FREQUENTLY ASKED QUESTIONS ABOUT BIPOLAR DISORDER AND TRAUMATIC BRAIN INJURY
QUESTION: What is bipolar disorder?
ANSWER: Bipolar disorder is also known as manic depression. It is generally thought to be an imbalance of the chemicals in the brain that causes extreme mood swings between depression and manic behavior. These mood swings are not just the normal ups and downs most people experience. They are much more severe. This disorder is manifested in different ways in different people. Bipolar I Disorder is the classic manic-depressive form of the illness and creates at least one manic episode and one depressive episode or a mixed episode. Bipolar II manifests in episodes of hypomania and severe depression but doesn’t result in full-blown manic episodes. Cyclothymia is a milder form of bipolar disorder. It manifests in cyclical mood swings but the symptoms are less severe than full-blown mania or depression.
QUESTION: What are the characteristics displayed in someone with bipolar disorder?
ANSWER: The symptoms vary widely and can manifest differently in people with the disorder. The manic phase presents feelings of heightened energy, creativity and euphoria. People in a manic episode talk rapidly frequently interrupting their speech because their thoughts are coming so fast. They sleep very little and can go days without sleep. They are hyperactive. They believe they are all powerful, invincible, destined for greatness, oblivious of any obstacles in their way and believe that money is in inexhaustible supply therefore they can either spend or give away large sums of money while on the manic side of the disorder. They can be unusually high and optimistic or extremely irritable.In a manic episode they tend to spiral out of control and behave recklessly: gambling away savings, engaging in inappropriate sexual activity, making foolish business investments and spending money recklessly. They can also become angry, aggressive which causes them to pick fights, lashing out at everyone and blaming anyone who criticizes their behavior. Some people even become delusional and begin hearing voices. Bipolar depression usually involves extreme irritability, guilt, unpredictable mood swings and feelings of restlessness. While in a depressive episode people tend to move and speak slowly, sleep for long uninterrupted periods, display feelings of hopelessness, sadness and emptiness. They have memory loss, inability to focus and feelings of worthlessness. The most dangerous feeling during a depressive episode is their thoughts of death and a desire to kill themselves. Mixed Episodes of bipolar disorder are a combination of both mania or hypomania and depression symptoms. Common manifestations are depression combined with agitation, irritability, anxiety, insomnia, distractibility and racing thoughts. It is this combination of high energy and low mood that creates the high risk for suicide. Both the signs of depression and mania can be seen in a mixed episode often within a very short span of time such as an hour. Mixed bipolar disorder is common with people diagnosed with bipolar disorder. It is estimated that 20-70% of people with bipolar experience mixed episodes. It is thought by some researchers that people, who develop bipolar at a younger age, particularly in adolescence, may be more likely to have mixed bipolar disorder.
QUESTION: Is bipolar disorder inherited and exactly what causes it?
ANSWER: Researchers and doctors are somewhat divided over what the exact causes of bipolar disorder are. Most agree that it has no single cause but there seem to be certain people who are in fact genetically predisposed to bipolar disorder. However, not everyone with an inherited potential develops the illness indicating that genes are not the only culprits. Some brain imaging studies indicate physical changes in the brains of people with bipolar disorder. Other research studies show neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances and high levels of the stress hormone cortisol as a cause of bipolar disorder. Even external factors in the environment and psychologically are thought to act as triggers that can set off new episodes of mania or depression or make it worse. Some studies indicate that a severe trauma or extreme stress can trigger the disorder. The National Institute for Mental Health (NIMH) believes it is an inherited disease. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression. The statistics regarding the inheritance of the disease vary widely depending on the source. One source (bipolar-lives.com) reports that when one parent is affected, the risk to each child is 15-30%. When both parents have the disorder the risk increases to 50-75%. There is some research that indicates it can also skip a generation. There is a diagnosis gap for this disease. Only one in four people receive an accurate diagnosis over a three-year period. Research has shown that many people with this disorder suffer as long as 10 years of coping with the symptoms before receiving an accurate diagnosis. Dr. Wes Burgess in his book Bipolar Handbook reports that almost 70% of bipolar patients had been misdiagnosed more than 3 times before receiving their correct diagnosis. Bipolar disorder is in fact difficult to diagnose because it can mimic other conditions such as ADHD.
QUESTION: At what age do most people with bipolar disorder manifest the symptoms?
ANSWER: The median age of onset is thought to be 25 years but it can begin in childhood and often doesn’t appear until a person is in their 40’s and 50’s.
QUESTION: Is there any difference between men and women, races, ethnicities or socio-economic backgrounds when it comes to having bipolar disorder?
ANSWER: Bipolar apparently effects all races, ethnic groups and socio-economic backgrounds. However, some researchers have found while there is no difference in the rate at which men and women have bipolar disorder there may be a difference in how it develops. These researchers report that women are three times more likely to experience rapidly cycling i.e. cycling from depression to mania to depression or mania to depression to mania. According to this research women have more depressive episodes and more mixed episodes than men (Journal of Clinical Psychiatry 1995). It is also thought that female hormones and reproductive factors may influence bipolar disorder as well as its treatment. Research indicates that hormones may play a role in the development and severity of bipolar in women. One study indicates that the late onset of bipolar disorder can be associated with menopause. Researchers reported that among women with the disorder almost one in five reported severe emotional disturbances during the onset of menopause. Studies have also looked at the link between bipolar disorder and premenstrual symptoms. The results suggest that women with mood disorders, including bipolar disorder, have more severe symptoms of PMS. The most compelling evidence of this link is found during pregnancy and the postpartum period. Women with bipolar disorder who are pregnant or have recently given birth are seven times more likely than other women to be admitted to the hospital for their bipolar disorder and twice as likely to have a recurrence of symptoms. (WebMD http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-women)
QUESTION: At what rate do people with bipolar disorder attempt and/or commit suicide?
ANSWER: Due to the high incidence of incorrect or delayed diagnosis it often accounts for 9.2 years of reduction in the expected life span. This accounts for up to 1 in 5 bipolar disordered people completing suicide. The statistics on suicide and bipolar disorder are a moving target. They are hard to nail down and have wide variation making it difficult to have any confidence in the data. For example, Dr. Burgess in the Bipolar Handbook reports that 30% of individuals with bipolar will attempt suicide during their lives and 20% will succeed. Yet other sources report both lower and higher incidences of attempted suicide and suicide. What is known and what we can put confidence in is the fact that suicide is more common in bipolar depression than in unipolar depression, panic disorder or even schizophrenia and that when bipolar disorder is adequately treated the suicide rate goes down dramatically.
QUESTION: IS THERE A RELATIONSHIP BETWEEN PHYSICAL HEALTH ISSUES AND BIPOLAR DISORDER?
ANSWER: Yes. The February 2009 Medical Journal of Psychiatric Services published some startling information regarding bipolar and a range of medical conditions. It was found that bipolar disorder can double the risk of early death from a wide range of medical conditions including many that can be controlled through diet and exercise.
- 35% of people with bipolar are obese which is the highest for any psychiatric illness
- People with bipolar are 3 times more likely to develop diabetes than someone in the general population.
- People with bipolar are 1.5-2 times more likely to die from conditions such as heart disease, diabetes and stroke.
- People with bipolar are also at higher risk for substance abuse. Almost 60% abuse drugs or alcohol. Substance abuse is related especially to those with a more severe bipolar disorder as well as those who are not managing the disorder or managing it poorly.
- Bipolar disorder affects energy level, appetite, sleep patterns, sex drive
QUESTION: Is bipolar a common mental illness? Do many people have this?
ANSWER: The World Health Organization (WHO) reports that bipolar disorder is the world’s sixth leading cause of disability. Statistics reported by the Depression and Bipolar Support Alliance (DBSA) indicate that approximately 5.7 million adult Americans or about 2.6% of the U.S. population age 18 and older are diagnosed as bipolar. Other sources place that figure between 5-10 million in the U.S. and approximately 30 million worldwide. Those figures are thought to be conservative estimates due to the fact that bipolar disordered people are often misdiagnosed, do not present themselves for diagnoses and/or lack the insight to realize that they are experiencing symptoms of the disorder. In short, bipolar disorder is very pervasive.
QUESTION: How is bipolar disorder treated?
ANSWER: Lithium is today the most common drug used for the treatment of bipolar. Success rates for bipolar disorder treatment with lithium vary from highs of 70% to 85% to lows of 40-50% (Surgeon General Report for Mental Health 1999). Nearly 9 out of 10 people with bipolar disorder are satisfied with their treatment although they report side effects remain a problem. Caution should be taken with this statistic because a large number of people diagnosed with bipolar disorder refuse to take their medicine precisely because of the side effects and refuse more often than not to participate in psychological counseling. They just don’t talk to anyone about their issues unless it is someone supporting them such as family members. New treatments for bipolar disorder (www.newsmax.com/…/bipolar-disorder-treatments…/2011/…/39052) are emerging because more people are being diagnosed. Even though lithium is the standard treatment over 75% of those who take the drug report side effects. One exciting and promising treatments being studied is one that is typically used for seasickness—scopolamine which has shown to improve overall mood and this can last from weeks to months. Scopolamine skin patches are now being used for the treatment of bipolar disorder with promising results.
QUESTION: Is there a cure for bipolar disorder?
ANSWER: The medical community is divided in their belief that bipolar or related mental illnesses can be cured. Everyone concedes that bipolar has its roots in physiology meaning it is the result of something physical not mental but its symptoms manifest as mental issues. There is advancement in some areas of research which are encouraging and will at least make the treatment of this disorder much more effective and efficient. It may ultimately lead to a cure in the distant future. The Heinz C. Prechter Bipolar Research Fund (http:/www.prechterfund.org/) based at the University of Michigan Depression Center has been conducting some cutting edge stem cell research aimed at unlocking the secrets of bipolar disorder for over 10 years. New stem cell lines from the skin of adults living with bipolar disorder are providing the researchers with an unprecedented opportunity to look in depth at the genetic and biological basis of this disorder. Scientists conducting the research will link their findings-such as how gene expression is affected by different medications-to extensive clinical and demographic data from the cell donors who are participants in an ongoing, long-term study of hundreds of individuals with bipolar disorder. Currently, the best treatments for bipolar disorder are only effective for 30-50 percent of patients according to Dr. Melvin McInnis. Dr. McInnis tells us that new discoveries have been limited in the past partially due to the lack of access to tissue and cells from individuals with bipolar disorder but due to the Prechter Fund research and the advances in stem cell research that is changing. We most often associate stem cells with therapies to treat diseases but this research application is a great example of stem cells’ utility for studying the mechanisms of disease according to Dr. Sue O’Shea who adds that this offers hope to those with bipolar disorder. Researchers caution that new treatments resulting from this work could be a decade or more away. New research is also being done to consider the link between DNA and bipolar disorder. DNA analysis is used to identify the wide variance in the way this disorder manifests itself in different people. From this research new treatments will very likely emerge. However, until more research dollars are made available not only will we not be able to determine if it can be cured we will also not be able to find our way to better medication and treatment protocol.
QUESTION: Can people with bipolar disorder live a normal life?
ANSWER: Yes. Many people with bipolar disorder enjoy successful careers, happy family lives and satisfying relationships. However, living with bipolar disorder is challenging and it must be strategically well managed. It requires long-term, consistent, closely monitored management. Medication alone is not enough. Studies have shown that combining psychotherapy with the appropriate medication in the appropriate dosage is the most effective treatment strategy. There are some specific strategies, which should be considered:
- Using Family Focused Treatment (FFT) in addition to appropriate medication was shown to produce significantly lower relapse to manifestation of the disorder (11%) than medication alone (61%) over a 9-month period.
- Cognitive Behavioral Therapy (CBT) in combination with the appropriate medication reduced depressive symptoms by 7.3% as opposed to a reduction of only 2.5% with medication alone in a 2001 study.
QUESTION: What is Traumatic Brain Injury?
ANSWER: According to IDEA traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem solving; sensory, perceptual and motor abilities; psychological behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative or to brain injuries induced by birth trauma (Sec. 300.8 (c) (12).
QUESTION: How many people incur traumatic brain injury and can it result in death?
ANSWER: Annually 1.7 million people in the U.S. incur a traumatic brain injury. 50, 000 people die due to a TBI each year.
It is estimated that a brain injury occurs every 20 seconds in the U.S. Traumatic brain injuries are more common in the U.S. than breast cancer, multiple sclerosis or spinal cord injury. (Mindstorms, John W. Cassidy M.D.)
QUESTION: Have many service men and women who have been in combat incurred a traumatic brain injury?
ANSWER: Traumatic brain injury is considered the “signature injury” of the conflicts in Iraq and Afghanistan because increasingly soldiers are surviving nearby bomb blasts. These bomb blasts produce brain injury through pressure waves that “shake” the brain. If the injury is severe enough it can cause irreversible results including depression, anxiety, personality changes, aggression, acting out and social inappropriateness. (NAMI Veterans Resource Center) It is estimated that 350, 000 servicemen and women have to date come home from Iraq and Afghanistan with mild to severe brain injuries. Much of the advancement in the treatment of TBI is due to these wars and the veterans who require effective treatment for this type of wound.
QUESTION: Does traumatic brain injury lead to bipolar disorder and other mental illnesses?
ANSWER: Mood disorders are more frequent after brain injury and both depressive and manic episodes are found with an increased risk of aggression. Bipolar is often considered as a secondary result of traumatic brain injury and occurs in as many as 9% of persons with a TBI. Drugs typically used to treat bipolar disorder such as antipsychotic drugs may actually exacerbate the symptoms of bipolar both the manic and depressive side of the disorder when a TBI has occurred. Even though mood disturbances can occur with in jury to either hemisphere of the brain mania has been primarily associated with right-side frontal lobe injury. Dr. Robert van Reekum’s (Baycrest Centre for Geriatric Care) results from a comprehensive review of data from the 1990s joins a growing body of evidence that supports the fact that a TBI causes many psychiatric illnesses including bipolar disorder.
- Bipolar Disorder Secondary to Head Injury; A Medline Search by Ivan K. Goldberg, MD
- National Alliance on Mental Illness
- IDEA, 2004
- WebMD, “Women With Bipolar Disorder”, September 6, 2012
- www.fixnews.com/story/02933,300544,00.html October 10, 2010
- Newsmax.com New Treatments for Bipolar Disorder March 23, 2011
- Bipolar-lives.com, Bipolar Disorder Statistics August 3, 2012
- WebMD, “Mixed Bipolar Disorder”, July 18, 2012
- HELPGUIDE.org, “Understanding Bipolar Disorder, July 18, 2012
- 10. Blue Cross Blue Shield Association, www.bcbs.com>Bluenews>Health and Wellness, “New Bipolar Disorder Treatments Tested”, Malcolm Ritter, July 20, 2011
- 11. Baycrest News and Media Information, Toronto, Ontario Canada, July 18, 2012
12. vfwlady.com, “Traumatic brain Injuries in OIF/OEF: Record Number of Vets Seeking Mental Healthcare”, October, 19, 2011
13. abcnews.com, “Do People of All Ages Get Bipolar Disorder, And Does Bipolar Manifest Itself At Different Ages?”, September 6, 2012