Bipolar Disorder

In 1686, Théophile Bonet, a French pathologist, described a mental illness he called maniaco-melancholicus. In 1854, Jules Falret, a French physician, described folie circulaire, distinguished by alternating moods of depression and mania. In 1899, Emil Kraepelin, a German psychologist, described manic-depressive psychosis. Bipolar disorder has a lifetime prevalence of 1.2 percent. It affects more than 2.3 million adult Americans each year. It is equally common in men and women.

There is a genetic link to bipolar disorder. About 50 percent of all bipolar disorder patients have at least one parent with a mood disorder. An in creased level of calcium ions is found in the blood of patients with bipolar disorder. There is also a lowered blood flow in the brain as well as slower overall metabolism. Some research suggests that bipolar disorder may be caused by disturbed circadian rhythms and related to disturbances in mela-tonin secretion.

The DSM-IV-TR divides bipolar disorder into bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Bipolar I disorder is characterized by the occurrence of one or more manic episodes or mixed episodes and one or more major depressive episodes. Bipolar II disorder is characterized by the occurrence of one or more major depressive episodes accompanied by at least one hypomanic episode. Cyclothymic disorder is a chronic, fluctuating mood disturbance involving periods of hypomanic episodes and periods of major depressive episodes.

Treatment options include psychotherapy and medication. Mood stabilizers, such as lithium and divalproex sodium, are the most commonly used medications. Lithium is a naturally occurring substance that increases serotonin levels in the brain. Side effects can include dry mouth, high overdose toxicity, nausea, and tremor. Divalproex sodium increases GABA (gamma-amino butyric acid) in the brain. Neurotransmitters trigger either "go" signals that allow messages to be passed on to other cells in the brain or "stop" signals that prevent messages from being forwarded. GABA is the most common message-altering neurotransmitter in the brain. Possible side effects of divalproex sodium include constipation, headache, nausea, liver damage, and tremor. Olanzapine increases levels of dopamine and serotonin. Side effects include drowsiness, dry mouth, low blood pressure, rapid heartbeat, and tremor. Anticonvulsants are also widely prescribed. Carbamaze-pine, for example, increases GABA and serotonin. Possible side effects include blurred vision, dizziness, dry mouth, stomach upset, or sedation. In the case of severe mania, patients may take a tranquilizer or a neuroleptic (antipsychotic drug) in addition to the mood stabilizer. During the depressive episode, the person may take an antidepressant. ECT may also be helpful during severe depressive episodes.

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