Bipolar disorder

Part 2

Bipolar disorder
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Bipolar disorder is a common, chronic, and often severe disorder that is characterized by fluctuations in mood, energy, and behavior. Generally speaking, the disorder tends to present around late adolescence or early adulthood, although the majority (over two thirds) develop symptoms before the age of 18. اضافة اعلان

The main features of bipolar disorder are episodes of depression, mania, or hypomania. Due to the fact that it is a cyclic disorder, an individual will routinely cycle between these features, and may or may not have periods of normal mood, also known as euthymia, between episodes. These fluctuations in mood may also be sporadic. Fluctuations may occur and continue for months, or after one episode, symptoms can disappear for years without any recurrence. Although this condition is incurable and potentially resistant to management, early treatment is important in order to help potentially avoid or manage a host of associated complications.

Cause of bipolar disorder

Our understanding of all mental health conditions is ever evolving, and bipolar disorder is no exception. The current consensus is that bipolar disorder has no singular cause, but is combination of genetic and environmental factors. Many family, twin, and adoption studies have found an increased risk between first-degree relatives with bipolar disorder.

As of current understanding, there is no singular gene responsible to bipolar disorder. In fact, several genetic linkage studies suggest that multiple genes are involved in the heredity of bipolar disorder.

Aside from genetics, abnormalities in the brain may also contribute to bipolar disorder. In terms of structural abnormalities, neuroimaging studies have found many abnormal areas of the brain that are consistent with those who suffer from bipolar disorder, primarily in the amygdala and the prefrontal cortex. Additionally, an imbalance of messengers in the brain, known as neurotransmitters, may also contribute, although the general consensus is that no single neurotransmitter is solely responsible.
The current consensus is that bipolar disorder has no singular cause, but is combination of genetic and environmental factors.
There are also many environmental and lifestyle factors that can cause or contribute to bipolar disorder. This can include extreme stress, traumatic experiences, physical illness and substance abuse.

Substance abuse and bipolar disorder

Substance abuse and bipolar disorder are closely related. The prevalence of substance abuse among those who suffer from bipolar disorder is high. A 1990 study found that over 60 percent of those with bipolar I and almost 50 percent of those with bipolar II have a prior history of substance abuse.

Many studies investigated the relationship and came up with many hypotheses as to whether substance abuse causes bipolar disorder or vice versa. One common hypothesis is that substance abuse is a symptom of bipolar disorder, since mania is one of the defining features of the condition. During manic episodes, an individual will do things in excess, which can include using drugs and alcohol.

Another hypothesis suggests that substance use and abuse is done in an attempt to self-medicate and relieve certain symptoms. There is also a hypothesis that substance abuse causes bipolar disorder. It is thought that the use of certain drugs may structurally alter the brain and cause bipolar; at the least, symptoms of substance abuse can mimic those of bipolar disorder, which may eventually result in the condition.

Finally, it is also believed that bipolar disorder and substance abuse may share a common risk factor, most probably relating to genetics. Although these hypotheses are difficult to test, it is likely that the relationship between bipolar disorder and substance abuse is a combination of all the hypotheses. Regardless, it is undeniable that substance abuse can have a serious negative impact on those diagnosed with bipolar. Substance abuse combined with bipolar disorder makes is more likely for the illness to have an earlier onset, higher rates of relapse, a poorer response to treatment, increased risk of suicide, and more psychiatric hospitalizations.

Suicide and bipolar disorder

Suicide is a serious concern at global level. Internationally, it is estimated that roughly 800,000 to 1 million deaths per year are due to suicide. Of all the psychiatric disorders, numerous studies have found that the bipolar disorder carries the greatest risk of suicide. When compared to the general population, those with bipolar disorder are 30 to 60 times at greater risk of suicide.

Additionally, it is estimated that 33-50 percent of those with bipolar disorder will attempt suicide once in their lifetime and roughly 15-20 percent die as a result of suicide.

Studies conducted on the risk of suicide per gender had mixed results. Some studies found that there is no increased risk in one gender compared to the other. Others found that suicide attempts are higher in women, but men have higher rates of death by suicide. There are many other factors based on bipolar subtype, age, and illness severity, although multiple studies have been inconsistent with one another.

Lifestyle changes

Medication is a must for those who suffer from bipolar disorder, but certain lifestyle changes are also important. If present, the most important lifestyle change is rehabilitation from substance abuse. Despite strict laws in Jordan on substance use, it is still prevalent. In Amman, the Drug Enforcement Administration allows for anonymous self-admittance, with no penalty, and a staff dedicated to rehabilitation.

Proper nutrition is also important. Any essential amino acids, fatty acids, vitamins, and mineral deficiency can exacerbate mood episodes and worsen overall outcome. Additionally, avoiding high stress situations, proper sleep, and regular exercise can also help manage the condition.


Treatment of bipolar disorder is highly variable and depends on its severity, response, and subtype. Although medication will not cure this condition, maintenance management is still important.

Depending on the case, medication will likely be one or a combination of mood stabilizers. These include lithium, anticonvulsants such carbamazepine and valproate products, and second-generation antipsychotics.

To manage certain acute mood episodes, medication such as benzodiazepines and antidepressants may be used. Mood stabilizer medication will need to be strictly adhered to and lifelong. The purpose of mood stabilizers is to help manage and prevent mood fluctuations. The additional medication (benzodiazepines and antidepressants) is only used short term to help manage acute episodes and will be discontinued once stabilized.

Adherence to these medications is important in order to avoid worsening in condition and prevention of complications. Those with bipolar disorder tend to have a poor rate of adherence to their medication. Exact estimates vary from study to study, but it can be estimated that 20-50 percent do not adhere. Ensuring adherence is a complex issue that requires cooperation on multiple fronts. The relationship between the healthcare system and patient is important but many studies have found that patient-centered variables such as family attitudes can impact adherence.

This condition is extremely debilitating and roughly 55-65 percent of those with bipolar I experience some form of functional disability. Additionally, approximately 10-20 percent experience severe impairment in social and occupational functioning. This can place a strain on familial relationships which can, in turn, worsen the individual’s condition.

If a loved one is affected by this condition, it is important to practice patience and pay close attention to their overall condition. Be vigilant about any signs of substance abuse or suicidal ideation, and ensure that the person takes the medication as prescribed and regularly.

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