Bipolar Disorder: A Literature Review
Grace LeeBipolar disorder, also known as manic-depressive disorder, causes severe mood swings from extreme depression to a false sense of euphoria. There are two forms of bipolar disorder: bipolar I disorder and bipolar II disorder. Bipolar I disorder is the most severe case. It affects about 3% of the United States’ population, however, that is only the cases that have been diagnosed. Patients with bipolar disorder are at a high risk for suicide and self-harm, due to the depression they suffer at the lows of their mood swings. Bipolar disorder affects patients’ lives dramatically, decreasing their quality of life and causing tensions on personal relationships. Although there has not been a cure for bipolar disorder, symptoms are maintained with a combination of medication and therapy. In order to help the millions of people with this illness, treatment plans should be personalized according to each specific case.
The most important part of treatment for bipolar disorder is the medication used to minimize the symptoms. Three of the studies show how the guidelines for treatment were created as well as how effective the guidelines are. The Canadian Network for Mood and Anxiety Treatments and the Japanese Society of Mood Disorders both released a treatment guideline for bipolar disorder. The CNMAT study says that oral therapy should be considered first, although intramuscular injections are an alternative. The first line of treatment contains lithium, lamotrigine, quetiapine, quetiapine XR or combination therapy consisting of lithium or divalproex and SSRI, olanzapine and SSRI, lithium and divalproex, lithium or divalproex bupropion. The second line of treatment, if medication from the first line proves ineffective, contains divalproex and lurasidon or combination therapy of quetiapine and SSRI, adjunctive modafinil, lithium or divalproex and lamotrigin, lithiumor divalproex and lurasidone. The third line of medication, only to be used if the first and second line proves ineffective, contains carbamazepine, olanzapine or combination therapy: lithium and arbamazepine, lithium and pramipexole, lithium or divalproex and venlafaxine, lithium and MAOI, lithium or divalproex or AAP and TCA, lithium or divalproex or carbamazepine and SSRI and lamotrigine, quetiapine and lamotrigine. In terms of intramuscular injections, olanzapine, ziprasidone, and aripoprazole, or a combination of intramuscular haloperidole and benzodiazepine could be used.
In order to test effectiveness of medication, a study of 113 subjects was conducted. First, the subjects went through The Structured Clinical Interview to assess diagnosis. Participants in the study were told to continue their prescriptions, which followed previous treatment guidelines in terms of medication and dosage. Then the proportions of subjects taking at least one of the psychotropics at any dosage and nature of the mood episodes they went through were compared. Data shows that most of the subjects were prescribed antidepressants, followed by neuroleptics, anticonvulsants, lithium, and anxiolytics benzodiazepines. Of the two top types of medication, 72.2% of bipolar I disorder patients taking antidepressants suffered from depressive mood episodes. 42.9% suffered from hypomanic, and 14.3% suffered from euthymia. 61.6% of patients taking neuroleptics suffered from depression. 42.9% suffered from hypomania, and 57.1% suffered from euthymia. One treatment plan may work for one patient, but most likely will not work for another. All bipolar disorder patients suffer from different types of mood episodes and react to medication differently; therefore, treatment plans should be specific and personalized for each patient.
In addition to medication, patients and family members should attend regular therapy sessions to further help maintain bipolar disorder symptoms. Similar to medication, there are many different type of therapies available for patients of bipolar disorder, and it is important to find which one is most effective for the patient. CNMAT determined that psychosocial interventions such as group psychoeducation, cognitive behavior therapy, and interpersonal and social rhythm therapy are useful in the treatment of bipolar disorder. In a study conducted by Peay, Rosentein, and Biesecker, they evaluated the importance and effectiveness of genetic counseling for patients with bipolar disorder that were parents. Genetic counseling proved significantly helpful as patients that are also parents deal with a different kind of stress compared to other patients. Genetic counseling dealt with the stress a parent with a genetic illness has concerning passing their illness to their children. In addition, genetic counseling promotes active coping with their condition and manage worry about perceived risk to their children. This therapy would be especially helpful for families with children in order to help relationships and possibly identify a child with a mood disorder earlier.
Another kind of therapy that studies have showed to be effective is cognitive reappraisal. Cognitive reappraisal consists of revisiting emotions that a patient with bipolar disorder felt and reacted to and determining why the patient felt that certain emotion and how they can react better next time they feel it. During the study, 23 participants with bipolar disorder and 23 participants that acted as a control group were tested for manic symptoms using the Young Mania Rating Scale. The Young Mania Rating Scale is a clinician-rated measure of current manic symptoms with scores raging from 0 to 60. Depressive symptoms were assessed using the Clinician-Rated Inventory of Depressive Symptoms. Participants were first shown two happy, two sad, and two neutral films without any instruction beforehand. Psychological responses were collected using the skin conductance response and respiratory sinus arrhythmia. After, participants were instructed to think about cognitive reappraisal while watching the films in order to reduce emotional intensity. Participants were then shown another set of happy, sad, and neutral films. Data showed that emotional reactivity and intensity were significantly decreased in both patients with bipolar disorder and the control group.
While patients with bipolar disorder may feel hopeless, as there is no exact “cure,” patients need to keep in mind the vast options to maintain the symptoms. If one treatment plan does not work, there are a hundred other options available to try. However, this can prove exhausting; therefore, more research should be conducted for the types of bipolar disorder as well as the manic episodes associated with it. If the types of manic episodes can categorize bipolar disorder, perhaps treatment can be more effective for patients who have been through multiple routes for maintenance. Most importantly, patients need to keep a positive and open mindset for treatment, not only for themselves, but also for their loved ones. As the millions of people in the United States can testify, beating a mental illness is a tough battle, but worth every step.
Works Cited
1) Gruber, June, Aleena C. Hay, and James J. Gross. “Rethinking Emotion:Cognitive Reappraisal Is an Effective Positive and Negative Emotion Regulation Strategy in Bipolar Disorder.” Emotion (2013): n. pag. PsycINFO Database with Full Text. Web. 3 Sept. 2014.
2) Joshi, Gagan, Carter Petty, Janet Wozniak, Stephen V. Faraone, Andrea E. Spencer, K. Yvonne Woodworth, Rachel Shelley-Abrahamson, Hannah Mckillop, Stephannie L. Furtak, and Joseph Biederman. “A Prospective Open-label Trial of Paliperidone Monotherapy for the Treatment of Bipolar Spectrum Disorders in Children and Adolescents.” Psychopharmacology 227.3 (2013): 449-58. PsycINFO Database with Full Text. Web. 10 Sept. 2014.
3) Kanba, Shigenobu, Tadafumi Kato, Takeshi Terao, and Kazuo Yamada. “Guideline for Treatment of Bipolar Disorder by the Japanese Society of Mood Disorders, 2012.” Psychiatry and Clinical Neurosciences 67.5 (2013): 285-300. PsycINFO Database with Full Text. Web. 10 Sept. 2014.
4) Paterniti, Sabrina, and Jean-Claude Bisserbe. “Pharmacotherapy for Bipolar Disorder and Concordance with Treatment Guidelines: Survey of a General Population Sample Referred to a Tertiary Care Service.” BMC Psychiatry 13.1 (2013): 211. PsycINFO Database with Full Text. Web. 10 Sept. 2014.
5) Peay, Holly L., Donald L. Rosenstein, and Barbara B. Biesecker. “Adaptation to Bipolar Disorder and Perceived Risk to Children: A Survey of Parents with Bipolar Disorder.” BMC Psychiatry 13.1 (2013): 327. PsycINFO Database with Full Text. Web. 3 Sept. 2014.
6) Yatham, Lakshmi N., Sidney H. Kennedy, Sagar V. Parikh, Ayal Schaffer, Serge Beaulieu, Martin Alda, Claire O’Donovan, Glenda Macqueen, Roger S. Mcintyre, Verinder Sharma, Arun Ravindran, L. Trevor Young, Roumen Milev, David J. Bond, Benicio N. Frey, Benjamin I. Goldstein, Beny Lafer, Boris Birmaher, Kyooseob Ha, Willem A. Nolen, and Michael Berk. “Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) Collaborative Update of CANMAT Guidelines for the Management of Patients with Bipolar Disorder: Update 2013.” Bipolar Disorders 15.1 (2013): 1-44. PsycINFO Database with Full Text. Web. 10 Sept. 2014.