“Premature Mortality from General Medical Illnesses among Persons with Bipolar Disorder”People with bipolar disorder are at higher risk to premature death from medical disorders. Patients are more likely to smoke heavy and a higher exposure to second hand smoke which ties in to the higher risk to premature death. Bipolar patients live extremely unhealthy live styles due to medication. Many bipolar patients are treated with mood stabilizers which have an increased risk of obesity and metabolic syndrome. It is believed if new treatment is introduced it will reduced the risk of premature death.

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“Antidepressant tolerability in anxious and depressed youth at high risk for bipolar disorder”
Depression and Anxiety are common in young adults who are at risk for Bipolar disorder.
Children of parents with bipolar disorder have a higher risk of developing mood swings and anxiety. Many young patients are treated with antidepressants. Several antidepressants are poorly tolerated in young adults and children. Further controlled studies need to be done on medications to treat depression and anxiety.

“Treatment Patterns of Youth with Bipolar Disorder”
Adolescents meeting DSM-IV criteria for bipolar I or II disorder 49% were treated for depression and mania. 38% adolescents aren’t treated at all for bipolar I or II. Treatment for depression and mania put adolescents at a higher risk for suicide attempts. Alcohol abuse showed in the adolescents who weren’t treated for their disorder. Adolescents who were treated also showed tripled the rate in ADHD and doubled in in behavior disorders.

“Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up”
Bipolar disorder affects about 5.7 children and adults in the United States. Children are less likely to show clear episodes of bipolar disorder and more likely to show chronic mania like symptoms. There are many difficulties in Pediatric Bipolar disorder diagnostic due to the overlapping of the mania symptom criteria with ADHD criteria, such as inattention and distractibility. Many ADHD patients have higher Bipolar disorder symptoms. Lack of clarity and agreement among researchers and clinicians on the diagnostic criteria may have contributed to the forty-fold rise in reported prevalence of PBD over the last two decades. Interaction between SLC6A4 promoter variants and childhood trauma on the age at onset of bipolar disorders

Bipolar disorder is a diverse and complex disorder with a high heritability close to 60%, and interactions with environmental risk factors. Childhood trauma has been proved to play a big part in Bipolar disorders. Both genetic and environmental studies have been done to determine which one plays a bigger part. Environmental factors can represent major risk factors for the development of mental disorders. Childhood traumatic events in Bipolar Disorders remain unclear.

Treatments
The most recent guidelines for the evidence-based treatment of bipolar disorder include antipsychotic agents. For acute mania, Lithium and valproate continue to be the recommended first line treatment strategies (Yatham, Kennedy, Parikh, and Schaffer, et al., 2013). Several new monotherapy treatments have been added to the old standards. These include asenapine, divalproex, and paliperidone are now considered standalone treatments. Asenapine has been added as an adjunct therapy with other medications (Yatham, Kennedy, Parikh, and Schaffer, et al., 2013). For those with bipolar depression, lithium, lamotrigine, and quetiapine have been added as monotherapies. The combination of olanzapine and SSRIs, lithium or divalproex and SSRI are also first line options of treatment (Yatham, Kennedy, Parikh, and Schaffer, et al., 2013). Lurasidone either as a monotherapy, or with lamotrigine are now second line options (Yatham, Kennedy, Parikh, and Schaffer, et al., 2013). Ziprasidone is now considered the most common option for maintenance treatment of bipolar disorder. The treatment of bipolar disorder is typically managed through the use of pharmaceuticals.

Pharmaceuticals are the first line of treatment in bipolar disorder. This is due to the physiological nature of the disease. Pharmaceutical treatment is typically combined with some forms of therapy to help the patient manage their symptoms. The therapy typically focuses on psychoeducation. This therapy was associated with a reduction in both positive and negative symptoms (Miklowitz, O’Brien, Schlosser, & Addington, et al, 2014). Family centered therapy that focused on building relationships had a positive effect on prevent symptoms in those at high risk for psychosis (Miklowitz, O’Brien, Schlosser, & Addington, et al, 2014). Therapy in combination with pharmaceutical therapy was found to be an effective combination.

Symptoms
Bipolar disorder is classified into four subtypes. Bipolar I disorder is a person that has zad at least one manic episode that was preceded or followed by a major depressive episode (Mayo Clinic Staff, 2016). Bipolar II disorder is someone who has had at least one major depressive episode an at least one manic episode lasting approximately four days. The condition qualifies if it has major consequences in the persons’ life (Mayo Clinic Staff, 2016). Cyclothymic disorder is diagnosed when the cyclic depression and manic episodes have lasted at least two years. The criteria only have to had lasted for one year in adolescents (Mayo Clinic Staff, 2016). The symptoms of this type of bipolar disorder are typically less acute, but they last for a sustained period of time. The final type of bipolar disorder is those that are a result of a physical condition such as a stroke, Cushing’s disease, or sclerosis (Mayo Clinic Staff, 2016). Bipolar II is the most severe as the depression cycle is more severe and lasts a long time (Mayo Clinic Staff, 2016).

Manic episodes are a period of abnormal, persistent elevated mood that includes irritability and hyperactivity. This condition lasts for at least one week, or less than a week if hospitalization was needed (Mayo Clinic Staff, 2016). Symptoms of manic episodes include racing thoughts, insomnia, inflated self-esteem or grandiosity, being easily distracted, having an increased goal-directed activity, agitation, or doing things that are irrational such as spending sprees, or sexual activities (Mayo Clinic Staff, 2016).

Depressive episodes can appear as a depressed mood that lasts most of the day, or nearly every day. There is a marked lack of interest in activities (Mayo Clinic Staff, 2016). Significant weight loss, insomnia, or sleeping excessively can be signs of a depressive episode (Mayo Clinic Staff, 2016). Depressed people are restless, have a lack of energy, decreased ability to concentrate, and sometimes thoughts of death or suicide (Mayo Clinic Staff, 2016). To be diagnosed with depression, the symptoms cannot be caused by medication or a medical condition (Mayo Clinic Staff, 2016).

A person with bipolar disorder will appear to have rapid mood swings that are not typical for them (Mayo Clinic Staff, 2016). The symptoms can be difficult to diagnose in teens and young adults because typical ups and downs are normal during this time. Due to the unpredictability of the symptoms, bipolar disorder can be difficult to diagnose and treat (Mayo Clinic Staff, 2016). The most prominent clinical sign is that the mood swings significantly affect the person’s life and ability to function.

Causes
The exact causes of bipolar disorder are not known, but several theories are currently being examined. Those in acute state or on lithium demonstrate abnormalities in the right amygdala, which suggests a biological or structural abnormality is responsible for the symptoms of bipolar disorder (Foland-Ross, Thompson, Sugar, and Narr, et al, 2013).

A recent study examined the high mortality of bipolar patients due to comorbid cardiovascular disease. They suggested that bipolar disorder might be part of a multi-system inflammatory response (Leboyer, Soreca, Frye, & Scott, et al, 2012). The study suggested that bipolar disorder might be the result of poor health choices. It suggested bipolar disorder might be an early manifestation of a multi-systemic disorder (Leboyer, Soreca, Frye, & Scott, et al, 2012). This research could lead to the discovery of biomarkers for bipolar disorder and the development of personalized treatment options (Leboyer, Soreca, Frye, & Scott, et al, 2012).

    References
  • Babak Roshanaei-Moghaddam, M. D., & Katon, W. (2015). Premature mortality from general Medical illnesses among persons with bipolar disorder: a review. Psychiatric Services.
  • Elmaadawi, A. Z., Jensen, P. S., Arnold, L. E., Molina, B. S., Hechtman, L., Abikoff, H. B., … & Galanter, C. A. (2015). Risk for emerging bipolar disorder, variants, and symptoms in children with Attention deficit hyperactivity disorder, now grown up. World journal of psychiatry, 5(4), 412.
  • Etain, B., Lajnef, M., Henrion, A., Dargél, A. A., Stertz, L., Kapczinski, F., … & Leboyer, M. (2015). Interaction between SLC6A4 promoter variants and childhood trauma on the age at onset of Bipolar disorders. Scientific reports, 5.
  • Foland-Ross, L., Thompson, P., Sugar, C. & Narr, K. et al. (2013). Three-dimensional mapping of hippocampal amygdalar structure in euthymic adults with bipolar disorder not treated with lithium. Psychiatry Research. 211 (3): 195-201.
  • Khazanov, G. K., Cui, L., Merikangas, K. R., & Angst, J. (2015). Treatment patterns of youth With bipolar disorder: Results from the National Comorbidity Survey—Adolescent Supplement (NCS-A). Journal of abnormal child psychology, 43(2), 391-400.
  • Leboyer, M., Soreca, I., Frye, M. & Scott, J. et al. (2012). Can bipolar disorder be viewed as a multi-system inflammatory disease? Journal of Affective Disorders. 141 (1): 1-10.
  • Mayo Clinic Staff. (2016), Bipolar Disorder. May Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/symptoms/con- 20027544
  • Miklowitz, D., O’Brien, M., Schlosser, D., & Addington, J. et al. (2014). Family-Focused Treatment for Adolescents and Young Adults at High risk for Psychosis: Results of a Randomized Trial. Journal of the American Academy of Child & Adolescent Psychiatry. 5 (8): 848-858.
  • Strawn, J. R., Adler, C. M., McNamara, R. K., Welge, J. A., Bitter, S. M., Mills, N. P., … & DelBello, M. P. (2014). Antidepressant tolerability in anxious and depressed youth at High risk for bipolar disorder: a prospective naturalistic treatment study. Bipolar Disorders, 16(5), 523-530.
  • Yatham, L., Kennedy, S., Parikh, S. & Schaffer, A. et al. (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) International Society for Bipolar Disorders (ISBD) Collaborative update of CANMAT guidelines for the management of patients with bipolar disorder update 2013. Bipolar Disorders. 15 (1): 1-44.