Bipolar depression or in other words known as maniac depression disorder is a psychiatric diagnosis which categorically describes mood disorder defined by presence of episodes of abnormality elevated energy levels , mood, and cognition with or without depression episodes. Moods which are elevated are referred to as mania from a clinical point of view and as hypomania if it is milder. Commonly individuals who go through maniac episodes experience depression episodes, or mixed episodes or symptoms, whereby features of both depressions and mania are present at the same time. Periods of ‘normal’ mood separate these episodes though in some individuals, mania and depression may change rapidly, a situation known as rapid cycling. Psychotic symptoms such as hallucination and delusion are sometimes observed as a result of extreme episodes of maniac. Onset of full symptoms occurs late in young adulthood or adolescent stage.(Bendelow 2005)
Abnormality episodes are associated with disruption and distress and a high risk of suicide, especially in times of depressive episodes. In some cases it has been associated with goal, creativity, positive achievement and striving while in others it can be a devastating long term disorder. Genetic and environmental factors have contributed substantially to the development of bipolar depression. Mood stabilizing medications is used in the treatment of mood episodes and psychiatric drugs are also employed in the management of maniac depression. (Borde2000). Involuntary commitment may be employed in serious cases where there is a risk of hating oneself or others. Widespread problems such as stereotypes, prejudice and social stigma exist against individual diagnosis, for example bipolar disorder.
Signs and symptoms of mania episode patients
Mania is the primary characteristic of bipolar disorder. It is characterized by distinct periods of high degrees of mood, which can take euphoria form. The patient commonly experienced increased energy levels and decreased desire to sleep. Patient’s speech was pressured and experienced racing thoughts. He was easily distracted and attention span was low. Judgment was impaired and engaged in behavior that is quite abnormal. The patient was found to indulge himself in substance abuse, particularly alcohol and other depressants such as cocaine or other stimulants or other sleeping pills. Patient’s behavior was intrusive, intolerant, and aggressive. He was feeling out of control or unstoppable as if he has been chosen on a special mission. Experienced increased sex drive. He had almost broken up with reality, which is his thinking was affected along with moods. Experienced severe anxiety and he was very irritable.(Dale2005)
Causes of these disorder vary from one individual to another .Studies have shown a substantial genetic contribution and influence from environmental factors. Genetic factors of chromosomal region and candidate genes were found to contribute to the mania affecting the patient, though the results were not consistent. Genetic linkage studies followed by fine mapping to search for the phenomenon of disequilibrium linkage with a single gene, then DNA sequencing were observed for the genes P2RXY and TPNI. Meta-analyses linkage studies detected significant genome-wide findings on chromosome 6q and on 8q .DGKN, a locus in a region rich of genes of high linkage disequilibrium on chromosomes 16p12 and also a single nucleotide polymorphism in MYO5B. (Busfield2002)Comparing these studies with new ones suggested an association of ANK3 and CACNAIC, believed to have relations to calcium and sodium voltage-gated ion channel. The patient’s advanced age paternally was linked to his disorder.
Studies carried out on the patient indicated a hypersensitivity of melatonin receptors in the eyes; which was a reliable indicator of the bipolar disorder, Melatonin receptor hypersensitivity to light during sleep, which was resulting to rapid drop in sleep time levels of melatonin compared to controls. Valporic acid which is a mood stabilizer was found to increase transcription of melatonin receptors and lower eye melatonin receptor sensitivity.(Davidson 2008)
Findings indicated that period leading up to mania was characterized by anxiety and depression at first, isolated sub-clinical symptoms of mania including racing thought and increased energy levels were observed. The patient was found to hold certain beliefs about himself, his internal state, and his social world which made him vulnerable during changing mood states in the face of relevant life event. Sub cuticle difficulties and subtle frontal-tempered difficulties related to planning, attention control and emotional regulation were found to play a significant role in the cause of the patient’s disorder. (Bickeribach 1999) Overall increase in impulses and levels of activation was also observed in the patient.
A number of psychotherapeutic and pharmacological techniques can be employed in the treatment of bipolar disorder. For instance mania episodes present in the treatment of bipolar 1 may require hospitalization .Long term impatient stay are now less common due to deinstitutionalization hospital admission accompanied by support services which include visits from community members belonging to a mental health team of Assertive Community Treatment team, intensive outpatient programs and patient-led support group, and supports that its employment can help; which may also be referred to as partial- impatient program.(Bordo 2000)
Psychotherapy which is aimed at alleviating core symptoms ,recognition of episode trigger, reduction of negative expressed emotion in relationship, recognition of personal symptoms before full-blown recurrence and practice of the factor that lead to maintenance of remission cognitive behavior therapy appeared to be more effective in regard to the residual depression symptoms.
Mood stabilizer medication such as lamotrigine or lithium carbonate is the mainstay of treatment. (Davidson 2008)Lamotrigine has been found to be good in depression prevention, while lithium is the only drug proven to reduce suicide in bipolar patient. Lithium and lamotrigine comprises a variety of unrelated compounds which have indicated positive result in the prevention of relapses of manic or depressive episode. Lithium, which is as widely used as vodium valporate is also used as an anticonvulsant. Treatment in an acute mania episode requires the use of antipsychotic medication such as a typical antipsychotic quietapine and olanzapine and the chlorpromazine use of antidepressants in treatment of bipolar depression has been debated, with some studies reporting a worse outcome with their use triggering manic, mixed episodes or hypomania especially where no mood stabilizer is employed.(Dale 2005) However, most of the mood stabilizers have a limited effectiveness in episodes of depression .Rapid cycling is made worse by antidepressants unless there is adjunctive treatment with mood stabilizers.
For a patient of bipolar disorder, prognosis results from good treatments which in turn result from accurate diagnosis. The patient affected with bipolar disorder was having periods of normal or near normal functioning in between episodes. Prognosis entirely depends on many factors such as the right medicine with the right dose of each other; positive relationship with a competent therapist and medical doctors; comprehensive knowledge of the disease and its effect and good physical health which includes nutrition exercise and regulation of stress level. (Birke 2002)
Values and beliefs relating to the practice on patients and families/ or carers
Positive relationship-a well coordinated and organized relationship which practices openness and transparency is of greater importance to the patient. Family members and loved ones belonging to the patient affected by bipolar disorder, have issue that results to finding a way to maintain a loving relationship through the long process of having effective treatment and achievement of greater stability .Sustaining such a relationship is made difficult by financial insecurity, alcoholism, infidelity, addiction, abusiveness, criminal activity and other factors that may be related to the illness. To understand and untangle these complex array and emotions that surround the patient, in the context of a loving relationship is difficult and takes much effort and time.(Busfield 2002) Both parties in the relationship should acquire insight, make difficult changes and develop coping strategies though sometimes separation or divorce is considered when stresses are too great.
‘Significant other’, a group that includes a spouse, girlfriend, boyfriend, parent, partner, sibling child or other near loved ones of the patient is involved. The member belonging to the ‘significant other’ should not be diagnosed with the disorder.
‘What is the nature of identity’ and ‘are certain values systems (cultural, religious and institution) healthier than others?’(Davidson 2008)The patient’s we are discussing attends a fairly strict church and believe strongly that he is a sinner by nature. These view of self-as- sinner is actually in sharp contrast to the view of human nature and the identity of the patient. Peopler are believed to develop psychological maladies and starts acting badly on losing contact with their good inner nature after constant bombardment by family cultural ideas and commandments. ’Organisimic Self-Valuing’, an idea that people vary from one another in terms of what they like, what is better for them at the level of organism and their core-being. If only left to themselves to choose, people would only choose what they preferred.
How values and beliefs underpin the practice
Religion- research was found to have quite supporting role in the management of the disorder. Patient were found to be willing to share their spiritual belief, but only if they had the believe that physicians would respect their values. An important and understudied area is the degree to which physicians can believe in prayers. Findings have suggested that patients and physicians have a shared belief concerning the roles of spirituality, religion, ad prayer in illness, and health studies have indicated that often involvement in religious activities is associated with reduced risk of depression. Two dimensions of religion, participating in a religious community and personal devotion are correlated with reduction of depression.(Dale 2002).
Rates of drug abuse and alcohol are generally lower in groups that follow organized religious activities. Feeling of deep personal devotion and conservation Christian values correlate with relatively reduced risk of alcohol or substance abuse and dependence. Deadly anxiety is less among individuals who practice a spiritual activity in which belief is an after life plays a central role in the reduction of stress.
In conclusion positive practice of values and beliefs has been found to play a significant role in the reduction of depression. Patients participating in religious activities show significant reduction of depression compared to non-religious. Positive relationship between members of the family also helps a great deal.
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