Mental Illness Paper Bipolar Disorder HCA/240 Week 8 Final Assignment Instructor: Pamela Williams By Marilyn Reeves

History shows that evidence exist that this mental disorder existed as far back as second century A. D. in ancient Turkey. Aretaeus a physician of Cappodociam talked about individuals who experienced depressive and manic episodes at the same time. It took another 1000 years before there was more documentation concerning this disorder. This was found in the writings of a British author named Richard Burton. He expanded on the symptoms seen in individuals in his book, which he named, Anatomy of Melancholia. Modern day depression used to be called melancholia and is what Mr. Burton was referring to when he discussed the signs and symptoms of depression in 1650.His finding are still used in research today. He is also known as the father of depression. Later in the 1850s two French doctors expanded bipolar disorder. They worked independently. Their names were Jean Falret and Jules Baillarger. These two doctors created the first hypothesis and distinguished between circular insanity, which they called folie circulaire, and dual insanity, which they called folie a double forme. This was how they described the difference between full-blown mania without depression and just simple depression alone. In the 1850s this disorder was described as insanity. In todays world we do not use the word insanity inside medical terminology to describe this mental disorder. There are claims that the two doctors work led to the term bipolar disorder. There are some claims that Dr. Jules Farlet coined the term manic depressive psychosis and labeled it as a psychiatric disorder. 25 more years passed and a German psychiatrist presented the concept of manic-depressive insanity. He received a great deal of criticism and it took almost 20 years going into the 1930s for the medical community to completely accept Dr. Krapelins studies and research. Through the 1950s and 1960s The Journal of Nervous and Mental disorders produced a publication that stated manic-depression runs in families and that there is a genetic link between all individuals that are diagnosed with both mood disorders and mental illnesses. The study of genetics, gene

expressions, age of onset diagnosis of mental illness and bipolar disorder, common symptoms throughout patients that had bipolar disorder, gender, and age were all being very deeply researched to make positive distinctions between the two conditions. In the mid 1960s researchers demonstrated that there were differences between bipolar disorders and unipolar depression. Acceptance was gradually beginning to merge that there were different bipolar disorders. In 1979, after a long battle with congress, The National Association of Mental Health was founded. This took place due to the need for further research in mood disorders and mental illness so that they could be understood. The American Psychiatry Association replaced the term manic depressive disorder with bipolar disorder. This is how the disorder appears in the third edition of the DSM IV (Diagnostic and Statistical Manual of Mental Disorders). The DSM V is expected to be published and released in 2013. Centuries ago mental illness was viewed as insanity and there were no treatments available (The History of Bipolar From Centuries Ago Until Present Day, http://www.bipolardisorderliving.com) Bipolar disorder is a longitudinal defined by multiple episodes that may occur years apart. As a result the proper diagnosis requires careful evaluation of both the current symptoms and the patients history. The majority of patients with bipolar disorder initially present during an episode of depression, which can be difficult to distinguish from major depressive disorder if there has not been a known manic or mixed episode in the past ( Roy-Byme P, Post RM, Uhde TW, et al.) Bipolar I comes two know sides of the disease possessing recurring episodes of mania and depression. There can also be mixed episodes, having symptoms of both mania and depression. Below is a list of symptoms.

Depression symptoms (manic depression): 1. feelings of emptiness and sadness, feeling hopeless inside, pessimism 2. lack of energy 3. sleeping more, laying in bed for long periods of time, difficulty concentrating, problems in making decisions and remembering previous conversations and events 4. mood swings, restlessness, loss of interest in activities once enjoyed 5. change in eating habits, weight loss or gained that is unintended 6. chronic pain that there is no apparent reason, 7. suicidal thoughts Full blown mania symptoms (the manic phase) 1. Restlessness, increased energy, excessively high optimistic mood, unusual feelings of euphoria 2. extreme mood swings and irritability or anger 3. racing thoughts, talking fast while jumping from one subject to another 4. easily distracted, talks about many topics in a few minutes (often misdiagnosed as ADD or ADHD) 5. inability to think in terms of certainty 6. not sleeping yet having lots of energy 7. having poor judgment-different than one once had, spending habits (spending sprees) 8. denial that anything is wrong 9. risky sexual behavior 10. abuse of illegal drugs or narcotics and medication

11. aggressive and intrusive behavior Mixed Symptoms: Agitation that can be mixed with or without depression problems, anxiety, insomnia for extended periods of time, depressive sadness (crying for no reason, suicidal thinking (killing oneself) and psychosis Psychosis has also been known to accompany severe episodes of depression and/or mania associated with all types of bipolar disorder. This is when a person is having delusions (unrealistic beliefs that are not from the basis of logic, reasoning, or religious beliefs) and hallucinations (seeing, hearing, feeling, and experiencing things or people that are not really there) This is a mental disorder that is very hard to diagnosis. Doctors most often have to really on symptoms reported by the patient. However doctors have come a long ways in making accurate diagnosis. The most important factor here is the patients willingness to talk openly and honestly about their mood swings, behaviors and lifestyle habits. The most telling symptoms of bipolar disorder include mood swings 9going from extreme highs to extreme lows) that do not follow a set pattern. The patients symptoms can be assed using the DSM-IV. The doctor will want a thorough family history. Numerous studies show a prevalence of anxiety disorders in individuals with bipolar including generalized anxiety disorder, obsessive-compulsive, panic disorder, phobic disorder, social anxiety disorder, and posttraumatic stress disorder. Most cases can be treated successfully with medication (WebMD). There are no laboratory test, but there are different types of questionnaires that psychiatrist can use in helping to diagnosis the disorder. Family and individual counseling improves social functioning (Mulvihill, 2006).

Structural brain imaging is assumed to be a key method to elucidate the underlying neuropathology of bipolar disorder. However, magnetic resonance imaging studies using region of interest analysis and voxel-based morphometry (VBM) revealed quite inconsistent findings (report from German investigators). Hence there is no clear evidence so far for core regions of cortical or subcortical structural abnormalities in bipolar disorder. We could not observe any significant correlations differences of grey and white matter volumes between patients with bipolar disorder and healthy control subjects (H. Scherk and colleagues, University of Gottingen). Next let us look at the biochemistry. Neurotransmitters are involved in the aetiology of mood disorders, especially the monoamines. While earlier simplistic theories suggested that an excess of neurotransmitters occurred during a manic episode and a decrease during depression, it is clearly not the case. It is the effectiveness of the cell functioning that underlies the pathoetiology of mood disorders (http://www.brainexplorer.org). Below is a list of neurotransmitters and regulatory actions associated with bipolar disorder as well as other mental illnesses. Dopamine: Mood, behavior, thought process, muscle movement, physical activity, heart rate, blood pressure, feeding, appetite, satiety Norephinephrine: Serotonin: Mood, anxiety, vigilance, arousal, heart rate, blood pressure

Perception of pain, feeding, sleep-awake cycle, motor activity, sexual behavior, temperature regulation

Some environmental causes have been associated with bipolar disorder as well as other mental illnesses, such as early parental loss, parental death or permanent separation before the age of seventeen. Loss of parent during childhood significantly increased the likelihood of developing a mood disorder in the study reviewed. The loss due to permanent separation was more striking than loss due to death, as was the loss before the age of nine years compared to later childhood and adolescence. Stressful situations may interfere some with treatment. If a patients family is involved with their treatment and family counseling to help understand and deal with the issues and symptoms the patient should respond very well to medication. Family and individual counseling improves social functioning by providing psychological support and treatment that stabilizes extreme characteristics of mania or depression (Mulvihill, 2006).

Resources: Mulvihill, M. L., Zelman M,. Holdaway, P., Tompary, E., & Raymond, J. (2006) Instructors resource manual: Human diseases: A systemic approach (6th ed.) Upper Saddle, NJ: Pearson Prentice Hall The History of Bipolar Disorder: From Centuries Ago Until Present Day http://www.bipolardisorderliving.com Caleb Adler, Understanding and Treating Bipolar Depression http://go.galegroup.com Reports from University of Gottingen describe recent advances in bipolar disorder http://go.galegroup.com Bipolar Diagnosis http://www.webmd.com Bipolar Disorder Aetiology http://www.brainexplorer.org Environmental and vulnerability to major psychiatric illness http://www.ncbi.nim.gov/pubmed/10208448