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Q2. Explain bipolar disorders.

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide.

Diagnosis

Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM). To be diagnosed with bipolar disorder, the symptoms must be a major change from your normal mood or behavior. There are four basic types of bipolar disorder:
1. Bipolar I Disorder—defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
2. Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.


3. Bipolar Disorder Not Otherwise Specified (BP-NOS)—diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
4. Cyclothymic Disorder, or Cyclothymia—a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Causes

Scientists are studying the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.
1.Genetics: Bipolar disorder tends to run in families. Some research has suggested that people with certain genes are more likely to develop bipolar disorder than others. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.
2. Brain structure and functioning: Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. Example: the brain's prefrontal cortex in adults with bipolar disorder tends to be smaller and function less well compared to adults who don't have bipolar disorder. 
3. Psychological Factors: There is fairly consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, as they do for onsets and recurrences of unipolar depression (Alloy et al. 2005).

Signs & Symptoms

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." Each mood episode represents a drastic change from a person’s usual mood and behavior. An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. 
Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Symptoms of mania or a manic episode:
1. Mood Changes
• A long period of feeling "high," or an overly happy or outgoing mood
• Extreme irritability
2. Behavioral Changes 
• Talking very fast, jumping from one idea to another, having racing thoughts
• Being easily distracted
• Increasing activities, such as taking on new projects
• Being overly restless
• Sleeping little or not being tired
• Having an unrealistic belief in one's abilities
• Behaving impulsively and engaging in pleasurable, high-risk behaviors

Symptoms of depression or a depressive episode:
1. Mood Changes
• An overly long period of feeling sad or hopeless
• Loss of interest in activities once enjoyed, including sex.
2. Behavioral Changes
• Feeling tired or "slowed down"
• Having problems concentrating, remembering, and making decisions
• Being restless or irritable
• Changing eating, sleeping, or other habits
• Thinking of death or suicide, or attempting suicide.

Prevalence

Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age Some people have their first symptoms during childhood, while others may develop symptoms late in life.

Treatment

Bipolar disorder cannot be cured, but it can be treated effectively over the long-term. The various methods are:
  1. Medications: The types of medications generally used to treat bipolar disorder include mood stabilizers, atypical antipsychotics, and antidepressants. 
    1. Mood stabilizers like Lithium (also known as Eskalith or Lithobid), Anticonvulsants like Valproic acid or divalproex sodium (Depakote), Lamotrigine (Lamictal), gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal).
    2. Atypical antipsychotics like Olanzapine (Zyprexa), Aripiprazole (Abilify), Quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon) 
    3. Antidepressants like Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin).
  2. Psychotherapy: In combination with medication, psychotherapy can be an effective treatment for bipolar disorder. Includes:
    1. Cognitive behavioral therapy (CBT), which helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
    2. Family-focused therapy, which involves family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. Improves communication among family members, as well as problem-solving.
    3. Interpersonal and social rhythm therapy, which helps people with bipolar disorder improve their relationships with others and manage their daily routines. 
    4. Psychoeducation, which teaches people with bipolar disorder about the illness and its treatment. Psychoeducation can help you recognize signs of an impending mood swing so you can seek treatment early, before a full-blown episode occurs. 
  3. Other treatments:
    1. Electroconvulsive Therapy (ECT) /Shock therapy: ECT can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments.
    2. Sleep Medications: People with bipolar disorder who have trouble sleeping may be prescribed sedatives or other sleep medications.
* * *

Bipolar disorder, also known as bipolar affective disorder or manic depression, is a mental disorder characterized by periods of depression and periods of elevated mood. During mania an individual feels or acts abnormally happy, energetic, or irritable. During depression there’s less energy, too much sleep, and a negative outlook on life. 
Bipolar disorder can happen due to genetic causes, biological factors and psychological factors. It can be treated using medications including mood stabilizers, atypical antipsychotics and antidepressants, psychotherapy including CPT, psychoeducation etc., and, ECT.

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