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Bipolar Disorder is thought to be based on biological conditions in the brain which may cause the chemical imbalance in serotonin and norepinephrine levels usually attributed to depression. According to the US government's National Institute of Mental Health (NIMH), "There is no single cause for bipolar disorder—rather, many factors act together to produce the illness." [3] Let's return to this claim at the end of this section. It is becoming increasingly clear that bipolar and unipolar mood disorders have a genetic component. Since bipolar disorder is so heterogeneous, it is likely that people experience different pathways towards the illness (Miklowitz & Goldstein, 1997).
The following is a quote from a successfully treated individual with bipolar disorder (from the U.S. The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. After World War II, Dr John Cade, Psychiatrist, Bundoora Repatriation Hospital, Melbourne, Australia was investigating the effects of various compounds on veteran patients with manic depressive psychosis. Clinical depression and bipolar disorder are currently classified as separate illnesses; some researchers are increasingly viewing them as part of an overlapping spectrum that also includes anxiety and psychosis. Hence, a very high percentage of subjects who seem to have a history of bipolar disoder at the interview are false positives for such a medical condition and apparently never suffered a fully clinical syndrome (that is, bipolar disorder type I): the population prevalence of bipolar disorder type I, which includes at least a lifetime manic episode, continues to be estimated at 1% (Soldani, Sullivan, Pedersen, 2005). Bipolar disorder is, almost without exception, a life-long condition that must be carefully managed throughout the individual's lifetime.
The vast majority of people diagnosed with, or who may be diagnosed with bipolar disorder suffer from depression.
Rapid cycling, defined as having four or more episodes per year, is found in a significant fraction of patients with bipolar disorder. Numerous studies show that bipolar disorder affects a patient's ability to think and perform mental tasks, even in states of remission.[5] Deborah Yurgelun-Todd of McLean Hospital in Belmont, Massachusetts has argued these deficits should be included as a core feature of bipolar disorder. People with bipolar disorder are about twice as likely to commit suicide as those suffering from major depression (12% to 20%). According to the DSM-IV-TR, a diagnosis of bipolar I disorder requires one or more manic or mixed episodes.
Bipolar II, the more common but by no means less severe type of the disorder, is characterized by episodes of hypomania and disabling depression. A diagnosis of cyclothymic disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified). There are many problems with symptom accuracy, relevance and reliability in making a diagnosis of bipolar disorder in the DSM-IV-TR. A variety of medications are used to treat bipolar disorder; most people with bipolar disorder require combinations of medications. Even when on medication, some people may still experience weaker episodes or have a complete manic or depressive episode.
Bipolar disorder runs in families.[6] More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a genetic component. Bipolar disorder is considered to be a result of complex interactions between genes and environment. In 2003, a group of American and Canadian researchers published a paper that used gene linkage techniques to identify a mutation in the GRK3 gene as a possible cause of up to 10% of cases of bipolar disorder.
The Maudsley Bipolar Twin Study, based at the Institute of Psychiatry in London is conducting research about the genetic basis of bipolar disorder using twin methdology. The MRC eMonitoring Project, another research study based at the Institute of Psychiatry and Newcastle Universities, is conducting novel research on electronic monitoring methodologies (electronic mood diaries and actigraphy) for tracking bipolar symptom fluctuations in Bipolar individuals who are interested in self-managing their condition. Researchers are using advanced brain imaging techniques to examine brain function and structure in people with bipolar disorder, particularly using the functional MRI and positron emission tomography. An evolving literature exists concerning the nature of personality and temperament in bipolar disorder patients, compared to major depressive disorder (unipolar) patients and non-sufferers.

Many famous people are believed to have been affected by bipolar disorder, based on evidence in their own writings and contemporaneous accounts by those who knew them. Bipolar disorder and its treatment with lithium dibromide is referenced to by Krusty the Klown in a Simpsons episode titled Midnight Rx. When faced with a very stressful, negative major life event, such as a failure in an important area, an individual may have their first major depression.
Childhood onset bipolar disorder should be treated early because according to Joseph Calabrese of Case Western Reserve University, childhood forms of the illness may be easier to treat than adult forms of the illness. For example, a family history of bipolar spectrum disorders can impart a genetic predisposition towards developing a bipolar spectrum disorder[2]. The words Depression (previously melancholia) and Mania have their etymologies in Ancient Greek. Marneros (2001) describes the concepts emerging out of this period as the “rebirth of bipolarity in the modern era”. Describing these patients in 1902, he coined the term "manic depressive psychosis." He noted in his patient observations that intervals of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals in which the patient was able to function normally.
In 1948, Dr John Cade discovered that Lithium Carbonate could be used as a successful treatment of manic depressive psychosis.
The current nosology, bipolar disorder, became popular only recently and some individuals prefer the older term because it provides a better description of a continually changing multi-dimensional illness. Also included in this view is premenstrual dysphoric disorder, postpartum depression and postpartum psychosis.
This and similar recent studies have been interpreted by some prominent bipolar disorders researchers as evidence for a much higher prevalence of bipolar disorders in the general population than previously thought. Some individuals with hyperthymic temperament (or "hypomanic" personality style) who experience depression in later life appear to have a form of bipolar disorder. Because there are many manifestations of the illness, it is increasingly being called bipolar spectrum disorder.
In fact, there is at least a 3 to 1 ratio of time spent depressed versus time spent euthymic (normal mood) or hypomanic or manic during the course of the bipolar I subtype of the illness. Typical examples include tearfulness during a manic episode or racing thoughts during a depressive episode.
Individuals with bipolar disorder tend to become suicidal, especially during mixed states such as dysphoric hypomania and agitated depression. The DSM-IV-TR details four categories of bipolar disorder, Bipolar I disorder, Bipolar II disorder, Cyclothymic disorder and Bipolar disorder NOS (Not Otherwise Specified) [6].
A depressive episode is not required for a diagnosis of BP I disorder, although the overwhelming majority of people with BP I suffer from them as well. Because bipolar disorder continues to have a high rate of both underdiagnosis and misdiagnosis it is often difficult for individuals with the illness to receive timely and competent treatment. However, many atypical antipsychotics, which were originally developed to treat schizophrenia, have also been shown to be effective in bipolar mania. Too much sleep (possibly caused by medication) can lead to depression, while too little sleep can lead to mixed states or mania. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes.
This gene is associated with a kinase enzyme called G protein receptor kinase 3, which appears to be involved in dopamine metabolism, and may provide a possible target for new drugs for bipolar disorder.
Kay Redfield Jamison, who herself has bipolar disorder and is considered a leading expert on the disease, has written several books that explore this idea, including Touched with Fire. Bipolar disorder is found in disproportionate numbers in people with creative talent such as artists, musicians, authors, poets, and scientists, and it has been speculated that the mechanisms which cause the disorder may also spur creativity. However, lithium bromide, the compound referred to, is rarely used to treat bipolar disorder.
Modern evidence based psychotherapies designed specifically for bipolar disorder when used in combination with standard medication treatment increase the time the individual stays well significantly longer than medications alone (Frank, 2005).

NIMH proposed the "kindling" theory [1] which asserts that people who are genetically predisposed toward bipolar disorder experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Since bipolar disorders are polygenic (involving many genes), there are apt to be many unipolar and bipolar disordered individuals in the same family pedigree. Since "many factors act together to produce the illness", bipolar disorder is called a multifactorial illness, because many genes and environmental factors conspire to create the disorder (Johnson & Leahy, 2004).
On January 31st 1854, Jules Baillarger described to the French Imperial Academy of Medicine a biphasic mental illness causing recurrent oscillations between mania and depression. The spectrum concept refers to subtypes of bipolar disorder that are sub-syndromal (below the symptom threshold) and typically misdiagnosed as depression.
People with the bipolar II subtype remain depressed for substantially longer (37 times longer) according to the study findings discussed in the epidemiology section above. The diagnostic subtypes of bipolar disorder are thus static descriptions--snapshots, perhaps--of an illness in change. Recent TV specials, for example MTV's "True Life: I'm Bipolar", talk shows and public radio shows have focused on mental illnesses thereby further raising public awareness. However, with appropriate treatment, many individuals with bipolar disorder can live full and satisfying lives.
Taking a lower dosage of an antidepressant, may cause the patient to relapse into depression, while higher doses can cause destabilization into mixed-states or mania. Using MBTI continuum scores, bipolar patients were significantly more extroverted, intuitive and perceiving, and less introverted, sensing, and judging than were unipolar patients.
This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5 to 8 years. Research indicates that while mania may contribute to creativity (see Andreasen, 1988), hypomanic phases experienced in bipolar I, II and in cyclothymia appear to have the greatest contribution in creativity (see Richards, 1988). Many historical figures gifted with creative talents commonly cited as bipolar were "diagnosed" after their deaths based on letters, correspondence or other material. These psychotherapies are Interpersonal and Social Rhythm Therapy for Bipolar Disorder, Family Focused Therapy for Bipolar Disorder, Psychoeducation, Cognitive behavioral therapy for Bipolar Disorder and Prodrome Detection. Individuals with bipolar disorder tend to experience episode triggers involving either interpersonal or achievement-related life events. Persons with bipolar disorder are more likely to have periods of normal or near normal functioning between episodes. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process.
This suggests that there might be a correlation between the Jungian extraverted intuiting process and bipolar disorder. For children, the main concern is that bipolar disorder needs to be diagnosed correctly and treated properly because it can look like unipolar depression, ADHD or conduct disorder. Delusions in a depression may be far more distressing, sometimes taking the form of intense guilt for supposed wrongs that the patient believes he or she has inflicted on others. If misdiagnosed with depression, patients are usually prescribed antidepressants and the person with bipolar depression can become agitated, angry, hostile, suicidal and even homicidal (these are all symptoms of hypomania, mania and mixed states).
If a child with bipolar disorder is misdiagnosed and treated with antidepressants or stimulants, the child may become violent, suicidal, homicidal or otherwise severely destabilized.
Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32) have been developed to assist the sometimes difficult detection of Bipolar II disorders.
Young children, adolescents and adults each express the illness differently according to child and adolescent bipolar disorders expert Demitri Papolos M.D.

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