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The Specter of Bipolar Disorder

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Definition to Bipolar Disorder

Bipolar disorder is a widespread, severe but curable frustration of mood. The term is new, as the disorder was called “maniac-depressive psychosis” before. Bipolar disorder is a chronic recurrent mood frustration, revealed with the alternation of the raised (mania) and lowered (depression) mood episodes. The consequences of the disease include considerable financial expenses for health care and society in general. In addition, it relates to such issues as criminalization, destruction of financial stability, family relations, deterioration of health and quality of life of patients and their relatives. The National Alliance on Mental Illness (2008) gives the following definition to bipolar disorder:

Bipolar disorder, also known as manic depression, is a common psychiatric disorder that includes periods of extremely elevated mood. Most people with bipolar disorder also experience periods of depression and periods of full or partial recovery. The cycles of high and low mood states and well periods may follow an irregular pattern (NAMI, 2008, p. 1).

The disorder is connected to the increased risk of suicide (10-15%). The frequency of suicides reaches 25 – 50%, especially at the mixed, psychotic and depressive episodes (Cavazzoni, Grof & Duffy, 2007, p. 377). The timely identification and the qualified treatment of patients with bipolar disorder can prevent their premature mortality and prolong life. The given research paper will cover the whole specter of bipolar disorder, including etiology and pathogenesis, symptoms, diagnostics, treatment and social consequences of the disease.

Etiology and Pathogenesis of Bipolar Disorder

The etiology of bipolar disorder is not clear. The significant role in disease development is assigned to heredity. The genetic researches indicate the communication of such disorder with several genes, which are allegedly located in 18 and 4 chromosomes. Except the hereditary causes, the development of the disorder is explained by autointoxication (disorders of endocrine balance, water and electrolytic exchange). The stressful situations can start an episode of mania or depression among people vulnerable to disorder. At the same time, a stress is not the only cause of it.

The first episode most often arises at the young age – 20-30 years. However, the cases of the disorder emergence are not excluded at any age starting from childhood up to senior age. The subsequent episodes arise periodically, in the form of phases, directly or through “light” intervals. The frequency of episodes and the nature of remissions and aggravations are various. The disorder can be revealed only in maniacal, hypomaniacal or depressive phases or in their change with correct or wrong alternation. Remissions are, as a rule, shortened with age and depressions become more often and longer in the middle age.

Maniacal episodes usually begin suddenly and last from 2 weeks to 4-5 months (the average duration of an episode composes 4 months). Depressions tend to last longer (average duration – approximately 6 months), though there is also a duration more than a year (except the patients of senior age). All the episodes often follow the stressful situations or mental injuries, though their existence is not obligatory for the disorder diagnostics. The duration of the phases fluctuates from several weeks to 1.5-2 years (on average 3-7 months), duration of “light” intervals (intermediary phases) between phases can take from 3 to 7 years. Anyway, the “light” intervals may be absolutely absent (Cavazzoni, Grof & Duffy, 2007, p. 383).

Symptoms of Bipolar Disorder

There are three severity levels of bipolar disorder: mild – hypomania; moderate – mania without psychotic symptoms; severe – mania with psychotic symptoms. In mild cases (hypomania – F31.0) there is a small raise of mood, hyperactivity and vigor, feeling of well-being and physical and mental efficiency within several days. There are such symptoms as an increased social activity, talkativeness, excessive familiarity, hyper sexuality, a reduced need for a dream and absent-mindedness. Sometimes, instead of the increased mood irritability, a rough behavior and hostility can take place. For the true diagnosis, at least 2 out of 3 symptoms described above should be revealed. Any of the specified symptoms should not reach a deep degree and the minimum duration of the whole episode is approximately 2 weeks (NAMI, 2008, p.3).

For the moderate mania (mania without psychotic symptoms – F31.1), the considerable elation of mood, the expressed hyperactivity and a speech pressure, persistent sleeplessness are characteristic. Moreover, the euphoric mood interrupts the periods of irritability, aggression and depression and the patient states the ideas of greatness. At some episodes of mania a patient can be aggressive or irritable and suspicious. Such state can last at least for a week and lead to the full violation of a working capacity and social activity.

In severe cases (mania with psychotic symptoms – F31.2) there is an uncontrollable psychomotor excitement, which can be followed by aggression and violence. The raised self-assessment and ideas of greatness can develop into nonsense, and irritability and suspiciousness into the nonsense of prosecution. The acoustical or olfactory hallucinations, voices of the accusing and offending character, smells of the decaying meat or dirt are also observed. A heavy motor blockage can develop into a stupor (APA, 2010, p. 9).

Diagnostics of Bipolar Disorder

In most cases, the bipolar disorder has the early beginning (to 25 years) and patients experience chronic recidivism frustration during the most part of the lives. Many patients remain not diagnosed with the disorder for a long time. More than 60% of patients do not receive treatment or it does not correspond to the diagnosis or is simply ineffective.

The diagnosis “bipolar disorder” replaced maniacal psychosis in the American classification of DSM-III in 1980. In 1994, the diagnosis of bipolar disorder appeared in the approved ICD-10 by the WHO. Bipolar disorder (F31) is included into the F3 heading “Mood Frustrations”. An episode of mood frustration represents the state, in which the mood violations are expressed in a certain degree in a certain time: 2 weeks – for depression, 1 week – for mania. A bipolar disorder includes hypomaniacal, maniacal or mixed episodes of any degree of expressiveness. The Young Mania Rating Scale (YMRS) is applied for the determination of the severity of mania (Cavazzoni, Grof & Duffy, 2007, p. 382).

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The diagnostics of the disorder is based on the identification of the repeated episodes of mood changes and level of motor activity. The diagnostics helps observe the episode of affective frustration, for example, hypomaniacal, maniacal without or with psychotic frustration, a moderate or mild depression, a severe depression with psychosis or without it. If the disorder is not observed, the diagnosis of remission, often connected with preventive therapy, is specified. Bipolar disorder is differentiated more often with schizoaffective disorder. However, the other types of mental disorders, like neurosises, infectious, psychogenic, toxic, traumatic psychoses, mental retardation and psychopathy are not excluded.


When a patient or his relatives find the symptoms of a bipolar disorder, they should immediately visit a doctor. The life with the patient suffering from a bipolar disorder can lead to many problems, such as the problems in career and relationship in society, and damage to health. Timely diagnosing and treatment can help avoid such consequences.

Alongside with medicamentous treatment, a bipolar disorder requires a constant psychotherapy, which is often called “communication therapy”. During the therapy people can discuss own feelings, ideas and behavior, which cause difficulties. The communication therapy can help understand and avoid problems. It can allow a person to prolong a medicamentous treatment and will help master the manifestations of bipolar disorder. There are the following types of psychotherapy, by means of which it is possible to overcome the disorder:

  • Cognitive therapy. Such approach means that the patient is obliged to learn to predetermine and change the mentality followed by the change of mood;
  • Behavioral therapy. Throughout the therapy there are behavioral models, which allow to avoid stress;
  • Therapy of a public rhythm. It allows to choose and handle daily routine (APA, 2010, p. 15).

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There are three main stages in the therapy of a bipolar disorder; they require various treatment:

  1. The stopping therapy – the elimination of manifestations of an acute severe state – mania, depression or a mixed episode to achievement of a normal mood.
  2. Stabilization of a state (the continuation of the therapy to the expected termination of an episode: average duration at depression and the mixed episode takes 6-9 months, at mania – 3-5 months).
  3. Supporting (preventive, anti-recurrent) therapy is carried out on an out-patient basis to the remissions of frustration and is aimed at prevention of its aggravation development (Cavazzoni, Grof & Duffy, 2007, p. 385).

Additionally, there is a treatment of depressions, manias and preventive therapy of attacks. The features of the therapy are defined by the depth of affective disorders and existence of the other productive symptoms. Antidepressants, electroconvulsive therapy, treatment by the deprivation of sleep and disinhibition by nitrous oxide are often used at depressive episodes. However, it is necessary to consider the risk of the inversion phase, which is transition of a patient from a depression to the maniacal state that can worsen the condition of the patient and lead to suicide.

The medicamentous treatment of bipolar disorder is subdivided into several groups:

  1. Mood stabilizers – lithium carbonate, valproate, carbamazepine, lamotrigine for all acute states and preventive therapy;
  2. Traditional (typical) neuroleptics – for manias, psychotic symptoms and agitation.
  3. Atypical neuroleptics – for any forms of manias and depressions without and with psychotic symptoms. It is a part of preventive therapy;
  4. Antidepressants prescribed at a bipolar disorder, such as the selective serotonin reuptake inhibitors (SSRIs), selective noradrenaline and serotonin reuptake inhibitors (SNSRIs), reciprocal inhibitors of monoamine oxidase, heterocyclic, benzodiazepine tranquilizers – diazepam, lorazepam, clonazepam (NAMI, 2008, p.21).

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Social Consequences of Bipolar Disorder

The harm to society from bipolar disorder is comparable to the consequences of depressions as the patients are not adapted to the professional, social and family life and have the increased risk of committing suicide. By the calculations of the APA (2012), bipolar disorder takes the 6th place among the reasons of disability. Unemployment among such patients can reach 57% within the first 6 months and 75% after 2 years of illness. The consequences of bipolar disorder include frequent changes of work, moves, divorces, bankruptcies, hyper sexuality and a high risk of sexually transmitted infections (APA, 2010, p. 18).

Bipolar disorder has the highest risk of suicides. Moreover, it can be accompanied by such somatic diseases as obesity, arterial hypertension, hyperlipidemia, diabetes, pathology of bone and articulate system, chronic obstructive pulmonary diseases. A high frequency of the accompanying somatic pathology also leads to the deterioration of the patients’ lives and a considerable reduction of their duration. The patients with bipolar disorder lose on average 9 years of life expectancy during disease, 14 years of working capacity and 12 years of normal health, first of all, due to the suicides and accompanying somatic diseases (APA, 2010, p. 20).


To sum up, the given research paper discussed the essence, symptomatology, diagnostics, treatment and social consequences of bipolar disorder. The modern researches revealed the following significant consequences of hypo diagnostics of bipolar disorder and its non-efficient therapy: the increased mortality caused, first of all, by suicides, disorders in professional, social and family life and problems with health. The pharmacotherapy by mood stabilizers can not only improve the condition of patients, but also overcome the negative consequences of the disorder.

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