Bipolar disorder is a classified as a mood disorder that affects an individual’s social, academic, and daily affairs. This instability of mood probably even leaves the individual with the disorder in a state of haze that is indistinguishable from reality. Surrounding people-such as friends, lovers, and family members-are often confused and, more so, hurt because they don’t necessarily know what is wrong. Ironically, the individual affected with the disorder is seldom aware of its presence. Doubt begins to occur during a depressive decline. Yet, dreams and elaborate hosts of ideas spring when on a manic incline. Nonetheless, in an attempt at understanding bipolar disorder further, one must look at the psychological, or behavioral, and physiological, or biological, underpinnings at play. Unfortunately, this discussion is beyond the scope of this paper. To put the preceding research analysis into perspective let us briefly look at the criteria, and diagnostic features, of bipolar I manic or mixed patients as defined by the DSM IV: ” The essential feature of Bipolar I Disorder is a clinical course that is Criteria for mania or a manic phase”. The disorder is distinguished by a “period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)” (DSM-IV, p. 332). And mixed phases are when “the mood disturbance is 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, or there are psychotic features” (DSM-IV, p. 335).
Bipolar disorder is a psychiatric condition which can greatly impair an individual’s functionality. Approximately 4.4% of the U.S. population experiences a bipolar spectrum disorder (Merikangas, Akiskal, Angst, Greenberg, et al., 2007). Exploring the biological bases of persons affected by bipolar disorder could lead to better treatment. Thus far, research suggests a heritability basis of origin for bipolar disorder (Kalat, 2007). Also brain structure abnormalities and neurobiological basis for the disorder have been identified as well. Along with a quick glimpse of what goes on in the brain of a bipolar patient, we’ll discuss two forms of treatment: (1) a psychotherapeutic approach that works to adjust circadian rhythms, and (2) medication usage that chemically treats the disorder.
As imaging techniques have advanced, the neurobiological contributors to bipolar disorder have somewhat been observed. PET scans show “brain’s increase in glucose use during mania and its decrease during depression” (Kalat, 2007, p. 466). The increase use of glucose-primary fuel for the brain-explains the rapid surge of energy and the prevalence of manic symptoms. In turn, the decrease in glucose metabolization is followed by a dramatic depletion of energy, resulting in excessive tiredness, fatigue, and exhaustion. The behavioral components seem to be mediated by semi-independent, although probably related, neural systems. More fMRI imaging indicates “activation differences between bipolar and healthy controls in the anterior limibic regions” (Strakowski, Delbello, & Adler, 2005). Srakowski et al. (2005) discovered that in patients with bipolar disorder a “diminished prefrontal modulation of subcortical and medial temporal structures within the anterior limbic network (amygdala, anterior striatum and thalamus) result in deregulation of mood.” Neurocognitive and neurophysiological mechanisms’ activity-in overdrive or otherwise-are major components that manifests themselves through a variety of behavioral facets.
It is widely acknowledged that sleep disturbance is among the predominating symptoms exhibited amongst people with this disorder. Usually in mania, sleep is deemed as unnecessary, or as a waste of time. However, a key method of mood stabilization is the regulation of normal circadian rhythms-in other words: sleep is crucial. An interesting form of psychotherapeutic approach designed specifically for the treatment of bipolar disorder is the Interpersonal and social rhythm therapy. This approach addresses the normalization of sleep patterns and the duration of sleep amongst patient with this disorder. Along with medication, interpersonal and social rhythm therapy combines the basics of interpersonal psychotherapy with behavioral therapy. This approach “modulates both biological and psychosocial factors to mitigate patients’ circadian and sleep-wake cycle vulnerabilities” ( Frank, Swartz, Kupfer, 2000).
Nonetheless, medication and psychopharmacological approaches to treatment of bipolar disorder are also a crucial aspect of keep the disorder under control. Drugs such as Lithium are found to be effective. Lithium is a salt that stabilizes mood and prevents relapse in mania or depression. However, the potential for dangerously high levels of lithium ions in the blood can be toxic and result in death. Also, low levels of lithium are virtually ineffective. So the exact ‘window’ must be determined for effective treatment and requires that the patient undergo regular testing to check for normal blood toxin levels. Also, anticonvulsant drugs such as valproate (marketed as Depakote) and carbamazepine (usually prescribed for bipolar II) are often utilized to treat bipolar disorder. All drugs work by blocking the synthesis of the brain chemical arachidonic acid, which is produced during brain inflammation (Kalat, 2007). Of course, medication can only go so far. The person who is undergoing treatment reaps optimum results when medication and psychotherapy are used together as a means of learning techniques to cope with the ‘ups and downs’.
Bipolar disorder is such a “multi-faceted construct that cannot be defined by a single behavioral component” (Strakowski et al., 2010). Stabilizing mood could be a much more daunting task than it sounds. Persons who suffer from bipolar disorder quite often suffer from other comorbidities as well. Before prescribing medications, psychiatrists must factor in addiction, ADHD, anxiety, the co-existence of other Axis I disorders, and so forth. Bipolar disorder is not easy to understand nor is it easy to treat. Treatment has to be specialized, must be kept consistent, and the professionals must be highly considerate of the patient’s conditions. We discussed structural and activational abnormalities in the brain of a bipolar patient. As with most psychiatric conditions, treatment is most effective when there is a well adjusted balance of medication and therapy. Medication helps address the biological need for balance and therapy should provide the psychological tools the patient needs to understand, cope, and stabilize his/her moods and behavior.
Ellen Frank, Holly A Swartz, David J Kupfer. Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder . (2000). Biological Psychiatry, 48(6), 593-604.
Strakowski, S. M., Delbello, M. P, & Adler, C.M. (2005). The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings. Mol Psychiatry., 10(1), doi:10.1038/sj.mp.4001585
Kalat, J. W. (2007). Psychological Disorders. Biological psychology. (9th International Student Edition ed., pp. 466, 467). Canada: Thomson Wadsworth.
Merikangas, Kathleen R., Akiskal, Hagop S., Angst, J., Greenberg, Paul E., Kessler, Ronald C., Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. (2007). Arch Gen Psychiatry., 64(5), 543-552.
Strakowski, S. M., Fleck, D. E., DelBello, M. P., Adler, C. M., Shear, P. K., Kotwal, R. and Arndt, S. (2010 May), Impulsivity across the course of bipolar disorder. Bipolar Disorders, 12: 285-297. doi: 10.1111/j.1399-5618.2010.00806.x