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Running head: PSYCHOPATHOLOGY 1

Bipolar I Disorder in Adulthood

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PSYCHOPATHOLOGY 2

Introduction

Bipolar disorder is a brain disorder commonly referred to as manic depressive illness that

causes unusual shifts of mood, ability to carryout daily tasks, activity levels, and energy. There

are four distinct types of bipolar disorder that are bipolar 1 disorder, bipolar 11 disorder, bipolar

disorder not specified, and cyclothymiacs disorder. The essay will only focus on bipolar 1

disorder which is defined by manic or mixed episodes lasting for at least seven days (Kessler et

al, 2005). Bipolar 1 disorder is defined by manic symptoms that are severe implying that the

individual require immediate medical attention. At later stages, depressive episodes also appear

and they may last for at least two weeks. This particular disorder appears in early adult years (25

to 65 years), and in many cases it is not easy to notice this disorder especially among the elderly.

Bipolar 1 disorder is a sever disorder to the extent that patients experience mania, longer highs,

and also psychotic episodes. Mania in this case refers to severely high mood in the sense that the

individual will experience delusions and hallucinations. The mania symptoms in this case lasts

for some days or even weeks (National Institute of Mental Health, 2015).

Relevant Symptomatology and Associated Clinical Features

Bipolar 1 disorder symptoms are so severe, and some of these symptoms among adults

are unusual intense emotional states occurring in distinct intervals commonly referred to as mood

episodes, a manic episode seen in people who are overly joyful or even overexcited, and a sad

state or mood commonly referred to as depressive episode. People with bipolar 1 disorder have

the manic or mixed episodes (both mania and depression) commonly referred to as mixed state

(Goodwin & Jamison, 2007). Also, people with bipolar 1 disorder can be irritable and explosive

especially during the mood episode. Different changes occur within the mood episode such as

sleep, behavior, energy, and daily activities. When these individuals are in manic episode, they

PSYCHOPATHOLOGY 3

experience mood changes such as extreme irritability and an overly long period of feeling high.

Other behavioral changes are also experienced such as being unusually distracted, talking too

much, jumping from one opinion to another, racing thoughts, being overly restless, increasing

activities such as handling multiple projects at the same time, sleeping little or not sleeping at all,

and having unrealistic belief in their abilities. Some individuals with the illness are involved in

high risk behaviors which can result into suicide. Other symptoms include damaged

relationships, poor school and job performance, and in other cases suicide (Plante & Winkelman,

2008).

The symptoms of depression episode are an overly long period of feeling hopeless or sad,

and loss of interest in daily activities. The behavioral changes include feeling tired more often,

having problems concentrating on a task, difficulty in remembering tasks and in making

congruent decisions, being irritable and restless, always imagining of suicide or death and in

some cases attempting suicide and changing sleeping patterns, eating habits, and other daily

habits. Research also shows that even when the mood swings are less extreme, bipolar 1 disorder

can be present. That said, bipolar 1 disorder occurs in a mixed state whereby the individual

experiences both manic and depression at the same time. When in a mixed state, these people can

be very agitated, experience trouble in sleeping, change in appetite, and also suicidal thoughts. In

other cases, they are strongly energized to the extent that they are not overly agitated (Goodwin

& Jamison, 2011).

Epidemiology

Epidemiology is the study of the disease distribution and determinants in human

populations studied by age, marital status, gender, and social class (Goodwin & Jamison, 2011).

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In this case, the epidemiology study will only focus on the bipolar 1 disorder etiology, course

prevalence, and gender issues.

Etiology

Bipolar 1 disorder according to epidemiological studies has no single cause but many

linked factors increase the risk of developing this disorder among adults. One of the main causes

of bipolar 1 disorder is genetics whereby it runs in families. Research shows that people with

similar genes are more likely to develop this brain disorder than others with unrelated genes. For

instance, children with a parent with this brain disorder are more likely to develop this disorder

compared to families without a family history of bipolar 1 disorder. That said, bipolar 1 disorder

is, therefore, inherited with the genetic factors accounting for 80 percent of the cause of this

illness (Goodwin & Jamison, 2011). Other than genetic vulnerability, biological vulnerability

and life stress also cause bipolar 1 disorder among adults. Biological vulnerability refers to the

biochemical imbalances in the brain thus making the individual vulnerable to mood episodes and

depression. The chemical imbalances in the brain or even the inability of these chemicals to

function normally results into high mood, which is one of the main symptoms of bipolar 1

disorder among adults. In addition to biological vulnerability and genetic vulnerability, life

stress also causes bipolar 1 disorder. Some of the stressful events in a person’s life for instance,

employment or family conflicts puts extra demands on the individual thus resulting into sad a

mood. An interaction of these three factors, therefore, results into bipolar 1 disorder among

adults (Hammen & Gitlin, 2007).

Course Prevalence

Epidemiological studies show that Bipolar 1 disorder has similar preference rates for both

men and women although there are important differences on how the illness manifests itself

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among men and women. The lifetime prevalence of bipolar 1 disorder is estimated at 1 to 5

percent in the general population. In recent World Mental Health Survey conducted in eleven

countries across the globe, it was found that bipolar 1 disorder has a lifetime prevalence of 0.6

percent (Angst & Zurich, 2002). In other recent general population surveys, it has been found

that bipolar 1 disorder has a high lifetime prevalence ranging from 0 to 3.3 percent. Bipolar 1

disorder is also manifested in the young adults with the first symptom appearing at 25 years

(Szadoczky et al, 2010). The most elderly people can also have bipolar 1 disorder symptoms but

the mania and depression symptoms are in mild cases. Epidemiology studies show a lifetime

prevalence rates of bipolar 1 disorder among adults from 0 percent to 2.4 percent. The large

prevalence rates were 1.6 percent carried out in the United States. However, the lifetime

prevalence of bipolar 1 disorder depends on diagnostic concepts (Wittchen, Nelson & Lachner,

2008).

Gender Issues

There has been an ongoing debate on the prevalence of bipolar 1 disorder among men

and women. Epidemiological studies show that gender influences the course and presentation of

bipolar 1 disorder. Research has proven that bipolar 1 disorder affects both men and women with

equal frequencies implying that both sexes have a high risk of developing this disorder.

However, there may be gender differences in clinical features whereby men have preponderance

in bipolar 1 disorder. The same research also shows that bipolar 1 disorder is better recognized in

men than women. This is different from other bipolar disorders such as bipolar 11 disorder which

is more common among women than men. Both men and women experience mania and manic

switches (Hendrick et al, 2009).

Psychological Treatment Modalities

PSYCHOPATHOLOGY 6

When administered in combination with medication, psychological treatment can be a

very effective treatment towards this illness. The psychological treatment provides education,

support, and guidance to individuals with bipolar 1 disorder and their families too (Thase &

Sachs, 2010). For mixed episodes or manic episodes such as depression, there are a number of

psychological treatments that can be administered to these individuals so that they can live a

normal life in societies, school, and in their work places. The psychological treatment modalities

include cognitive behavior therapy, family therapy, dialectical behavioral therapy, patient

education, interpersonal therapy, support networks, and self management. Regarding the

cognitive behavioral therapy, therapists aim at examining and monitoring any change in the

dysfunctioning thinking of the individuals based on the assumption that mood, thinking, and

behavior affect one another. The therapists aim at changing the dysfunctioning thinking and also

behavior mostly related with undesirable mood states such as an overly sadness and hopelessness

in life. Individuals are able to learn to change the negative and harmful behaviors and thoughts.

The cognitive behavioral therapy helps in relapse prevention and also enhancing social

functioning such as enhanced relationships among adults. Therapists train patients to identify the

possible mania and depression symptoms (Jamison, 2013). The other form of psychological

treatment is interpersonal and social rhythmic treatment whereby the therapists teach patients

with bipolar 1 disorder to regularize their sleep wake patterns, meal times, exercise, work, and

daily activities. This is important because it helps individuals with this disorder to live a normal

life by ensuring that they have a plan of activities to be achieved. It also helps these individuals

enhance their relationship with others and also manage their daily activities. Their regular daily

routines are monitored and also sleep schedules thus protecting against manic episodes (Gray &

Otto, 2011). The behavioral family therapy is also administered in order to improve mood,

PSYCHOPATHOLOGY 7

enhance family functioning, and also reduce the risk of relapse. Behavioral family therapy is also

important because of the increased cases on suicidal attempts among patients with bipolar 1

disorder. The family focused therapy, therefore, helps in enhancing family coping strategies such

as helping their loved ones. It also helps in enhancing family communication and problem

solving important for the functioning of the family. Research shows that the risk of suicide has

been increasing with estimates ranging from mortality ratios of 12 to 22 hence the need to

enhance family therapists in order to reduce the suicidal rates (Tompson et al, 2010).

Psycho-education therapy is also administered to individuals with the illness whereby

they are taught how to manage the symptoms. These individuals are taught how to recognize

signs of an impeding mood swing or harmful behavior so that they can seek for early treatment

before a full blown episode occurs. Psycho-education is also administered to caregivers and

family members so that they can assist the people with bipolar 1 disorder to manage the

symptoms effectively and also seek medical attention early. Psychological form of treatment

among people with bipolar 1 disorder is important but a point of recommendation is that the

psychological treatment should be made available to people in addition to pharmacological

treatment because these people have severe mania and depression symptoms which requires

medical attention (Sachs & Thase, 2011).

Conclusion

In conclusion, bipolar 1 disorder is defined by manic symptoms (extreme high moods

with psychotic features) and depressive episodes. The symptoms are so severe and in many

cases, these individuals are hospitalized for proper medication. Research shows that bipolar 1

disorder is experienced by more than 1 percent of the population over their lifetime with no

gender differences as it affects both men and women. Bipolar 1 disorder is characterized by both

PSYCHOPATHOLOGY 8

mania and depression episodes which occur at the same time such as extremely irritable mood,

increased risky behaviors, inability to experience joy, and impaired thinking. The main causes of

bipolar 1 disorder are genetic vulnerability, biological vulnerability, and life stress which occur

together thus increasing the risk of getting the illness. There are a number of treatment

approaches which can be used to prevent the illness and one of these approaches is psychological

treatment. Some of the discussed psychological treatment modalities include cognitive behavior

therapy, family therapy, dialectical behavioral therapy, patient education, interpersonal therapy,

support networks, and self management. Research shows that psychological treatment is one of

the most effective approaches to treating bipolar 1 disorder in that people with the disorder are

able to manage the symptoms thus able to live a normal life.

PSYCHOPATHOLOGY 9

References

Angst, J., & Zurich, A. (2002). Prevalence of Bipolar Disorders: Traditional and Novel

Approaches. Retrieved from: http://www.association-atb.org/maladie/prevbipdis.pdf

Goodwin FK, & Jamison KR. (2011). Manic-Depressive Illness. New York, Oxford University

Press.

Goodwin, FK, & Jamison KR. (2007). Manic-Depressive Illness: Bipolar Disorders and

Recurrent Depression, Second Edition. Oxford University Press: New York.

Gray, SM, & Otto, MW. (2011). Psychosocial approaches to suicide prevention: applications to

patients with bipolar disorder. J. Clin Psychiatry 62 (25), 56-64.

Hammen, C, & Gitlin, M. (2007). Stress reactivity in bipolar patients and its relation to prior

history of disorder. Am J Psychiatry 154:856–857.

Hendrick V, Altshuler LL, Gitlin MJ, Delrahim S, & Hammen C. (2009). Gender and bipolar

illness. J Clin Psychiatry 61:393–396.

Jamison, KR. (2013). Manic-depressive illness: the overlooked need for psychotherapy, in

Integrating Pharmacotherapy and Psychotherapy. Washington, DC, American

Psychiatric Press.

Kessler, RC, Berglund, P, Demler O, Jin R, Merikangas KR, & Walters EE (2005). Lifetime

prevalence and age-of-onset distributions of DSM-IV disorders in the National

Comorbidity Survey Replication. Arch Gen Psychiatry 2005 Jun;62(6):593–602.

National Institute of Mental Health. (2015). Bipolar Disorder in Adults. Retrieved from:

http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-

adults/Bipolar_Disorder_Adults_CL508_144295.pdf

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Plante DT, & Winkelman JW (2008). Sleep disturbance in bipolar disorder: therapeutic

implications. Am J Psychiatry 165(7):830–43.

Sachs, GS, & Thase ME. (2011). Bipolar disorder therapeutics: maintenance treatment. Biol

Psychiatry 48(6):573–581.

Szadoczky, E, Papp, Z, Vitrai J, Rihmer Z, & Füredi J. (2010). The prevalence of major

depressive and bipolar disorders in Hungary. Results from a National Epidemiologie

Survey. J Affect Disord 50: 153-162.

Thase ME, & Sachs GS (2010). Bipolar depression: pharmacotherapy and related therapeutic

strategies. Biol Psychiatry 48(6):558–572.

Tompson, MC, Rea, MM, Goldstein, MJ, Miklowitz, DJ, & Weisman AG. (2010). Difficulty in

implementing a family intervention for bipolar disorder: the predictive role of patient and

family attributes. Fam Process 39:105–120.

Wittchen, HU, Nelson, CS, & Lachner G. (2008). Prevalence of mental disorders and

psychosocial impairments in adolescents and young adults. Psychol Med 28: 109-126.

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