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What Is The Primary Cause Of Bipolar Disorder

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Bipolar disorder (depression & mania) – causes, symptoms, treatment & pathology

Many people with bipolar disorder also may have other mental health disorders or conditions such as:

  • Psychosis. Sometimes people who have severe episodes of mania or depression also have psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the persons extreme mood. For example:
  • Someone having psychotic symptoms during a manic episode may falsely believe that he or she is famous, has a lot of money, or has special powers.
  • Someone having psychotic symptoms during a depressive episode may believe he or she is financially ruined and penniless or has committed a crime.
  • Anxiety Disorders Deficit/Hyperactivity Disorder . Anxiety disorders and ADHD often are diagnosed in people with bipolar disorder.
  • Misuse of Drugs or Alcohol. People with bipolar disorder are more prone to misusing drugs or alcohol.
  • Eating Disorders. People with bipolar disorder occasionally may have an eating disorder, such as binge eating or bulimia.
  • Some bipolar disorder symptoms are like those of other illnesses, which can lead to misdiagnosis. For example, some people with bipolar disorder who also have psychotic symptoms can be misdiagnosed with schizophrenia. Some physical health conditions, such as thyroid disease, can mimic the moods and other symptoms of bipolar disorder. Street drugs sometimes can mimic, provoke, or worsen mood symptoms.

    What Is Bipolar Disorder

    Bipolar disorder is a chronic or episodic mental disorder. It can cause unusual, often extreme and fluctuating changes in mood, energy, activity, and concentration or focus. Bipolar disorder sometimes is called manic-depressive disorder or manic depression, which are older terms.

    Everyone goes through normal ups and downs, but bipolar disorder is different. The range of mood changes can be extreme. In manic episodes, someone might feel very happy, irritable, or up, and there is a marked increase in activity level. In depressive episodes, someone might feel sad, indifferent, or hopeless, in combination with a very low activity level. Some people have hypomanic episodes, which are like manic episodes, but less severe and troublesome.

    Most of the time, bipolar disorder develops or starts during late adolescence or early adulthood. Occasionally, bipolar symptoms can appear in children. Although the symptoms come and go, bipolar disorder usually requires lifetime treatment and does not go away on its own. Bipolar disorder can be an important factor in suicide, job loss, and family discord, but proper treatment leads to better outcomes.

    What If Im Not Happy With My Treatment

    If you arent happy with your treatment you can:

    • talk to your doctor about your treatment options,
    • ask for a second opinion,
    • get an advocate to help you speak to your doctor,
    • contact Patient Advice and Liaison Service , or
    • make a complaint.

    There is more information about these options below.

    How can I speak to my doctor about my treatment options?

    You can speak to your doctor about your treatment. Explain why you arent happy with it. You could ask what other treatments you could try.

    Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you arent given this treatment, ask your doctor to explain why it isnt suitable for you.

    Whats a second opinion?

    A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

    You dont have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

    What is advocacy?

    An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.

    There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS.

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    The Role Of Mitochondria

    Experts also believe mitochondria which you may remember from science class as the cells that generate energy, aka the powerhouse of the cell may have something to do with the development of mood disorders.

    When cells dont produce or metabolize energy as they typically would, the resulting imbalances in brain energy could lead to the changes in mood and behavior often seen with bipolar disorder.

    Symptoms Of Manic Episodes

    Bipolar Disorder

    Episodes of mania and hypomania are prevalent features of bipolar disorder. While the signs of mania may at first be a pleasant diversion from the dark depressive episodes, the manic phase can also be destabilizing and self-destructive.

    Symptoms include:

    • Racing thoughts and difficulty staying focused, easily distracted
    • Rapid speech
    • Impulsive behaviors, using poor judgment
    • Risky behaviors, such as substance use or sexual promiscuity
    • Psychosis

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    Biological Cause Of Bipolar Disorder

    In considering the biological explanations, the first issue is inheritability. This question has been researched via multiple family, adoption and twin studies. In families of persons with bipolar disorder, first-degree relatives are more likely to have a mood disorder than the relatives of those who do not have bipolar disorder.

    Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.

    Infection Disease And Toxins

    Several psychiatric disorders have often been associated with microbial pathogens, particularly viruses. There have been some suggestions of associations from animal studies that have inconsistent evidence for infectious and immune mechanisms. Some human disorders, infectious disease models in psychiatry are reported to have not yet shown significant promise except in isolated cases.

    There have been some inconsistent findings of links between infection by the parasite Toxoplasma gondii and human mental disorders such as schizophrenia, with the direction of causality unclear. Several diseases of the white matter can cause symptoms of mental disorder.

    Poorer general health has been found among individuals with severe mental illnesses, thought to be due to direct and indirect factors including diet, bacterial infections, substance use, exercise levels, effects of medications, socioeconomic disadvantages, lowered help-seeking, or treatment adherence, or poorer healthcare provision. Some chronic general medical conditions have been linked to some aspects of mental disorders, such as AIDS-related psychosis.

    The research on Lyme disease caused by a deer tick and toxins is expanding the link between bacterial infections and mental illness.

    Research shows that infections and exposure to toxins such as HIV and streptococcus cause dementia and OCD. The infections or toxins that trigger a change in the brain chemistry can develop into a mental disorder.

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    Cause Of Bipolar Disorder

    The cause of bipolar disorder is unclear but hereditary, biological. and psychological factors may playa part. For example, the incidence of bipolar disorder among relatives of affected patients is higher than in the general population, and highest among maternal relatives.

    Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder-rather, many factors act together to produce the illness. Some of the causes of bipolar disorder are as follows:

    Risk Factor Of Bipolar Disease

    Causes of bipolar disorder

    The factors that increase the risk of having bipolar disorder or the main trigger of the condition can include:

    • If you abuse drugs or alcohol.
    • Events relating to high stress, such as the death of beloved or other traumatic periods.
    • Having a close relative with the same disease as a parent or sibling.

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    Causes Of Mental Disorders

    A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.

    What Is The Treatment For Mania Hypomania And Depression

    You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence website.

    NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at:

    The NHS doesnt have to follow these recommendations. But they should have a good reason for not following them.

    What medications are recommended?

    Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.

    The mood stabilisers we talk about in this factsheet are:

    • Lithium
    • Certain benzodiazepine medication

    Mania and hypomaniaYou should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as antimanic medication.

    If you are taking antidepressants your doctor may advise you to withdraw from taking them.

    You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:

    • Haloperidol
    • Quetiapine
    • Risperidone

    If the first antipsychotic you are given doesnt work, then you should be offered a different antipsychotic medication from the list above.

    If a different antipsychotic doesnt work, then you may be offered lithium to take alongside it. If the lithium doesnt work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.

    Sodium Valproate shouldnt be given to girls or young women who might want to get pregnant.

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    Any Other Factors That May Contribute To Developing Bipolar

    As we described earlier, experts have good reason to believe that biology is mainly to blame for bipolar disorderin particular, specific areas in the brain that over- or under-produce particular brain chemicals.

    However, its possible that certain environmental factors may trigger the disease in those who were already susceptible. Thats not to say that youd get the disease if you werent predisposed to it in the first place.

    But its conceivable that bipolar could lie idle, only activating if certain factors arise. These may include:

    • Stressful events. Highly disturbing happenings like divorce, experiencing a death of a family member, or losing a job can set off a bipolar incident. Also, people whove experienced a traumatic event like sexual or physical abuse, neglect, or death of a parent early in life have an increased risk of bipolar later.

    • Sleep disturbances. Research found that 25% to 65% of people with bipolar had experienced a social rhythm disruptionscience speak for daily routines that can impact the sleep/wake cyclebefore an episode of mania.

    • Drugs and alcohol. More than 60% of people with bipolar disorder abuse alcohol or drugs. The classic chicken/egg questions arises here , and the answer is, its likely bidirectional. That is, people with bipolar take more risks, which allows for more alcohol and substance abuse, which may lead to brain and social stressors that increase the likelihood of the disorder.

    Symptoms Of Depressive Episodes

    BPD vs. Bipolar: Symptoms and Treatment

    Depressive episodes can also emerge without warning. Some of the triggers for these depressive periods include lack of sleep, excessive stress, or a negative life event, but often there is no known cause for the depression. The depressive episodes must be carefully monitored, as there is an increased risk of suicidal behavior during these phases.

    Symptoms include:

    • Feelings of despair and hopelessness
    • Intense fatigue
    • Loss of interest in activities once enjoyed
    • Chronic pain with no known medical cause
    • Trouble concentrating
    • Suicidal thoughts

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    Brain Chemistry And Biology

    Bipolar disorder also has a neurological component.

    Neurotransmitters are chemical messengers in the brain. They help relay messages between nerve cells throughout the body. These chemicals play an essential role in healthy brain function. Some of them even help regulate mood and behavior.

    Older links three main neurotransmitters to bipolar disorder:

    • serotonin
    • dopamine
    • norepinephrine

    Imbalances of these brain chemicals may prompt manic, depressive, or hypomanic mood episodes. This is particularly the case when environmental triggers or other factors come into play.

    What Can I Expect After Treatment

    For most people, a good treatment program can stabilize severe moods and provide effective symptom relief. Treatment that is continual has proven more effective in preventing relapses. Those who also have a substance abuse problem may need more specialized treatment.

    Last reviewed by a Cleveland Clinic medical professional on 01/27/2018.


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    Treatment For Bipolar Disorder

    • Success rates of 70 to 85% were once expected with lithium for the acute phase treatment of mania, however, lithium response rates of only 40 to 50% are now commonplace.
    • Participation in a DBSA patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization.
    • Consumers with bipolar disorder face up to ten years of coping with symptoms before getting an accurate diagnosis, with only one in four receiving an accurate diagnosis in less than three years.
    • A gender bias exists in the diagnosis of bipolar disorder: women are far more likely to be misdiagnosed with depression and men are far more likely to be misdiagnosed with schizophrenia.
    • Nearly 9 out of 10 consumers with bipolar disorder are satisfied with their current medication, although side effects remain a problem.
    • Consumers who report high levels of satisfaction with their treatment and treatment provider have a much more positive outlook about their illness and their ability to cope with it.
    Crisis Information

    If you or someone you know has thoughts of death or suicide, call 273-TALK or 9-1-1 immediately. You can also text DBSA to 741-741. Or contact a medical professional, clergy member, loved one, friend, or hospital emergency room.

    Genetics: A Primary Cause Of Bipolar Disorder

    Understanding Bipolar Disorder

    In searching for the answer to what causes bipolar disorder, scientists report genetics may be one of the key culprits, as bipolar disorder seems to run in families. Here are some important statistics on bipolar genetics:

    • First-degree relatives of people with bipolar disorder type 1 are seven times more likely to develop bipolar 1 over the regular population.
    • Children of a parent with bipolar disorder have a 50% chance of having a major psychiatric illness. Children remain at an increased risk even if they are raised in the home of parents without the illness.
    • Identical twin studies show if one twin has bipolar 1, the other twin has between a 33% – 90% chance of also having bipolar type 1.

    Multiple genes, involving several chromosomes, have been linked to the development of bipolar disorder.

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    What Are The Risk Factors For Bipolar Disorder

    Several factors contribute to a persons risk for developing the disorder, including both genetic and environmental factors. A persons family history plays an important role. It is more common in people who have a relative with the condition, especially a first-degree relative, such as a sibling or parent. Other risk factors include:

    • Chronic stress
    • Traumatic experience or Post Traumatic Stress Disorder
    • Substance use disorder
    • Medications and/or steroids

    In many cases, individuals experience their first episodes of mania or hypomania during their childhood or adolescence. It can be difficult to diagnose because it begins slowly and gradually worsens over time. Its important to take changes in your mood or behavior seriously. If you experience any of the above symptoms over an extended period of time, talk to your doctor or consider seeing a behavioral health specialist. Bipolar disorder can be effectively managed with treatment, and is most beneficial when treated early on.

    What Risks And Complications Can Bipolar Disorder Cause

    There can be complications and risks for people who live with bipolar disorder. But these risks can be lessened with the right support and treatment.

    What about suicide and self-harm?

    You might have an illness where you experience psychosis, such as schizophrenia or bipolar disorder. Your risk of suicide is estimated to be between 5% and 6% higher than the general population.

    You are more likely to try to take your own life if you have a history of attempted suicide and depression. It is important that you get the right treatment for your symptoms of depression and have an up to date crisis plan.

    There is also research that suggests you are 30% – 40% more likely to self-harm if you live with bipolar disorder.

    What about financial risk?

    If you have mania or hypomania you may struggle to manage your finances. You may spend lots of money without thinking about the effect that it may have on your life.

    You could make a Lasting Power of Attorney. This is a legal process. This means that you pick someone that you trust to manage your finances if you lack mental capacity to manage them by yourself.

    You can work with your carer and mental health team. You can form an action plan. This can say what they can do if you have a period of mania or hypomania and you start to make poor financial decisions.

    What about physical health risk?

    What about alcohol and drugs risk?

    If you want advice or help with alcohol or drug use contact your GP.

    What about driving risk?

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    Searching For A Cause

    The exact cause of bipolar disorder is unknown.

    However, the Mayo Clinic says several factors may be involved. These include physical changes in the brain, an imbalance of naturally occurring brain chemicals, and inherited traits.

    If someone has bipolar disorder type I, the severe form of the illness, the odds that their child will have it are about 5 to 10 percent. That is 5 to 10 times the rate in the general population, Potash said.

    The study Potash was involved in looked at eight families with a history of bipolar disorder through several generations. The researchers used next-generation sequencing to examine the DNA of 36 of the family members.

    Next-generation sequencing is a way of combing through each of the chemical letters in DNA that spell out genes, Potash explained. In our study we went through about 50 million of these for each person we looked at. The idea is to look for misspellings that are present in people with bipolar disorder.

    Earlier studies examining the genetic cause of bipolar disorder focused on identifying common DNA changes that could only explain a small percentage of the risk for bipolar disorder.

    This latest research, led by Dr. Fernando Goes of the Johns Hopkins University School of Medicine, instead focused on identifying more rare genetic mutations that are less common, but may be linked to the more severe forms of bipolar disorder.

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