PSYCHOLOGY PROJECT

BIPOLAR DISORDER

BY MOHAMMED SIKANDER SHAIKH 12-K

 Acknowledgement

I would like to take this opportunity to thank Mrs. Shivani, my

psychology teacher, my academic guide for her cordial support,
valuable information and guidance throughout my project work.
I would also like to thank my friends who helped and supported
me throughout. Lastly, I would like to thank my family for all
their immense support.
 INDEX

INTRODUCTION
Bipolar disorder, formerly called manic depression, is a mental health
condition that causes extreme mood swings that include emotional highs
(mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose
interest or pleasure in most activities. When your mood shifts to mania
or hypomania (less extreme than mania), you may feel euphoric, full of
energy or unusually irritable. These mood swings can affect sleep,
energy, activity, judgment, behavior and the ability to think clearly.

SIGNS AND SYMPTOMS

Late adolescence and early adulthood are peak years for the onset of
bipolar disorder. The condition is characterized by intermittent episodes
of mania and/or depression, with an absence of symptoms in
between. During these episodes, people with bipolar disorder exhibit
disruptions in normal mood, psychomotor activity (the level of physical
activity that is influenced by mood)—e.g. constant fidgeting during
mania or slowed movements during depression—circadian rhythm and
cognition. Mania can present with varying levels of mood disturbance,
ranging from euphoria, which is associated with "classic mania",
to dysphoria and irritability.] Psychotic symptoms such as delusions or
hallucinations may occur in both manic and depressive episodes; their
content and nature are consistent with the person's prevailing mood.

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 73–93% 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 I disorder, the rate at which identical twins (same
genes) will both have bipolar I disorder (concordance) is around 40%,
compared to about 5% in fraternal twins. A combination of bipolar I, II,
and cyclothymia similarly produced rates of 42% and 11% (identical and
fraternal twins, respectively).[ The rates of bipolar II combinations
without bipolar I are lower—bipolar II at 23 and 17%, and bipolar II
combining with cyclothymia at 33 and 14%—which may reflect
relatively higher genetic heterogeneity.

GENETIC
Behavioral 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 with bipolar disorder than in the general population;
similarly, the risk of major depressive disorder is three times higher in
relatives of those with bipolar disorder than in the general population

Although the first genetic linkage finding for mania was in 1969, linkage
studies have been inconsistent. Findings point strongly to heterogeneity,
with different genes implicated in different families. Robust and
replicable genome-wide significant associations showed several
common single-nucleotide polymorphisms (SNPs) are associated with
bipolar disorder, including variants within the genes CACNA1C, ODZ4,
and NCAN. The largest and most recent genome-wide association
study failed to find any locus that exerts a large effect, reinforcing the
idea that no single gene is responsible for bipolar disorder in most cases.
[50]
Polymorphisms in BDNF, DRD4, DAO, and TPH1 have been
frequently associated with bipolar disorder and were initially associated
in a meta-analysis, but this association disappeared after correction
for multiple testing. On the other hand, two polymorphisms
in TPH2 were identified as being associated with bipolar disorder.

ENVIRONMENTAL
Psychosocial factors play a significant role in the development and
course of bipolar disorder, and individual psychosocial variables may
interact with genetic dispositions. Recent life events and interpersonal
relationships likely contribute to the onset and recurrence of bipolar
mood episodes, just as they do for unipolar depression. In surveys, 30–
50% of adults diagnosed with bipolar disorder report traumatic/abusive
experiences in childhood, which is associated with earlier onset, a higher
rate of suicide attempts, and more co-occurring disorders such as post-
traumatic stress disorder. The number of reported stressful events in
childhood is higher in those with an adult diagnosis of bipolar spectrum
disorder than in those without, particularly events stemming from a
harsh environment rather than from the child's own behavior. Acutely,
mania can be induced by sleep deprivation in around 30% of people with
bipolar disorder.

SUBSTANCE ABUSE
Data from both developed and developing countries countries reveal
high levels of comorbidity in bipolar illness. Data collected on bipolar
disorder show rates of substance abuse that are 5–6 times greater than
those among general populations. Three studies found the rate of
substance misuse in those with Bipolar I disorder to be over 60 percent,
and at least 35 percent of total bipolar disorder cases were complicated
by alcohol abuse. A diagnosis of an underlying bipolar illness may be
missed because of the high rate of comorbidity and the more
conspicuous signs and symptoms of substance abuse.

trakowski and DelBello's recent review of the existing literature on the

co-occurrence of bipolar disorder and substance abuse found evidence to
support four distinct hypotheses to explain this association: 1) substance
abuse occurs as a symptom of bipolar disorder; 2) substance abuse is an
attempt by bipolar patients to self-medicate symptoms; 3) substance
abuse causes bipolar disorder; and 4) substance use and bipolar disorders
share a common risk factor. The variability in findings from the existing
evidence suggests that additional studies to examine the relationship
between substance abuse and bipolar disorder are needed. Future studies
that increase the understanding of this frequent co-occurrence may
eventually provide guidance toward improved prevention and treatment
strategies for both conditions.

ASSOCIATION WITH AGE AND GENDER

Findings of recent studies in developed as well as developing countries
estimate the peak age of onset for bipolar disorder between 18 and
24.Though the age of onset and number of affective episodes of each
polarity have not been shown to differ between men and women, some
studies have shown that women experience depressive episodes of the
disorder more frequently and men have been shown to be at greater risk
for manic episodes.
Several studies have yielded similar findings for childhood-onset bipolar
disorder. Irritability was the predominant affective disturbance in
younger manic children, but prepubertal bipolar children began their
illness with cycles of dysphoria, hypomania, and agitation intermixed,
and increasingly extreme cycles of manic and depressive states became
more common with the onset of puberty.Adolescents who are early into
their illness are often prone to highly elevated mood states and grandiose
delusions resulting in poor adherence to treatment. findings on the
course of bipolar disorder in children have been reported in India.

BIPOLAR SPECTRUM
Bipolar spectrum disorders include: bipolar I disorder, bipolar II
disorder, cyclothymic disorder and cases where subthreshold symptoms
are found to cause clinically significant impairment or distress. These
disorders involve major depressive episodes that alternate with manic or
hypomanic episodes, or with mixed episodes that feature symptoms of
both mood states. The concept of the bipolar spectrum is similar to that
of Emil Kraepelin's original concept of manic depressive illness.
Bipolar II disorder was established as a diagnosis in 1994 within DSM
IV; though debate continues over whether it is a distinct entity, part of a
spectrum, or exists at all.

FACTORS AFFECTING COURSE AND OUTCOME

Bipolar disorder is quite disabling because of its recurrent course,
frequency of suicidal ideation, and significant impact on social
functioning during acute episodes of both polarities. Data on the
frequency of variable levels of recurrence are inconsistent, yet telling.
An older study found that patients averaged as many as 12 episodes
during a 25-year period. Winokur et al. (1994) estimated that over a 10-
year period, patients averaged three episodes and five hospitalizations.
Even with pharmacological intervention, those suffering one manic
episode almost always go on to have another.Ongoing and significant
symptoms between major episodes occur even in individuals who suffer
infrequent acute episodes.

PROPOSED MECHANISM
The precise mechanisms that cause bipolar disorder are not well
understood. Bipolar disorder is thought to be associated with
abnormalities in the structure and function of certain brain areas
responsible for cognitive tasks and the processing of emotions. A
neurologic model for bipolar disorder proposes that the emotional
circuitry of the brain can be divided into two main parts. The ventral
system (regulates emotional perception) includes brain structures such as
the amygdala, insula, ventral striatum, ventral anterior cingulate cortex,
and the cortex. The dorsal system (responsible for emotional regulation)
includes the hippocampus, dorsal anterior cingulate cortex, and other
parts of the prefrontal cortex. The model hypothesizes that bipolar
disorder may occur when the ventral system is overactivated and the
dorsal system is underactivated. Other models suggest the ability to
regulate emotions is disrupted in people with bipolar disorder and that
dysfunction of the ventricular prefrontal cortex (vPFC) is crucial to this
disruption.
Meta-analyses of structural MRI studies have shown that certain brain
regions (e.g., the left rostral anterior cingulate cortex, fronto-insular
cortex, ventral prefrontal cortex, and claustrum) are smaller in people
with bipolar disorder, whereas other regions are larger (lateral
ventricles, globus pallidus, subgenual anterior cingulate, and the
amygdala). Additionally, these meta-analyses found that people with
bipolar disorder have higher rates of deep white matter hyperintensities.

RAPID CYCLING
Most people who meet criteria for bipolar disorder experience a number
of episodes, on average 0.4 to 0.7 per year, lasting three to six
months. Rapid cycling, however, is a course specifier that may be
applied to any bipolar subtype. It is defined as having four or more
mood disturbance episodes within a one-year span. Rapid cycling is
usually temporary but is common amongst people with bipolar disorder
and affects between 25.8 and 45.3% of them at some point in their life.
These episodes are separated from each other by a remission (partial or
full) for at least two months or a switch in mood polarity (i.e., from a
depressive episode to a manic episode or vice versa). The definition of
rapid cycling most frequently cited in the literature (including the DSM-
V and ICD-11) is that of Dunner and Fieve: at least four major
depressive, manic, hypomanic or mixed episodes during a 12-month
period. The literature examining the pharmacological treatment of rapid
cycling is sparse and there is no clear consensus with respect to its
optimal pharmacological management. People with the rapid cycling or
ultradian subtypes of bipolar disorder tend to be more difficult to treat
and less responsive to medications than other people with bipolar
disorder.

CHILDREN
In the 1920s, Kraepelin noted that manic episodes are rare before
puberty. In general, bipolar disorder in children was not recognized in
the first half of the twentieth century. This issue diminished with an
increased following of the DSM criteria in the last part of the twentieth
century.[112][113] The diagnosis of childhood bipolar disorder, while
formerly controversial,[114] has gained greater acceptance among
childhood and adolescent psychiatrists. American children and
adolescents diagnosed with bipolar disorder in community
hospitals increased 4-fold reaching rates of up to 40% in 10 years around
the beginning of the 21st century, while in outpatient clinics it doubled
reaching 6%.[114] Studies using DSM criteria show that up to 1% of youth
may have bipolar disorder. The DSM-5 has established a diagnosis—
disruptive mood dysregulation disorder—that covers children with long-
term, persistent irritability that had at times been misdiagnosed as having
bipolar disorder,[116] distinct from irritability in bipolar disorder that is
restricted to discrete mood episodes.

ELDERLY
Bipolar disorder is uncommon in older patients, with a measured
lifetime prevalence of 1% in over 60s and a 12-month prevalence of 0.1
to 0.5% in people over 65. Despite this, it is overrepresented in
psychiatric admissions, making up 4 to 8% of inpatient admission to
aged care psychiatry units, and the incidence of mood disorders is
increasing overall with the aging population. Depressive episodes more
commonly present with sleep disturbance, fatigue, hopelessness about
the future, slowed thinking, and poor concentration and memory; the last
three symptoms are seen in what is known as pseudodementia. Clinical
features also differ between those with late-onset bipolar disorder and
those who developed it early in life; the former group present with
milder manic episodes, more prominent cognitive changes and have a
background of worse psychosocial functioning, while the latter present
more commonly with mixed affective episodes, and have a stronger
family history of illness. Older people with bipolar disorder experience
cognitive changes, particularly in executive functions such as abstract
thinking and switching cognitive sets, as well as concentrating for long
periods and decision-making.

TREATMENT
Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental
health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may
have a treatment team that also includes a psychologist, social worker and psychiatric nurse.
Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending
on your needs, treatment may include:

Medications.
Often, you'll need to start taking medications to balance your
moods right away.

 Mood stabilizers. You'll typically need mood-stabilizing

medication to control manic or hypomanic episodes. Examples
of mood stabilizers include lithium (Lithobid), valproic acid
(Depakene), divalproex sodium (Depakote), carbamazepine
(Tegretol, Equetro, others) and lamotrigine (Lamictal).
 Antipsychotics. If symptoms of depression or mania persist in
spite of treatment with other medications, adding an
antipsychotic drug such as olanzapine (Zyprexa), risperidone
(Risperdal), quetiapine (Seroquel), aripiprazole (Abilify),
ziprasidone (Geodon), lurasidone (Latuda) or asenapine
(Saphris) may help. Your doctor may prescribe some of these
medications alone or along with a mood stabilizer.
 Antidepressants. Your doctor may add an antidepressant to
help manage depression. Because an antidepressant can
sometimes trigger a manic episode, it's usually prescribed
along with a mood stabilizer or antipsychotic.
 Antidepressant-antipsychotic. The medication Symbyax
combines the antidepressant fluoxetine and the antipsychotic
olanzapine. It works as a depression treatment and a mood
stabilizer.
 Anti-anxiety medications. Benzodiazepines may help with
anxiety and improve sleep, but are usually used on a short-
term basis.
 PSYCHOTHERAPY
Psychotherapy is a vital part of bipolar disorder treatment and can be
provided in individual, family or group settings. Several types of therapy
may be helpful. These include:

 Interpersonal and social rhythm therapy (IPSRT). IPSRT

focuses on the stabilization of daily rhythms, such as sleeping,
waking and mealtimes. A consistent routine allows for better
mood management. People with bipolar disorder may benefit
from establishing a daily routine for sleep, diet and exercise.

 Cognitive behavioral therapy (CBT). Cognitive behavioral therapy

(CBT) is a type of psychotherapy that can be used to help manage bipolar
disorder.Psychotherapy may involve a one-on-one interaction with a therapist.
It may also involve group sessions that include the therapist and other people
with similar issues.Although there are many approaches, they all involve
helping people manage their thoughts, perceptions, and behavior.
Psychotherapy is also a resource for finding healthy ways to deal with
problems.The focus is identifying unhealthy, negative beliefs and
behaviors and replacing them with healthy, positive ones. CBT can
help identify what triggers your bipolar episodes. You also learn
effective strategies to manage stress and to cope with upsetting
situations. CBT is used to treat bipolar disorder by:addressing
depressive symptoms that occur as part of periods or episodes of
depression.addressing feelings of guilt or other negative thoughts
and beliefs about manic episodes.addressing feelings of losing
friends or relationships.

 Psychoeducation. Learning about bipolar disorder

(psychoeducation) can help you and your loved ones
understand the condition. Knowing what's going on can help
 you get the best support, identify issues, make a plan to
prevent relapse and stick with treatment.

Family-focused therapy. Family support and communication

can help you stick with your treatment plan and help you and
your loved ones recognize and

 manage warning signs of mood swings.

TREATMENT IN KIDS AND

TEENAGERS
Treatments for children and teenagers are generally decided on a case-by-case basis, depending
on symptoms, medication side effects and other factors. Generally, treatment includes:

 Medications. Children and teens with bipolar disorder are often prescribed the same types
of medications as those used in adults. There's less research on the safety and effectiveness
of bipolar medications in children than in adults, so treatment decisions are often based on
adult research.
 Psychotherapy. Initial and long-term therapy can help keep symptoms from returning.
Psychotherapy can help children and teens manage their routines, develop coping skills,
address learning difficulties, resolve social problems, and help strengthen family bonds and
communication. And, if needed, it can help treat substance abuse problems common in
older children and teens with bipolar disorder.
 Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder
and how they differ from behavior related to your child's developmental age, the situation
and appropriate cultural behavior. Understanding about bipolar disorder can also help you
support your child.
 Support. Working with teachers and school counselors and encouraging support from
family and friends can help identify services and encourage success.
 CONCLUSION
Bipolar disorder, a complex and multifaceted mental health condition,
poses significant challenges for individuals, families, and communities.
Through comprehensive research and analysis, this project has shed light
on the intricacies of bipolar disorder, including its symptoms, causes,
risk factors, and available treatment options.

By examining the impact of bipolar disorder on various aspects of life,

such as relationships, work, and overall well-being, it has become
evident that early diagnosis and appropriate intervention are crucial for
managing this condition effectively. Moreover, the project has
emphasized the importance of holistic approaches that combine
medication, therapy, and lifestyle adjustments to promote long-term
stability and quality of life for individuals living with bipolar disorder.

Additionally, the research has highlighted the need for increased public
awareness, destigmatization, and improved access to mental health
resources for those affected by bipolar disorder. By fostering a more
empathetic and informed societal perspective, we can create a supportive
environment that encourages open dialogue, understanding, and
acceptance for individuals navigating the challenges of bipolar disorder.

In conclusion, while bipolar disorder presents significant obstacles, with

the right support, education, and treatment, individuals can lead
fulfilling lives and contribute meaningfully to their communities.
Continued research, advocacy, and collaborative efforts are crucial to
advancing our understanding of bipolar disorder and to developing more
effective strategies for diagnosis, management, and support.
 BIBLIOGRAPHY
https://www.nimh.nih.gov/health/topics/
bipolar-disorder#:~:text=Bipolar
%20disorder%20(formerly%20called
%20manic,day%2Dto%2Dday%20tasks.
https://www.mayoclinic.org/diseases-
conditions/bipolar-disorder/symptoms-
causes/syc-20355955
https://my.clevelandclinic.org/health/
diseases/9294-bipolar-disorder
https://www.samhsa.gov/mental-health/
bipolar
https://www.nhs.uk/mental-health/
conditions/bipolar-disorder/symptoms/