Risks of Untreated Bipolar Disorder

Bipolar disorder is a serious mental health problem that can adversely affect your life. It is not just one disease but includes subcategories such as Bipolar I, Bipolar II, Cyclothymia, etc., referred to as Bipolar Spectrum Disorders. So, strict adherence to medications is necessary to help keep episodes to a minimum. Variables that differentiate the types of bipolar disorder include the term and intensity of the mood swings. Delay in the treatment or untreated bipolar can result in severe consequences such as major depression, hypomanic and manic episodes. In addition, bipolar have high mortality rates due to suicide, various heart disease, stroke, and cancer. This is because people with untreated bipolar symptoms face troubles in social life, personal relationships, compromises their financial status and thus, indulges in behaviors such as drinking, substance abuse, addictions, and drug abuse and risky behaviors.

Unlike illnesses, such as Diabetes and Blood pressure, where the patient agrees for the need of medication, bipolar patients often refuse to take their medication, known as treatment compliance as they do not accept their condition, even during a certain episode (called anosognosia) and therefore, refuse the need for medication.

Another major reason for the untreated Bipolar disorder is that it is hard to diagnose or often misdiagnosed with addiction and anxiety disorders, schizophrenia, substance abuse and many more. The average time it takes for the proper diagnosis of Bipolar Disorder is 10 years.

Some of the reasons for the misdiagnosed bipolar disorder are:

• Many people with mania, especially hypomania, do not consider it abnormal and think of it as simply a high amount of energy or joy.
• Continuous depressive episodes rather than mania may result in misdiagnosed major depression.
• People in a severe manic episode may see unrealistic things and be misdiagnosed as having schizophrenia.
• More than 50% of people with bipolar disorder also abuse drugs or alcohol, and so, is sometimes misdiagnosed as substance abuse.
• Due to the symptoms in children and adolescents with bipolar disorder, it may be misdiagnosed as ADHD (attention deficit hyperactivity disorder).

Eating Disorder- A mental illness

If you are obsessed with food, body weight, and shape, there might be a chance of having an Eating Disorder. People often think that eating disorders are a lifestyle choice. But they are actually serious and often fatal mental illness and are an important cause of physical and psychosocial morbidity in an individual. According to various studies on eating disorders, the results found that the frequency of occurrence is much less in men as compared to adolescent girls and young adult women and a large proportion of eating disorder patients were exercising excessively during an acute phase of the disorder.

Types of Eating Disorders

They are divided into three diagnostic categories: Anorexia Nervosa, Bulimia Nervosa, and Binge-eating disorder.

·           Anorexia Nervosa, characterized by inadequate intake of food. In this condition, people may have an unrealistic perception of overweight, even when they are dangerously underweight and thus, they severely restrict the amount of food they eat and eat very small quantities of only certain foods. It can lead to damaging health effects, such as loss of bones and skin integrity, increases the risk of heart attacks and related heart problems, brain damage, multi-organ failure, and infertility. The mortality rate is highest in this disease as compared to other mental disorders, either due to complications associated with starvation or the patient commits suicide.

·           Bulimia Nervosa, characterized by an excessive intake of food followed by compensatory behaviors for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Although people usually maintain their relatively normal and healthy weight, the irregular food behaviors can have injuring effects, such as chronically inflamed and sore throat, severe gastrointestinal problems, severe dehydration, and various heart difficulties resulting from an electrolyte imbalance.

·           Atypical eating disorders: There are many other types of eating disorders including Binge-eating Disorder (lack of control on eating), other specified feeding or eating disorder (OSFED), Diabulimia, etc.

Cause of Eating Disorder

Although the cause of eating disorders is not clear, it seems like the combination of biological, psychological, and environmental factors plays an important role in the development of these illnesses.

·      A high proportion of individuals diagnosed with body dysmorphic disorder (the way the person sees themselves) also had some type of eating disorder.

·      Biological conditions such as hormone irregularities and nutritional deficiencies can also lead to eating disorders.

·      The environmental factors include Dysfunctional family dynamic, aesthetically oriented sports, Professions and careers, childhood traumas and other stressful transitions.

Treatment for an Eating Disorder

People often ignore such conditions which then results in severe adverse effects. Because of the severity and complexities of these conditions, it has become necessary to establish a comprehensive and professional treatment. Addressed with medical doctors, nutritionists, and therapists for complete care, the treatment includes:

·         Individual, group, and/or family psychotherapy

·         Medical care and monitoring

·         Nutritional counseling

·         Medications

Mental Health Awareness

Physical health problems, such as cancer, diabetes, and other heart diseases, there is a vast knowledge of preventions and early intervention. People are fully aware of the cures, medications, and treatments available for so.  For example, in the area of cardiovascular disease, there is widespread knowledge about modifiable risk factors like smoking and exercise, people know the value of screening and treatment for hypertension and high cholesterol, many people have the first aid skills to apply cardiopulmonary resuscitation in an emergency, and some would know the warning signs of a stroke and the need to call an ambulance immediately.

But as far as mental health is concerned, the knowledge in the public has generally lagged behind the major physical diseases despite their high prevalence. Surveys of the many countries showed the lifetime prevalence rates of 18 % to 36 % (Kessler et al., 2009). Every year, millions of people are diagnosed with various mental health conditions such as depression, anxiety, schizophrenia, bipolar disorder, epilepsy, etc. Mental illnesses affect about 20% of the adult population, 45% of teenagers and 15% of children each year.  This high prevalence means that either the person is affected by a mental disorder or has close contact with other people who are. Despite the high exposure to mental disorders in the population, unfortunately, the stigma and misunderstanding associated with mental illness are also widespread. Only half of those who are affected with such condition receive treatment. The untreated ones become prone to other health issues contributing higher medical expenses, poorer performance in their respective fields, fewer opportunities and increased risk of suicide.

Although this perception of mental illness has improved over the past decades, studies show that stigma against mental illness is still powerful. Due to the current rates of occurrence, it has become necessary that everyone should be well aware of the conditions and symptoms and must be skilled to take action to improve community mental health. The community must be educated to fight stigma and provide support.

Medications for Bipolar Disorder

Bipolar Disorder, also known as manic depression, is a mental disorder which causes periods of abnormally elevated mood (i.e., Mania) or the periods of depression. It affects approximately 1% of the global population and the stats are increasing day by day. Hence, it is an active area of research.

The causes are not clearly understood, but both environmental factors (such as child abuse, long-term stress, addictions, etc.) and the genetic factors play a role. Even the genes with the small effect are involved. The neurological conditions such traumatic brain injury may also lead to bipolar disorder, but it’s not very common.

The treatment commonly includes the psychotherapy (such as Cognitive Behavioral Therapy) as well as the Medications. Medications are an essential part of the treatment for Bipolar Disorder. This helps to keep the periods or the moods in balance enabling the person to live a normal life. They do not cure the disorder but helps to stabilize the condition.  Numbers of medication used to treat Bipolar Disorder. Some of them help to fight the manic episodes and others prevent the episodes of depression.

•  Mood Stabilizers: They are used for long-term mood stabilization but are unable to quickly treat acute bipolar depression. The examples include lithium, and the anticonvulsants like carbamazepine, lamotrigine, and valproic acid. By far, lithium is the most effective medication of all. They treat bipolar depressions, acute manic episodes and prevent relapses. It also reduces the suicidal risk and deaths in people with bipolar disorder.

•   Antipsychotics: Also known as neuroleptics, or major tranquilizers, principally they are used in conditions of Schizophrenia and Bipolar Disorder. They are effective for the short-term treatment of both manic and depressive episodes of the bipolar and hence, are considered to be more superior to the lithium and other anticonvulsants. Olanzapine is an example of an antipsychotic drug. Now doctors prescribe new antipsychotic drugs including Aripiprazole (Abilify), Quetiapine fumarate (Seroquel), Ziprasidone (Geodon), Lurasidone (Latuda), Asenapine (Saphris), Cariprazine (Vraylar), Olanzapine (Zyprexa).

•  Medication for Bipolar Depression or Antidepressant drugs: In the treatment of bipolar disorder, antidepressants are not prescribed to use alone as they may trigger the manic episode. It is usually prescribed along with a mood stabilizer or antipsychotic drug.

• Others: Several other medications such as anti-anxiety medication, sleep medications, benzodiazepines, omega 3 fatty acids may have some beneficial effects in certain conditions.

•  Side Effects: Like any other drug, bipolar medications also have some side effects and the symptoms vary depending on the medication. They include nausea, tremors, hair loss, weight gain, liver damage, kidney damage, diarrhea, skin problems, and several other conditions.

•  Recommendations: As the medications for bipolar are very powerful drugs, it should always be taken according to the doctor’s recommendation for the given period of time. The abrupt withdraw of medicine without Doctor’s approval can be very dangerous.

Understanding the aspects of Psychiatric Disorders

The recent acknowledgment of the worldwide importance of mental disorders has put psychiatry firmly on the international health agenda. The World Health Organization has evaluated that neuropsychiatric disorders and suicide account for 12.7% of the worldwide burden of illness. Major bipolar affective disorder, depression, schizophrenia, alcohol misuse, and obsessive-compulsive disorder account for five of the 10 leading causes of disability in underdeveloped and developing countries. In developed countries, dementia is the third most common neuropsychiatric disorder. Few aspects for the better understanding are given below.

•           Combating the Stigma of Psychiatric Disorders

Psychiatric stigmatization is the inappropriate and erroneous association of mental illness with something disgraceful or shameful. Stigma generates a hidden burden and results in barriers to mental health care, reluctance to seek appropriate care, delay in return to wellbeing, and discrimination in the allocation of resources. Stigmatising attitudes are found universally and can be deeply entrenched. There are two important factors to reduce the burden of stigma:

•           Personnel awareness, and   

•           Availability of effective treatments

Due to advancements in psychiatric research, today we have various effective treatments for the major brain disorders; the key to changing attitudes is education. But still today, people disagree on the symptoms of the disorders and ignore their mental health.

•           Neurobiological aspects of post-traumatic stress disorder

The traumatic stresses such as combat, sexual assault, car crash, or intensive cancer treatment, cause pervasive distress in almost anyone and triggers the post-traumatic stress disorder. The disorder arises because of the various emotional challenges during the trauma, resulting in a delayed and protracted response.

•           Cost-effectiveness of atypical antipsychotics

Atypical antipsychotics (clozapine, risperidone, olanzapine, amisulpride, and quetiapine) are the newer generation of drugs that produce fewer extrapyramidal side effects than conventional antipsychotics such as chlorpromazine. Generally, their effect is similar to the conventional ones, although few of them are shown to be more effective, for example-

clozapine in the treatment of schizophrenia. Because atypical antipsychotic drugs are better tolerated, it is often suggested that they should become the first-line treatment for schizophrenia. However, as the newer drugs can be up to 30 times more expensive than the older drugs, such a change has major cost implications. If atypical drugs are truly associated with greater patient benefits then it is reasonable to expect them to be cost-effective. Unfortunately, economic evaluations often fail to take full account of direct and indirect costs and exclude subjects who discontinue treatment.

The Diet association with the Bipolar Disorder

Bipolar Disorder, also known as manic-depressive disorder, is a brain disorder which is characterized by abnormal mood episodes with highs and lows. These episodes can range from very mild to the extreme depending on their intensity and severity.

There is no specific diet for bipolar but some foods are strongly recommended to avoid if you have bipolar disorder as they can increase the severity of the mood episodes. Too much Caffeine consumption is one of them as they lead to insomnia (unable to sleep). During depressive episodes, caffeine may boost up your mood but in the long run, they disrupt sleep and cause nervousness and worsen high blood pressure.

In addition to the consumption of caffeine, high-fat meals including red meat, saturated fats, trans fats, and simple carbohydrates are also recommended to avoid. Earlier, the reason was considered as the difficulties and delay in the absorption of bipolar medication due to high-fat meals but does not cause any symptoms of the bipolar disorder. However recent advances in the research have shown that nitrates, chemicals used to cure meats such as beef jerky, salami, hot dogs and other processed meat snacks, may contribute to the manic episode. Mania is characterized by hyperactivity, euphoria, and insomnia.

It was found that people hospitalized for an episode of mania had more than three times the odds of having ever eaten nitrate-cured meats than people without a history of a serious psychiatric disorder. The researchers say that their new study adds to evidence that certain diets and potentially the amounts and types of bacteria in the gut may contribute to mania and other disorders that affect the brain.

During the course of time, numbers of genetic risk factors have been discovered that are associated with bipolar disorder and in other psychiatric conditions. However the evidence of the diet associated with the symptoms has increased the researches on environmental factors, such as diet, that may play a role.

This is a great area for the future works as the researches on this association could lead to dietary interventions to help reduce the risk of various manic and depressive episodes in those who have bipolar or other psychiatric disorders.

Is Bipolar a hereditary disorder???

People say “you’ve got your father’s eyes” but did they know that bipolar is also hereditary. Bipolar disorder is a complex disorder involving untold genes, and family history does not necessarily mean that a person will inherit the disorder. But it plays an important role.  Researches show that generation to generation, family members observe and reflect on patterns of bipolar. When a family gets socked on the diagnosis of their kids or any other family member with bipolar, sooner or later they seem to be very familiar with the symptoms in their own lives.

The inheritance pattern or the genes involved with bipolar disorder is still unknown but it is observed that the first- degree relatives (siblings and children) are at the higher risk of developing the disorder than the general public. It would not be surprising to see more than one case in a family just by chance.

It does not always have to be bipolar for you to inherit from your family. Various other moods, psychotic and anxiety disorders such as schizophrenia and depression can be diagnosed in the family members of the individual suffering from the bipolar disorder as they share some of the genetic risk factors with bipolar disorder.

Studies suggest that nongenetic (environmental) factors also contribute to a person's risk of developing bipolar disorder. Stressful events in a person's life, such as a death in the family, can trigger symptoms of the disease. Substance abuse and traumatic brain injuries have also been associated with bipolar disorder. It appears likely that natural conditions connected with hereditary components to decide the overall risk of creating this illness.

So, one can suggest that it does not always have to be someone in your family with the psychiatric disorder for you to inherit. Although. Studying the genes involved with bipolar disorder is an active area of research.