Главная | Обратная связь | Поможем написать вашу работу!
МегаЛекции

Depressive episodes




Ministry of Education and Science of the Russian Federation Federal State Educational Institution of Higher Professional Education

"Chuvash State University named I. N. Ulyanov"

Faculty of Management and Social technologies

Department of Social and Clinical Psychology

Occupation: Clinical Psychology

 

Coursework

On the subject "English"

 

Bipolar disorder

 

  Finished: Zhuravlev A.V.
  2nd year student groups: ОЗУСТ-24-12
  evening classes
  Alexey Zhuravlev Vladimirovich
   
  Supervisor:
  Ph.D., Associate Professor
  Vaybert Margarita Ivanovna
  Rating:__________________________
  «____»______________________2014г.

 

Cheboksary 2014


Contents:

Introduction  
1. Signs and symptoms  
1.1. Manic episodes  
1.2. Depressive episodes  
2. Causes  
2.1. Physiological  
3. Prevention  
4. Diagnosis  
5 Management  
6 Prognosis  
7 Epidemiology  
8 History  
9 Society and culture  
10 Specific populations  
10.1 Children  
10.2 Elderly  

From Wikipedia, the free encyclopedia

 

 

Introduction

Bipolar disorder, also known as bipolar affective disorder, manic-depressive disorder, or manic depression, is a mental illness characterized by episodes of an elevated mood known as mania, usually alternating with episodes of depression. During mania an individual feels abnormally happy, energetic, or excitable, but often makes poor decisions due to unrealistic ideas or poor regard of consequences. Manic and depressive episodes can impair the individual's ability to function in ordinary life.

About 3% of people have bipolar disorder worldwide, a proportion consistent for both men and women and across racial and ethnic groups. The cause is not clearly understood, but both genetic and environmental risk factors are believed to play a role. Treatment commonly includes mood stabilizing medication and psychotherapy.

There are widespread problems with social stigma, stereotypes, and prejudice against individuals with bipolar disorder. Contents

 

Signs and symptoms

Mania is the defining feature of bipolar disorder, and can occur with different levels of severity. With milder levels of mania, known as hypomania, individuals appear energetic, excitable, and may be highly productive. As mania worsens, individuals begin to exhibit erratic and impulsive behavior, often making poor decisions due to unrealistic ideas about the future, and sleep very little. At the most severe level, manic individuals can experience very distorted beliefs about the world known as psychosis. A depressive episode commonly follows an episode of mania. The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode or vice versa remain poorly understood.

Manic episodes

Mania is a distinct period of at least one week of elevated or irritable mood, which can take the form of euphoria, and exhibit three or more of the following behaviors (four if irritable): speak in a rapid, uninterruptible manner, are easily distracted, have racing thoughts, display an increase in goal-oriented activities or feel agitated, or exhibit behaviors characterized as impulsive or high-risk such as hypersexuality or excessive money spending. To meet the definition for a manic episode, these behaviors must impair the individual's ability to socialize or work. If untreated, a manic episode usually lasts three to six months.

People with mania may also experience a decreased need for sleep, speak excessively in addition to speaking rapidly, and may have impaired judgment. Manic individuals often have issues with substance abuse due to a combination of thrill-seeking and poor judgment. At more extreme levels, a person in a manic state can experience psychosis, or a break with reality, a state in which thinking is affected along with mood. They may feel out of control or unstoppable, or as if they have been "chosen" and are on a special mission, or have other grandiose or delusional ideas. Approximately 50% of those with bipolar disorder experience delusions or hallucinations.This may lead to violent behaviors and hospitalization in an inpatient psychiatric hospital. The severity of manic symptoms can be measured by rating scales such as the Young Mania Rating Scale.

The onset of a manic (or depressive) episode is often foreshadowed by sleep disturbances.Mood changes, psychomotor and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops.

Depressive episodes

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 thoughts. In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features. These symptoms include delusions or, less commonly, hallucinations, which are usually unpleasant. A major depressive episode persists for at least two weeks, and may continue for over six months if left untreated.

The earlier the age of onset, the more likely the first few episodes are to be depressive. Because a bipolar diagnosis requires a manic or hypomanic episode, many patients are initially diagnosed and treated as having major depression.

Causes

The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear. Genetic influences are believed to account for 60-80% of the risk of developing the disorder indicating a strong hereditary component. The overall heritability of the bipolar spectrum has been estimated at 0.71. Twin studies have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For bipolar disorder type I, the (probandwise) concordance rates in modern studies have been consistently estimated at around 40% in identical twins (same genes), compared to about 5% in fraternal twins. 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. There is overlap with unipolar depression and if this is also counted in the co-twin the concordance with bipolar disorder rises to 67% in monozygotic twins and 19% in dizygotic. 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.

Genetic

Genetic studies have suggested that many chromosomal regions and candidate genes are related to bipolar disorder susceptibility with each gene exerting a mild to moderate effect. The risk of bipolar disorder is nearly ten-fold higher in first degree-relatives of those affected with bipolar disorder when compared to the general population; similarly, the risk of major depressive disorder is three times higher in relatives of those with bipolar disorder when compared to the general population.

Although the first genetic linkage finding for mania was in 1969, the linkage studies have been inconsistent. The largest and most recent genome-wide association study failed to find any particular locus that exerts a large effect reinforcing the idea that no single gene is responsible for bipolar disorder in most cases.

Findings point strongly to heterogeneity, with different genes being implicated in different families. Robust and replicable genome-wide significant associations showed several common single nucleotide polymorphisms, including variants within the genes CACNA1C, ODZ4, and NCAN.

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.

 

Physiological

Brain imaging studies have revealed differences in the volume of various brain regions between BD patients and healthy control subjects

Abnormalities in the structure and/or function of certain brain circuits could underlie bipolar. Meta-analyses of structural MRI studies in bipolar disorder report an increase in the volume of the lateral ventricles, globus pallidus and increase in the rates of deep white matter hyperintensities. Functional MRI findings suggest that abnormal modulation between ventral prefrontal and limbic regions, especially the amygdala, are likely contribute to poor emotional regulation and mood symptoms.

According to the "kindling" hypothesis, when people who are genetically predisposed toward bipolar disorder experience stressful events, the stress threshold at which mood changes occur becomes progressively lower, until the episodes eventually start (and recur) spontaneously. There is evidence supporting an association between early-life stress and dysfunction of the hypothalamic-pituitary-adrenal axis (HPA axis) leading to its over activation, which may play a role in the pathogenesis of bipolar disorder.

Other brain components which have been proposed to play a role are the mitochondria and a sodium ATPase pump. Alterations to these components are believed to cause cyclical periods of poor neuron firing (depression) and hypersensitive neuron firing (mania).[citation needed] Circadian rhythms and melatonin activity also seem to be altered.

Prevention

Prevention of bipolar has focused on stress (such as childhood adversity or highly conflictual families) which, although not a diagnostically specific causal agent for bipolar, does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. There has been debate regarding the causal relationship between usage of cannabis and bipolar disorder.

 

 

Diagnosis

Bipolar disorder often goes unrecognized and is commonly diagnosed during adolescence or early adulthood. Diagnosis is based on the self-reported experiences of an individual as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a psychiatrist, nurse, social worker, clinical psychologist or other clinician in a clinical assessment. There are lists of criteria for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the current version being DSM-IV-TR, and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, currently the ICD-10. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions, as well as prevailing in research studies. The DSM-V, published in 2013, included further and more accurate sub-typing.

An initial assessment may include a physical exam by a physician. Although there are no biological tests which confirm bipolar disorder, tests may be carried out to exclude medical illnesses such as hypothyroidism or hyperthyroidism, metabolic disturbance, a chronic disease, or an infection such as syphilis or HIV.[58] An EEG may be used to exclude a seizure disorder such as epilepsy, and a CT scan of the head may be used to exclude brain lesions. Investigations are not generally repeated for relapse unless there is a specific medical indication. There is no specific medical test to diagnose bipolar disorder.

Several rating scales for the screening and evaluation of bipolar disorder exist, such as the Bipolar spectrum diagnostic scale. The use of evaluation scales can not substitute a full clinical interview but they serve to systematize the recollection of symptoms. On the other hand, instruments for the screening of bipolar disorder have low sensitivity[clarification needed] and limited diagnostic validity.

Management

Light therapy is one of several approaches to treating bipolar disorder. No one method is universally successful and most persons suffering from the illness need several forms of support.

There are a number of pharmacological and psychotherapeutic techniques used to treat bipolar disorder. Individuals may use self-help and pursue recovery.

Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (if mental health legislation allows and varying state-to-state regulations in the USA) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although these can still occur. Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment and patient-led support groups, intensive outpatient programs. These are sometimes referred to partial-inpatient programs.

 

Prognosis

For many individuals with bipolar disorder a good prognosis results from good treatment, which, in turn, results from an accurate diagnosis. Of the various forms of bipolar disorder, rapid cycling bipolar disorder is associated with the worst prognosis.[15] Because bipolar disorder can have a high rate of both under-diagnosis and misdiagnosis,[17] it is often difficult for individuals with the condition to receive timely and competent treatment.

Bipolar disorder can be a severely disabling medical condition. However, many individuals with bipolar disorder can live full and satisfying lives. Quite often, medication is needed to enable this. Persons with bipolar disorder may have periods of normal or near normal functioning between episodes.

 

Epidemiology

Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 3% in the general population. However, a reanalysis of data from the National Epidemiological Catchment Area survey in the United States suggested that 0.8% of the population experience a manic episode at least once (the diagnostic threshold for bipolar I) and a further 0.5% have a hypomanic episode (the diagnostic threshold for bipolar II or cyclothymia). Including sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, an additional 5.1% of the population, adding up to a total of 6.4%, were classified as having a bipolar spectrum disorder.A more recent analysis of data from a second US National Comorbidity Survey found that 1% met lifetime prevalence criteria for bipolar I, 1.1% for bipolar II, and 2.4% for subthreshold symptoms. There are conceptual and methodological limitations and variations in the findings. Prevalence studies of bipolar disorder are typically carried out by lay interviewers who follow fully structured/fixed interview schemes; responses to single items from such interviews may suffer limited validity. In addition, diagnoses (and therefore estimates of prevalence) vary depending on whether a categorical or spectrum approach is used. This consideration has led to concerns about the potential for both underdiagnosis and overdiagnosis.

The incidence of bipolar disorder is similar in men and women as well as across different cultures and ethnic groups. A 2000 study by the World Health Organization found that prevalence and incidence of bipolar disorder are very similar across the world. Age-standardized prevalence per 100,000 ranged from 421.0 in South Asia to 481.7 in Africa and Europe for men and from 450.3 in Africa and Europe to 491.6 in Oceania for women. However, severity may differ widely across the globe. Disability-adjusted life year rates, for example, appear to be higher in developing countries, where medical coverage may be poorer and medication less available.

Within the United States, African and European Americans have similar rates of bipolar disorder, while Asian Americans have lower rates.

Late adolescence and early adulthood are peak years for the onset of bipolar disorder. One study also found that in 10% of bipolar cases, the onset of mania had happened after the patient had turned 50.

History

German psychologist Emil Kraeplin first distinguished between manic–depressive illness and "dementia praecox" (now known as schizophrenia) in the late 19th century

Variations in moods and energy levels have been observed as part of the human experience since throughout history. The words "melancholia" (an old word for depression) and "mania" originated in Ancient Greek. The word melancholia is derived from melas/μελας, meaning "black", and chole/χολη, meaning "bile" or "gall", indicative of the term's origins in pre-Hippocratic humoral theories. Within the humoral theories, mania was viewed as arising from an excess of yellow bile, or a mixture of black and yellow bile. The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the Roman physician Caelius Aurelianus, including the Greek word ania, meaning "to produce great mental anguish", and manos, meaning "relaxed" or "loose", which would contextually approximate to an excessive relaxing of the mind or soul. There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic poetry and mythologies.

In the early 1800s, French psychiatrist Jean-Étienne Dominique Esquirol's lypemania, one of his affective monomanias, was the first elaboration on what was to become modern depression. The basis of the current conceptualisation of manic–depressive illness can be traced back to the 1850s; on January 31, 1854, Jules Baillarger described to the French Imperial Academy of Medicine a biphasic mental illness causing recurrent oscillations between mania and depression, which he termed folie à double forme ("dual-form insanity"). Two weeks later, on February 14, 1854, Jean-Pierre Falret presented a description to the Academy on what was essentially the same disorder, and designated folie circulaire ("circular insanity") by him.

These concepts were developed by the German psychiatrist Emil Kraepelin (1856–1926), who, using Kahlbaum's concept of cyclothymia, categorized and studied the natural course of untreated bipolar patients. He coined the term manic depressive psychosis, after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally.

The term "manic–depressive reaction" appeared in the first American Psychiatric Association Diagnostic Manual in 1952, influenced by the legacy of Adolf Meyer who had introduced the paradigm illness as a reaction of biogenetic factors to psychological and social influences. Subclassification of bipolar disorder was first proposed by German psychiatrist Karl Leonhard in 1957; he was also the first to introduce the terms bipolar (for those with mania) and unipolar (for those with depressive episodes only).

Поделиться:





Воспользуйтесь поиском по сайту:



©2015 - 2024 megalektsii.ru Все авторские права принадлежат авторам лекционных материалов. Обратная связь с нами...