Defy Gravity is a Canadian drama film, directed by Michael Gibson and released in 1990.
87-451: The film stars R. H. Thomson as Bill Fiddich, an inventor with bipolar disorder who is physically abusive to his wife Mary ( Chapelle Jaffe ) and daughter Debbie (Karen Saunders); Simon Reynolds as Patrick, his teenage son who is spared the physical abuse but is struggling to understand how to stand up to his father to protect the rest of the family; and Tracey Moore as Miss McInnis, Patrick's high school history teacher who tries to provide
174-401: A basic metabolic panel or a complete blood count . Blood tests are also used in drug tests to detect drug abuse. A venipuncture is useful as it is a minimally invasive way to obtain cells and extracellular fluid ( plasma ) from the body for analysis. Blood flows throughout the body, acting as a medium that provides oxygen and nutrients to tissues and carries waste products back to
261-537: A blood sample that is usually extracted from a vein in the arm using a hypodermic needle , or via fingerprick . Multiple tests for specific blood components, such as a glucose test or a cholesterol test , are often grouped together into one test panel called a blood panel or blood work . Blood tests are often used in health care to determine physiological and biochemical states, such as disease , mineral content, pharmaceutical drug effectiveness, and organ function. Typical clinical blood panels include
348-450: A lipid profile , require fasting (or no food consumption) eight to twelve hours prior to the drawing of the blood sample. For the majority of tests, blood is usually obtained from the patient's vein. Other specialized tests, such as the arterial blood gas test, require blood extracted from an artery . Blood gas analysis of arterial blood is primarily used to monitor carbon dioxide and oxygen levels related to pulmonary function, but
435-770: A meta-analysis , but this association disappeared after correction for multiple testing . On the other hand, two polymorphisms in TPH2 were identified as being associated with bipolar disorder. Due to the inconsistent findings in a genome-wide association study , multiple studies have undertaken the approach of analyzing SNPs in biological pathways. Signaling pathways traditionally associated with bipolar disorder that have been supported by these studies include corticotropin-releasing hormone signaling, cardiac β-adrenergic signaling, phospholipase C signaling, glutamate receptor signaling, cardiac hypertrophy signaling, Wnt signaling , Notch signaling , and endothelin 1 signaling. Of
522-411: A byproduct of serotonin , are present in the cerebrospinal fluid of persons with bipolar disorder during both the depressed and manic phases. Increased dopaminergic activity has been hypothesized in manic states due to the ability of dopamine agonists to stimulate mania in people with bipolar disorder. Decreased sensitivity of regulatory α 2 adrenergic receptors as well as increased cell counts in
609-462: A consequence of substance use. In November 2018, Cyberpsychology published a systematic review and meta-analysis of 5 studies that found evidence for a relationship between problematic smartphone use and impulsivity traits. In October 2020, the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found that
696-439: A definitive diagnosis. Neurologic diseases such as multiple sclerosis , complex partial seizures , strokes, brain tumors, Wilson's disease , traumatic brain injury , Huntington's disease , and complex migraines can mimic features of bipolar disorder. An EEG may be used to exclude neurological disorders such as epilepsy , and a CT scan or MRI of the head may be used to exclude brain lesions. Additionally, disorders of
783-415: A depressive episode, or vice versa, remain poorly understood. Also known as a manic episode, mania is a distinct period of at least one week of elevated or irritable mood, which can range from euphoria to delirium . The core symptom of mania involves an increase in energy of psychomotor activity . Mania can also present with increased self-esteem or grandiosity , racing thoughts , pressured speech that
870-524: A diagnosis— disruptive mood dysregulation disorder —that covers children with long-term, persistent irritability that had at times been misdiagnosed as having bipolar disorder, distinct from irritability in bipolar disorder that is restricted to discrete mood episodes. Bipolar on average, starts during adulthood. Bipolar 1, on average, starts at the age of 18 years old, and Bipolar 2 starts at age 22 years old on average. However, most delay seeking treatment for an average of 8 years after symptoms start. Bipolar
957-481: A diagnostically specific causal agent for bipolar, does place genetically and biologically vulnerable individuals at risk for a more severe course of illness. Longitudinal studies have indicated that full-blown manic stages are often preceded by a variety of prodromal clinical features, providing support for the occurrence of an at-risk state of the disorder when an early intervention might prevent its further development and/or improve its outcome. The aim of management
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#17327807009851044-449: A few weeks to a few months. Symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, irritability or anger, loss of interest in previously enjoyed activities , excessive or inappropriate guilt , hopelessness , sleeping too much or not enough , changes in appetite and/or weight, fatigue , problems concentrating, self-loathing or feelings of worthlessness, and thoughts of death or suicide. Although
1131-549: A hospital admission, support services available can include drop-in centers , visits from members of a community mental health team or an Assertive Community Treatment team, supported employment , patient-led support groups , and intensive outpatient programs . These are sometimes referred to as partial-inpatient programs. Compared to the general population, people with bipolar disorder are less likely to frequently engage in physical exercise. Exercise may have physical and mental benefits for people with bipolar disorder, but there
1218-455: A job, leading to trouble with healthcare access, leading to more decline in their mental health due to not receiving treatment such as medicine and therapy. Bipolar disorder is uncommon in older patients, with a measured lifetime prevalence of 1% in over 60s and a 12-month prevalence of 0.1–0.5% in people over 65. Despite this, it is overrepresented in psychiatric admissions, making up 4–8% of inpatient admission to aged care psychiatry units, and
1305-523: A manic episode usually lasts three to six months. In severe manic episodes, a person can experience psychotic symptoms, where thought content is affected along with mood. They may feel unstoppable, persecuted , or as if they have a special relationship with God, a great mission to accomplish, or other grandiose or delusional ideas. This may lead to violent behavior and, sometimes, hospitalization in an inpatient psychiatric hospital . The severity of manic symptoms can be measured by rating scales such as
1392-434: A medical work-up to rule out other causes. Caregiver-scored rating scales, specifically from the mother, have shown to be more accurate than teacher and youth-scored reports in identifying youths with bipolar disorder. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from
1479-718: A mild to moderate effect . The risk of bipolar disorder is nearly ten-fold higher in first-degree relatives of those with bipolar disorder than in the general population; similarly, the risk of major depressive disorder is three times higher in relatives of those with bipolar disorder than in the general population. Although the first genetic linkage finding for mania was in 1969, linkage studies have been inconsistent. Findings point strongly to heterogeneity, with different genes implicated in different families. Robust and replicable genome-wide significant associations showed several common single-nucleotide polymorphisms (SNPs) are associated with bipolar disorder, including variants within
1566-604: A mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal. They are considered to have a higher risk for suicidal behavior as depressive emotions such as hopelessness are often paired with mood swings or difficulties with impulse control . Anxiety disorders occur more frequently as a comorbidity in mixed bipolar episodes than in non-mixed bipolar depression or mania. Substance (including alcohol ) use also follows this trend, thereby appearing to depict bipolar symptoms as no more than
1653-433: A negative outlook on life, and demonstrate poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm . Other mental health issues, such as anxiety disorders and substance use disorders , are commonly associated with bipolar disorder. The global prevalence of bipolar disorder is estimated to be between 1-5% of
1740-399: A neurological condition or injury including stroke, traumatic brain injury , HIV infection , multiple sclerosis , porphyria , and rarely temporal lobe epilepsy . The precise mechanisms that cause bipolar disorder are not well understood. Bipolar disorder is thought to be associated with abnormalities in the structure and function of certain brain areas responsible for cognitive tasks and
1827-421: A one-year span. Rapid cycling is usually temporary but is common amongst people with bipolar disorder and affects 25.8–45.3% of them at some point in their life. These episodes are separated from each other by a remission (partial or full) for at least two months or a switch in mood polarity (i.e., from a depressive episode to a manic episode or vice versa). The definition of rapid cycling most frequently cited in
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#17327807009851914-584: A patient. However, in special circumstances, and/or emergency situations, paramedics and physicians extract the blood. Also, respiratory therapists are trained to extract arterial blood to examine arterial blood gases . A basic metabolic panel measures sodium , potassium , chloride , bicarbonate , blood urea nitrogen (BUN), magnesium , creatinine , glucose , and sometimes calcium . Tests that focus on cholesterol levels can determine LDL and HDL cholesterol levels, as well as triglyceride levels. Some tests, such as those that measure glucose or
2001-556: A role in bipolar disorder are the mitochondria and a sodium ATPase pump . Circadian rhythms and regulation of the hormone melatonin also seem to be altered. Dopamine , a neurotransmitter responsible for mood cycling, has increased transmission during the manic phase. The dopamine hypothesis states that the increase in dopamine results in secondary homeostatic downregulation of key system elements and receptors such as lower sensitivity of dopaminergic receptors. This results in decreased dopamine transmission characteristic of
2088-646: A significant decrease in the individual's ability to socialize or work, lacks psychotic features such as delusions or hallucinations , and does not require psychiatric hospitalization. Overall functioning may actually increase during episodes of hypomania and is thought to serve as a defense mechanism against depression by some. Hypomanic episodes rarely progress to full-blown manic episodes. Some people who experience hypomania show increased creativity, while others are irritable or demonstrate poor judgment. Hypomania may feel good to some individuals who experience it, though most people who experience hypomania state that
2175-405: A weak-to-moderate positive association between mobile phone addiction and impulsivity. People with bipolar disorder often have other co-existing psychiatric conditions such as anxiety (present in about 71% of people with bipolar disorder), substance abuse (56%), personality disorders (36%) and attention deficit hyperactivity disorder (10–20%) which can add to the burden of illness and worsen
2262-530: Is a lack of research. Psychotherapy aims to assist a person with bipolar disorder in accepting and understanding their diagnosis, coping with various types of stress, improving their interpersonal relationships, and recognizing prodromal symptoms before full-blown recurrence. Cognitive behavioral therapy (CBT), family-focused therapy , and psychoeducation have the most evidence for efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and cognitive-behavioral therapy appear
2349-494: Is also used to measure blood pH and bicarbonate levels for certain metabolic conditions. While the regular glucose test is taken at a certain point in time, the glucose tolerance test involves repeated testing to determine the rate at which glucose is processed by the body. Blood tests are also used to identify autoimmune diseases and Immunoglobulin E -mediated food allergies (see also Radioallergosorbent test ). Blood tests results should always be interpreted using
2436-410: Is associated with "classic mania", to dysphoria and irritability . Psychotic symptoms such as delusions or hallucinations may occur in both manic and depressive episodes; their content and nature are consistent with the person's prevailing mood. In some people with bipolar disorder, depressive symptoms predominate, and the episodes of mania are always the more subdued hypomania type. According to
2523-539: Is characterized by intermittent episodes of mania , commonly (but not in every patient) alternating with bouts of depression, with an absence of symptoms in between. During these episodes, people with bipolar disorder exhibit disruptions in normal mood , psychomotor activity (the level of physical activity that is influenced by mood)—e.g. constant fidgeting during mania or slowed movements during depression— circadian rhythm and cognition. Mania can present with varying levels of mood disturbance, ranging from euphoria , which
2610-771: Is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode (but no full manic episodes) and one major depressive episode. It is classified as cyclothymia if there are hypomanic episodes with periods of depression that do not meet the criteria for major depressive episodes. If these symptoms are due to drugs or medical problems, they are not diagnosed as bipolar disorder. Other conditions that have overlapping symptoms with bipolar disorder include attention deficit hyperactivity disorder , personality disorders , schizophrenia , and substance use disorder as well as many other medical conditions. Medical testing
2697-407: Is crucial to establishing a treatment plan where these comorbidities exist. Children of parents with bipolar disorder more frequently have other mental health problems. In the 1920s, Kraepelin noted that manic episodes are rare before puberty. In general, bipolar disorder in children was not recognized in the first half of the twentieth century. This issue diminished with an increased following of
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2784-413: Is difficult to interrupt, decreased need for sleep, disinhibited social behavior, increased goal-oriented activities and impaired judgement, which can lead to exhibition of behaviors characterized as impulsive or high-risk, such as hypersexuality or excessive spending . To fit the definition of a manic episode, these behaviors must impair the individual's ability to socialize or work. If untreated,
2871-600: Is effective in acute manic and depressive episodes, especially with psychosis or catatonia . Admission to a psychiatric hospital may be required if a person is a risk to themselves or others; involuntary treatment is sometimes necessary if the affected person refuses treatment. Bipolar disorder occurs in approximately 2% of the global population. In the United States, about 3% are estimated to be affected at some point in their life; rates appear to be similar in females and males. Symptoms most commonly begin between
2958-402: Is higher in those with an adult diagnosis of bipolar spectrum disorder than in those without, particularly events stemming from a harsh environment rather than from the child's own behavior. Acutely, mania can be induced by sleep deprivation in around 30% of people with bipolar disorder. Less commonly, bipolar disorder or a bipolar-like disorder may occur as a result of or in association with
3045-403: Is less severe and does not significantly affect functioning, it is called hypomania . During mania, an individual behaves or feels abnormally energetic, happy, or irritable, and they often make impulsive decisions with little regard for the consequences; there is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying, have
3132-453: Is made, while substance/medication-induced bipolar and related disorder is used if a medication is thought to have triggered the condition. Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months. Rapid cycling , however, is a course specifier that may be applied to any bipolar subtype. It is defined as having four or more mood disturbance episodes within
3219-577: Is not required for a diagnosis , though blood tests or medical imaging can rule out other problems. Mood stabilizers , particularly lithium , and certain anticonvulsants , such as lamotrigine , valproate , and carbamazepine , as well as atypical antipsychotics, including quetiapine , cariprazine , and aripiprazole , are the mainstay of long-term pharmacologic relapse prevention. Antipsychotics are additionally given during acute manic episodes as well as in cases where mood stabilizers are poorly tolerated or ineffective. In patients where compliance
3306-401: Is of concern, long-acting injectable formulations are available. There is some evidence that psychotherapy improves the course of this disorder. The use of antidepressants in depressive episodes is controversial: they can be effective but have been implicated in triggering manic episodes. The treatment of depressive episodes, therefore, is often difficult. Electroconvulsive therapy (ECT)
3393-443: Is often misdiagnosed with other psychiatric disorders. There is no definitive association between race, ethnicity, or Socioeconomic status (SES). Adults with Bipolar report having a lower quality of life, even outside of a manic or depressive episode. Bipolar can put strain on marriage and other relationships, having a job, and everyday functioning. Bipolar is associated with having higher rates of unemployment. Most have trouble keeping
3480-518: Is the nature of the mood swings; in contrast to the sustained changes to mood over days to weeks or longer, those of the latter condition (more accurately called emotional dysregulation ) are sudden and often short-lived, and secondary to social stressors . Although there are no biological tests that are diagnostic of bipolar disorder, blood tests and/or imaging are carried out to investigate whether medical illnesses with clinical presentations similar to that of bipolar disorder are present before making
3567-527: Is to treat acute episodes safely with medication and work with the patient in long-term maintenance to prevent further episodes and optimise function using a combination of pharmacological and psychotherapeutic techniques. Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (local legislation permitting) involuntary . Long-term inpatient stays are now less common due to deinstitutionalization , although these can still occur. Following (or in lieu of)
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3654-614: The American Psychiatric Association 's (APA) Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5) and the World Health Organization 's (WHO) International Statistical Classification of Diseases and Related Health Problems , 10th Edition (ICD-10). The ICD-10 criteria are used more often in clinical settings outside of the U.S. while the DSM criteria are used within
3741-606: The Bipolar spectrum diagnostic scale , Mood Disorder Questionnaire , the General Behavior Inventory and the Hypomania Checklist . The use of evaluation scales cannot substitute a full clinical interview but they serve to systematize the recollection of symptoms. On the other hand, instruments for screening bipolar disorder tend to have lower sensitivity . Bipolar disorder is classified by
3828-454: The DSM-5 criteria, mania is distinguished from hypomania by the duration: hypomania is present if elevated mood symptoms persist for at least four consecutive days, while mania is present if such symptoms persist for more than a week. Unlike mania, hypomania is not always associated with impaired functioning. The biological mechanisms responsible for switching from a manic or hypomanic episode to
3915-516: The International Classification of Diseases as a mental and behavioural disorder . Mental disorders that can have symptoms similar to those seen in bipolar disorder include schizophrenia , major depressive disorder, attention deficit hyperactivity disorder (ADHD), and certain personality disorders, such as borderline personality disorder . A key difference between bipolar disorder and borderline personality disorder
4002-514: The Young Mania Rating Scale , though questions remain about the reliability of these scales. The onset of a manic or depressive episode is often foreshadowed by sleep disturbance . Manic individuals often have a history of substance use disorder developed over years as a form of "self-medication". Hypomania is the milder form of mania, defined as at least four days of the same criteria as mania, but which does not cause
4089-839: The bipolar spectrum has been estimated at 0.71. Twin studies have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For bipolar I disorder, the rate at which identical twins (same genes) will both have bipolar I disorder (concordance) is around 40%, compared to about 5% in fraternal twins . A combination of bipolar I, II, and cyclothymia similarly produced rates of 42% and 11% (identical and fraternal twins, respectively). The rates of bipolar II combinations without bipolar I are lower—bipolar II at 23 and 17%, and bipolar II combining with cyclothymia at 33 and 14%—which may reflect relatively higher genetic heterogeneity . The cause of bipolar disorders overlaps with major depressive disorder. When defining concordance as
4176-1140: The endocrine system such as hypothyroidism , hyperthyroidism , and Cushing's disease are in the differential as is the connective tissue disease systemic lupus erythematosus . Infectious causes of mania that may appear similar to bipolar mania include herpes encephalitis , HIV, influenza , or neurosyphilis . Certain vitamin deficiencies such as pellagra ( niacin deficiency), vitamin B 12 deficiency , folate deficiency , and Wernicke–Korsakoff syndrome ( thiamine deficiency ) can also lead to mania. Common medications that can cause manic symptoms include antidepressants, prednisone , Parkinson's disease medications, thyroid hormone , stimulants (including cocaine and methamphetamine), and certain antibiotics . Bipolar spectrum disorders include: bipolar I disorder, bipolar II disorder, cyclothymic disorder and cases where subthreshold symptoms are found to cause clinically significant impairment or distress. These disorders involve major depressive episodes that alternate with manic or hypomanic episodes, or with mixed episodes that feature symptoms of both mood states. The concept of
4263-513: The hippocampus , dorsal anterior cingulate cortex, and other parts of the prefrontal cortex. The model hypothesizes that bipolar disorder may occur when the ventral system is overactivated and the dorsal system is underactivated. Other models suggest the ability to regulate emotions is disrupted in people with bipolar disorder and that dysfunction of the ventricular prefrontal cortex is crucial to this disruption. Meta-analyses of structural MRI studies have shown that certain brain regions (e.g.,
4350-706: The lingual gyrus compared to people without bipolar disorder. In contrast, they demonstrate decreased activity in the inferior frontal cortex during manic episodes compared to people without the disorder. Similar studies examining the differences in brain activity between people with bipolar disorder and those without did not find a consistent area in the brain that was more or less active when comparing these two groups. People with bipolar have increased activation of left hemisphere ventral limbic areas—which mediate emotional experiences and generation of emotional responses—and decreased activation of right hemisphere cortical structures related to cognition—structures associated with
4437-469: The locus coeruleus indicated increased noradrenergic activity in manic people. Low plasma GABA levels on both sides of the mood spectrum have been found. One review found no difference in monoamine levels, but found abnormal norepinephrine turnover in people with bipolar disorder. Tyrosine depletion was found to reduce the effects of methamphetamine in people with bipolar disorder as well as symptoms of mania, implicating dopamine in mania. VMAT2 binding
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#17327807009854524-593: The 16 genes identified in these pathways, three were found to be dysregulated in the dorsolateral prefrontal cortex portion of the brain in post-mortem studies: CACNA1C , GNG2 , and ITPR2 . Bipolar disorder is associated with reduced expression of specific DNA repair enzymes and increased levels of oxidative DNA damages . Psychosocial factors play a significant role in the development and course of bipolar disorder, and individual psychosocial variables may interact with genetic dispositions. Recent life events and interpersonal relationships likely contribute to
4611-422: The 1990s is a stub . You can help Misplaced Pages by expanding it . Bipolar disorder Bipolar disorder , previously known as manic depression or manic depressive disorder , is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis , it is called mania ; if it
4698-568: The DSM criteria in the last part of the twentieth century. The diagnosis of childhood bipolar disorder, while formerly controversial, has gained greater acceptance among childhood and adolescent psychiatrists. American children and adolescents diagnosed with bipolar disorder in community hospitals increased 4-fold reaching rates of up to 40% in 10 years around the beginning of the 21st century, while in outpatient clinics it doubled reaching 6%. Studies using DSM criteria show that up to 1% of youth may have bipolar disorder. The DSM-5 has established
4785-461: The DSM-5 criteria for diagnosing unipolar and bipolar episodes are the same, some clinical features are more common in the latter, including increased sleep, sudden onset and resolution of symptoms, significant weight gain or loss, and severe episodes after childbirth. The earlier the age of onset, the more likely the first few episodes are to be depressive. For most people with bipolar types 1 and 2,
4872-598: The U.S. and are the prevailing criteria used internationally in research studies. The DSM-5, published in 2013, includes further and more accurate specifiers compared to its predecessor, the DSM-IV-TR . This work has influenced the eleventh revision of the ICD, which includes the various diagnoses within the bipolar spectrum of the DSM-V. Several rating scales for the screening and evaluation of bipolar disorder exist, including
4959-402: The ages of 20 and 25 years old; an earlier onset in life is associated with a worse prognosis. Interest in functioning in the assessment of patients with bipolar disorder is growing, with an emphasis on specific domains such as work, education, social life, family, and cognition. Around one-quarter to one-third of people with bipolar disorder have financial, social or work-related problems due to
5046-748: The bipolar spectrum is similar to that of Emil Kraepelin 's original concept of manic depressive illness. Bipolar II disorder was established as a diagnosis in 1994 within DSM IV; though debate continues over whether it is a distinct entity, part of a spectrum, or exists at all. The DSM and the ICD characterize bipolar disorder as a spectrum of disorders occurring on a continuum. The DSM-5 and ICD-11 lists three specific subtypes: When relevant, specifiers for peripartum onset and with rapid cycling should be used with any subtype. Individuals who have subthreshold symptoms that cause clinically significant distress or impairment, but do not meet full criteria for one of
5133-538: The co-twins having either bipolar disorder or major depression, then the concordance rate rises to 67% in identical twins and 19% in fraternal twins. The relatively low concordance between fraternal twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes. Behavioral genetic studies have suggested that many chromosomal regions and candidate genes are related to bipolar disorder susceptibility with each gene exerting
5220-449: The depressive episodes are much longer than the manic or hypomanic episodes. Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having major depression and incorrectly treated with prescribed antidepressants. In bipolar disorder, a mixed state is an episode during which symptoms of both mania and depression occur simultaneously. Individuals experiencing
5307-520: The depressive phase. The depressive phase ends with homeostatic upregulation potentially restarting the cycle over again. Glutamate is significantly increased within the left dorsolateral prefrontal cortex during the manic phase of bipolar disorder, and returns to normal levels once the phase is over. Medications used to treat bipolar may exert their effect by modulating intracellular signaling, such as through depleting myo- inositol levels, inhibition of cAMP signaling , and through altering subunits of
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#17327807009855394-440: The dopamine-associated G-protein. Consistent with this, elevated levels of G αi , G αs , and G αq/11 have been reported in brain and blood samples, along with increased protein kinase A (PKA) expression and sensitivity; typically, PKA activates as part of the intracellular signalling cascade downstream from the detachment of G αs subunit from the G protein complex. Decreased levels of 5-hydroxyindoleacetic acid ,
5481-411: The emotional guidance Patrick isn't getting at home. The film's cast also includes Louis Ferreira , London Juno, Damir Andrei and Earl Pastko . The film's working title was Resistance . The film premiered at the 1990 Festival of Festivals . Moore received a Genie Award nomination for Best Supporting Actress at the 13th Genie Awards in 1992. This article related to a Canadian film of
5568-516: The excretory systems for disposal. Consequently, the state of the bloodstream affects or is affected by, many medical conditions. For these reasons, blood tests are the most commonly performed medical tests . If only a few drops of blood are needed, a fingerstick is performed instead of a venipuncture . Indwelling arterial, central venous and peripheral venous lines can also be used to draw blood. Phlebotomists , laboratory practitioners and nurses are those in charge of extracting blood from
5655-635: The former group present with milder manic episodes, more prominent cognitive changes and have a background of worse psychosocial functioning, while the latter present more commonly with mixed affective episodes, and have a stronger family history of illness. Older people with bipolar disorder experience cognitive changes, particularly in executive functions such as abstract thinking and switching cognitive sets, as well as concentrating for long periods and decision-making. Attempts at prevention of bipolar disorder have focused on stress (such as childhood adversity or highly conflictual families) which, although not
5742-434: The general population. Substance use disorder is a common comorbidity in bipolar disorder; the subject has been widely reviewed. The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear. Genetic influences are believed to account for 73–93% of the risk of developing the disorder indicating a strong hereditary component. The overall heritability of
5829-449: The genes CACNA1C , ODZ4 , and NCAN . The largest and most recent genome-wide association study failed to find any locus that exerts a large effect, reinforcing the idea that no single gene is responsible for bipolar disorder in most cases. Polymorphisms in BDNF , DRD4 , DAO , and TPH1 have been frequently associated with bipolar disorder and were initially associated in
5916-438: The illness. Bipolar disorder is among the top 20 causes of disability worldwide and leads to substantial costs for society. Due to lifestyle choices and the side effects of medications, the risk of death from natural causes such as coronary heart disease in people with bipolar disorder is twice that of the general population. Late adolescence and early adulthood are peak years for the onset of bipolar disorder. The condition
6003-428: The incidence of mood disorders is increasing overall with the aging population. Depressive episodes more commonly present with sleep disturbance, fatigue, hopelessness about the future, slowed thinking, and poor concentration and memory; the last three symptoms are seen in what is known as pseudodementia . Clinical features also differ between those with late-onset bipolar disorder and those who developed it early in life;
6090-465: The left rostral anterior cingulate cortex , fronto-insular cortex , ventral prefrontal cortex, and claustrum ) are smaller in people with bipolar disorder, whereas other regions are larger ( lateral ventricles , globus pallidus , subgenual anterior cingulate , and the amygdala). Additionally, these meta-analyses found that people with bipolar disorder have higher rates of deep white matter hyperintensities . Functional MRI findings suggest that
6177-467: The levels in non-manic people, suggesting that ventricular prefrontal cortex activity is an indicator of mood state. However, while pharmacological treatment of mania reduces amygdala hyperactivity, it remains more active than the amygdala of those without bipolar disorder, suggesting amygdala activity may be a marker of the disorder rather than the current mood state. Manic and depressive episodes tend to be characterized by dysfunction in different regions of
6264-447: The literature (including the DSM-V and ICD-11) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes during a 12-month period. The literature examining the pharmacological treatment of rapid cycling is sparse and there is no clear consensus with respect to its optimal pharmacological management. "Ultra rapid" and "ultradian" have been applied to faster-cycling types of bipolar disorder. People with
6351-408: 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 . Blood tests A blood test is a laboratory analysis performed on
6438-541: The onset and recurrence of bipolar mood episodes, just as they do for unipolar depression. In surveys, 30–50% of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated with earlier onset, a higher rate of suicide attempts, and more co-occurring disorders such as post-traumatic stress disorder . Subtypes of abuse, such as sexual and emotional abuse, also contribute to violent behaviors seen in patients with bipolar disorder. The number of reported stressful events in childhood
6525-421: The processing of emotions. A neurologic model for bipolar disorder proposes that the emotional circuitry of the brain can be divided into two main parts. The ventral system (regulates emotional perception) includes brain structures such as the amygdala , insula , ventral striatum , ventral anterior cingulate cortex , and the prefrontal cortex . The dorsal system (responsible for emotional regulation) includes
6612-419: The prognosis. Certain medical conditions are also more common in people with bipolar disorder as compared to the general population. This includes increased rates of metabolic syndrome (present in 37% of people with bipolar disorder), migraine headaches (35%), obesity (21%) and type 2 diabetes (14%). This contributes to a risk of death that is two times higher in those with bipolar disorder as compared to
6699-468: The proteins found in blood. Saliva testing may not be appropriate or available for all markers. For example, lipid levels cannot be measured with saliva testing. In February 2011, Canadian researchers at the University of Calgary's Schulich School of Engineering announced a microchip for blood tests. Dubbed a microemulsion, a droplet of blood captured inside a layer of another substance. It can control
6786-444: The ranges provided by the laboratory that performed the test. Example ranges are shown below. Upon completion of a blood test analysis, patients may receive a report with blood test abbreviations. Examples of common blood test abbreviations are shown below. (UK: FBC) (UK: Full Blood Count) In 2008, scientists announced that the more cost effective saliva testing could eventually replace some blood tests, as saliva contains 20% of
6873-655: The rapid cycling or faster-cycling subtypes of bipolar disorder tend to be more difficult to treat and less responsive to medications than other people with bipolar disorder. The diagnosis of bipolar disorder can be complicated by coexisting ( comorbid ) psychiatric conditions including obsessive–compulsive disorder , substance-use disorder , eating disorders , attention deficit hyperactivity disorder , social phobia , premenstrual syndrome (including premenstrual dysphoric disorder ), or panic disorder . A thorough longitudinal analysis of symptoms and episodes, assisted if possible by discussions with friends and family members,
6960-472: The regulation of emotions. Neuroscientists have proposed additional models to try to explain the cause of bipolar disorder. One proposed model for bipolar disorder suggests that hypersensitivity of reward circuits consisting of frontostriatal circuits causes mania, and decreased sensitivity of these circuits causes depression. According to the "kindling" hypothesis, when people who are genetically predisposed toward bipolar disorder experience stressful events,
7047-483: The stress of the experience is very painful. People with bipolar disorder who experience hypomania tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings , the individual will often deny that anything is wrong. If not accompanied by depressive episodes, hypomanic episodes are often not deemed problematic unless the mood changes are uncontrollable or volatile. Most commonly, symptoms continue for time periods from
7134-422: The stress threshold at which mood changes occur becomes progressively lower, until the episodes eventually start (and recur) spontaneously. There is evidence supporting an association between early-life stress and dysfunction of the hypothalamic-pituitary-adrenal axis leading to its overactivation, which may play a role in the pathogenesis of bipolar disorder. Other brain components that have been proposed to play
7221-411: The three subtypes may be diagnosed with other specified or unspecified bipolar disorder. Other specified bipolar disorder is used when a clinician chooses to explain why the full criteria were not met (e.g., hypomania without a prior major depressive episode). If the condition is thought to have a non-psychiatric medical cause, the diagnosis of bipolar and related disorder due to another medical condition
7308-405: The ventricular prefrontal cortex regulates the limbic system , especially the amygdala. In people with bipolar disorder, decreased ventricular prefrontal cortex activity allows for the dysregulated activity of the amygdala, which likely contributes to labile mood and poor emotional regulation. Consistent with this, pharmacological treatment of mania returns ventricular prefrontal cortex activity to
7395-442: The ventricular prefrontal cortex. Manic episodes appear to be associated with decreased activation of the right ventricular prefrontal cortex whereas depressive episodes are associated with decreased activation of the left ventricular prefrontal cortex. These disruptions often occur during development linked with synaptic pruning dysfunction. People with bipolar disorder who are in a euthymic mood state show decreased activity in
7482-451: The world's popluation. While the causes of this mood disorder are not clearly understood, both genetic and environmental factors are thought to play a role. Many genes, each with small effects, may contribute to the development of the disorder. Genetic factors account for about 70–90% of the risk of developing bipolar disorder. Environmental risk factors include a history of childhood abuse and long-term stress . The condition
7569-400: Was found to be increased in one study of people with bipolar mania. Bipolar disorder is commonly diagnosed during adolescence or early adulthood, but onset can occur throughout life. Its diagnosis is based on the self-reported experiences of the individual, abnormal behavior reported by family members, friends or co-workers, observable signs of illness as assessed by a clinician, and ideally
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