Clinical Characteristics of Attention Deficit Hyperactivity Disorder in African American Children
Comedy and tragedy masks without background. Bipolar disorder is characterized by episodes of depression and mania. Bipolar disorder, previously known as manic depression, is a mental clinical Characteristics of Attention Deficit Hyperactivity Disorder in African American Children that causes periods of depression and periods of abnormally elevated mood. The causes are not clearly understood, but both environmental and genetic factors play a role.
Many genes of small effect contribute to risk. Treatment commonly includes psychotherapy as well as medications such as mood stabilizers and antipsychotics. The most common age at which symptoms begin is 25. Mania is the defining feature of bipolar disorder and can occur with different levels of severity. With milder levels of mania, known as hypomania, individuals are energetic, excitable, and may be highly productive. People with hypomania or mania may experience a decreased need of sleep, impaired judgment, and speak excessively and very rapidly. Manic individuals often have a history of substance abuse developed over years as a form of “self-medication”.
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The onset of a manic or depressive episode is often foreshadowed by sleep disturbances. Mood changes, psychomotor and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops. Hypomania may feel good to some persons who experience it, though most people who experience hypomania state that the stress of the experience is very painful. Bipolar people who experience hypomania, however, 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. The earlier the age of onset, the more likely the first few episodes are to be depressive. Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having major depression and then incorrectly treated with prescribed antidepressants. In bipolar disorder, mixed state is a condition during which symptoms of both mania and depression occur simultaneously. Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal. Associated features are clinical phenomena that often accompany the disorder but are not part of the diagnostic criteria. In adults with the condition, bipolar disorder is often accompanied by changes in cognitive processes and abilities.
The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear. 80 percent of the risk of developing the disorder indicating a strong hereditary component. Although the first genetic linkage finding for mania was in 1969, the linkage studies have been inconsistent. Due to the inconsistent findings in GWAS, multiple studies have undertaken the approach of analyzing SNPs in biological pathways. Findings point strongly to heterogeneity, with different genes being implicated in different families. Advanced paternal age has been linked to a somewhat increased chance of bipolar disorder in offspring, consistent with a hypothesis of increased new genetic mutations. Environmental factors play a significant role in the development and course of bipolar disorder, and individual psychosocial variables may interact with genetic dispositions.
It is probable that recent life events and interpersonal relationships contribute to the onset and recurrence of bipolar mood episodes, just as they do for unipolar depression. Less commonly, bipolar disorder or a bipolar-like disorder may occur as a result of or in association with a neurological condition or injury. Manic and depressive episodes tend to be characterized by ventral versus dorsal dysfunction in the ventral prefrontal cortex. During attentional tasks and resting, mania is associated with decreased Orbitofrontal cortex activity, while depression is associated with increased resting metabolism. Euthymic bipolar people show decreased activity in the lingual gyrus, while people who are manic demonstrate decreased activity in the inferior frontal cortex, while no differences were found in people with bipolar depression.
One proposed model for bipolar suggests that hypersensitivity of reward circuits consisting of fronto-striatal circuits causes mania and hyposensitivity of these circuits cause depression. Some of the brain components which have been proposed to play a role are the mitochondria and a sodium ATPase pump. Dopamine, a known neurotransmitter responsible for mood cycling, has been shown to have increased transmission during the manic phase. 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.
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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 G coupled proteins. Decreased levels of 5-hydroxyindoleacetic acid, a byproduct of serotonin, are present in the cerebrospinal fluid of persons with bipolar disorder during both the depressed and manic phases. Bipolar disorder is commonly diagnosed during adolescence or early adulthood, but onset can occur throughout the life cycle. There are several other mental disorders with symptoms similar to those seen in bipolar disorder. Bipolar spectrum disorders includes: bipolar I disorder, bipolar II disorder, cyclothymic disorder and cases where subthreshold symptoms are found to cause clinically significant impairment or distress. Unipolar hypomania without accompanying depression has been noted in the medical literature.
The DSM and the ICD characterize bipolar disorder as a spectrum of disorders occurring on a continuum. I, but are unnecessary for the diagnosis. Bipolar II disorder: No manic episodes and one or more hypomanic episodes and one or more major depressive episode. Cyclothymia: A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. 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 the three subtypes may be diagnosed with other specified or unspecified bipolar disorder.
Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0. 7 per year, lasting three to six months. Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more mood disturbance episodes within a one-year span and is found in a significant proportion of individuals with bipolar disorder. There are a number of pharmacological and psychotherapeutic techniques used to treat bipolar disorder. Individuals may use self-help and pursue recovery.
Examples of Core Courses
Hospitalization may be required especially with the manic episodes present in bipolar I. Psychotherapy is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing prodromal symptoms before full-blown recurrence, and, practicing the factors that lead to maintenance of remission. Lithium is often used to treat bipolar disorder and has the best evidence for reducing suicide. A number of medications are used to treat bipolar disorder. The medication with the best evidence is lithium, which is an effective treatment for acute manic episodes, preventing relapses, and bipolar depression. Lithium and the anticonvulsants carbamazepine, lamotrigine, and valproic acid are used as mood stabilizers to treat bipolar disorder.
Antipsychotic medications are effective for short-term treatment of bipolar manic episodes and appear to be superior to lithium and anticonvulsants for this purpose. Atypical antipsychotics are also indicated for bipolar depression refractory to treatment with mood stabilizers. Antidepressants are not recommended for use alone in the treatment of bipolar disorder and 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. Contrary to widely held views, stimulants are relatively safe in bipolar disorder, and considerable evidence suggests they may even produce an antimanic effect. In cases of comorbid ADHD and bipolar, stimulants may help improve both conditions. Several studies have suggested that omega 3 fatty acids may have beneficial effects on depressive symptoms, but not manic symptoms.
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However, only a few small studies of variable quality have been published and there is not enough evidence to draw any firm conclusions. A lifelong condition with periods of partial or full recovery in between recurrent episodes of relapse, bipolar disorder is considered to be a major health problem worldwide because of the increased rates of disability and premature mortality. Compliance with medications is one of the most significant factors that can decrease the rate and severity of relapse and have a positive impact on overall prognosis. Early recognition and intervention also improve prognosis as the symptoms in earlier stages are less severe and more responsive to treatment. Onset after adolescence is connected to better prognoses for both genders, and being male is a protective factor against higher levels of depression.
Despite the overly ambitious goals that are frequently part of manic episodes, symptoms of mania undermine the ability to achieve these goals and often interfere with an individual’s social and occupational functioning. One third of people with BD remain unemployed for one year following a hospitalization for mania. Bipolar disorder can cause suicidal ideation that leads to suicidal attempts. Individuals whose bipolar disorder begins with a depressive or mixed affective episode seem to have a poorer prognosis and an increased risk of suicide. Burden of bipolar disorder around the world: disability-adjusted life years per 100,000 inhabitants in 2004. Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 3 percent in the general population.
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However, a reanalysis of data from the National Epidemiological Catchment Area survey in the United States suggested that 0. There are conceptual and methodological limitations and variations in the findings. The incidence of bipolar disorder is similar in men and women as well as across different cultures and ethnic groups. Late adolescence and early adulthood are peak years for the onset of bipolar disorder.
One study also found that in 10 percent of bipolar cases, the onset of mania had happened after the patient had turned 50. Variations in moods and energy levels have been observed as part of the human experience throughout history. The words “melancholia”, an old word for depression, and “mania” originated in Ancient Greece. Within the humoral theories, mania was viewed as arising from an excess of yellow bile, or a mixture of black and yellow bile. The linguistic origins of mania, however, are not so clear-cut.
In the early 1800s, French psychiatrist Jean-Étienne Dominique Esquirol’s lypemania, one of his affective monomanias, was the first elaboration on what was to become modern depression. Kahlbaum’s concept of cyclothymia, categorized and studied the natural course of untreated bipolar patients. DSM in 1952, influenced by the legacy of Adolf Meyer. There are widespread problems with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder. Several dramatic works have portrayed characters with traits suggestive of the diagnosis that has been the subject of discussion by psychiatrists and film experts alike. On April 7, 2009, the nighttime drama 90210 on the CW network, aired a special episode where the character Silver was diagnosed with bipolar disorder. A link between mental illness and professional success or creativity has been suggested, including in accounts by Socrates, Seneca the Younger, and Cesare Lombroso.
Despite prominence in popular culture, the link between creativity and bipolar has not been rigorously studied. In the 1920s, Emil 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 the DSM criteria in the last part of the twentieth century. While in adults the course of bipolar disorder is characterized by discrete episodes of depression and mania with no clear symptomatology between them, in children and adolescents very fast mood changes or even chronic symptoms are the norm.
Goal and Purpose
The diagnosis of childhood bipolar disorder is controversial, although it is not under discussion that the typical symptoms of bipolar disorder have negative consequences for minors suffering them. Drug prescription usually consists in mood stabilizers and atypical antipsychotics. Current research directions for bipolar disorder in children include optimizing treatments, increasing the knowledge of the genetic and neurobiological basis of the pediatric disorder and improving diagnostic criteria. There is a relative lack of knowledge about bipolar disorder in late life. The impact of environmental factors in severe psychiatric disorders”. DSM IV Criteria for Manic Episode”.
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