolar II Disorder 0.8 0.3%
%
Cyclothymic
Disorder 0.4% – 1.0% 1:1
Lifetime 3.0% – 5.0%
With mood disorders

DSM-IV Bipolar I,

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Bipolar II, and

Bipolar Disorder 2.7% 1.8%
Not Otherwise
Specified in Youths
12 and older

3) SYMPTOMS OF BIPOLAR DISORDER:

In bipolar disorder, the dramatic episodes of high and low moods do not follow a set
pattern. Someone may feel the same mood state (depressed or manic) several times
before switching to the opposite mood. These episodes can happen over a period of
weeks, months, and sometimes even years.
How severe it gets differs from person to person and can also change over time,
becoming more or less severe.
Symptoms of mania ("the highs"):

 Excessive happiness, hopefulness, and excitement

 Sudden changes from being joyful to being irritable, angry, and hostile
 Restlessness
 Rapid speech and poor concentration
 Increased energy and less need for sleep
 Unusually high sex drive
 Making grand and unrealistic plans
 Showing poor judgment
 Drug and alcohol abuse
 Becoming more impulsive
 Less need for sleep
 Less of an appetite
 Larger sense of self-confidence and well-being
 Being easily distracted

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

 Sadness
 Loss of energy
 Feelings of hopelessness or worthlessness
 Not enjoying things they once liked
 Trouble concentrating
 Forgetfulness
 Talking slowly
 Less of a sex drive
 Inability to feel pleasure
 Uncontrollable crying
 Trouble making decisions
 Irritability
 Needing more sleep
 Insomnia
 Appetite changes that make you lose or gain weight
 Thoughts of death or suicide
 Attempting suicide

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4) CAUSES OF BIPOLAR DISORDER:

The exact cause of bipolar disorder is unknown. Experts believe there are a number
of factors that work together to make a person more likely to develop it.
These are thought to be a complex mix of physical, environmental and social factors.

1. Chemical Imbalance in the Brain:

 Bipolar disorder is widely believed to be the result of chemical imbalances in the
brain.
 The chemicals responsible for controlling the brain's functions are called
neurotransmitters, and include noradrenaline, serotonin and dopamine.
 There's some evidence that if there's an imbalance in the levels of 1 or more
neurotransmitters, a person may develop some symptoms of bipolar disorder.
 For example, there's evidence that episodes of mania may occur when levels of
noradrenaline are too high, and episodes of depression may be the result of
noradrenaline levels becoming too low.

2. Genetics:
 It's also thought bipolar disorder is linked to genetics, as it seems to run in
families.
 The family members of a person with bipolar disorder have an increased risk of
developing it themselves.
 But no single gene is responsible for bipolar disorder. Instead, a number of
genetic and environmental factors are thought to act as triggers.

3. Triggers:
A stressful circumstance or situation often triggers the symptoms of bipolar disorder.
 Examples of stressful triggers include:
 the breakdown of a relationship
 physical, sexual or emotional abuse
 the death of a close family member or loved one
 These types of life-altering events can cause episodes of depression at any time in
a person's life.
Bipolar disorder may also be triggered by:
 physical illness
 sleep disturbances
 overwhelming problems in everyday life, such as problems with money, work or
relationships.

5) CHANGES FROM THE DSM-IV to DSM-5:

DSM-5 has adapted and incorporated a range of different changes if we look at it in
comparison with the DSM-IV. Focusing specifically on the Bipolar and Related
Disorders, a number of changes have been made in the DSM-5. These changes
include both adding specific components about the disorder and also eliminating
certain factors regarding the Bipolar and Related Disorders that were previously
present in DSM-IV. The purpose of making these changes were to allow for a better
and more accurate diagnosis to be made which would help in ensuring that a person
with the illness gets the correct and required treatment that would be best suited to the
kind of symptoms that they would be experiencing.

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In the DSM-5, bipolar disorders and depressive disorders were split, and the chapter
“Bipolar and Related Disorders” was put in between “Schizophrenia Spectrum and
Other Psychotic Disorders” and “Depressive Disorders”.
This change was made because according to research on symptoms, family history
and genetics, APA now considers Bipolar Disorder as a bridge or connecting medium
between psychotic and depressive disorders.

In DSM-5, the diagnostic criteria for manic and hypomanic episodes include a greater
emphasis on activity, energy changes and mood changes.
The DSM-5 has also incorporated a new specifier called “with mixed features” that
basically applies to episodes of mania or hypomania with depressive elements, as well
as periods of depression in the setting of the major depressive disorder or bipolar
disorder with mania/ hypomania features.
Another specifier called” anxious distress” has been added to DSM-5. It identifies
those patients who have anxiety symptoms that are not a part of the bipolar diagnostic
criteria.
The DSM-5 has also both incorporated and removed several diagnoses as compared to
DSM-IV. “Bipolar disorder not otherwise specified”, which was diagnoses in the
DSM-IV, has been replaced by “bipolar and related disorder due to another medical
condition”, “other specified bipolar and related disorder”, and “unspecified bipolar
and related disorder”. These diagnoses essentially allow the clinician or psychologist
to narrow down the symptoms that characterize bipolar disorder.
The DSM-5 added or incorporated a category of depressive disorders which are called
disruptive mood dysregulation disorder. This disorder was not a part of DSM-IV and
the purpose of adding it to DSM-5 was to prevent the inappropriate and excessive
diagnosis of bipolar disorder being applied to different kinds of childhood irritability.

The DSM-IV did not include the term “abnormally” in criterion A for a hypomanic
episode, but it was used in criterion A of a manic episode. The DSM-5 uses the term
of “abnormality” in both hypomanic and manic episode’s criteria. This brings the
entire set of criteria for the two kinds of episodes much closer together.

6) DIAGNOSIS:
To determine if you have bipolar disorder, your evaluation may include:
 Physical exam. Doctor may do a physical exam and lab tests to identify any
medical problems that could be causing your symptoms.
 Psychiatric assessment. Doctor may refer you to a psychiatrist, who will talk to
you about your thoughts, feelings and behavior patterns. You may also fill out a
psychological self-assessment or questionnaire. With your permission, family
members or close friends may be asked to provide information about your
symptoms.
 Mood charting. May asked to keep a daily record of your moods, sleep patterns
or other factors that could help with diagnosis and finding the right treatment.
 Criteria for bipolar disorder. Psychiatrist may compare your symptoms with
the criteria for bipolar and related disorders in the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5), published by the American Psychiatric
Association.
Bipolar Disorder DSM-5 Diagnostic Criteria:
Manic Episode:
To be considered mania, the elevated, expansive, or irritable mood must last for at

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least one week and be present most of the day, nearly every day. To be considered
hypomania, the mood must last at least four consecutive days and be present most of
the day, almost every day.
During this period, three or more of the following symptoms must be present and
represent a significant change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Increased talkativeness
4. Racing thoughts
5. Distracted easily
6. Increase in goal-directed activity or psychomotor agitation
7. Engaging in activities that hold the potential for painful consequences, e.g.,
unrestrained buying sprees

Depressive Episode:
The depressive side of bipolar disorder is characterized by a major depressive episode
resulting in depressed mood or loss of interest or pleasure in life. The DSM-5 states
that a person must experience five or more of the following symptoms in two weeks
to be diagnosed with a major depressive episode:
1. Depressed mood most of the day, nearly every day
2. Loss of interest or pleasure in all, or almost all, activities
3. Significant weight loss or decrease or increase in appetite
4. Engaging in purposeless movements, such as pacing the room
5. Fatigue or loss of energy
6. Feelings of worthlessness or guilt
7. Diminished ability to think or concentrate, or indecisiveness
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a
suicide attempt

Mixed Episode:
Moreover, examples have been added to Other Specified Bipolar and related disorder
and to Other Specified Depressive Disorder so that manic episodes or major
depressive episodes that are superimposed on a psychotic disorder can also be
diagnosed.
The DSM-5 explicitly states that mixed features associated with a major depressive
episode have been found to be a significant risk factor for the development of bipolar
I or II disorder and that such features should be noted in planning and monitoring the
response to treatment. Ultimately, the changes from the DSM-IV-TR to the DSM-5
represent a shift in the conceptualization of bipolar disorder from one of discrete
categories (ie, depressed, manic) to a more commonly encountered dimensional
spectrum of symptomatology.

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Levels of severity:
 Mild: Minimum symptom criteria are met for a manic episode.
 Moderate: Very significant increase in activity or impairment in judgment.
 Severe: Almost continual supervision is required in order to prevent physical
harm to self or others
Specifiers:
For bipolar disorder, there are two categories of specifiers: those for defining the
current or most recent mood episode, and those concerning the course of
recurrent, or repeating, mood episodes.

Bipolar I and Bipolar II Disorders:

Changes to Bipolar I Disorder criterion B and Bipolar II Disorder criterion C
For Bipolar I disorder,
“B. At least one manic episode is not better explained by schizoaffective disorder and
is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia spectrum and other psychotic
disorder.”

For Bipolar II Disorder,

“C. At least one hypomanic episode and at least one major depressive episode are not
better explained by schizoaffective disorder and are not superimposed on
schizophrenia, schizophreniform disorder, delusional disorder, or other specified or
unspecified schizophrenia spectrum and other psychotic disorder.”

Bipolar Spectrum Disorders: M, m, D, d

The basic concept of a bipolar spectrum is more than a century old, having been
proposed by the original founders of modern psychiatry. It gained new life in the
1970s after a leading psychiatrist proposed classifying mood symptoms as follows:

Upper-case "M": Episodes of full-blown mania

Lower-case "m": Episodes of mild mania (hypomania)
Upper-case "D": Major depressive episodes
Lower-case "d": Less-severe symptoms of depression

Diagnosis in children

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Although diagnosis of children and teenagers with bipolar disorder includes the same
criteria that are used for adults, symptoms in children and teens often have different
patterns and may not fit neatly into the diagnostic categories.

Also, children who have bipolar disorder are frequently also diagnosed with other
mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or
behavior problems, which can make diagnosis more complicated. Referral to a child
psychiatrist with experience in bipolar disorder is recommended.

7) RISK FACTORS:
Bipolar disorder is a disorder characterized by uncertain epidemiology. Knowledge of
potential risk factors enables physicians to diagnose and treat patients with bipolar
disorder, which directs further investigation, follow-up, and monitoring.
Appropriately, identifying the specific causes of bipolar disorder can make
interventions at the individual or human level to prevent the progression of the
disease, and improve outcomes with previous treatment. This article reviews the
epidemiology of bipolar disorder, as well as the risk factors for human, genetic, and
environmental factors, as well as examining the strengths of these organizations and
their potential “cause”.
Following are some major risk factors discussed:

1. Environmental Factors:
Prenatal infections have been linked to a number of psychiatric disorders, including
bipolar disorder. A recent review by Barichello and colleagues14 investigated
associations between bipolar and 10 infectious agents. Findings between studies were
often inconsistent, and no association was found with the Epstein-Barr virus, human
herpesvirus 6 or varicella zoster virus. Five of the eleven studies investigating
cytomegalovirus found an association between antibody and bipolar levels, while two
studies found an association between maternal flu and bipolar disorder with
psychosis, although other studies found no association. None of these studies were
expected or longitudinal and it is not certain whether these diseases occurred during
or after pregnancy. Therefore, the evidence for maternal infection as a bipolar
disorder remains weak, in general.

2. Medical Factors:
It is well-known that bipolar disorder is associated with a wide range of medical and
psychological conditions. There are a number of reasons for this, including genetic
and environmental risks, treatment outcomes, physician-recognized bias and possible
strengths. with the relationship of the direct cause in any way.
There is strong evidence of a link between bipolar and irritable bowel syndrome
(IBS) highlighted in the most recent analysis of meta-retrospective cohort studies.
However, potential significant crosses, such as the use of antidepressant, have not
been corrected. There is also evidence that both disorders may be associated with
inflammation, and stress-related etiologies, that may be associated with this disorder.
Similarly, a recent meta-analysis showed asthma, obesity, migraine and head
injury were associated with bipolar. Evidence of these organizations mediates with a
very small number of studies included, many of which were partial and did not have
the data to correct confusing aspects. However, with asthma, retrospective cohort and
a large expected study also support the organization, which may be resolved through
shared inflammatory mechanisms or the use of corticosteroids during childhood.

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which are a few things that will be studies and weak evidence of a relationship that is
a direct cause, while the association with traumatic brain injury may be confused with
‘accidental tendencies’ or physical abuse. MS) completely uncountable is steroid-
induced mania, and in some cases, psychiatric symptoms may precede the diagnosis
of MS. However, other studies have not supported this association.

8) PROGNOSIS:
Bipolar disorder have a poor prognosis of 50% accuracy. Good prediction comes from
good treatment, which is also the result of an accurate diagnosis. Because bipolar
disorder continues to have high levels of both low and poor diagnosis, it is often
difficult for people with this condition to receive timely and effective treatment.
Bipolar disorder can be a very debilitating health condition. With proper treatment,
however, most people with bipolar disorder can live a full and satisfying life. People
with bipolar disorder may have normal or near normal working hours between
episodes.
Ultimately human prediction depends on many factors, in fact, under human control:
appropriate drugs; each appropriate dose; highly experienced patient; good working
relationships with a competent physician; a competent, supportive and warm
therapist; supportive family or significant other; and a balanced lifestyle including a
controlled level of stress, regular exercise and regular sleep and wake times.
Apparently there are other factors that lead to better prediction, such as being more
aware of small changes in a person's energy, mood, sleep and eating behavior, and
having a plan in conjunction with your doctor on how to control subtle changes. that
may indicate the onset of mood swings. Some people find that keeping a record of
their feelings can help them to predict changes.

1. Repetition
Even when taking medication, some people may have mild episodes, or have a
complete episode of insanity or depression. In fact, a recent study found that bipolar
disorder "is characterized by a low rate of recovery, a high rate of recurrence, and
inter episodic dysfunction." Worse, this study confirmed the severity of the disease
by saying that "the average mortality rate among patients with BD is about 2 times
higher." Bipolar disorder is currently considered to be “one of the most costly mental
disorders in the United States.”

The following behaviors can lead to depression or manic recurrence:

 Stopping or reducing a person's dose of medication, without consulting your
doctor.
 Low or overdose. Often, taking a low dose of mood stabilizer can lead to a return
to mania. Taking a low dose of antidepressant, may cause the patient to return to
depression, while high doses may cause a decrease in mixed conditions or
dementia.
 Taking strong drugs — for pleasure or not — such as cocaine, alcohol,
amphetamines, or opiates. This can make the situation worse.
 A constant sleep pattern may stop the illness. Excessive sleepiness (possibly due
to medication) can lead to depression, while sleep deprivation may result in
mixed moods or delirium.
 Caffeine can cause irritability, dysphoria and mania. Anecdotal evidence seems to
suggest that low doses of caffeine can have effects from anti-depressant to mania-
inducing.

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 Adequate stress management and poor lifestyle choices. Left untreated,

depression can cause a person to return to normal. Medication raises the level of
stress in some ways, but severe depression still causes recurrence.
 People with bipolar disorder are often under the influence of self-medication,
drugs, and marijuana. Sometimes they can turn to hard drugs. Studies show
that smoking cessation causes depression in many people with bipolar
disorder, and a much higher percentage of sufferers smoke.
 Recurrence can be controlled by the patient with the help of a close friend,
based on the emergence of idiosyncratic prodromal events. [6] This assumes
that a close friend can detect which emotions, activities, behaviors, thought
processes, or thoughts are normally present at the beginning of bipolar
episodes. They can then take precautionary measures to reduce or reverse the
onset of the illness, or they can take steps to prevent the episode from
becoming harmless.

2. Mortality:
"Death research has documented an increase in the leading causes of death in patients
with BD. A newly established and rapidly growing database shows that deaths from
chronic medical conditions (e.g., heart disease) are one major cause of premature and
severe death. BD is estimated at 18 to 25, and it emphasizes suicide. "
Although most people with bipolar disorder who attempt suicide do not really get rid
of it, the annual suicide rate for men and women with bipolar disorder (0.4%) is 10 to
20 times higher than in the general population.
People with bipolar disorder often commit suicide, especially during a combination of
conditions such as dysphoric mania and depression. People with Bipolar II have
higher suicide rates compared to people suffering from other mental health conditions,
including Depression. Major Depression episodes are part of the Bipolar II
experience, and there is evidence that sufferers spend more time in their depression
phase than their counterparts with Bipolar I Disorder.

9) DIFFERENTIAL DIAGNOSIS:
Patients with bipolar disorder spend about half of their lives experiencing symptoms
and most of the time suffer from depressive symptoms, making it difficult to diagnose
bipolar disorder.
The diagnosis of bipolar disorder, or manic-depressive disorder (MDI), is based on
the patient's history and clinical course.
Major Disorders such as:
 Epilepsy
 Fahr disease
 Acquired Immunodeficiency Syndrome (AIDS)
 Medications (e.g. antidepressants can cause a patient to become insane; other
medications may include baclofen, bromide, bromocriptine, captopril,
cimetidine, corticosteroids, cyclosporine, disulfiram, i -hydralazine, isoniazid,
levodopa, methylphenidate, metrizamide, proidicarnibazinebazinebazi).
 Circadian rhythm desynchronization
 Cyclothymic disorder
 Multiple personality disorder
 Oppositional defiant disorder (children)
 Problems with substance abuse (eg, alcohol, amphetamines, cocaine,
hallucinogens, opiates)

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 Various Diseases
 Anxiety Problems
 Head Trauma
 Hyperthyroidism and Thyrotoxicosis
 Hypothyroidism
 Iatrogenic Cushing Syndrome
 Lyme disease
 Multiple Sclerosis
 Neurosyphilis
 Pediatric Attention Deficit Hyperactivity Disorder (ADHD)
 Physical Therapy and Rehabilitation of Systemic Lupus Erythematosus
 Posttraumatic Stress Disorder
 Schizoaffective Disorder
 Schizophrenia
 Seasonal Affective Disorder

Results
The lifetime rate of major depressive disorder (i.e., unipolar depression) is more than
3 and a half times the number of bipolar spectrum disorders. The clinical presentation
of a major episode of depression in a bipolar patient is not significantly different from
that of a patient with major depressive disorder (unipolar depression). Therefore, it is
not surprising that in addition to proper and thorough evaluation, most patients with
bipolar disorder may be diagnosed with depressive disorder (unipolar depression). In
general, antidepressants have shown little or no success in depressive episodes
associated with bipolar disorder, and treatment guidelines recommend the use of
drugs only as a supplement to emotional strengthening in patients with bipolar
disorder. Therefore, accurate diagnosis of bipolar disorder among patients presenting
with depression is important in providing appropriate treatment and improving patient
outcomes.

Limitations: Clinical features indicating bipolar disorder against major depressive

disorder identified in this review are based on a variety of groups and may not work in
each patient.

10) COMORBIDITY:
Comorbidity means co-occurrence of two or more disorders in a person. In all types
of bipolar disorder, co-occurring disorders are common.

1. Comorbidity in Bipolar I disorder:

In bipolar-I, comorbidity is common with the disorders of any anxiety-related disorder
such as panic attacks, social anxiety disorders etc. ADHD or any other impulse-
control disorder can co-exist with bipolar-I disorder. In more than half individuals
having bipolar-I disorder, substance use disorder occurs. In adults, the comorbidity
rate of medical conditions with bipolar disorder is very high and untreated as well
such as migraine and metabolic syndrome occurrence is very common.

2. Comorbidity in Bipolar II Disorder:

According to the estimates, about 60% individuals with bipolar II disorder have more
than two co-existing mental disorders; 37% people have substance use disorder; and

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75% have anxiety disorder. If comparing with bipolar I disorder, children and
adolescents with bipolar II disorder have a higher rate of comorbidity with anxiety
disorder. Substance use disorder also co-occurs with bipolar-II disorder individuals.
About 14% individuals with this disorder have at least one eating disorder.

3. Cyclothymic Disorder:
Individuals suffering from cyclothymic disorder may have co-occurring mental
disorders like substance-related disorders and sleep disorders. Cyclothymic disorder
also tends to be comorbid with ADHD or other impulse-control issues.

4. Bipolar and Related Disorder due to Another Medical Condition:

Some conditions that comorbid with this disorder are those associated with medical
conditions of etiological relevance. Along or during manic symptom in individuals
suffering with Cushing’s disease, delirium can co-exist.

11) CULTURAL CONSIDERATIONS:

When assessing, diagnosing and essentially treating people with Bipolar disorder or
even other forms of mental health disorders, it is integral that the clinician focuses on
the client’s ethnic and cultural background.
Different cultures may have different views on psychological issues. A lot of minority
cultures may not view bipolar disorder or other mental health disorders as something
serious or perhaps something that may require medical help or attention. In such
cultures, someone suffering from a mental disorder may not even be characterized as
a mental health illness in the first place for it to be treated or looked into
professionally.
The cultural background of a person with bipolar disorder may also account for small
but impactful variations in terms of how they choose to communicate the symptoms
that they are experiencing as well as what they choose to tell the clinician. Hence, the
clinician must take into consideration, the differing communication styles of people
due to their culture and not miss out on any important details that the client may be
expressing but in a different manner due to the cultural background that they belong
to.
A person’s cultural background also has an effect on whether they seek help or not in
the first place, what kind of coping mechanisms they make use of and what sort of
social support they really have when dealing with their disorder. This is something
that has a rather huge impact on the way a client’s disorder shows through and affects
them so it is something that the clinician must take into consideration when assessing
them and moving towards a diagnosis.

12) CASE STUDY:

Sarah is a 42-year-old married woman who has a long history of both depressive and
hypomanic episodes. Across the years she has been variable diagnoses as having
major depression, borderline personality disorder, and most recently, bipolar
disorder. Review of symptoms indicates that she indeed have multiple episodes of
depression beginning in her late teens, but that clear hypomanic episodes later
emerged. Her elevated interpersonal conflict, hyper-sexuality and alcohol use during
her hypomanic episodes led to the provisional borderline diagnosis, but in the context
of her full history, bipolar disorder appears the best diagnosis. Sarah notes that she is
not currently in a relationship and that she feels alienated from her family. She has
been taking mood stabilizers for the last year, but continues to have low level

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symptoms of depression. In the past, she has gone off her medication multiple times,
but at present she says she is “tired of being in trouble all the time” and wants to try
individual psychotherapy.

Symptoms of the Case Study:

 Depression
 Impulsivity
 Alcohol Intake
 Hypomania
 Mood swings/ Mood cycles
 Isolation
 Mood elevation

13) TREATMENT FOR BIPOLAR DISORDER:

1. Medication:
Medications are used to treat a person with bipolar disorder as they can balance the
mood right away. Medications given to the person are based on their current condition
and symptoms. Some of them are:
 Mood Stabilizers:
Mood stabilizers are useful for controlling manic and hypomanic episodes. Some of
the them are lithium, carbamazepine, lamotrigine and divalproex sodium.
 Antipsychotics:
Olanzapine (Zyprexa), quetiapine (Seroquel), asenapine (Saphris), lurasidone,
ziprasidone and aripiprazole (Abilify) are some antipsychotic drugs that help in the
treatment when signs of depression are persistent.
 Antidepressants:
Antidepressants are given to the patient to manage depression symptoms. However, it
has a possibility to trigger a manic episode that is why it is prescribed with
antipsychotic drugs or mood stabilizers.
 Anti-anxiety:
Anti-anxiety medications are usually used on a short-term basis. Benzodiazepines are
the anti-anxiety medicines that control and manage anxiety as well as improve the
sleep quality of the person. Diazepam and clonazepam are the examples for anti-
anxiety medication.

2. Psychotherapy:
Psychotherapy is basically treating mental disorders psychologically instead of
medical means. It is a talk-therapy in which coping skills are taught by the therapist.
Several types of therapies important for the treatment of bipolar disorder are:
 Interpersonal and social rhythm therapy:
This type of therapy focuses on the daily routine of the individual such as seeping
time, waking time, meal timings. A healthy and consistent routine will result in better
mood management skills in person. People having bipolar disorder have a proper diet,
exercise and sleep routine.
 Cognitive Behavioural Therapy:
CBT technique allows a person to change his negative attitude and beliefs with
positive ones. This therapy can help in identifying the root causes or triggering factors
for bipolar episodes in a person having bipolar disorder. The cognitive abilities are
improved in this therapy and coping skills for emotional difficulties are developed.

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 Family-Focused Therapy:
This therapy focuses on mood symptoms, preventing relapse, and improved or
enhanced psychosocial functioning. Family support and communication benefits the
treatment plan of the individual.
 Psycho education:
Psychoeducation is very important for patient as well as the family of patient in which
they are guided and given complete information about the illness. Better
understanding and awareness regarding illness is provided to the family.

3. Other Methods:
Some other methods can help in managing the symptoms of bipolar disorder.
 Calming technique:
To reduce anxiety and stay calm, some of the methods are yoga, massage therapy,
meditation, acupuncture technique etc.
 Healthy Diet:
Healthy diet such as intake of fish and omega-3 fatty acids reduces the chemical
imbalances in brain.

CONCLUSION:

Bipolar disorder is a common psychiatric disorder characterized by affective

instability and cognitive deficits, particularly during mood episodes. Abnormalities
within the ALN and related brain regions appear to be involved in the
neurophysiology of bipolar disorder. Moreover, studies indicate a high level of
heritability in bipolar disorder, although the involvement of specific genes has not
been definitively established. Several effective pharmacological treatment options
exist for patients with bipolar disorder. Future studies combining neurocognitive,
neuroimaging, and genetic techniques may be useful to identify endophenotypes of
bipolar disorder and ultimately to develop rationale treatment strategies and improve
the outcomes of individuals with bipolar disorder.

References:

American Psychological Association. (n.d.). Bipolar disorder. American

Psychological Association. Retrieved May 22, 2022, from

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Pugle, M. (n.d.). Are mood swings a sign of bipolar disorder? Verywell Health.
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