silverblk mystix
08-26-2010, 09:54 AM
Bipolar disorder
From Wikipedia, the free encyclopedia
"Manic depression" redirects here. For other uses, see Manic depression (disambiguation).
Bipolar disorder
Classification and external resources
Many people involved with the arts, such as Vincent van Gogh, are believed to have suffered from bipolar disorder
ICD-10 F31.
ICD-9 296.80
OMIM 125480 309200
DiseasesDB 7812
MedlinePlus 001528
eMedicine med/229
MeSH D001714
Bipolar disorder or manic-depressive disorder, which is also referred to as bipolar affective disorder or manic depression, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes, or symptoms, or mixed episodes in which features of both mania and depression are present at the same time.[1] These episodes are usually separated by periods of "normal" mood; but, in some individuals, depression and mania may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to such psychotic symptoms as delusions and hallucinations. The disorder has been subdivided into bipolar I, bipolar II, cyclothymia, and other types, based on the nature and severity of mood episodes experienced; the range is often described as the bipolar spectrum.
Data from the United States on lifetime prevalence varies; but it indicates a rate of around 1% for bipolar I, 0.5%–1% for bipolar II or cyclothymia, and 2%–5% for subthreshold cases meeting some, but not all, criteria. The onset of full symptoms generally occurs in late adolescence or young adulthood. Diagnosis is based on the person's self-reported experiences, as well as observed behavior. Episodes of abnormality are associated with distress and disruption and an elevated risk of suicide, especially during depressive episodes. In some cases, it can be a devastating long-lasting disorder. In others, it has also been associated with creativity, goal striving, and positive achievements. There is significant evidence to suggest that many people with creative talents have also suffered from some form of bipolar disorder.[2]
Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizer medications and, sometimes, other psychiatric drugs. Psychotherapy also has a role, often when there has been some recovery of stability. In serious cases, in which there is a risk of harm to oneself or others, involuntary commitment may be used. These cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder.[citation needed] People with bipolar disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having schizophrenia, another serious mental illness.[3]
The current term "bipolar disorder" is of fairly recent origin and refers to the cycling between high and low episodes (poles). A relationship between mania and melancholia had long been observed, although the basis of the current conceptualisation can be traced back to French psychiatrists in the 1850s. The term "manic-depressive illness" or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all kinds of mood disorder. German psychiatrist Karl Leonhard split the classification again in 1957, employing the terms unipolar disorder (major depressive disorder) and bipolar disorder.
Contents [hide]
1 Signs and symptoms
1.1 Depressive episode
1.2 Manic episode
1.3 Hypomanic episode
1.4 Mixed affective episode
1.5 Associated features
2 Causes
2.1 Genetic
2.2 Childhood precursors
2.3 Life events and experiences
2.4 Neural processes
2.5 Melatonin activity
2.6 Psychological processes
3 Diagnosis
3.1 Clinical scales
3.2 Criteria and subtypes
3.2.1 Rapid cycling
3.3 Challenges
4 Management
4.1 Psychosocial
4.2 Medication
5 Prognosis
5.1 Functioning
5.2 Recovery
5.3 Recurrence
5.4 Morbidity
6 Epidemiology
6.1 Children
6.2 Older age
7 History
8 Society and culture
8.1 Cultural references
9 References
9.1 Cited texts
10 Further reading
11 External links
Signs and symptoms
Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and, in many cases, abnormally depressed states for periods of time in a way that interferes with functioning. Bipolar disorder has been estimated to afflict more than 5 million Americans—about 1 out of every 45 adults.[4] It is equally prevalent in men and women and is found across all cultures and ethnic groups.[5] Not everyone's symptoms are the same, and there is no blood test to confirm the disorder. Bipolar disorder can appear to be unipolar depression. Diagnosing bipolar disorder is often difficult, even for mental health professionals. What distinguishes bipolar disorder from unipolar depression is that the affected person experiences states of mania and depression. Often bipolar is inconsistent among patients because some people feel depressed more often than not and experience little mania whereas others experience predominantly manic symptoms.
Depressive episode
Main article: Major depressive episode
Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation.[6] In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features.
Manic episode
Main article: Mania
Mania is the signature characteristic of bipolar disorder and, depending on its severity, is how the disorder is classified. Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person's speech may be pressured, with thoughts experienced as racing. Attention span is low, and a person in a manic state may be easily distracted. Judgment may become impaired, and sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant, or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen" and are "on a special mission" or have other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood.[7] Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose.
To be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required.[8]
Hypomanic episode
Main article: Hypomanic episode
Hypomania is generally a mild to moderate level of mania, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Generally, hypomania does not inhibit functioning like mania. Many people with hypomania are actually in fact more productive than usual. Some people have increased creativity while others demonstrate poor judgment and irritability. Many people experience signature hypersexuality. These persons generally have increased energy and tend to become more active than usual. They do not, however, have delusions or hallucinations. Hypomania can be difficult to diagnose because it may masquerade as mere happiness, though it carries the same risks as mania.
Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.[9] What might be called a "hypomanic event", if not accompanied by complementary depressive episodes ("downs", etc.), is not typically deemed as problematic: The "problem" arises when mood changes are uncontrollable and, more importantly, volatile or "mercurial". If unaccompanied by depressive counterpart episodes or otherwise general irritability, this behavior is typically called hyperthymia, or happiness, which is, of course, perfectly normal. Indeed, the most elementary definition of bipolar disorder is an often "violent" or "jarring" state of essentially uncontrollable oscillation between hyperthymia and dysthymia.
Mixed affective episode
Main article: Mixed state (psychiatry)
In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage).[10]
Associated features
Associated features are clinical phenomena that often accompany the disorder but are not part of the diagnostic criteria for the disorder.
Cognitive functioning
Reviews have indicated that most individuals diagnosed with bipolar disorder, but who are euthymic (not experiencing major depression or mania), do not show neuropsychological deficits on most tests.[11] Meta-analyses have indicated, by averaging the variable findings of many studies, cognitive deficits on some measures of sustained attention, executive function and verbal memory, in terms of group averages. On some tests, functioning is superior; however,[11] and sub-threshold mood states and psychiatric medications may account for some deficits.[12][13] A 2010 study found that "excellent performance" at school at age 15–16 was associated in males with a higher rate of developing bipolar disorder, but so was the poorest performance.[14] A 2005 study of young adult males found that poor performance on visuospatial tasks was associated with a higher rate of developing bipolar disorder, but so was high performance in arithmetic reasoning.[15]
Creativity
Main article: Creativity and mental illness
Bipolar disorder has been associated with people involved in the arts but it is an ongoing question as to whether many creative geniuses had bipolar disorder.[16][17][18] Some studies have found a significant association between bipolar disorder and creativity, although it is unclear in which direction the cause lies or whether both conditions are caused by a third unknown factor; temperament has been hypothesized to be one such factor.[19][20][21]
Goals
A series of authors have described mania or hypomania as being related to a high motivation to achieve, ambitious goal-setting, and sometimes high achievement. One study indicated that the pursuit of goals, encouraged by sometimes achieving them, can become emotionally dysregulated and involve the development of mania.[22] Individuals may have low self-esteem and difficulties in social adjustment, however, and by definition there are periods of depression with difficulty in motivation and functioning.[23]
Causes
The causes of bipolar disorder likely vary between individuals. Twin studies have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For bipolar I, the (probandwise) concordance rates in modern studies have been consistently put at around 40% in monozygotic twins (same genes), compared to 0 to 10% in dizygotic twins.[24] A combination of bipolar I, II and cyclothymia produced concordance rates of 42% vs 11%, with a relatively lower ratio for bipolar II that likely reflects heterogeneity. The overall heritability of the bipolar spectrum has been put at 0.71.[25] There is overlap with unipolar depression and if this is also counted in the co-twin the concordance with bipolar disorder rises to 67% (Mz) and 19% (Dz).[26] The relatively low concordance between dizygotic twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes.[25]
Genetic
Genetic studies have suggested many chromosomal regions and candidate genes appearing to relate to the development of bipolar disorder, but the results are not consistent and often not replicated.[27] Although the first genetic linkage finding for mania was in 1969,[28] the linkage studies have been inconsistent.[29] (Genetic linkage studies may be followed by fine mapping searching for the phenomenon of linkage disequilibrium with a single gene, then DNA sequencing; using this approach causative DNA base pair changes have been reported for the genes P2RX7[30] and TPH1[citation needed]). Recent meta-analyses of linkage studies detected either no significant genome-wide findings or, using a different methodology, only two genome-wide significant peaks, on chromosome 6q and on 8q21. Genome-wide association studies have also not brought a consistent focus — each has identified new loci, while none of the previously identified loci were replicated.[29] Findings did include a single-nucleotide polymorphism in DGKH;[31] a locus in a gene-rich region of high linkage disequilibrium (LD) on chromosome 16p12;[32] and a single-nucleotide polymorphism in MYO5B.[33] A comparison of these studies, combined with a new study, suggested an association with ANK3 and CACNA1C, thought to be related to calcium and sodium voltage-gated ion channels.[34] Diverse findings point strongly to heterogeneity, with different genes being implicated in different families.[35] Numerous specific studies find various specific links.[36][37][38][39][40] Advanced paternal age has been linked to a somewhat increased chance of bipolar disorder in offspring, consistent with a hypothesis of increased new genetic mutations.[41] A review seeking to identify the more consistent findings suggested several genes related to serotonin (SLC6A4 and TPH2), dopamine (DRD4 and SLC6A3), glutamate (DAOA and DTNBP1), and cell growth and/or maintenance pathways (NRG1, DISC1 and BDNF), although noting a high risk of false positives in the published literature. It was also suggested that individual genes are likely to have only a small effect and to be involved in some aspect related to the disorder (and a broad range of "normal" human behavior) rather than the disorder per se.[42]
Sportcamper
08-26-2010, 12:07 PM
When ever I am feeling down, I look for Gods love in nature…The other night we were finishing a round of golf rather late & happened upon two bobcats dining on two freshly caught bunnies…(The bunnies like to munch on the greens as the sun goes down)
There they were, two beautiful bobcats eating supper, watching us put out our final hole…I thought, this is like natures version of a TV dinner…It made me feel happy…:toast
grindmouse
08-26-2010, 04:10 PM
I saw bigsnack today he dropped off around 50 dollars in food and was talking about he doesn't have long to live. I wasn't shocked in fact I was rather upset i don't drink 2% milk and eat veggie burgers. The 200 pack of Top Ra-min noodles will take at least a few months to eat, and I hope my neighbor can help me with the 60 pack of Activia , but I am great full for his efforts and I will make sure nothing goes to waste.
But what I did find odd was he showed up wearing a huge Diaper made of bluejeans.I knew the food came with a price he wanted to do a re-make of a huggies commercial and i was the camera man. Giving the fact that i have outstanding traffic warrants i did not want to be questioned by security or SAPD as they ask me why i am filming a half naked man wearing a diaper, so I made BigZac hurry and walk up and down the mall by fiesta Texas and I talked him into taking me back home, a few times he talked about driving the car off IH-10 and just ending his time on earth but as soon as the traffic cleared he reminded me God has a plan for him so long story short today was really no different than any other day with the zax!
Ps: Someone PM zax and have him post the Huggies commercial remake video on Youtube! :tu
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