1
Bipolar Disorder Research Paper
Johannah Travis
School of Behavioral Sciences, Liberty University
PSYC 430-D02: Abnormal Psychology
Professor Cindy Bremer
April 29, 2024
2
Bipolar Disorder Research Paper
Bipolar disorder is a psychotic disorder characterized by dramatic mood trends that entail
not only mania, hypomania, depression but also mixed episodes (Grover et al., 2022). It is a
chronic mental health disorder, one of the leading causes of diminished function and cognition,
affecting the patient’s quality of life (Zhao et al., 2020). The Diagnostic Statistical Manual of
Mental Disorders (DSM-5) identifies the following bipolar episodes: melancholic features,
mood-congruent psychotic features, anxious distress, rapid cycling, seasonal features (American
Psychiatric Association, 2013). Bipolar disorder has two central types. Bipolar I disorder, which
is diagnosed when more than five symptoms of mania last more than a week daily, including
increased energy and mood disturbances of flight ideas, and the impairment of social and
professional functioning may require hospitalization (APA, DSM-5, 2013).
Manic episodes among patients with bipolar I include three or more of the following
symptoms: inflated self-esteem, decreased need for sleep, more talkative than usual, racing
thoughts, distractibility, increased goal-oriented activities, and voracious consumption (APA,
DSM-5, 2013). The second type is bipolar II; it is diagnosed if the patient experiences one
hypomanic episode and after that, an episode that requires hospitalization or the patient’s
efficient functioning is severely impaired (APA, DSM-5, 2013). It is critical to emphasize the
point that bipolar disorder is highly associative with psychotic symptoms, loss of functioning,
and neuropsychological impairments. While the bipolar type I is identified by overt manic
episodes, which include psychotic symptoms, bipolar type II is primarily disastrous due to
depression episodes and hypomania, rather than the bipolar I full-blown maniac episode (Firth &
Eduard, 2022). Hypomanic and hypermanic episodes share the same criteria but are different
from elevated moods continuity. The former lasts for more than 4 continuous days, while the
3
latter includes seven days. The diagnosis of Bipolar I disorders occurred when at least one
episode of mania and followed by hypomanic or depressive episode before and after a manic
episode or more than one. The bipolar I disorder diagnosis, on the other hand, required exposure
to the hypomanic episode and the depressive episode before and after a hypomanic episode with
significant impairment of some important areas in life while ruling out disturbance due to other
psychotic disturbances or schizophrenic spectrum (APA, DSM-5, 2013). It is important to note
that bipolar disorder is a widespread disease type as it is one of the leading causes of disability in
young people and affects more than 1% of people globally, irrespective of nationality, social-
economic and ethnic background (Zhao et al., 2020).
History on Bipolar Disorder
The historical path starts with Aristotle, Plato, and Socrates from the well-known
philosophers from the ancient times. Even the philosophers wrote about people who seemed to
be in a constant state of melancholy and could become happy and laugh at some times. The
disease was not conceptually outlined until the 1850s, particularly with Falret’s definition and
was called a Melancholia disease (Firth & Eduard, 2022). It is still used when it refers to bipolar-
like episodes. Instead of the specifiers of mixed features, it was defined collectively in DSM-5
(APA, DSM-5, 2013). The term mania comes from the Greek definition of madness and was first
described as a subtype of a mental disease by the father of medicine, Hippocrates (Chakrabarti &
Singh, 2022). The concept that described the components in a single illness was proposed by
Jean-Pierre Falret; the condition concept had formerly been defined as two separate conditions
(Chakrabarti & Singh, 2022). While Emil Kraepelin utilized the term manic-depressive psychosis
during the end of the century and Karl Leonhard introduced the concept of polarity during the
1950s (Chakrabarti & Singh, 2022). Research within the previous five years describes the
4
importance of comprehending bipolar disease within a historical context. Research performed
during the 19th and previous decades of the 20th century continues to represent a crucial and
valuable source of information regarding the natural history of the disease. Before the
introduction of oral agents or drugs, antidepressants, or lithium, few pharmacological strategies
had been effective (Chakrabarti & Singh, 2022). The DSM’s versions have altered the Diagnostic
Criteria for Bipolar Disorder over time. Currently, Bipolar, and Related Disorders has an entire
section that straddles the Depressive Disorders and Schizophrenia Spectrum Disorders
categories.
Causes
Bipolar disorder was seen as being affected by psychosocial, structural, and functional
abnormality, neurotransmitter systems and genetics indicating the biogenetic components, as
well as biological and environmental factors (Grover et al, 2022). Another study, comparing the
course of bipolar disorder in India as compared with western countries revealed that the impact
of psychotic symptoms is evidently different (Grover et al, 2022). This study based on 207
individuals of lower education, which are often single, saw the lifetime rates of psychotic
symptoms as high as 75% (my editing). There is still an idea that if one is separated, divorced, or
widowed, it increases their risk of being diagnosed with bipolar disorder, however, the research
as well as evidence still must establish a connection (APA, DSM-5, 2013).
Bipolar disorder is central on genetic factors (70-90%), precedents of abnormalities on
the hypothalamic-pituitary-adrenal axis, potentially playing a role on the progression of the
disorder (Firth and Eduard, 2022). A family history of psychiatric issues, amongst those with
bipolar disorder is often observed. Researchers identified 30 genetic loci on which bipolar
disorder was associated, distinguishing between bipolar I and II (Köhler-Forsberg et al, 2020). To
5
further elaborate, Lena Köhler and her team indicated more strongly the correlation between
familial history, as well as the severity of bipolar disorder, as well as sociodemographic
parameters (Köhler-Forsberg et al, 2020). Recent studies also indicated abnormalities on the
cerebellum of those with bipolar disorder, characterized by a reduced grey matter volume in the
region (Zhao et al, 2020). For example, there are many factors that can trigger episodes, such as
sleep and diet. Moreover, neuropsychological dysfunction, specifically in executive functions,
has been observed, with these brain regions becoming more and more sensitive to stress
exposure; executive function closely relates to emotional regulation (King, Stone, Cleare &
Young, 2019). Substance abuse, which can include prescribed medications, and certain medical
conditions can induce manic episodes, which are considered in the diagnosis of medication or
substance-induced bipolar-related disorders (APA, DSM-5, 2013).
Treatment
Despite its complexity, bipolar disorder can be treated with different pharmacological and
psychotherapeutic approaches depending on the individual.DIt is not uncommon for bipolar
disorder patients to respond positively to treatment, but people with a strong genetic
predisposition may require more intensive treatment.DIt has been found that individuals with a
family history of bipolar disorder tend to respond better to stronger psychopharmacological
treatments (Köhler-Forsberg et al., 2020).DAntidepressants are often considered when managing
depressive episodes, despite ongoing debates about their efficacy.DNevertheless, lithium has
emerged as the most popular relapse-prevention drug.DIt remains one of the most effective drugs
for managingDbothDdepressive and manic episodes in bipolar disorder (Firth & Eduard, 2022).
AlthoughDlithiumDcarries a moderateDrisk of toxicity,Dregular blood tests can help monitor levels
and ensure safety.
6
Bipolar disorder patients should be closely monitored during the treatment process
regardless of the potential side effects of all medications being used (Chakrabarti & Singh,
2022).DTo prevent relapses and recurrences of major affective episodes in bipolar disorder,
electroconvulsive therapy can be combined with psychosocial interventions if pharmacotherapy
is ineffective (Firth & Eduard, 2022).DThe fact that there are people diagnosed with bipolar
disorder who are resistant to treatments, known as treatment-resistant bipolar depression, is
unfortunate. About 30% of bipolar cases may fail to respond well to conventional treatments
(Jauhar, Arnone, & Young, 2020).
Prevention
Bipolar disorder is genetically based, butDcurrently, there isDno way to preventDit from
occurring.DIt is possible to minimize the recurrence of cycling manic and depressive episodes
through effective strategies.DLithium salts' antimanic effect was discovered by John Cade in 1867
as a treatment for bipolar disorder, and improvements are ongoing to maintain the antimanic
effect (Chakrabarti & Singh, 2022).DIn addition to medication, psychotherapeutic
approachesDhave proven effectiveDinDmanaging bipolar depression. Examples of such modalities
includeDcognitive-behavioralDtherapy, family-focused therapy, and interpersonal and social
rhythm therapy. TheyDaid individuals in restoringDcircadian rhythms, integrating daily activities,
and enhancing overall mood (Firth & Eduard, 2022).DA pharmacological treatment alone may not
be enough to address the complexities of bipolar disorder.
Therefore, while there are no preventative measures available for this disorder at the
cellular level, there are effective strategies for preventing and managing manic and depressive
episodes.DTreatment for bipolar disorder can be significantly improved by combining
psychotherapeutic interventions with medication.DIndividuals with bipolar disorder can better
7
navigate the challenges posed by the disorder by considering both biological and psychosocial
aspects in a comprehensive approach.DIt is hoped that ongoing research and improvements in
both pharmacological and psychotherapeutic realms will contribute to continuing improvements
in the management of bipolar disorder, enhancing the quality of life for those suffering from it.
Cross Cultural Issues
Exploring cultural differences inDthe realm ofDbipolar disorder reveals a lack of
information and limited research.DStudies conducted on patients in Asia also present limited data
sets, while most of the available data from Western countries comes from small sample
sizes.DHowever, despite these limitations, insights from Asia, particularly India, suggest notable
variations compared to Western countries.DAccording to research (Grover et al., 2022), Indians
are more likely to have manic episodes than depressive ones, as well as higher rates of substance
abuse, higher hospitalizations, and higher rates of suicidal behavior. They also prefer anti-
psychotic medications to antidepressants.
In the United States, a study found thatDthe diagnosis of bipolar I disorderDwas less
common among African Caribbean individuals compared to Whites or African Americans (APA,
DSM-5, 2013).DTo diagnose and treat patients effectively, cultural factors need to be
considered.DIn addition, gender differences have been observed inDthe manifestation of bipolar
disorder.DDepressive symptoms are more common among females with the disorder than males
(Grover et al., 2022).DUnderstanding these cultural nuances is crucial for providing tailored and
effective interventions forDindividuals with bipolar disorderDacross diverse populations. Different
aspects of the disorder are affected byDculturalDfactors, including how symptoms
areDpresented,Dhow people seek help, and how they prefer to receive treatment. Therefore,
culturally sensitive approaches should be incorporated into bipolar disorder treatment efforts to
8
ensure equitable and optimal care for all individuals suffering from this disorder.DTo improve
outcomes for individuals with bipolar disorder worldwide, we need to conduct further research
into cultural differences.
Biblical Worldview
The fields of health science and psychology acknowledge the significance of religion and
spirituality in patients' lives. Achieving holistic healing often necessitates addressing patients'
spiritual well-being. Individuals grappling with mental illness must embark on a unique journey
to restore their faith, requiring a shift in perspective (de Diego-Cordero et al., 2022). Scripture
emphasizes that humans are created in the image of God, with a mind, body, and soul (Genesis
1:27). However, this divine image was marred by humanity's fall into sin, resulting in a world
tainted by corruption. This corruption affects not only the body and soul but also the mind,
contributing to the varied manifestations of conditions like bipolar disorder. Scripture
admonishes believers to guard their minds and focus on godly things. The Apostle Paul urges
believers not to conform to the world's standards but to renew their minds (Romans 12:2), while
Peter exhorts them to have "minds that are alert and fully sober, " (1 Peter 1:13, NIV).
Additionally, Paul instructs believers to think on things that are true, honest, just, pure, lovely,
and praiseworthy (Philippians 4:8).
Perception can play a critical role in bipolar disorder episodes. In manic states,
individuals may perceive miracles as abundant rewards for great faith, while depression can lead
to feelings of hopelessness and the belief that miracles no longer exist (de Diego-Cordero et al.,
2022). This study shows the importance of perception and the significance of one's thought
patterns. Individuals who mostly struggle with mental illness, must focus on spiritual truths, and
place their faith in Christ. During periods of darkness and depression, hope may seem distant,
9
and despair may seem large. However, shifting focus from darkness to Christ reveals Him as the
beacon of hope, capable of dispelling the darkness. As He is the one true light for us as
Christians.
Conclusion
Bipolar disorder presents as a chronic and intricate condition, often challenging to
diagnose due to its multifaceted nature. Further research is imperative to comprehensively grasp
the interplay of environmental and genetic factors underlying the disorder. Enhanced
understanding, gleaned from accumulating data, holds promise for refining treatment options,
particularly for individuals resistant to current therapies. Both pharmacological and
psychotherapeutic approaches warrant exploration to develop interventions tailored to address
the diverse environmental and neurobiological mechanisms at play across different stages of
bipolar disorder.
Ongoing investigations are necessary to discover whether cerebellar abnormalities
observed in bipolar II patients during depressive episodes extend to those with bipolar I (Zhao et
al., 2020). Studies on both bipolar I and II have revealed comparable levels of cognitive
impairment, particularly in executive function domains (King, Stone, & Cleare, 2019). However,
limitations, such as small sample sizes and dependence on self-reported psychiatric histories,
continue across various studies. Insights have gathered from these efforts have sparked
heightened interest in bipolar disorder research, which could possibly pave the way for
significant treatment advancements. Advancements in treatment hold promise for not only
mitigating the frequency, duration, and severity of manic and depressive episodes but also for
preventive measures. Given the disorder's chronic and recurrent nature, it imposes substantial
10
burdens on individuals, families, and society. Targeted interventions aimed at averting major
complications of bipolar disorder are paramount (Chakrabarti & Singh, 2022).
11
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.), pp. 123-139. https://doi.org/10.1176/appi.books.9780890425596
Chakrabarti, S., & Singh, N. (2022, September 19).DPsychotic symptoms in bipolar disorder and
their impact on the illness: A systematic review. World journal of psychiatry.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9521535/D
de Diego-Cordero, R., Ávila-Mantilla, A., Vega-Escaño, J., Lucchetti, G., & Badanta, B. (2022,
June).DThe role of spirituality and religiosity in healthcare during the COVID-19
pandemic: An Integrative Review of the scientific literature. Journal of religion and
health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8960681/
Grover, S., Avasthi, A., Chakravarty, R., Dan, A., Chakraborty, K., Neogi, R., Desouza, A.,
Nayak, O., Kumar Praharaj, S., Menon, V., Ramandeep, Bathla, M., Subramanyam, A. A.,
Nebhinani, N., Ghosh, P., Lakdawala, B., & Bhattacharya, R. (2022). Prevalence of
psychotic symptoms and their impact on course and outcome of patients with bipolar
disorder: Findings from the bipolar disorder course and outcome study from india (BiD
CoIN study). Journal of Affective Disorders, 305, 233-239.
https://doi.org/10.1016/j.jad.2022.02.070
Firth, J., & Eduard, V. (2020). Bipolar Disorder. The New England Journal of Medicine, 383(1),
58-66. https://doi.org/10.1056/NEJMra1906193
King, S., Stone, J., Cleare, A., & Young, A. (2019). A systematic review on neuropsychological
function in bipolar disorders type I and II and subthreshold bipolar disorders—something
to think about. CNS Spectrums, 24(1), 127-143.
https://doi.org/10.1017/S1092852918001463
12
Köhler-Forsberg, O., Sylvia, L. G., Ruberto, V. L., Kuperberg, M., Shannon, A. P., Fung,
V.,Overhage, L., Calabrese, J. R., Thase, M., Bowden, C. L., Shelton, R. C., McInnis,
M.,Deckersbach, T., Tohen, M., Kocsis, J. H., Ketter, T. A., Friedman, E. S., Iosifescu, D.
V.,McElroy, S., ... Nierenberg, A. A. (2020). Familial severe psychiatric history in bipolar
disorder and correlation with disease severity and treatment response. Journal of
Affective Disorders, 273, 131-137. https://doi.org/10.1016/j.jad.2020.03.157
The Holy Bible. New International Version (1978). www.biblegateway.com/
Turnbull, O. H., & Salas, C. E. (2021, August 17).DThe neuropsychology of emotion and emotion
regulation: The role of laterality and hierarchy. Brain sciences.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392558/
Zhao, L., Luo, Z., Qiu, S., Jia, Y., Zhong, S., Chen, G., Lai, S., QI, Z., Luo, X., Huang, G., Huang,
L., & Wang, Y. (2020). Abnormalities of aquaporin-4 in the cerebellum in bipolar II
disorder: An ultra-high b-values diffusion weighted imaging study. Journal of Affective
Disorders, 274, 136-143. https://doi.org/10.1016/j.jad.2020.05.035
