Title : A Bipolar Disorder Lesson through a Bipolar Patient's Point-Of-View
When acquiring knowledge the idea is usually best to define terms either before or as they are being used. Let us begin by defining:
Bipolar (Affective) Disorder (manic-depression): a "mental disorder" exhibiting oscillating periods of elation as well as "clinical depression." the idea is usually essentially a psychiatric diagnosis of elevated as well as depressive cognition, moods, behaviors as well as energy levels. The clinical term for the elated moods is usually "mania". A gentler form is usually "hypomania." Afterwards, bipolar individuals usually manifest either depressive symptoms or a "mixed state" in which features of both highs as well as lows are simultaneously present. These up-as well as-down events quickly slide through "average" mood zones enjoyed by the general population. For some folks,"rapid-cycling" between up-as well as-down mood levels occurs. Fierce manic episodes can exhibit delusions, psychosis as well as hallucinations. The bipolar mood range, in increasing levels of manic severity, are termed cyclothymia, hypomania (bipolar-II) as well as mania (bipolar-I). Descending levels of clinical depression are cyclothymia, depression (bipolar-II) as well as clinical depression (bipolar-I). Clinical depression alone is usually termed "unipolar." [abridged-paraphrased Wikipedia "Bipolar Disorder" entry]
The bipolar continuum (spectrum) is usually best illustrated verbally as follows:
MANIA (BIPOLAR-I)
HYPOMANIA (BIPOLAR-II)
CYCLOTHYMIA (HIGH)
AVERAGE MOOD HIGH
AVERAGE MOOD
AVERAGE MOOD LOW
CYCLOTHYMIA (LOW)
DYSTHYMIA (BIPOLAR II)
CLINICAL DEPRESSION (BIPOLAR I)
Patient moods are continuously variable as they ascend as well as descend This specific bi-directional spectrum, prompting Johns Hopkins leading Professor of Psychiatry, Dr. Kay Redfield Jamison as well as Bipolar I patient, to call bipolar disorder "This specific quicksilver illness."
"Average Mood" is usually just another day at the office as well as at home with no cause for either sadness or celebration.
"Average Mood High" might be a time when you marry, birth a baby, earn a raise or win the lottery.
"Average Mood Low" could range through the loss of a favorite pet to the passing of a family member.
"Cyclothymia High" might be a time of extra energy as well as focus as well as general exuberance without drug use.
"Cyclothymia Low" can be a habit of extra sleepfulness or sleeplessness as well as a gloomy outlook.
"Hypomania" is usually a period of excess energy, high productivity, many achievements as well as goal-orientation.
"Dysthymia" is usually sluggishness, loss of normal interests, negativity as well as general malaise.
"Mania" is usually a time of grandiosity, rapid as well as pressured speech as well as frightening, erratic behaviors.
"Clinical or Major Bipolar Depression" is usually a total loss of interests as well as desire, often featuring suicidality
Here are a few American statistics:
- Women suffer major depression twice as much as men
- 0% of all suicides result through clinical depression
- Men as well as women suffer manic-depression equally
- 1 of 3 bipolar individuals will either attempt or complete the act of suicide
You have likely seen more than enough lists of manic as well as depressive visible behaviors, although the idea is usually important to adhere to those listed from the "Psychiatrist's Bible," DSM-IV (Diagnostic as well as Statistical Manual of Mental Disorders). The DSM-5 will be published in May 2013. the idea is usually through these basic definitions in which we can build a discussion as well as understand what is usually to follow. Here are the essential "Diagnostic Criteria for Manic Episode:"
- Abnormally, persistently elevated, expansive, or irritable mood
- Inflated self-esteem or grandiosity [w/uninhibited, skewed volition]
- Decreased need for sleep, e.g., feeling rested after only 3 hours of sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience in which thoughts are racing
- Distractibility, i.e., attention too easily drawn to unimportant or irrelevant external stimuli
- Increase in goal-directed activity (either socially, at work, at school or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities in which have a high potential for painful consequences, e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments
- Mood disturbance sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others
- [Giving away money or cherished or valuable possessions]
I have included This specific last, bracketed symptom, as in which has been my own personal experience during my bipolar I episodes as well as also in which of many of my co-patients as well as manic-depressive friends. Although This specific frightening list is usually not intended for use by "armchair psychiatrists," the idea is usually useful for spotting as well as obtaining professional help for a mood-challenged friend or family member. Mania reminds me of the metamorphosis in which produces the "Incredible Hulk." My bipolar-I episodes always involve an obsession-either "seeking true love" or "starting my own high-tech energy company." Oh, the wonders of manic grandiosity!
Well, DSM-IV has been kind enough to help us understand what bipolar mania is usually. Here the idea does likewise for clinical depression from the form of "Diagnostic Criteria for Major Depressive Episode":
- Depressed mood (can be irritable mood in children as well as adolescents) most of the day, nearly every day, as indicated either by subjective account or observation by others
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observations by others of apathy most of the time
- Significant weight loss or weight gain when not dieting (e.g., more than 5% of Centeng weight in a month), or decrease or increase in appetite nearly every day (in children, consider failure to make expected weight gains)
- Insomnia or hypersomnia almost every day
- Psychomotor agitation or retardation nearly every day (observable by by others, not merely subjective feelings of restlessness or being slowed down
- Fatigue or loss of energy almost every day
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide
- [Vegetative, catatonic; retarded or loss of motor skills; unable to commit the act of suicide]
Again, This specific last, bracketed listing is usually based on my personal experience as well as in which of many of my co-patients as well as manic-depressive friends. When taken together, all of these up-as well as-down states are can be peppered with psychosis, hallucinations as well as delusions, generating a psychiatrist's diagnosis in which much more difficult to make. Bipolar diagnoses are primarily made by psychiatrists (64%), psychologists (18%), as well as general practitioners (13%). In suspected cases of mental issues the idea only makes sense to cut to the chase as well as make an appointment having a psychiatrist. This specific specially trained professional is usually best able to treat a mood disorder patient. There are also "mixed episodes" during which an individual will suffer both manic as well as depressive characteristics simultaneously-pure hell. Once correctly diagnosed, the patient as well as doctor will need three years, on average, to sculpt a useful combination of psychotropic (psychiatric) drugs to achieve acceptable patient mood stability, the goal of which is usually to reduce the frequency, duration as well as intensity of episodes. These potent drugs have wicked side-effects as well as must be a carefully selected combination chosen through the several major classes of psych medicines:
- Mood Stabilizers
- Antidepressants
- Antipsychotics
- Anxiolytics
- Anticonvulsants
When the bipolar patient is usually manic, he or she is usually feeling Great as well as is usually unlikely to visit a doctor unless coerced by another individual. in which is usually why psychiatrists often diagnose manic-depressive patients with unipolar (depressive) disorder because the only time he gets to see the patient is usually when he or she is usually feeling bad. the idea is usually fascinating in which nearly 70% of bipolar-disorder sufferers are misdiagnosed an average of 3.5 times before in which correct diagnosis is usually dialed-in. The manic individual is usually on a "high" as well as feels wonderful-there is usually "no need" for a doctor.
Because bipolar or depressive disorders involve relative amounts of neurotransmitters (serotonin, dopamine, norepinephrine) from the brain's limbic system (in which portion of the brain responsible for emotion, behavior, motivation as well as long-term memory), a paucity of them results in depression as well as a surplus of them results in mania. Neurotransmitters are what transmit electrical signals between nerve endings, as well as, in This specific case, those of the neurons found from the brain. Unfortunately, there are no physical tests, no "dipsticks," blood tests, imaging, invasive or non-invasive medical techniques for determining the relative levels of these biochemicals. Bipolar disorder is usually every bit a physical disease as are diabetes, cancer as well as heart disease. Here are the ways psychiatrists must achieve their diagnoses for their mood patients:
- Questioning the patient
- Questioning family, significant others
- Establishing a patient history
- Behavioral observation
- Reading Centeng language
- Evaluating speech characteristics
- Combining the results of these presentations with knowledge as well as experience
Although bipolar disease can strike anyone at anytime, the idea usually can be traced to either a genetic component or a crippling physical, mental, or emotional stressor like child abuse or PTSD (Post Traumatic Stress Disorder) in which produces tremendous amounts of anxiety as well as stress. On the genetic side, children having a sibling or parent with manic-depression have up to six times the likelihood of inheriting the disorder. some other predispositions as well as correlations for having bipolar disorder are having a Germanic heritage, a high IQ, or being an artist or scientist. Musicians, composers, poets, painters, philosophers, photographers, comedians, TV personalities, sculptors, etc., have an elevated risk of being bipolar when compared with the general population. My casual study of 277 famous persons revealed 84% were in those fields as well as suffer(ed) mood disorders. I can identify at least several triggers in which launch bipolar episodes:
- Stressors (including major life events); physical, mental as well as emotional
- Substance abuse
- Sleep deprivation as well as severe circadian rhythm disruption
- Seasonal change
- Medicinal side-effects
When the idea comes to religion, much of Christendom judges those having mental disorders as being sinful, shameful, lacking faith, weak, self-centered, selfish, storytellers, guilty or demon-possessed. Or "in which is usually just an excuse, you are trying to get attention." These judgments result in private upbraiding, public ridicule, shunning or excommunication. The affected person's beliefs fail when his mind fails. some other significant world religions either quarantine or eradicate mentally persons (defectives) by using any means possible, including homicide. the idea is usually interesting to note the statistical incidence of people's mood disorders is usually unaffected by any particular religious belief or affiliation.
Depression is usually the number three reason for doctor visits in America today as well as the class of psychiatric drugs prescribed is usually second only to analgesics (painkillers). the idea has historically taken an average of four doctors as well as ten years to correctly diagnose a case of bipolar disorder. Even today only 49% of those with manic-depression receive treatment. Most of the remainder, unaware of their disease, will unwittingly self-medicate with "feel-Great" drugs, food, alcohol as well as wanton (hyper) sex. Denial can be a mental patient's best friend. Bipolar disorder is usually very much like a "mood roller-coaster," with rapid ascents into mania, yet slower descents into suicidal depression stemming through a loss of confidence, identity as well as neurotransmitter imbalances. Our thoughts race at disturbing speeds while manic. When depressed we feel envious of anyone who is usually not in our place. We must train others to understand us as well as help us no matter how impossible in which seems. as well as we must live "from the moment" every day. Our only real duty is usually to avoid mood swings in which steal our reason as well as cause the loss of desire in which constitutes our desire for death.
Fortunately, these numbers are gradually trending better due to higher levels of awareness as well as today's many campaigns against stigma as well as discrimination targeting the mentally ill. Stigma of the disorder is usually fueled by the common media characterization of bipolar individuals as being crazed homicidal maniacs having murderous/suicidal intent. Stigma means "disapproval as well as disgrace." the idea alienates its victims, creates undeserved prejudice against them, as well as produces a societal shame in which delivers a powerful blow to those already suffering a horrific mental disease. Stigma is usually every bit as inappropriate for the mental patient as the idea might be for the heart or cancer patient!The sufferer considers herself a public "killjoy," as well as hides the idea as best she can. She as well as others like her often cannot summon the self-esteem as well as confidence to share their emotional battles. Every societal aberrance appears to have its own equal as well as opposite form using the word "phobia." Should those guilty of fear of the mentally ill be branded "psycho-phobes?" the idea has been my experience in which, like "mean" drunks as well as "happy" drunks, there are both "mean" as well as "happy" individuals who suffer episodes of bipolar disorder. The "mean" as well as violent ones are only those who abuse drugs as well as alcohol. After all, violent persons aren't born, they're made.
Bipolar individuals, on average, will suffer 8 to 10 episodes over their lifetimes. the idea is usually living hell on earth without a cure. the idea can only be managed. The impact on society includes these facts:
- Manic-depression is usually nearly the 2nd-highest reason for federal disability awards
- Unemployment for mood disorder sufferers is usually 50% higher than the U.S. average
- Bipolar patient lifespans are 9.2 years shorter than the nominal U.S. age of 78 years
Because drug therapy often requires 2-3 weeks to begin exhibiting a therapeutic effect, hospitalization may be indicated for the patient's safety during a mood disorder episode. Sadly, "completely new as well as improved upon" healthy patient outlooks, beliefs as well as budding improved upon behavioral habits, when compared with previous behaviors, can actually spook family as well as friends as well as cause a separation of ways. Co-dependencies vanish. Outpatient counseling is usually often required to either prevent This specific ordeal or deal with its aftermath. A completely new setting may be a big boon to the psychiatric patient. Whether manic or depressed, the individual's feelings must be moderated-restored to a stable range. Julie A. Fast has described a "centered" bipolar's life as being possible, wonderful, having fun as well as enjoying one's talents. I have also found these aspects of stability to be true as well as have reached my treasured state of serenity..
For me, clinical depression, a crafty adversary, produces the worst suffering. Its simplest definition is usually "anger turned inward." A depressed patient must find a non-injurious, non-damaging way to vent those demons of anger to slam the brakes on a dangerously deepening depression.
Imagine awaking after being buried 6 feet under, the utter hopelessness of your shouts going unheard, unable to roll over in your coffin, claustrophobic. Clinical depression's hopelessness is usually worse! Suicide easily becomes a viable, attractive option. from the words of Marybeth Smith, "... I just want to end the pain." The wild mood swings of bipolar disorder in a sufferer have nothing to do with volition, choices or will. With depression, one may unknowingly begin to sink into the abyss of hopelessness.
"You can always think your way into a depression although cannot always think your way out [of one]." - Dr. Lewis Britton
At in which point the only option is usually either drug therapy or ECT. Because psychiatric treatment usually involves only 15-minute "meds checks," a patient must request a referral for a psychologist who can provide the "talk therapy" needed for the patient to work out thinking, behaviors, lifestyle as well as myriad some other issues. Patients must be ascertain whether or not their psychiatrists as well as psychologists will communicate with one another to create a holistic continuum of care. The patient must learn habits of living including eating, exercise as well as sleeping habits. Mood disorder behaviors are non-volitional as well as re-learning healthy physical, mental as well as emotional habits is usually a must for preventing further mental mayhem. Friends as well as family can neither sympathize nor empathize, never having "been there."
Serenity is usually my ultimate mental health goal. I have nearly achieved the idea by eliminating nearly most stressors in my life as well as the idea feels great. No problem distracts or bothers me anymore, most likely due to having already survived the worst in which can happen to me at both extremes of bipolar mania as well as depression. In addition to Psychiatric as well as Psychological help are voluntary support groups, both physical as well as online. Internet forums as well as communities, if their members stay on-track, can be quite helpful for depressed as well as manic-depressive folks as episodes, doctors, medications as well as the like are hashed over as well as common ground is usually established for self-revelation, sharing as well as caring.
I am often asked whether there is usually 1) a greater number of mentally ill persons today, 2) if the bar is usually being lowered by the Psychiatric community to drum up more patients, or 3) whether there have always been so many of us from the past who were misunderstood, misdiagnosed or ignored. I am inclined to say in which the idea is usually an amalgam of all three at the risk of sounding simplistic or "politically correct." I say This specific because I believe all three propositions can easily be tied to the increasingly rapid advance of technology's increasing impact on mankind over the decades. although I'm certainly open for any suggestions to the contrary.
In conclusion, "manic-depression" remains a "hot-button" topic today among health professionals, the media, patients as well as a confused public. Well-meaning websites as well as blogs litter the internet with both accurate as well as erroneous content as well as advice, as well as these venues must be fact-checked as well as negotiated with care. Although not up to academic standards, a Wikipedia search of "bipolar disorder" is usually probably the most handy as well as accurate source for the average inquisitor. Having read the idea myself, This specific mental patient recommends the idea for all concerned.
Source : A Bipolar Disorder Lesson through a Bipolar Patient's Point-Of-View by Jeff C. Baker
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