Bipolar Disorder 1: Focus on Adolescence
One of the most prevalent psychological disorders in adolescence includes mood disorders, which are characterized by a disturbance in the regulation of mood, behavior, and affect. Such mood disorders are subdivided into depressive disorders, bipolar disorders, and depression in association with medical illness or alcohol and substance abuse. The focus of this paper is the bipolar disorders, which is known as manic-depressive disorder and involves episodes of alternate serious mania and depression, where mood swings from high elation and irritability to extreme sadness and hopelessness (, 2007). Because researches have found out that the onset of this type of psychological disorder is first evident on the pubescent period, this paper aims to examine and discuss the Bipolar Disorder 1 on the perspective of adolescence. Discussion and examination of the psychological disorder includes its description, features, prevalence, and manifestations with respect to DSM-IV TR, or the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. In addition, the possible methods of treatment and the implications of the disorder to the individual and the community would be given emphasis.
Bipolar Disorder 1: Manic-Depressive Disorder
Bipolar Disorder 1 or commonly called as the Manic-Depressive Disorder is said to be one of the most severe forms of mental illness, which is characterized by recurrent episodes of mania and depression, and is a condition that has a high rate of recurrence, thus, if left untreated, it leads to a high risk of suicide (, 2005). Emotional states of manic-depressives differ in magnitude and severity, and their mood swings from profound feelings of elation or mania to hypomania or feelings in between, to desperate feelings of hopelessness and helplessness or depression (, 2006). Although “normal” moments of a manic-depressive can be identified, such normal moments are considered transitions from one mood swing to another.
This neurological disorder is characterized by unpredictable mood swings from mania or hypomania to depression. Some clients suffer only from recurrent attacks of mania, which in its pure form is associated with increased psychomotor activity. In addition, excessive social extroversion, decreased need for sleep, impulsivity, impairment in judgment, and expansive, grandiose, and sometimes irritable mood can be observed. In clients with severe mania, they may experience delusions and paranoid thinking indistinguishable from that associated with schizophrenia. On the other hand, depressive states of clients may be characterized by depressed mood and loss of interest in pleasurable activities, and includes disturbances in appetite, sleep, and energy level and concentration (, 1988). Clients having depressive episodes may also be so fatigued that they sleep all day and night or cannot go to work or do household chores because of intense sadness and lethargy. They often feel worthless, shoulder excessive guilt, and are preoccupied with thoughts of suicide and death. More recent data show that approximately half of the patients with this type of disorder have sustained difficulties in work performance and psychosocial functioning. It has been reported that most frequent age of onset for bipolar disorder is between 20 and 30 years of age, but many individuals report premorbid symptoms in late childhood or early adolescence. The prevalence is similar for men and women, who are likely to have more depressive episodes and men who are more likely to experience more manic episodes over a lifetime. Its worldwide prevalence is 3-5% of the population, with no significant differences among racial groups (, 2005).
The causes or etiology of manic-depression is unknown, but a number of factors are said to determine its incidence, namely, genetics, biological, and psychosocial factors. It has been reported that the evidence for the heritability of bipolar disorder is stronger than that for unipolar disorder, thus, it has been found out that 50% of bipolar clients have at least one parent with a mood disorder. If one parent has bipolar disorder, there is a 7% chance that any child will have a mood disorder, and if both parents have bipolar disorder, then there is a 50-70% chance that a child will have a mood disorder. Twin studies have also shown that a concordance rate of 0.67 for bipolar disorder in monozygotic twins and 0.20 for bipolar disorder in dizygotic twins (, 1988). In regard of biological causes, it has been supposed that norepinephrine and serotonin are the two neurotransmitters most implicated in the pathophysiology of bipolar disorder. A decrease in serotonin levels affects the depressive state of the client, while increase in dopaminergic activity is increased in mania (, 1988). The last factor considered and crucial to cause bipolar disorder is the psychosocial factors, including the psychological and environmental events that affect the client. Life events and environmental stress serves to be strong causes of bipolar disorders and other psychological disorders. This involves a significant loss on the part of the client, which generates depression and severe emotional distress. Thus, in this regard, it can be perceived that the onset of bipolar disorder is multifactorial in nature.
Bipolar Disorder in Adolescence
(2002) reports that the criteria for diagnosing bipolar disorder in adolescence are the same as those for adults, and defined in DSM-IV TR, having several variations and combinations of mood strength and frequency of mood shift. As similarly and previously discussed, in Bipolar Disorder 1, the individual experiences one or more manic episodes, or mixed episodes and possibly one or more major depressive episodes. There can also be periods of relative or complete wellness between the episodes. Adolescents may initially exhibit either mania or depressive episodes, and a loss or other traumatic event may trigger the episode of depression or mania in adolescents. Additional episodes may occur independently or may be precipitated by stress. The onset of puberty is often thought to trigger the disorder. Symptoms in females may vary with their monthly menstrual cycle. In addition, adolescents may consumer illegal drugs in an attempt to control their mood swings and insomnia. Sudden development of the disorder following puberty often results in addiction to drugs and alcohol in these vulnerable adolescents. It then becomes necessary to treat both the bipolar disorder and the substance abuse. In children and younger adolescents, bipolar disorder is more continuous, with a cycle between depression and mania as few as several times per year, while several times throughout the day. This mixed state can cause them to feel full of energy, restless, worthless, and self-destructive simultaneously ( ., 2002).
Moreover, it has been reported that adolescent bipolar disorder showed significant continuity across developmental periods and was associated with adverse outcomes during young adulthood. Due to high rates of comorbidity with other psychological disorders, definitive conclusions regarding the specific clinical significance of bipolar disorder must await studies and researches with large numbers of cases. This leads to recent surveys that the lifetime prevalence of manic-depression in adolescents was estimated to be approximately 0.5%, and as of now, no national or international epidemiological study of manic-depression in children is available (, 2005). In this regard, it can be seen that causes of bipolar disorder among adolescents are may be due to the changing and ranging hormones and traumatic events both in the society and in the family. With such causes and symptoms observed among adolescents with bipolar symptoms, it would be essential to know how to administer treatment and assistance to both the individual experiencing the psychological disorder and his or her family and community.
Treatment of Bipolar Disorder in Adolescents
Based on such symptoms, the treatment of the client can be administered. Possible treatment of the bipolar adolescent includes the combination of both psychosocial and pharmacological treatments. Pharmacological treatments include administering anti-depressant drugs. Because the cause of depression is the deficiency in neurotransmitters norepinephrine and serotonin, and possible dopamine, administering anti-depressants, such as Selective Serotonin Reuptake Inhibitors or SSRIs, tricyclics, and Monoamine Oxidase Inhibitors or MAOIs, is based on the restoration of normal levels of these neurotransmitters. In addition, Lithium Carbonate remains the mainstay of treatment of bipolar disorder, although sodium valproate or valproic acid is equally effective. Carbamazepine is also efficacious. Serious side effects from lithium administration are rare, but minor complaints, including gastrointestinal discomfort, nausea, diarrhea, polyuria, weight gain, skin eruptions, and edema are common. In the end, urine-concentrating ability may be decreased, but changes in function are not significant. In addition, valproic acid is an alternative for clients who cannot tolerate lithium or respond poorly to it. Valproic acid may be better than lithium for clients who have a rapid-recycling course. Its most serious side effect is hepatotoxicity, which may be fatal. However, such cases are rare, but regular monitoring of liver enzymes of the client must be indicated. Carbamazepine, although not formally approved by the Food and Drug Administration, has clinical efficacy in the treatment of acute mania. It may be initiated 400 to 600 mg/d in divided doses, and increased to achieve a blood level of 4 to 12 mg/L. The recurrent nature of manic-depression necessitates maintenance treatment, and as such, anti-depressant medications may be required. However, the use of anti-depressants must be generally avoided during maintenance treatment because of possible risk of precipitating mania or accelerating the cycle frequency. As such, an alternative agent or combination therapy usually restores the therapeutic benefit (, 1994). Herbal or natural supplements can also be used, as there is evidence that St. John’s wort can reduce depression, but little is still known about its effect on bipolar disorder. Such forms of medications can be provided for by the family of the bipolar adolescent, but must be under the supervision, guidance, and prescription of a psychiatrist. In this regard, over dosages would be avoided that would contribute to further adverse complications.
Aside from pharmacology, the treatment of a bipolar adolescent can be hastened using psychosocial interventions. Psychosocial interventions involve activities and education of the bipolar adolescent, his or her family, and the whole community, thus, providing overall and wholesome assistance and care for the individual with bipolar disorder. One of the psychosocial interventions that can be provided is the Cognitive-Behavioral Therapy, which would help bipolar adolescents by learning how to change inappropriate or negative thought patterns and behaviors associated with the disorder. Methods involved in this type of therapy include modifying the environmental contingencies that surround the problem, weakening previous conditioned associations that have resulted in maladaptive emotional reactions, offering clients more effective models of problem-solving and interpersonal behavior, seeking to change ways in which stimuli are recognized and interpreted, and offering an objectively superior basis for the therapeutic, counseling or casework roles of the psychologist or psychiatrist (, 1995). Another form of psychosocial intervention is Psychoeducation, which involves teaching clients with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown bipolar episode occurs. It may also be helpful for family members. Equally helpful is the use of family therapy, a form of psychotherapy, which uses strategies to reduce the level of distress within the family that may either contribute to or result from the adolescent’s symptoms. Family therapy also helps families or members of the family to understand and improve on how family members interact with each other and resolve conflicts (“, 2007). The last type of psychosocial intervention that can be used is the Interpersonal and Social Rhythm Therapy, which aims to help people with manic-depression both to improve interpersonal relationships and to regularize their daily routines, on the basis that regular daily routines and sleep schedules may help protect against manic episodes. In addition, because biological rhythms are affected by disruptions in social rhythms, this type of therapy aims to correct or alter daily rhythms, including the wake-sleep cycle and times of eating, working, socializing and other daily activities that are unique to each individual (, 2004).
Implications of Bipolar Disorder in Adolescents
Because an adolescent experiencing manic-depression exhibits a number of alternating and opposing symptoms, it can be perceived that a number of implications can be identified. Such implications affect not only the individual suffering from manic-depression, but affect his or her family and community as well. It has been reported that adolescents exhibit irritability and outbursts of destructive rage that are violent and often result in exhaustion. Such rages are frequently precipitated by a requirement to follow a rule or by a denial of a request (., 2002). As such, destruction of property and of self can be observed, thus, making the bipolar adolescent socially destructive and deviant, not only in terms of properties and objects, but in terms of the emotional and psychological aspects of the people around him or her.
This is also supported by the feature of bipolar adolescents, as being oppositional and tyrannical. They defy authority and dictate to their parents how they should relate to and discipline their siblings, and display an outburst of rage and anger when told that he or she cannot engage in a requested activity, and often becomes verbally abusive (., 2002). This contributes to the self-destructive behavior of the bipolar adolescent, and the emotional and psychological trauma of the people around him or her, most especially his or her family and friends. Because they tend to defy authority, further implications include more violations in school and the state, thus, may lead to imprisonment and sentences. Manic-depression is also characterized by akathesia, which is restless inner tension, and contributes to the sleep disturbance of bipolar adolescents. It has been observed that bipolar adolescent’s cycle through periods of hyperactivity that is oddly magnified at night, and because of this, they usually sneak out at night after everyone is asleep or driving at night streets without a license (., 2002). Sleep disturbance or lack of sleep has adverse effects on the biological functioning of an individual, most especially on the biological functioning of adolescents, which is in its crucial development at this time. (2006) reports that sleep is needed to regenerate certain parts of the body, especially the brain. During extended wakefulness or reduced sleep, as being exhibited by bipolar adolescents, neurons may begin to malfunction, visibly affecting a person’s behavior (, 2006). This explanation further supports that the lack of sleep of bipolar adolescents may have been one of the factors that changes their moods and behavior toward situations and other individuals. In addition, because they engage in risky activities at nighttime, they also cause sleep disturbance to other individuals in the neighborhood and to their family, most especially if they engage in noisy, dangerous, and destructive activities. In summation, it can be perceived that the sleep disturbance of the bipolar adolescent also leads to the lack of sleep of his or her family members and the people in the neighborhood. Another trait of bipolar adolescents, which presents adverse implications, is their impulsivity. They act impulsively to energize themselves when depressed (., 2002), thus making them decide on things without using their right and good judgments. Such leads to more serious problems, including premarital sex, teenage pregnancy, single-parenthood, murder, rape, and other crimes and violations of the law that may risk the safety and integrity of the adolescent and his or her family. The lack of proper cognitive functioning of the bipolar adolescent causes him or her to have lack of self-control and to have lack of concentration. This leads the adolescent to quit school, thus, may become socially withdrawn due to extreme depression, and make him or her to think of committing suicide. This presents complications and other problems to be experienced by his or her family, thus, making them make decisions that would worsen the condition of the bipolar adolescent. Such decisions may include abandonment or desertion, reprimanding at all times, isolation, and having the perception that the adolescent is socially deviant or having behavioral problems. In this regard, it can be perceived that such actions can be the effects or the implications of the lack of understanding of the family and community of the bipolar adolescent. Due to ignorance, lack of proper and relevant information, and education, the condition of the bipolar adolescent may worsen and become a full-blown manic-depression. The worst implication of this psychological disorder is to become a full-blown manic-depression and later on lead to psychosis on the later part of the life of the individual. In this regard, the individual would become non-functional in all aspects, such as psychologically, emotionally, rationally, and socially. As such, the end-result of the process would be taking the individual to mental institutions for confinement and to undergo more significant psychological and mental treatments.
In this sense, it can be seen that bipolar disorder or manic-depression must not be taken lightly, although its manifestations in the adolescents may seem hard to determine. However, in this regard, the saying, “an ounce of prevention is worth a pound of cure”, is the most relevant saying in addressing problems in bipolar disorder because proper care of the adolescents starts from the family and the community. Preventive measures must be observed in order not to contribute to full-blown manic-depression or other psychotic disorders.
Works Cited
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