DR.

RAM MONOHAR LOHIYA

NATIONAL LAW UNIVERSITY,
LUCKNOW.

ON

Topic: Bipolar Disorder

Submitted to:

Submitted by:

Ms. Isha Yadav

Preksha Vardhan

Asst. Professor

Enroll. No- 150101100

RMLNLU.

Semester- 1
Section-B

ACKNOWLEDGEMENT:

I would like to take this opportunity to express my profound gratitude and deep regards to my
guide, Dean (Academics),Professor C.M. Jariwala and Assistant Professor Ms. Isha Yadav
for their exemplary guidance, monitoring and constant encouragement which helped me give
shape to this project. The blessings, help and guidance given by them from time to time, I
hope, shall carry me a long way in the journey of life on which I am about to embark.
I also take this opportunity to express a deep sense of gratitude to my respected seniors who
share their cordial support, valuable information and guidance, which helped me in
completing this task through various stages.
Lastly, I thank the Almighty, my parents, my brother and my friends for their constant
encouragement without which this assignment would not have been possible. I hope that my
effort would be a good one.

-Preksha Vardhan

TABLE OF CONTENTS:

1. Introduction to the project.

2. Origin of Bipolar Disorder.
3. People likely to suffer from Bipolar Disorder.
4. Types of Bipolar Disorder.
5. Signs indicating presence of Bipolar Disorder.
6. Effects of Bipolar Disorder.
7. Connection between Bipolar Disorder and Addiction or Substance Abuse.
8. Treatment.
9. Helping people with Bipolar Disorder.
10. References.

INTRODUCTION TO THE PROJECT:

Bipolar Disorder is a mental illness characterised by constantly changing moods. A person
with Bipolar Disorder experiences alternating "Highs" ( or Maniac or Hypomania depending
on the severity or whether there is Psychosis) and "Lows".
A Maniac episode is characterised by extreme happiness, hyperactivity, little need for sleep
and racing thoughts which may lead to rapid speech and poorly thought out decisions.
A depressive episode is characterised by extreme sadness, lack of energy, poor eye contact
with people, a negative outlook towards life and feelings of hopelessness and helplessness.
Moving from one mood to another is known as "Cycling". Bipolar Disorder mood episodes
can last for days, weeks, months or even longer. So the cycles may take various amount of
time from person to person.
The cause of Bipolar Disorder is not clearly understood, but both genetic and environmental
factors are known to play a role.

OBJECTIVE:

Extreme Disapproval of mental illness from the side of the society has been existent since the
advent of time. The objective of the project is to enhance knowledge on Bipolar Disorder and
to gain a more realistic view on mental illness.

RESEARCH QUESTIONS:

1. What are the factors leading to Bipolar Disorder?

2. What are the symptoms that may indicate the presence of Bipolar Disorder?
3. What is the difference between Depression and Bipolar Disorder?
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4. What is the effect of Bipolar Disorder on the life of the person suffering?

RESEARCH METHODOLOGY:

I have adopted Doctrinal methodology for my research on Bipolar Disorder.

ORIGIN OF BIPOLAR DISORDER:

Aretaeus of Cappadocia began the quest into the disorder by beginning the process of
detailing symptoms in the medical field as early as the 1stCentury in Greece. But his notations
on the link between mania and depression went largely unnoticed for many centuries.
The ancient Greeks and Romans were responsible for the terms mania and melancholia,
which are now known as the modern day terms "manic" and "depressive". They even
discovered that using lithium salts in baths calmed manic patients and lifted the spirits of
depressed people. Today, lithium is a common treatment for bipolar patients. The Greek
philosopher. Aristotle not only acknowledged melancholy as a condition, but thanked it as the
inspiration for the great artists of his time.
It was common during this time that people across the globe were executed for having bipolar
disorder and other mental conditions because as the study of medicine advanced, strict
religious dogma stated these people were possessed by demons and should therefore be put to
death.
In the 17th Century, Robert Burton wrote the book, "The Anatomy of Melancholy", which
addressed the issue of treating melancholy (non-specific depression) using music and dance
as a form of treatment. While mixed with medical knowledge, the book primarily serves as a
literary collection of commentary of depression, and vantage point of the full effects of
depression on society. It did, however, expand deeply into the symptoms and treatments of
what is now known as clinical depression.
Later that century, Theophilus Bonet published a great work titled "Sepuchretum", a text that
drew from his experience performing 3,000 autopsies. In it, he linked mania and melancholy
in a condition called manico-melancolicus.
This was a substantial step in diagnosing the disorder because mania and depression were
most often considered separate disorders.
Centuries past, and little new was discovered about bipolar disorder until French psychiatrist
Jean-Pierre Falret published an article in 1851 describing what he called la folie circulaire,
which translates to circular insanity. The article details patients switching through severe

depression and manic excitement, and is considered the first documented diagnosis of bipolar
disorder.
Besides the diagnosis, Falret noted the genetic connection in bipolar disorder, something
medical professionals still believe to this day.
However, the history of bipolar disorder changed with Emil Kraepelin, a German psychiatrist
who broke away from Sigmund Freuds theory that society and the suppression of desires
played a large role in mental illness. Kraepelin recognized biological causes of mental
illnesses. He is believed to be the first person to seriously study mental illnesses.
A professional classification system for mental disorderswhich was important to better
understand and treat conditionshas its earliest roots in the early 1950s from German
psychiatrist Karl Leonhard and others.
The term bipolarwhich means two poles signifying the polar opposites of mania and
depressionfirst appeared in the American Psychiatric Associations Diagonostic and
Statistical Manual of Mental Disorders (DSM) in its third revision in 1980.

PEOPLE LIKELY TO SUFFER FROM

BIPOLAR DISORDER:

Bipolar disorder affects about 2 million people solely in the United States in any given year.
Both men and women are affected at the same rate. There are few risk factors that reliably
predict a significant increased likelihood of being diagnosed with Bipolar Disorder.
Genetics and ones family history appear to both have some influence over the likelihood of
being diagnosed with bipolar disorder. Bipolar disorder is more common in those who have a
sibling or parent with the illness and in families having several generations affected with
mood disorders.
Differing rates of bipolar disorder have not been reported for different races. Lower
socioeconomic status may be slightly linked to a higher rate of bipolar disorder.
Men and women have an equal chance of being diagnosed with the disorder. The first episode
in men tends to be a maniac episode, while women are more likely to first experience a
depressive episode.
The estimated average age for the onset of bipolar disorder is during the early 20s, although
there have been reports of the disorder beginning as early as elementary school. In fact,
bipolar disorder appears before age 20 in about one in five manic individuals.
Younger patients first may suffer cyclothymia, which is basically a less extreme form of
bipolar disorder characterized by hypomanic and mild depressive episodes. Although people
with cyclothymia display less intense symptoms, nearly half of them will progress to having a
full manic episode. Younger patients who have full manic episodes are called juvenile bipolar
patients.

TYPES OF BIPOLAR DISORDER:

The Diagnostic and Statistical Manual of Mental Disorders identifies four basic types of
bipolar disorder.
Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven
days, or by manic symptoms that are so severe that the person needs immediate hospital care.
Usually, the person also has depressive episodes, typically lasting at least two weeks. The
symptoms of mania (excessive excitement) or depression must be a major change from the
persons normal state.
Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth
with hypomanic episodes (low intensity mania), but no full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has
symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The
symptoms may not last long enough, or the person may have too few symptoms, to be
diagnosed with bipolar I or II. However, the symptoms are clearly out of the normal range of
behavior expected for the person.
Cyclothymic Disorder, or cyclothymia, is a mild form of bipolar disorder. People who have
cyclothymia have episodes of hypomania that shift back and forth with mild depression for at
least two years. However, the symptoms do not meet the diagnostic requirements for any
other type of bipolar disorder.

SIGNS INDICATING THE PRESENCE OF

BIPOLAR DISORDER:

Bipolar disorder can look very different in different people. The symptoms vary widely in
their pattern, severity, and frequency. Some people are more prone to either mania or
depression, while others alternate equally between the two types of episodes. Some have
frequent mood disruptions, while others experience only a few over a lifetime.
There are four types of mood episodes in bipolar disorder: mania, hypomania, depression,
and mixed episodes. Each type of bipolar disorder mood episode has a unique set of
symptoms.

In everyday life, people have a variety of moods and feelings. These feelings include
frustration, joy and anger. Usually these moods last one day rather than several days. For
people with bipolar disorder, however, moods usually swing from weeks of feeling overly
high and irritable to weeks of feeling sad and hopeless with normal periods in between.
An important distinction between bipolar disorder and the normal emotions of life is that
bipolar disorder results in an inability to handle daily activities. The person cannot work or
communicate effectively and may have a distorted sense of reality (for example,
unrealistically high or low opinion of ones skills).
Bipolar disorder often is not recognized by the patient, relatives, friends or even physicians.
However, recognizing the mood states that occur is essential. Treatment can help a person
with bipolar disorder avoid harmful consequences such as destruction of personal
relationships, job loss and suicide.
During a manic phase, symptoms include:

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heightened sense of self-importance

exaggerated positive outlook

significantly decreased need for sleep

poor appetite and weight loss

racing speech, flight of ideas, impulsiveness

ideas that move quickly from one subject to the next

poor concentration, easy distractibility

increased activity level

excessive involvement in pleasurable activities

poor financial choices, rash spending sprees

excessive irritability, aggressive behavior

During a depressed phase, symptoms include:

feelings of sadness or hopelessness

loss of interest in pleasurable or usual activities

difficulty sleeping; early-morning awakening

loss of energy and constant lethargy

sense of guilt or low self-esteem

difficulty concentrating

negative thoughts about the future

weight gain or weight loss

talk of suicide or death

The main method used to diagnose bipolar disorder is a thorough interview with a
psychiatrist, psychologist or other mental health professional. Although there are written
methods for documenting the severity and number of symptoms, those tests only complement
a complete interview. They do not substitute for a face-to-face evaluation by a professional.
There are not yet any blood tests or other biological tests that can be used to diagnose bipolar
disorder.

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EFFECTS OF BIPOLAR DISORDER:

The effects of bipolar disorder symptoms on a persons life can range from minor
disturbances to major disruption. This depends on whether the person receives an accurate
diagnosis, including identification of any co-occurring disorders. For example, there is a very
high rate of substance abuse or dependence co-occurring with bipolar disorder. The effects of
bipolar disorder may include:

damaged relationships
poor job or school performance
legal or financial consequences from impulsive decisions
medical side effects from prolonged abuse of drugs, alcohol or prescriptions
repetitive self-mutilation or other self-harming behaviors
suicide, in extreme cases

The length of the manic and depressive episodes also takes a toll on the family, friends and
co-workers of those who suffer with bipolar disorder. Weeks of unpredictable behavior by a
person with manic depression make it difficult to rely on the sufferer to fulfill obligations,
and often times loved ones struggle to maintain a sense of security

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CONNECTION BETWEEN BIPOLAR

-DISORDER AND ADDICTION OR
SUBSTANCE ABUSE:

Bipolar depression is often complicated by attempts to self-medicate both manic and

depressive phases with addictive drugs, alcohol or prescription drug abuse. When substance
abuse is combined with psychotropic medications commonly used to control depressive
symptoms and stabilize the individuals moods, symptoms may become even more erratic
and dangerous.
An experienced psychiatrist can manage bipolar disorder and help people with this illness to
lead full and productive lives. While in many cases bipolar disorder can be treated very
effectively in an outpatient setting, it can also pose a grave challenge for suffers who also
have symptoms of drug addiction, alcohol abuse or eating disorders, such as anorexia or
bulimia. Sufferers of bipolar depression and co-occurring disorders or addictions will face a
much more challenging path to recovery, and require more aggressive and integrated
treatment. It is essential for both the bipolar disorder and the substance abuse disorder to be
expertly addressed.
Thats why experts in bipolar disorder and addiction psychiatry may recommend inpatient or
residential treatment when a person with bipolar disorder also shows signs of addiction. This
allows them to cope with the effects of their manic and depressive episodes under the
constant care of medical and clinical staff experienced at treating co-occurring disorders. It
also allows mood disorder and addiction treatment staff to carefully monitor symptoms and
avoid confusion among symptoms of bipolar disorder, symptoms of addiction, and signs of
withdrawal from alcohol, drugs or prescriptions.

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TREATMENT:

There are a number of pharmacological and psychotherapeutic techniques used to treat

bipolar disorder. Individuals may use self-help and pursue recovery.
Hospitalization may be required especially with the manic episodes present in bipolar I. This
can be voluntary or (if mental health legislation allows and varying state-to-state regulations
in the USA) involuntary (called civil or involuntary commitment). Long-term inpatient stays
are now less common due to deinstitutionalization, although these can still occur. Following
(or in lieu of) a hospital admission, support services available can include drop-in centers,
visits from members of a community mental health team or anAssertive Community
Treatment team, supported employment and patient-led support groups, intensive outpatient
programs. These are sometimes referred to as partial-inpatient programs.

Psychosocial:
Psychotherapy is aimed at alleviating core symptoms, recognizing episode triggers, reducing
negative expressed emotion in relationships, recognizing prodromal symptoms before fullblown recurrence, and, practicing the factors that lead to maintenance of remission. Cognitive
behavioral therapy, family-focused therapy, andpsychoeducation have the most evidence for
efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and
cognitive-behavioral therapy appear the most effective in regard to residual depressive
symptoms. Most studies have been based only on bipolar I, however, and treatment during
the acute phase can be a particular challenge. Some clinicians emphasize the need to talk with
individuals experiencing mania, to develop a therapeutic alliance in support of recovery.

MEDICATION:
A number of medications are used to treat bipolar disorder. The medication with the best
evidence is lithium, which is effective in treating acute manic episodes and preventing

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relapses; lithium is also an effective treatment for bipolar depression. Lithium reduces the
risk of suicide, self-harm, and death in people with bipolar disorder.
Four anticonvulsants are used in the treatment of bipolar disorder. Carbamazepine effectively
treats manic episodes, with some evidence it has greater benefit in rapid-cycling bipolar
disorder, or those with more psychotic symptoms or a more schizoaffective clinical picture. It
is less effective in preventing relapse than lithium or valproate. Carbamazepine became a
popular treatment option for bipolar in the late 1980s and early 1990s, but was displaced
by sodium valproate in the 1990s.[citation needed] Since then, valproate has become a commonly
prescribed treatment, and is effective in treating manic episodes. Lamotrigine has some
efficacy in treating bipolar depression, and this benefit is greatest in more severe
depression. It has also been shown to have some benefit in preventing further episodes,
though there are concerns about the studies done, and is of no benefit in rapid cycling
disorder. The effectiveness oftopiramate is unknown. Depending on the severity of the case,
anticonvulsants may be used in combination with lithium or on their own.
Antipsychotic medications are effective for short-term treatment of bipolar manic episodes
and appear to be superior to lithium and anticonvulsants for this purpose. However, other
medications such as lithium are preferred for long-term use. Olanzapine is effective in
preventing relapses, although the evidence is not as solid as for lithium. Antidepressants have
not been found to be of any benefit over that found with mood stabilizers.
Short courses of benzodiazepines may be used in addition to other medications until mood
stabilizing become effective.

ALTERNATIVE MEDICATION:
There is some evidence that the addition of omega 3 fatty acids may have beneficial effects
on depressive symptoms, although studies have been scarce and of variable quality.

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HELPING PEOPLE WITH BIPOLAR

DISORDER:

Dealing with the ups and downs of bipolar disorder can be difficultand not just for the
person with the illness. The moods and behaviors of a person with bipolar disorder affect
everyone aroundespecially family members and close friends. During a manic episode, you
may have to cope with reckless antics, outrageous demands, explosive outbursts, and
irresponsible decisions. And once the whirlwind of mania has passed, it often falls on you to
deal with the consequences. During episodes of depression, you may have to pick up the
slack for a loved one who doesnt have the energy to meet responsibilities at home or work.
The good news is that most people with bipolar disorder can stabilize their moods with
proper treatment, medication, and supportand you can play a significant role in his or her
recovery. Often, just having someone to talk to can make all the difference to your loved
ones outlook and motivation.
Here are some other ways you can help:

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Learn about bipolar disorder. Learn everything you can about the symptoms and
treatment options. The more you know about bipolar disorder, the better equipped
youll be to help your loved one and keep things in perspective.

Encourage the person to get help. The sooner bipolar disorder is treated, the better the
prognosis, so urge your loved one to seek professional help right away. Dont wait to
see if the person will get better without treatment.

Be understanding. Let your friend or family member know that youre there if he or
she needs a sympathetic ear, encouragement, or assistance with treatment. People with
bipolar disorder are often reluctant to seek help because they dont want to feel like a

burden to others, so remind the person that you care and that youll do whatever you
can to help.

Be patient. Getting better takes time, even when a person is committed to treatment.
Dont expect a quick recovery or a permanent cure. Be patient with the pace of
recovery and prepare for setbacks and challenges. Managing bipolar disorder is a
lifelong process.

REFERENCE:

The Bipolar Disorder Survival Guide: What You and Your Family Need to Know by
David J. Miklowitz.

The Bipolar Workbook: Tools for Controlling Your Mood Swings by Monica
Ramirez Basco.

Bipolar Disorder Survival Guide: How to Manage Your Bipolar Symptoms, Become
Stable and Get Your Life Back
by Sara Elliott Price.

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http://www.timberlineknolls.com/mood-personality/bipolar-disorder/signseffects/#What-are-the-Effects-of-Bipolar-Disorder

http://www.timberlineknolls.com/mood-personality/bipolar-disorder/signseffects/#What-are-the-Effects-of-Bipolar-Disorder

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http://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-signsand-symptoms.htm

http://www.webmd.com/bipolar-disorder/helping-loved-one-with-bipolar

http://www.helpguide.org/articles/bipolar-disorder/helping-a-loved-onewith-bipolar-disorder.htm

http://www.dbsalliance.org/site/PageServer?
pagename=education_brochures_helping_friend_family