Term Paper: Bipolar Disorder

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[. . .] When one parent has bipolar disorder, the risk to each child is estimated to be 15-30%. When both parents have bipolar disorder, the risk increases to 50-75%. Bipolar illness is usually diagnosed in children over the age of twelve. Unfortunately, for bipolar children under age twelve, behaviors that should be associated with manic depression are often confused with attention deficit hyperactivity disorder (ADHD). In many cases, the child may suffer from both ADHD as well as bipolar disorder resulting in the latter going undiagnosed.

Bipolar children usually have uninterrupted, rapidly cycling and severe mood disturbance producing a chronic irritability with few periods of wellness. They are also given to irrational thought processes called as "thought errors." When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, there may be complaints of headaches, stomach aches, tiredness, poor performance in school, poor communication and extreme sensitivity to rejection or failure. (Durand & Barlow, 2000)

The onset of puberty is when the symptoms of adolescent bipolar disorder often manifest. Symptoms typically mirror those of adults with manic depression. For some, adolescent bipolar disorder may initially be triggered by a traumatic event, such as the loss of a loved one, or severe stress. Later episodes may occur even in the absence of stress, or may worsen with stress. (Davis & Palladino, 2000)

Hormones may also trigger adolescent bipolar disorder in girls just starting to menstruate and they may notice that their symptoms vary in severity with their cycle.

Because a majority of teens with adolescent bipolar disorder abuse drugs or alcohol, their manic depression behavior is often masked by the substance abuse. The treatment of bipolar disorder in children is based on experience in treating adults with the illness, since very few studies have been done of the effectiveness and safety of the medications in children and adolescents. In all cases, an early bipolar disorder diagnosis and start of treatment is vital to establishing mood stability and mental wellness.

Thought Errors in Bipolar Disorder

Most children and adolescents with bipolar disorder may have a type of thinking that is irrational and difficult for others to understand. These types of thinking are called "thought errors." Not only are these thought styles in error, they're intensely uncomfortable to the person who suffers from them, because no one would deliberately choose to have these anxiety-producing thoughts. When these thoughts emerge in words and deeds, the damage can be even worse. If these thought patterns are left uncorrected they cause development of the hard-to-treat personality disorders making treatment of adults with manic depression impossible. Some of the most common problematic thought processes are:

Catastrophizing: The person will see only the worst possible outcome in everything.

Minimization: This is another side of catastrophizing involving the minimizing of one's own good qualities, or refusing to see the good (or bad) qualities of other people or situations.

Grandiosity: Some people have an exaggerated sense of self-importance or ability. They believe themselves to be of great importance and expect everyone to respect or fear him or her.

Personalization: This is a particularly unfortunate type of grandiosity that makes the person presume that they are the center of the universe, and that they cause all events whether good or ill to occur. For example, a child might believe his mean thoughts made his mother sick or unwell. (Mitzi Walsh, 2000)

Magical thinking: This is most common in people with obsessive-compulsive disorder, but are also seen in people with bipolar disorders. Magical thinkers come to believe that by doing some sort of ritual they can avoid harm to themselves or others. Others may come to feel that ritual behavior will bring about some positive event. The ritual may or may not be connected with the perceived harm, and sufferers tend to keep their rituals secret. (Mitzi Walsh, 2000)

Leaps in logic: Some people tend to jump to conclusions or make statements, often negative ones which they believe are based on logical reasoning, even though the process that led to the idea may be missing obvious steps. One common type of logical leap is assuming that they know what someone else is thinking.

All or nothing" thinking: This is an inability to see shades of gray in everyday life. Such a person expects everything to be either black or white, leading to despair and depression. They either believe themselves to be great successes or abject failures. (Mitzi Walsh, 2000)

Paranoia: In its extreme forms, paranoia slides into the realm of delusion. Many bipolar people experience less severe forms of paranoia because of personalizing events, catastrophizing, or making leaps in logic.

Delusional thinking: Most of the error thought styles are mildly delusional. Seriously delusional thinking has even less basis in reality, and can include holding persistently strange beliefs. For example, a child may insist that aliens kidnapped him, and really believe that it is true. (Mitzi Walsh, 2000)

The same chemical imbalances that cause bipolar disorder are at the root of these thought errors, although they also have a basis in life experiences. Many clinicians suspect that because people with bipolar disorders often deal with illogical waves of emotion and activity, they try to impose strict structures on their thoughts and beliefs to compensate. Because these thought styles have at least some chemical basis, medication helps in many cases. Another good approach (especially when it's used in conjunction with medication) is cognitive therapy, a type of talk therapy geared precisely toward helping people identify erroneous thinking and mistaken beliefs about themselves and the world. (Mitzi Walsh, 2000)

Truly delusional thinking can become entrenched, sometimes very quickly especially as many people with delusional thoughts are very secretive about them. Because delusions are a type of psychosis (a loss of connection with objective reality), medication is almost always used to help break the pattern. (Mitzi Walsh, 2000)

Types of Bipolar Disorder

The standard classification of bipolar disorders was given by Gerald Klerman, MD, who identified six forms of bipolar disorder. (American Psychiatric Association, 1994)

Bipolar I disorder is Mania and depression. This is the "classic" bipolar disorder. In this type, a person has long bouts of depression and long bouts of mania or mixed episodes. Suicide attempts are high, with 10 to 15% completed. Abuse and violent behavior is common. This is the most severe form of the disorder.

Those with bipolar II disorder experience hypomanic and depressive episodes, but never full manic or mixed episodes. Bipolar II disorder is often hard to recognize because the hypomania simply makes the individual feel happy and energetic. They often become more focused and productive. Oftentimes, those with bipolar II disorder may overlook their episodes of hypomania and seek treatment only for their depression.

Bipolar III (Cyclothymic disorders) produces irregular, short cycles of depression and hypomania. While the episodes are typically less severe than those of either bipolar I or II disorder, they may still interrupt work and social life.

Bipolar IV (hypomania or mania precipitated by antidepressant drugs), V (depressed patients with bipolar relatives) and VI (mania without depression) are classified under Bipolar Disorder Not Otherwise Specified (NOS). In these cases, the person experiences some of the symptoms of bipolar disorder but does not fit into any of the standard bipolar disorder classifications or any other category of mood disorder.

Bipolar Rapid Cycling is a condition where at least four cycles are completed in a twelve-month period. While mood changes with bipolar disorder typically occur gradually, with bipolar rapid cycling, however, a full cycle can be completed within days or in rare cases even in hours. This pattern of rapid cycling is seen in approximately 5 to 15% of patients with bipolar disorder and tends to develop late in the disorder.

Diagnosis of Bipolar Disorder

Bipolar disorder usually sets in at adolescence or early childhood, although it can sometimes start as late as the 40s or 50s. Bipolar disorder symptoms occurring late in life is generally triggered by factors such as excessive stress or substance abuse.

Manic depression behavior typically follows a pattern that cycles - sometimes rapidly - from depression to euphoria or irritability. One person's symptoms may include more mania (excitability) then depression; another person may suffer primarily from depression with mania occurring infrequently. Symptoms of mania and depression may be mixed together in any combination, but the person's mood swings from intense lows to extreme highs.

Without a professional diagnosis, symptoms of bipolar I or bipolar II disorder can be difficult to track and may be invisible except to those who know the person very well. In the early stages of the disorder, manic depression behavior may actually appear as a different problem such as substance abuse, changes in sleep patterns, strained relationships, or poor performance at work or school. (American Psychiatric Association, 1994)

Cyclothymic disorder is characterized by chronic, frequent swings between hypomania and depression that occur… [END OF PREVIEW]

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