Literature Review

Bipolar disorder, or manic depression, is a mood disorder.  There is a social stigma associated with this mental illness because society does not understand it. The behavior exhibited by those with bipolar disorder can be described using the words crazy, maniac, and madness.   Understanding bipolar disorder can make a dramatic difference on how this mental illness is viewed.  The majority of information found about bipolar disorder may seem negative, but there are many positive attributes that can manifest from having this disorder.  Bipolar disorder is a complicated disease that can be managed with knowledge, understanding, and patience.  My research paper will emphasize the following categories:  statistics, diagnostic criteria, effective treatment, positive attributes of the disorder, and coping skills.

Two separate sources contained statistical information.  “Bipolar Disorder Statistics” by DBS Alliance (Depression and Bipolar Support Alliance), shows statistics for bipolar depression as reported by NIMH (National Institute of Mental Health).  It includes the number of the American population affected by the disease, the age of onset for the disorder, and the factors of how heredity affects the development of the disorder in an individual.  This article will help to document the prevalence of the disorder in our society.  Another article with the same title from the website Statistic Brain gives statistical information on bipolar disorder as verified by the DBS Alliance, Bipolar ism [sic], and Bipolar Lifestyles.  It elaborates on aspects of the disorder by distributing the statistical information into sub categories.  The use of this source will add additional information about the prevalence of the illness in the population.

 Using diagnostic criteria, it is still difficult to accurately diagnose bipolar disorder.  A resource from the John Hopkins Medicine Health Library, “Manic Depression/Bipolar Disorder” gives the definition of bipolar disorder, explains who is affected by the illness, as well as the symptoms, diagnosis, and treatment.  It gives a thorough list of symptoms in comparison to the other resources I have encountered.  This is a valuable source for describing the criteria of the illness for my research paper.  In fact, Jules Angst reported in a journal article titled “Bipolar Disorders in DSM-5: Strengths, Problems and Perspectives” published in the International Journal of Bipolar Disorders explores the differences in the diagnostic classification of bipolar disorder between the DSM-IV and DSM-V.  Healthcare professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a guide to diagnose mental illness.  The updated version has created subdiagnostic bipolar categories allowing them to more accurately diagnose and treat the disorder.  It will help to clarify the diagnostic criteria when describing the disorder.  The journal article “Everyday Functional Ability Across Different Phases of Bipolar Disorder” published in Psychiatry Research written by Henry L. Brook, Arpi Minassian, and William Perry elaborates on the neurocognitive impairment and functional deficits characterized in bipolar disorder.  It assesses the functionality, impairment, and limitations of patients diagnosed with bipolar depression in their daily lives.  This article will show that bipolar disorder is a serious illness that can adversely affect the everyday lives of individuals who are affected by it.  A report published by the University of Maryland Medical Center titled “Bipolar Disorder” explores the causes, diagnosis, and treatment of bipolar disorder.  It examines the different categories of the disorder, risk factors associated with the illness, other disorders that accompany the disease, similar conditions that can mimic bipolar disorder, and the treatment of the various forms of the disorder.  The use of this resource will enhance the information that I have already collected creating a paper with more details to support my paper.  Bipolar disorder is an illness that can reduce quality of life and often is associated with many challenges.  The research article, “Adaptation to Bipolar Disorder and Perceived Risk to Children: A Survey of Parents With Bipolar Disorder” for BMC (BioMed Central) Psychiatry by Holly L. Peay and colleagues, explore the perceptions of adults with the disorder and examines the coping methods of parents who are at risk of passing on their illness to their offspring.  This information will be used to inform my readers about the heritability of bipolar disorder and the emotional struggles that each parent may have in regards to passing this debilitating disease to their children.  In addition, the journal article by Guy M. Goodwin and colleagues, “ECNP Consensus Meeting.  Bipolar depression.  Nice, March 2007” published in European Neuropsychopharmacology, bipolar disorder usually manifests itself in the late teen years or early twenties.  It has been found that children and those is their early teens who suffer from unipolar depression actually have bipolar depression.  It is not uncommon for children to be misdiagnosed with attention deficit hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD).  This study will help me illustrate how this is a progressive illness that worsens over time.     

Despite the many effective treatments for bipolar disorder, many patients find it difficult to adhere to treatment.  In the pamphlet “Understanding Bipolar Disorder and Recovery” written by Ken Duckworth and distributed by NAMI (National Alliance of Mental Illness), it describes the symptoms of bipolar disorder.  It specifies some of the causes of the disorder along with other disorders that are associated with the disease.  It elaborates on the risks of letting the illness go untreated as well as treatment using medication and coping strategies.  In my final paper, I will use this information to describe bipolar disorder and its treatment.  The research article by Victoria E. Cosgrove and Trisha Suppes, “Informing DSM-5: Biological Boundaries Between Bipolar I Disorder, Schizoaffective Disorder, and Schizophrenia” for BMC Medicine, shows that the DSM-V opted to retain the criteria that distinguish the differences between these three disorders.  These mood disorders are similar and they are often misdiagnosed for one another.  Many of the same medications are used to treat all these disorders.  I will use this source to discuss the use of medication in treating bipolar depression.  Susanne Gibson and colleagues provide statistical information and analyze reasons why over half of the participants in the study do not follow treatment recommendations in their research article “Understanding Treatment Non-adherence in Schizophrenia and Bipolar Disorder: A Survey of What Service Users Do and Why” in BMC Psychiatry.  Patients may choose non-adherence or unintentional non-adherence to treatment as prescribed because they felt that they were “better”, did not like the side effects of medications, or felt that they needed more energy to complete tasks and that skipping medication made them more alert.  Non-adherence leads to relapse of the illness that can cause serious side effects, including suicide.  This source will help to document the reasons why many people with bipolar disorder choose not to follow medical advice.  Bipolar disorder is a debilitating illness that may require intensive treatment that frequently requires impatient psychiatric care.  In their research article “The Cost of Relapse for Patients with a Manic/Mixed Episode of Bipolar Disorder in the EMBLEM Study” for Pharmacoecomonics, Jihyung Hong and his colleagues did a study to analyze the substantial costs and the economic impact of relapse of bipolar patients during a 21 month maintenance phase.  The reoccurrence of the disorder may lead to progressive functional deterioration, worsening treatment response, and clinical prognosis.  This information will show the importance for the patient to follow medical advice to prevent relapse and worsening of the progression of the disease.  Doctors using the DSM-IV may misdiagnose patients with unipolar depression, instead of bipolar depression, if the patient is evaluated in a depressed state.  This can lead to treatment that has a poor outcome.  In their journal article “Identify Changes of Brain Regional Homogeneity in Bipolar Disorder and Unipolar Depression Using Resting-State fMRI” Min-Jie Liang and colleagues discuss how the use of fMRI (magnetic resonance imaging) may aid in correctly diagnosing bipolar disorder by studying abnormalities in specific parts of the brain.  This information may help to demonstrate that these disorders are caused by biological changes in the brain and aid in the correct diagnosis leading to proper treatment.  When comparing the diagnostic criteria between bipolar I and II disorder, the symptoms are similar.  Antipsychotic drugs are used for patients with bipolar I because they are more cognitively impaired compared to those who are type II.  For the research article “Neurocognitive Function in Bipolar Disorder: a Comparison Between Bipolar I and II Disorder and Matched Controls” for BMC Psychiatry, Erik Pålsson and his colleagues performed various neuropsychological tests on subjects with bipolar I and II disorder and a control group to determine their neurocognitive function.  The test results were similar in those with bipolar disorder.  Antipsychotic treatment manifested as a strong prediction of cognitive impairment.  Using this information for my project will show that there is a close relationship between bipolar I and II disorder.  In the publication Bipolar Disorder published on the government website for the Department of Health and Human Services, it gives general information on the different aspects of bipolar disorder as reported by NIMH.  It includes information about the different causes, signs and symptoms, risks, a list of the various forms of the disorder, the different treatments used for this illness as well as finding support.  Included are some of the negatives side effects associated the different medications prescribed to patients.  I found this resource to be valuable because it provided a wide range of information that can be incorporated into my work.  However, “Insight in Bipolar Disorder” written by Klára Látalová, M.D. Ph.D., for Psychiatric Quarterly, illustrates the value of insight for bipolar disorder.  The association has shown better results in the treatment of the disorder.  Awareness about the disorder has led to patients adhering to treatment which leads to better outcomes.  Information is a factor in successful treatment.  I will use this to demonstrate that knowledge is a powerful tool in coping with bipolar disorder.   

In spite of the negative characteristics surrounding the disorder, some patients consider some of the symptoms as positive.  In her book, Touched with Fire, Kay Redfield Jamison, Ph.D., cites many works of people throughout history who suffer from bipolar disorder.  She describes work from numerous famous people, both literal and visual artists.  According to journals and medical records at the time of their lives, she shows the likelihood of the person having the disorder and how their moods affected their personal and professional lives.  She documents their productivity and quality of work depending on the state of mood they were experiencing during the creative process.  I plan to use this information to show that there are some positive aspects to having this illness.  Similarly, Tracy Pedersen’s website article, “Benefits of Bipolar Disorder?” from psychcentral.com, she describes a study where some individuals experience positive effects with having bipolar disorder.  Researchers investigated evidence and reported that some people value certain experiences associated with the disorder and would prefer to retain their condition.  Some of the aspects of this illness can be considered as highly valuable attributes in some people.  This article will reveal some benefits of this illness and why some people refuse treatment.  For instance, in her article “Is There a Bright Side to Bipolar Disorder?”from everydayhealth.com, Madeline Vann, MPH, describes advantages of bipolar disorder that are considered to be appealing to those who have the condition.  These characteristics include productivity, confidence, charm, euphoria, and insight. Although there are many disadvantages associated with the illness, some patients risk the negative effects by discontinuing treatment because they miss the positive aspects involved with the disorder.  This will illustrate the reasons why some people choose to deny medical intervention.

Lastly, acquiring necessary coping skills has a valuable impact in the lives of people with bipolar disorder and those who interact with them.  In the book, Living with Someone Who’s Living with Bipolar Disorder: A Practical Guide for Family, Friends, and Coworkers, authors Chelsea Lowe and Bruce M. Cohen, describe bipolar disorder and shows how having an understanding of the illness can help others not affected by the disease cope with the behavior of the person affected by the disease.  Knowledge about the illness and possessing the skills on how to deal with the triggers that can worsen the behavior of the individual with bipolar disorder can make life easier for everyone involved.  This resource will help me show the importance that understanding, knowledge, and support can bring to coping with the everyday life of a person suffering with bipolar disorder.