Tuesday, September 1, 2009

Health Care and Bi-Polar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe, according to the National Institute of Mental Health (NIMH). They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. Bipolar disorder often develops in a person's late teens or early adult years.

Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year, according to the NIMH. The median age of onset for bipolar disorders is 25 years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life. Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

According to MedicineNet.com, Bipolar disorder symptoms include depression and feelings of hopelessness during the depressive phase of the condition. Other depressive symptoms include thoughts of suicide, alterations in sleep patterns, and loss of interest in activities that once were a source of pleasure. What differentiates bipolar disorder from major depression is the occurrence of manic episodes, often described as emotional "highs," between the episodes of depression. Symptoms of manic states are varied and include restlessness, increased energy, euphoric mood, racing thoughts, poor judgment, intrusive or provocative behavior, difficulty concentrating, and a decreased need for sleep. People experiencing manic episodes often speak very rapidly, seem overly irritable, and may have unrealistic beliefs about their own power and capability. Much more info about this disorder can be found at http://www.medicinenet.com/bipolar_disorder/article.htm.

One side of the scale includes severe depression, moderate depression, and mild low mood, according to the NIMH. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood. At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression. During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized. Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions. People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness.

According to the American Foundation for Suicide Prevention (AFSP), early recognition and treatment of bipolar disorder may prevent years of needless suffering and death by suicide. And, 80 percent to 90 percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy. The mood stabilizers lithium carbonate, carbamazepine and valproate, are the most commonly prescribed medications to treat bipolar disorder. Lithium carbonate has shown more effectiveness in preventing suicidal behaviors associated with bipolar disorder. The death rate for untreated bipolar patients is higher than that of most types of heart disease and many types of cancer. Studies of bipolar patients indicate that 25 percent to 50 percent of persons with this illness make at least one suicide attempt. Studies also indicate that most bipolar patients who die by suicide communicate their suicidal state to others, most often through direct and specific statements of suicidal intent. People suffering from bipolar disorder may die by suicide earlier in the course of this chronic illness than patients with other mental disorders. Recent hospital discharge is a very high-risk time. Hopelessness, a family history of suicide and previous attempts indicate bipolar patients at highest risk of suicide. Maintaining treatment for bipolar illness is critical. The suicide rate in the first year off lithium treatment is 20 times that during treatment. Early and accurate diagnosis of bipolar disorder and aggressive professional treatment are essential in preventing suicide.

According to Pendulum.org, the US Food and Drug Administration (FDA) has just approved the atypical antipsychotic Geodon (ziprasidone) for maintenance treatment of bipolar I disorder as an adjunct to lithium or Depakote (valporate) in adults. In 2004, the FDA approved Geodon for treatment of acute manic or mixed episodes in Bipolar 1 Disorder. The additional approval for maintenance treatment, gives doctors and patients another long-term use drug to help stabilize moods. Geodon was initially FDA approved, in 2001, to treat schizophrenia. Unlike other atypical antipsychotics, it appears that Geodon may not to be associated with weight gain. In a six-week, head-to-head study between Zyprexa (olanzapine) and Geodon, the Zyprexa patients' median weight gain over the six weeks was ten pounds, while Geodon patients gained less than one pound. In line with this finding, Zyprexa patients saw significant increases in cholesterol and other blood fats, while Geodon patients lipid profiles remained stable. These results suggest that not only is Geodon a healthier alternative, but patients may also be less inclined to stop taking it on their own due to weight gain.

Frontline recently aired a program, according to Pendulum.org, that explores the rapid increase in diagnoses of bipolar disorder in children during the past 7-8 years; the program is an update from earlier Frontline pieces which aired in 2001 and 2008. This program offers an overview of the current environment and attitude in the US vis-à-vis diagnosing young children with bipolar disorder and prescribing psychiatric medicines (many of which are "off label" for kids and adolescents). The video asserts that the rapid increase in diagnosis of bipolar disorder for kids is primarily a US phenomenon and conveys the heart wrenching uncertainty for families who wrestle with the counter-intuitive notion of giving young children psychiatric medicines. It also provides updates on kids who were first interviewed in 2001 and 2008 to see how they are progressing and how their bipolar diagnosis affects their lives. It's worthwhile to watch this program as it aptly raises critical issues for families and young kids faced with a bipolar disorder diagnosis.

According to Time Magazine online, some experts believe that kids are being tipped into bipolar disorder by family and school stress, recreational-drug use and perhaps even a collection of genes that express themselves more aggressively in each generation. Others argue that the actual number of sick kids hasn't changed at all; instead, we've just got better at diagnosing the illness. If that's the case, it's still significant, because it means that those children have gone for years without receiving treatment for their illness, or worse, have been medicated for the wrong illness. Regardless of the cause, plenty of kids are suffering needlessly. Yet scientists are making progress against the disease. Genetic researchers are combing through gene after gene on chromosomes that appear to be related to the condition and may offer targets for drug development. Pharmacologists are perfecting combinations of new drugs that are increasingly capable of leveling the manic peaks and lifting the disabling lows. Behavioral and cognitive psychologists are developing new therapies and family-based programs that get the derailed brain back on track and keep it there.

Bipolar disorder is a recognized health care issue. With the amount of resources devoted to those who suffer from the disease, treatment and medications are available, and research continues to improve understanding of the illness. Those who suffer from it should recognize the need to seek help, and those who have been diagnosed should continue to seek health care management of their medical, mental, and social situations. Intervention by those closest to the patient may likely be necessary to help with care. Stay in tune with updates about bipolar disorder through your medical provider or primary physician. For a huge amount of online data, go to the NIMH website and view material at http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml.

Until next time. Let me know what you think.


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