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Bipolar Disorder

Monday, 23 November 2009

Mental health issues hitting the headlines a lot in the last few weeks, and it is clear that the issue is on the increase. With this in mind, it is important to know the signs within ourselves or for someone else that may be experiencing a mental health problem, so that it won't be ignored.

With over 40,000 people in Ireland diagnosed with Bipolar Disorder and more living with it in silence or unbeknownst to themselves, today we'll be finding out what exactly what it is as well as what it is like to live with Bipolar. We're also looking at the signs, symptoms and stigma attached.

Prof. Paul Fearon, St. Patrick's University Hospital

Bipolar Disorder (formerly known as Manic Depression) is a mood disorder that affects approximately 0.5-1% of the adult population of Ireland and roughly the same percentage in other countries around the world.

. Estimated that up to 40,000 people in Ireland with Bipolar.
. Four in 10 people living with bipolar disorder or schizophrenia in Ireland believe their mental illness has had a highly negative impact on their own lives.
. Forty-five per cent of the 280 respondents surveyed had to stop working or studying as a result of their mental illness.
. Thirty one per cent of respondents feel they have been discriminated against as a result of their condition.
. 80 per cent of people living with mental illness believed that the general public did not understand mental illness or what it is like to live with a mental condition.
. 63 per cent felt that mental illness is not accurately represented in the media.

What is Bipolar disorder?

. Mood swings between lows and highs
. Depressive and manic episodes
. Often unaware of behaviour during manic phase

Bipolar disorder is an illness which results in mood swings between low mood (depression) and overactive, excited behaviour (mania). Some people may also see or hear things that others around them don't. About 0.5-1% of the general population (ie 1 in between 100 and 200 people) is diagnosed with bipolar disorder. It affects both men and women equally.

In the manic phase, a person is often unaware of their overexcited behaviour. They may spend money extravagantly and build up debts, sleep very little and talk very quickly.

During the depressive phase, they may feel despair, worthless and often suicidal.

Bipolar disorder involves both highs and lows. Hypomania is a less severe form of mania which often allow the person to continue functioning for some time.

Some people have very few bipolar episodes, with years of stability between them. Others have more frequent episodes and some have "rapid cycling" with 4 or more episodes a year.

Causes of Bipolar disorder
. Genetic predisposition
. Stressful life events
. Family background
. Life problems
. Chemical imbalance

There are a number of different theories.
. Some experts believe that genetics have a part to play. Studies in identical twins show that if one twin has bipolar disorder there is a 70% chance of the other twin being diagnosed with it.
. It is understood though that there is usually a stressful "trigger event". This could be for instance a relationship breakdown or money problems.
. Another theory states that bipolar disorder can result from emotional damage caused in early life, such as a child being over-protected or over-criticised.
. Some professionals would place emphasis on the effects of life problems, reasoning that bipolar disorder is a reaction to overwhelming problems in daily living. This is why talking treatments can be very helpful for some sufferers.

. Medication, especially Mood Stabilisers e.g. Lithium, Carbamazepine, Olanzapine
. Talking treatments, e.g. Psychotherapy, Cognitive behaviour therapy CBT-not effective during a manic episode, though.
. Electroconvulsive Therapy

Bipolar disorder is a diagnosis normally confirmed by a consultant psychiatrist but can often be made initially by ones GP.

The most common form of treatment is medication. Lithium is the most often used drug. Regular blood tests are necessary for anyone on lithium as too high a level can cause toxicity. Other drugs used include carbamazepine and sodium valproate. In addition, some antipsychotic drugs (e.g. olannzapine) are now known to be effective mood stabilizers.

Talking treatments may also be helpful. Psychotherapy aims to help people understand why they feel the way they do. Cognitive behaviour therapy has a more active approach which focuses on changing negative thoughts.

In some areas, there may be crisis response services or home treatment services which aim to provide support in a home setting. However, hospital admission may be necessary to provide a protective environment, especially if someone is very elated. Hospital admission is usually voluntary, but in some cases compulsory admission under the Mental Health Order may be necessary.

Electroconvulsive therapy, (ECT) may be considered in rare cases of severe life threatening depression or elation.

Self help
. Go to your GP
. Local services: Social services, voluntary organisations
. Support from friends and relatives

Local services, e.g. day centres, social services, community mental health teams and voluntary organisations often provide specific help for people with bipolar disorder. There may be, for instance, a self help group that meets regularly in your area. Community mental health teams can also arrange for a CPN to visit you at home. Hostels and sheltered housing schemes provide a supportive environment so that you can gain confidence and live independently again.

Some people find that they are able to "self manage" their illness. This involves developing skills to recognise and control mood swings. This takes time to learn but can lead to greater self confidence and less reliance of professionals.

The support of friends and relatives is also important as they can often help at a practical level.

Difference Between Bipolar and Schizophrenia
The essential differences are that bipolar affective disorder is a condition affecting mood while schizophrenia affects the individual's perceptions and beliefs often in association with disorganised thinking.

The number of the St. Patrick's Support & Information line is (01) 249 3333, or email: