BiPolar Type I

by kburton

27 May
2012

Bipolar Disorder Type I

Park University

Kelly Burton

 

 Abstract

This paper cover bipolar disorder type I.  Paper is formatted in a specific order as required per the core assessment guideline provide in Park University’s Abnormal Psychology class.  The main topics are: Description, DSM-IV Application, 4Ds Distress, Deviance, Dysfunction, and Danger, Models of Abnormality That Explain the Etiology, Treatments, Historical and Cultural Contexts, and Prognosis.

 Introduction

            Fifty percent of people who have bipolar attempt suicide, of those twenty  percent who are untreated are successful in their attempt (Hinshaw, 2010).  Staggering numbers for a abnormal condition that is manageable with effective treatment.  This paper is specifically formatted for my Abnormal Psychology class as the core assessment and will have the following topics covered.  The topics prescribed for this paper are as follows:

  • Description
  • DSM-IV Application
  • 4Ds Distress, Deviance, Dysfunction, and Danger
  • Models of Abnormality That Explain the Etiology
  • Treatments
  • Historical and Cultural Contexts
  • Prognosis

There are several types of bipolar, however, this paper will only cover bipolar type I disorder, most recent episode depressed, DSM-IV 296.5x (Morrison, 1995, p217).

Description

All people experience mood shifts during their normal day to day life.  External events that we are subjected to can alter or change our mood from happy to sad, to somewhere in between.  For a person with bipolar, their moods swing from high end of the spectrums quickly and with detrimental effects.  Manic state is the high end of the mood spectrum for a person with bipolar, during this phase the person is in a hyper state of excitement.  This phase can be very productive for the person, they have a feeling of being able to tackle the whole world.  While the manic state can be productive it can also hamper their ability to focus their attention and their actions can be sporadic.  The low end of the bipolar spectrum is deep depression.  In my opinion the deep depression is the part of the condition that is most debilitating.  Life tasks that were initiated during their manic phase come to a crashing halt, causing the person to feel like a failure, compounding their feelings of depression. It is during the depressive state that most people seek treatment.

DSM-IV Application

The DSM-IV has specific guidelines for diagnosing bipolar typeI disorder.  For bipolar type I disorder 296.5x the following criteria must be met: (Morrison, 1995, p218)

  • The patient’s most recent episode is a Major Depressive Episode
  • The patient’s has had at least one previous Manic or Mixed episode

The DSM Axis for a bipolar type I disorder would roughly be:

Axis I: 296.5x (The fifth digit would be the degree of the depressive state as outlined in the DSM-IV)

Axis II:  No Diagnosis

Axis III: None

Axis IV: Implications from the Depression

Axis V: The GAF Score determined

The ability for the patient to accurately describe their moods up to the time of the treatment is crucial.  Patients that don’t recognize their manic state could be misdiagnosed with just severe depression, which would limit the effects of treatment.

4Ds Distress, Deviance, Dysfunction, and Danger

In order for a person’s behavior to be considered abnormal it should have qualities associated with the fours Ds, deviance, dysfunction, distress and Danger (Comer 2009).  Deviant behavior is that behavior that does not fall into the norms of society.  Deviant behavior for a bipolar person would be there sporadic and compulsive actions during the manic phase.  Often not able to focus on a single subject and feeling like they must constantly be in some type of motion.  Excessive solitude, sleeping and over all melancholy during the depressive state are examples of deviant behavior for a person with bipolar disorder type I.

Dysfunctional behavior impedes the normal activity of the person (Comer 2009).  Actions that are deviant for a bipolar also follow under dysfunctional when they are so severe they alter their daily lives. For most bipolars their severe depression and withdrawal from people is considered dysfunctional.

Distress is subjective to the individual, not all symptoms are stressful to the person.  Some people might consider the manic stage of bipolar as very productive and think things are okay (Comer 2009).  Distress could of the person with the illness or those around them that are subjected to their abnormal behaviors.  While the manic state can be a happy state for the individual, tasks that are taken on during the manic state will be become a burden for when their mood comes crashing down to a depressive state.  Uncompleted tasks will weigh on the individual causing them much distress and increase their depressive state.

Danger is the most serious of the 4Ds, as the individuals behavior can cause harm to themselves or others.  For bipolar disorder the high recurrent thoughts of suicide coupled with the number of people that attempt this action make it highly dangerous.  Some cases of suicide are preempted with a killing of others out of revenge, or listening to the voices that can sometimes occur during manic and depressive states, makes it dangerous for those around the person with the abnormal behaviors.

Not all the of the 4Ds have to be present in order for a person to be considered having an abnormal psychological condition, rather, they are a set of guidelines to follow when diagnosing a patient for an abnormal condition.

Models of Abnormality That Explain the Etiology

Currently there are no tests that can adequately verify if a person has bipolar disorder and the ability to properly diagnose can be delayed do to the time in between manic and depressive episodes.  Only through direct observation or patient questioning can one determine a pattern of manic and depressive behavior in a bipolar disorder patient (Miller 2006).  Establishing a valid history during patient intake is vital for proper diagnosis.  Approximately 30% of depression diagnosed patients are actually mis-diagnosed and suffer from bipolar.  Bipolar disorder patients that are not cared for are expected to lose 14 years of major activity and 9 years of life due to the high rate of suicide (Miller, 2006).

People with bipolar disorder type I are symptomatic 50% of the time, with depressive symptoms occurring three times more often than manic (Miller 2006).  Several studies have shown that there is a strong heredity factor for bipolar, children who have parents with bipolar are more likely to develop bipolar themselves (Miller 2006)(Hinshaw, 2010).  “Children with a parent or sibling who has bipolar disorder are four to six times  more likely to develop the illness compared  with children who do not have a family history of bipolar disorder (National Institute of Mental Health, 2011).

Treatments

Mood stabilizing drugs are the first choice for bipolar treatment, with the exception of lithium these drugs are anticonvulsant.  Anticonvulsant are normally used to treat seizures, but also work as a mood stabilizer.  One serious side effect of the anticonvulsant is increase of suicidal thoughts and behaviors.  Lithium was approved in the 70s as a mood stabilizing drug to help curb the effects of mania.  Valproic acid or divalproex sodium is also used in place of lithium for treating manic states of bipolar (National Institute of Mental Health, 2011).  Anti-depressants are used in conjunction with the stabilizers to help balance out the patient.

Lithium and mood stabilizers to control the manic periods and anti-depressants for the depressive states (Comer 2009).  Lithium for controlling the manic phase has a 60% success rate and patients have have fewer episodes as long as they stay on the medication;  most patients find it has a calming effect on them during their manic stages (Comer 2009).  Some patients with bipolar think that they are more productive during their manic phase and find the mood stabilizers as a means of bringing them down, resulting in them skipping their medication routine.   Lack of dedication to a medication routine will inhibit stabilizing the patients moods.  While the use of lithium is controversial in some circles, there have been various studies showing patients obtain positive effects while taking lithium.  Additionally,  several studies show that lithium reduces the high suicide rate associated with mode disorders (Grandjean & Aubry, 2009)

Historical and Cultural Contexts

Early on bipolar was a condition that was diagnosed but not understood what was the root cause.  Hippocrates around the 4th and 5th centuries BC, attributed bipolar to the imbalances of the 4 humours, yellow bile, black bile, blood and phlegm (emental-health.com, 2011).  Mania was caused by an excess of yellow bile and the depressive state was caused by the excess of black bile (emental-health.com, 2011).  Aretaeus of Cappadocia in the 2nd century AD postulated the the mania state was cyclic end of the depressive state, naming this this aliment cyclothymia, the alternation of states from manic to depressive (emental-health.com, 2011).  In the middle ages the church’s position on mental illness was a punishment of God or the person was inflicted with. The church offer exorcism and prayer as a remedy(emental-health.com, 2011).  Moving forward through history we find that in the 1950s the ideas on mental illness split between America and Europe, America followed the findings of Adolf Meyer.  Meyer believed mental illness was a combination of biological, psychological and environment (emental-health.com, 2011).

It is estimated that bipolar effects one percent of the worldwide population, however there is not sufficient data to support this finding (Phillips, 2005).  The United States and United Kingdom have the most data on this disorder, with the UK showing that a higher number of minorities are bipolar, but no reason why this occurs; while the United States’ data shows that bipolar affects all ethnic groups at approximately the same rate (Phillips, 2005).

Prognosis

People with bipolar disorder can still lead fully functional long lives.  The administration of a proper drug regiment along with psychotherapy can bring balance to a person with bipolar and even out the mood swings.  There is not short term fix for this disorder, individuals must understand that current bipolar treatments are for a lifetime.  Following proper care under a physician this disorder is very manageable and allows the person to live a quite normal life.

Drugs for bipolar are not exact, there is a trial and error period when trying new drugs for this disorder.  A doctor will prescribe a new drug and normally conduct a feedback session in a couple of weeks.  While this method might work for drug adjustments, initial patients should be seen in a followup session as soon as the drug is at a level in the body that can cause a change.  Because some of the side effects of the drugs for bipolar can cause suicidal thoughts and attempts, doctors need to closely monitor their new patients or when prescribing a new drug.

Some cases of bipolar could require hospital stays during the apexes of the mood spectrums, severe depression or erratic manic behavior could require the person be hospitalized to control the symptoms or for their protection if they become self destructive.

One aspect not often covered in the information on bipolar disorders is the effects on the family members.  Family members will be become care givers, ensuring that medications are taken, and life routines are set up and followed.  Family members can be subjected to mood swings and erratic behavior while the person has stopped taking the medications.  Family members half to cope with side effects of medicines prescribed for this disorder, deeper depression, suicidal thoughts,  and attempts of suicide to name a few.  Care providers should offer information and counseling services for family members if needed.

References:

Comer, R.J. (2009).  Abnormal Psychology. New York, NY: Worth Pub.

emental-health.com, . (2011, Jan 01). History of bipolar disorder. Retrieved from http://www.emental-health.com/bipo_history.htm

Grandjean, E.M., & Aubry, J.M. (2009). Lithium: updated human knowledge using an evidence…[CNS Drugs. 2009] – PubMed result. CNS Drugs, 23(3), 225-40.  Retrieved from http://www.ncbi.nlm.gov/pubmed/19320531

Hinshaw, S.P. (Writer). (2010). Origins of the Human Mind [DVD]. Available from www.TheTeachingCompany.com

Miller, K. (2006). Bipolar disorder: Etiology, diagnosis, and management. Journal of the American Academy of Nurse Practitioners, 18(8), 368-373. doi:10.111/j.1745-7599.2006.00148.x.

Morrison, J. (1995). DSM-IV made easy: the clinician. New York, NY: The Guilford Press.

National Institute of Mental Health, NIMH. (2011, Feb 10). Bipolar disorder. Retrieved from http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

Phillips, J. (2005, June 01). Tracking down the footprints of bipolar disorder. Retrieved from http://www.csa.com/discoveryguides/bipolar/overview.php

 

 

 

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