Mood disorders such as bipolar disorder or also known as manic-depression have been closely studied and researched for many years. Due to the inability to find one or any specific gene that contributes to this disorder it has been a long and difficult journey into the understanding of manic-depressive illness. With the contributions of many scientist and researchers slowly the understanding and treatment of bipolar disorder is becoming more clear. The use of lithium and other forms of treatment such as the integration of pharmacotherapy and psychotherapy have facilitated substantial results in the lives of patients and families living with this disorder. Without the continual research into such mood disorders such as manic-depressive illness assumptions may become fact, which will in turn misconstrue the meaning behind this disorder.
And the Different Aspects of Treatment
A growing body of research has indicated that as many as three million people in the United States are estimated to suffer from Bipolar Disorder or also known as Manic-Depression (Bower,2000). This condition is marked by periods of severe depression interspersed with episodes of uncontrollable elation, restlessness, racing thoughts and delusions of grandeur. As expected with these symptoms, this diseases not only affects the person who has the disease, but those around them. Many treatments have been used to try and calm the effects of this disorder, however only one treatment seems to be working the best and this treatment is know as Lithium chloride (Bower, 1987).
It sounds almost simplistic. Mental disorders are complex and relatively common in the population. It would be too much to ask that their genetics be straight forward, that they are caused by single mutant genes.
Yet there is a precedent. Huntington’s disease is caused by a single gene and whoever inherits the gene sooner or later develops the disease. In about half of all cases, the first symptoms of this progressive neurological disease are psychiatric ones (Kolata, 1986). Patients may be depressed or irrational, forgetful or disoriented. Those who do not start out with psychiatric symptoms start with movement disorders—clumsiness and an unsteady gait. So the example of Huntington’s disease at least raises the possibility that complex psychiatric syndromes are caused by single genes.
It has been suspected for years now that there is a strong genetic component to bipolar disorder. For example, if one identical twin has bipolar disorder, the other has a nearly 80% chance of having it too. If one member of a pair of fraternal twins has the illness, the other member has about a 20% chance of having it. When adopted persons with bipolar disorder were studied, investigators found that more than 30% of their biological parents also had bipolar disorder, but only 2% of the adoptive parents did (Kolata, 1986).
The majority of patients with bipolar disorder will experience significant
symptoms before the age of 25 years ( Suppes, Dennehy, Gibbons, 2000). However, there are some patients who develop new onset of illness in much later decades. Onset of symptoms of bipolar illness after the age of 60 years is likely due to secondary medical causes including major medical or neurologic illnesses. As stated before there is somewhat of an association between the rate of certain types of paring of family members to have bipolar disorder. The individuals who have this disorder have wayward brain chemicals and genes gone bad which seem to bully people back and forth between weeks of moderate-to-intense euphoria and comparable spells of soul-deadening depression. A few weeks of relative calm spells often separate these disparate moods. These different moods swings are mainly controlled by the drug Lithium.
Lithium treatment was introduced into psychiatry approximately 50 years ago by John Cade, but was not approved by the Federal Drug Administration until the 1970’s (Dunner, 2000). Since then lithium has become established for the treatment of acute mania and for maintenance treatment for patients who have bipolar I and bipolar II disorder. Lithium is administered orally to those patients who are willing to take it. Dunner (2000) notes that the formulations currently available include pills and capsules (which are both available as immediate release and sustained release) and liquid preparations.
It is difficult to know with a great amount of certainty the biochemical mode of action for lithium. According to Schou (1988) researchers are familiar with a large number of effects in the brain, but the difficulty is to pick out those that are relevant for the action of manic-depressive illness. Research in this area is very active, and lithium offers a number of specific advantages. (1) Lithium acts against both mania and depressive manifestations of the disease, prophylactically and therapeutically against manias, prophylactically and to some extent therapeutically against the depressions (2) lithium prevents relapses as effectively in unipolar as in bipolar manic-depressive illness (3) lithium is not metabolized in the organism, and problems of active or inactive metabolites do not exist (4) the chemical determination of lithium levels in tissues and body fluids is rapid, specific, and accurate (5) last and perhaps most important, although lithium counteracts abnormal mood changes with considerable efficacy, it interferes to a remarkably low extent with normal mood level and emotional reactivity.
It is essential that the guidelines of this drug be conveyed not only to the physicians but also in nontechnical language to patients and relatives. At the beginning of the treatment, patients should receive a physical examination and laboratory analysis to include a complete blood count and thyroid and renal function tests (Dunner, 2000). Clinicians should be aware of drug interactions before they begin the treatment of lithium. Furthermore, clinicians will need to monitor the blood levels of the patient and monitor the side effects. Until the patients achieves a satisfactory blood level, it would be appropriate to measure serum lithium levels every one to two weeks; after that the levels should be measured every two to three months for the first six months of treatment and at least every six to twelve months thereafter (American Psychiatric Association, 1994). Due to the nonadherence of these guidelines other forms of treatment may be combined.
According to Rothbaum and Astin (2000) it has been estimated that 32% to 45% of the patients who are taking medications such as lithium to treat bipolar disorder do not adhere to taking their medications. Patients who do not adhere, if married, have failed marriages, and can not maintain their employment status. Due to these reasons, the integration of pharmacotherapy and psychotherapy has been recommended by the American Psychiatric Association which aim to increase the patients adherence to medication, decrease the number of hospitalizations and relapses, to enhance social and occupational functioning, and most importantly to improve the patient’s quality of life (Hirschfield, Clayton, and Cohen, 1994).
Approaches towards achieving these goals include psychoeducation which gives the patient a theoretical and practical approach toward understanding and coping with the consequences of their illness, cognitive behavioral therapy which includes (1) education the patients and family members about bipolar disorder, (2) teaching the patients and families about methods of monitoring the occurrence, severity, and course of mania and depressive symptoms (3) facilitating medication adherence by removing obstacles to adherence (4) providing nonmedical strategies for coping with cognitive and behavioral occurrences of mania and depression and (5) teaching skills for coping with common psychosocial problems. Other interventions include family therapy and the goals included are increasing medication adherence through education, decreasing resistance to accepting the illness, and exploration of the symbolic meaning of medication-taking and worries about the future.
Other approaches included in the pharmacotherapy and psychotherapy integration are: interpersonal and social rhythm therapy, adjunctive therapies, and psychodynamic interventions.
Lithium treatment, in use in psychiatry for over fifty years has been proved to be of considerable benefit to mood disorder patients. John Cade’s discovery of lithium was not only important on the medicinal level but has given relief to bipolar patients and their families, and the economic benefits to the wider community has been estimated that from 1970 to 1994 saved the United States alone over $145 billion dollars in hospitalization costs (Kirschner, Marincola, and Teisberg, 1994). Moreover, the research suggests that better recovery is possible when psychotherapy is used in conjunction with pharmacotherapy, however clearly pharmacotherapy is the foundation treatment. To enhance long-term compliance, the clinician must adjust the treatment in order to minimize side effects and monitor the dosage for optimal results. Furthermore, since lithium treatment prevents both manic and depressive relapses, one may visualize lithium as exerting a regulating or stabilizing effect on those metabolic processes that at times are out of balance in the brains of manic-depressive patients. The day will presumably come when scientists and researchers succeed in finding the solution, and this may lead to development of treatments with sill greater specificity and a still higher response.
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