Bipolar Disorder
The phenomenon of bipolar affective disorder has been a mystery since the 16th
century. History has shown that this affliction can appear in almost anyone.

Even the great painter Vincent Van Gogh is believed to have had bipolar
disorder. It is clear that in our society many people live with bipolar
disorder; however, despite the abundance of people suffering from the it, we are
still waiting for definite explanations for the causes and cure. The one fact of
which we are painfully aware is that bipolar disorder severely undermines its\'
victims ability to obtain and maintain social and occupational success. Because
bipolar disorder has such debilitating symptoms, it is imperative that we remain
vigilant in the quest for explanations of its causes and treatment. Affective
disorders are characterized by a smorgasbord of symptoms that can be broken into
manic and depressive episodes. The depressive episodes are characterized by
intense feelings of sadness and despair that can become feelings of hopelessness
and helplessness. Some of the symptoms of a depressive episode include anhedonia,
disturbances in sleep and appetite, psycomoter retardation, loss of energy,
feelings of worthlessness, guilt, difficulty thinking, indecision, and recurrent
thoughts of death and suicide (Hollandsworth, Jr. 1990 ). The manic episodes are
characterized by elevated or irritable mood, increased energy, decreased need
for sleep, poor judgment and insight, and often reckless or irresponsible
behavior (Hollandsworth, Jr. 1990 ). Bipolar affective disorder affects
approximately one percent of the population (approximately three million people)
in the United States. It is presented by both males and females. Bipolar
disorder involves episodes of mania and depression. These episodes may alternate
with profound depressions characterized by a pervasive sadness, almost inability
to move, hopelessness, and disturbances in appetite, sleep, in concentrations
and driving. Bipolar disorder is diagnosed if an episode of mania occurs whether
depression has been diagnosed or not (Goodwin, Guze, 1989, p 11). Most commonly,
individuals with manic episodes experience a period of depression. Symptoms
include elated, expansive, or irritable mood, hyperactivity, pressure of speech,
flight of ideas, inflated self esteem, decreased need for sleep,
distractibility, and excessive involvement in reckless activities (Hollandsworth,

Jr. 1990 ). Rarest symptoms were periods of loss of all interest and retardation
or agitation (Weisman, 1991). As the National Depressive and Manic Depressive

Association (MDMDA) has demonstrated, bipolar disorder can create substantial
developmental delays, marital and family disruptions, occupational setbacks, and
financial disasters. This devastating disease causes disruptions of families,
loss of jobs and millions of dollars in cost to society. Many times bipolar
patients report that the depressions are longer and increase in frequency as the
individual ages. Many times bipolar states and psychotic states are misdiagnosed
as schizophrenia. Speech patterns help distinguish between the two disorders (Lish,

1994). The onset of Bipolar disorder usually occurs between the ages of 20 and

30 years of age, with a second peak in the mid-forties for women. A typical
bipolar patient may experience eight to ten episodes in their lifetime. However,
those who have rapid cycling may experience more episodes of mania and
depression that succeed each other without a period of remission (DSM III-R).

The three stages of mania begin with hypomania, in which patients report that
they are energetic, extroverted and assertive (Hirschfeld, 1995). The hypomania
state has led observers to feel that bipolar patients are "addicted"
to their mania. Hypomania progresses into mania and the transition is marked by
loss of judgment (Hirschfeld, 1995). Often, euphoric grandiose characteristics
are displayed, and paranoid or irritable characteristics begin to manifest. The
third stage of mania is evident when the patient experiences delusions with
often paranoid themes. Speech is generally rapid and hyperactive behavior
manifests sometimes associated with violence (Hirschfeld, 1995). When both manic
and depressive symptoms occur at the same time it is called a mixed episode.

Those afflicted are a special risk because there is a combination of
hopelessness, agitation, and anxiety that makes them feel like they "could
jump out of their skin"(Hirschfeld, 1995). Up to 50% of all patients with
mania have a mixture of depressed moods. Patients report feeling dysphoric,
depressed, and unhappy; yet, they exhibit the energy associated with mania.

Rapid cycling mania is another presentation of bipolar disorder. Mania may be
present with four or more distinct episodes within a 12 month period. There is
now evidence to suggest that sometimes rapid cycling may be a transient
manifestation of the bipolar disorder. This form of the disease exhibits more
episodes of mania and depression than bipolar. Lithium has been the primary
treatment of bipolar disorder since its introduction in the 1960\'s. It is main
function is to stabilize the cycling characteristic of bipolar disorder. In four
controlled studies by