Bipolar Disorder

Understanding Bipolar Disorder

Bipolar disorder is a serious mental health condition that affects millions of people worldwide and disrupts their daily functioning and well-being. It can have a harmful influence on various aspects of life, such as cognitive processes, energy levels, sleep, and behavior.

The main characteristic of bipolar disorder is extreme mood swings. 

These mood swings include:

• very energetic moods (called mania, a state of abnormally elevated or irritable mood) and 
• very low moods (called depression, episodes of intense sadness and low energy). 

People who suffer from bipolar disorder also experience changes in their energy levels, thinking, behavior and sleep patterns.

During these mood episodes, it can be hard to do everyday activities, go to work or school, and keep up with relationships.

Characteristics of Mania

A manic episode is a period of at least one week where a person has an extremely elevated or irritable mood along with increased energy or activity. During this time, the individual shows at least three other symptoms, such as:

• Inflated self-esteem
• Less need for sleep
• Being overly talkative
• Racing thoughts
• Being easily distracted
• Taking on multiple activities
• Or risky behavior

These moods can shift quickly and may cause issues with daily life. During manic episodes, it is also possible that the individual feels a sense of unrealistic self-confidence and unrealistic beliefs about oneself.

Characteristics of Depression

Depressive episodes in bipolar disorder are characterized by feelings of extreme sadness, hopelessness, and tiredness. The person may also avoid social contacts, such as friends, and family, or participation in their usual activities.

Depressive episodes usually include:

• Feelings of sadness, anxiousness, worthlessness, emptiness
• Low energy levels
• Forgetfulness
• Issues concentrating
• Changes in sleep
• Changes in appetite
• Thoughts of suicide
• In severe cases, delusions (false beliefs) and hallucinations (seeing or hearing something that isn’t there)

Prevalence of Bipolar Disorder

A study from 2011 points out that it is difficult to conclude the exact prevalence of bipolar disorder since there is a lack of data for many global regions. Still, the study estimates that the global prevalence of bipolar disorder is around 0.7%.

However, a more recent article from 2015 suggests that the prevalence of people suffering from bipolar disorder characterized by manic episodes is about 1.06%. On the other hand, the article states that the prevalence of bipolar disorder characterized by depressive episodes is higher, about 1.57%. Crucially, the article notes that the diagnosis of bipolar disorder changes over time, influencing its prevalence as well.

Development and Progression of Bipolar Disorder

The age of onset (the first time the condition has been noted) of symptoms of bipolar disorder is around the age of 18. In children, it is important to consider their individual development stages since children of the same age can develop at different rates. However, bipolar disorder can begin at any age, including people in their 60s and 70s. In these cases, it is important to check for medical issues, such as brain disorders, or problems related to the use of substances.

Furthermore, an article published in 2010 explains that despite new treatments for bipolar disorder, it is still challenging to predict how the condition can progress. Although long-term relief from symptoms is often possible, this does not mean that the person can recover their ability to function in day-to-day life.

Another study from 2021 analyzed the progression of bipolar disorder in cases where the first symptoms appeared in childhood or adolescence. According to the study, although many people recover from initial episodes, relapse is common, occurring in about 35-73% of cases. The study also states that in cases with an earlier onset of bipolar disorder, the condition often has a tougher course, and other mental health issues are more likely to appear alongside it (such as ADHD or anxiety).

Risk Factors of Bipolar Disorder

Environmental

Bipolar Disorder occurs more often in high-income countries (1.4%) than in low-income ones (0.7%). People who are separated, divorced, or widowed have higher rates of bipolar disorder than married people or those who have never been married. However, it’s not clear if bipolar disorder leads to relationship problems or if relationship problems contribute to bipolar disorder.

Moreover, many studies, such as a study published in Therapeutic Advances in Psychopharmacology, suggest that childhood trauma, stressful life events, and certain medical conditions (like asthma and irritable bowel syndrome) also contribute. Moreover, the study also notes that substance abuse, including cannabis and opioid use, increases the likelihood of developing bipolar disorder.

Genetic and Physiological

Having a family history of bipolar disorder is a major risk factor. Adults with close relatives who suffer from bipolar disorder are ten times more likely to develop the disorder themselves. The closer the family connection, the higher the risk.

A Combination of Factors

A study from 2005 examined environmental, cognitive (negative thinking patterns and certain personality traits), and developmental risk factors in developing bipolar disorder and concluded that the combination of these factors, rather than any single one, typically influences the onset and progression of bipolar disorder. Because of this, the study suggests that the treatment of bipolar disorder requires addressing both biological and psychosocial (psychological and social factors) elements.

Bipolar Disorder and Culture

There isn’t much information about how bipolar appears in different cultures. In one study in the United States, the rate of bipolar disorder over a year was much lower for Afro-Caribbeans compared to African Americans or whites.

However, some studies, such as a study published in the Brazilian Journal of Psychiatry point out that there are significant differences in how emotions are expressed across cultures, affecting the understanding and treatment of the disorder. It stresses the need for understanding different cultures in mental health practices to ensure accurate diagnosis and effective management of bipolar disorder. Because of this cultural layer, it is difficult to create diagnostic tools that can be applied on a global level to every culture.

Bipolar Disorder and Gender

A study from 2004 explored the differences between how bipolar disorder affects men and women. The study claims that men are more likely to have mania as their first episode, while women usually experience depression first. Women with bipolar disorder often face more changes in weight and appetite and are more prone to insomnia (difficulty falling or staying asleep) during depressive episodes. Men are more likely to have co-occurring conditions such as alcohol and cannabis abuse, gambling, and conduct disorder (antisocial or aggressive behaviors).

Moreover, a study published in 2005 states that the overall number of mood episodes and the age at which bipolar disorder first appears are similar between genders. However, the study also agrees that men are more likely to have their first episode of mania and to have higher rates of co-occurring substance use disorders, while women are more likely to begin with a depressive episode and to have higher rates of eating disorders.

Risk of Suicide

People suffering from bipolar disorder are at least 15 times more likely to commit suicide compared to the general population. Bipolar disorder may be responsible for about one-quarter of all suicides.

However, a study from 2006 that compares suicide risk of individuals suffering from bipolar disorder to the general population, points at an even more concerning statistic. The study states that bipolar disorder has a suicide rate approximately 60 times higher than the global average, with about 1% of individuals with the disorder attempting suicide annually. The study also emphasizes a high lethality of suicide attempts among those with bipolar disorder since there is a low attempts-to-completion ratio. This poignant statistic highlights the critical need for effective management and support of those affected.

The Impact of Bipolar Disorder

Although many people with bipolar disorder can return to normal functioning between episodes, many struggle with job performance, leading to lower income and economic issues. Moreover, people suffering from the disorder also tend to do worse on thinking and memory tests compared to healthy people. These cognitive problems can cause difficulties at work and in relationships and can last a lifetime, even when they are not experiencing mood swings.

Moreover, an article from 2009 explains that even during periods of remission (the reduction or disappearance of symptoms), individuals with bipolar disorder often struggle with daily activities, impacting their social, family and working lives. Challenges in maintaining employment and social relationships are common, and personal relationships within families can also suffer. The disorder not only affects the individual’s mood and behavior but also significantly impairs their overall quality of life.

Co-Occurring Mental Disorders

People with bipolar disorder often suffer from other mental health issues. About 75% have anxiety disorders, such as:

• Panic attacks
• Social anxiety
• Specific phobias

Over half of the individuals also suffer from:

• ADHD
• Impulse-control or conduct disorders (antisocial or aggressive behaviors, explosive outbursts)
• Substance use problems (particularly alcohol)

Many adults with bipolar disorder also face serious or untreated medical issues, like metabolic syndrome (a syndrome associated with the development of cardiovascular disease and type 2 diabetes) and migraines, more frequently than the general population.

The Efficacy of Cognitive-Behavioral Therapy (CBT) in Bipolar Disorder

A study from 2017 highlights that CBT is effective for individuals with bipolar disorder. The study claims that CBT helps reduce the chance of relapse (the return of the signs and symptoms of a disease), alleviates the severity of both manic and depressive episodes, and enhances overall psychosocial functioning. The study finds that longer sessions especially (90 minutes or longer), significantly improve symptoms and lower the rates at which patients experience relapse.

Similarly, an article from 2010 claims that, alongside medication, CBT can significantly enhance the quality of life for those affected by bipolar disorder by reducing both the frequency and severity of mood episodes. The focus of the therapy on changing unhelpful thinking and behavior patterns helps prevent severe mood swings.

Furthermore, an article that discusses the treatment of bipolar disorder notes that CBT, when combined with medication, helps individuals manage their symptoms more effectively. CBT teaches patients strategies to handle their mood swings and to deal with life’s challenges, which can prevent the condition from worsening. The therapy helps reduce the frequency and severity of episodes by improving patients’ coping mechanisms and by addressing problematic thought patterns.

Cognitive behavioral therapy thus proves to be an effective treatment for bipolar disorder as it equips individuals with strategies to better manage and cope with their episodes.

How the Sintelly App Can Help

The Sintelly app leverages Cognitive Behavioral Therapy (CBT) and artificial intelligence (AI) to provide comprehensive support for individuals with bipolar disorder.

Immediate access to supportive dialogue is crucial for managing extreme mood swings. The chatbot offers personalized, context-aware responses, helping users challenge unhelpful thoughts and adopt healthier behaviors. During manic episodes, it mitigates risky behaviors; during depressive episodes, it offers encouragement and coping techniques.

Regular CBT exercises build resilience and essential coping strategies. These exercises help users alter negative thought patterns, improve problem-solving skills, and enhance emotional regulation, aiding in the management of fluctuating energy levels and sleep disturbances.

Psychodiagnostic tests, driven by AI, provide deep insights into mental and emotional health, track progress, and identify early signs of mood episodes. These tests offer detailed feedback, aiding in informed treatment adjustments and understanding co-occurring issues like anxiety and substance use problems.

Together, these features create a robust support system that addresses both immediate and long-term needs.