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Roller-coaster: The Ups and Downs of Bipolar Disorder
By Kevin Brown

Maher O. Ayyash“Bipolar” has become a popular catchphrase to describe someone who displays a sudden mood swing. While mood swings are characteristic of bipolar disorder, it is a serious mental health condition that can have deadly consequences.

“Bipolar disorder is a mood disorder that affects an individual’s behavior and function,” says Maher O. Ayyash, MD, FAPA, FACLP.

Dr. Ayyash sees a number of patients with bipolar disorder at Ohio Valley Hospital (OVH) as medical director of their Outpatient Psychiatry Center and the Willow Brook Geropsychiatric Unit.

“It used to be called ‘manic-depressive disorder’ and involves a condition of elated and expansive moods,” he says. “Bipolar disorder affects 0.6 percent of the population in the United States with an average age of onset at about 18 years.”

Types and Causes
Generally, bipolar disorder is characterized by two main types of behaviors: manic and depressive. The manic behavior usually involves an “up” or energized state with heightened activity. Depressive behavior includes feelings of being “down” with sadness, hopelessness and depression.

Dr. Ayyash notes that bipolar disorder is grouped into two primary types: Bipolar I and Bipolar II.

According to the National Institutes of Health, Bipolar I is defined by manic episodes of at least seven days’ duration, or manic behavior so severe it requires immediate hospitalization.  Also, the Bipolar I disorder includes depressive episodes lasting at least two weeks.

Bipolar II involves a pattern of depressive episodes and less severe manic episodes than those typically associated with Bipolar I. These milder manic episodes are called “hypomania.”

As to the causes of bipolar disorder, Dr. Ayyash notes that certain environmental factors may be indicators. “Bipolar disorder is more common in higher income countries and in separated, divorced or widowed individuals,” he says.

Signs and Symptoms
According to Dr. Ayyash, those with bipolar disorder may experience varying symptoms such as increased goal-oriented activities, inflated self-esteem, and decreased need for sleep. Other symptoms of bipolar disorder may include pressured speech, flight of ideas, easy distractibility and grandiosity.

“Conversely, patients with bipolar disorder may also have symptoms of depression including sad moods, loss of energy, lack of interest, feelings of guilt, poor concentration, loss of appetite and thoughts of death,” he explains.

Dr. Ayyash notes that having bipolar disorder usually leads to impaired functioning in different parts of a person’s life.

Diagnosing Bipolar Disorder
Current literature indicates that bipolar disorder is difficult to diagnose and, since many bipolar patients first seek help during a depressive episode, bipolar disorder is often misdiagnosed as depression and initially treated inappropriately with antidepressants, which can exacerbate manic episodes.

“Up to 35 percent of bipolar cases are missed even after seeing as many as three professionals,” says Dr. Ayyash.

According to Dr. Ayyash, the diagnosis of bipolar disorder involves ruling out other causes of symptoms such as underlying medical conditions, substance use, and medication-related causes. “Differential diagnoses such as major depressive disorder, ADHD, anxiety disorders, and personality disorders should be considered.”

Heredity and Other Risk Factors
Dr. Ayyash believes that a family history of bipolar disorder is a strong risk factor. “There is about a tenfold increased risk among relatives with Bipolar I or Bipolar II disorders,” he says. “Heredity is more of a factor with the degree of kinship.”

When it comes to bipolar disorder, all is not equal between the sexes. “Females with bipolar disorder experience more rapid cycling of manic and depressive episodes and mixed states,” says Dr. Ayyash. “Females are more prone to experience depressive episodes than males and they are more at risk for alcohol abuse,” he explains.

Dr. Ayyash is a former assistant professor of psychiatry and surgery at the University of Pittsburgh School of Medicine. Dr. Ayyash earned his medical degree from Alexandria University in Alexandria, Egypt, and completed residencies in psychiatry at the Duke University Medical Center in Durham, North Carolina, and the University of Kansas School of Medicine in Wichita. He is board- certified in psychiatry and psychosomatic medicine.

Because of the depressive episodes characteristic of bipolar disorder, suicide is a deadly complication.

“The risk of suicide in bipolar patients is about 15 times that of the general population and accounts for 25 percent of completed suicides,” says Dr. Ayyash.

Bipolar patients also experience difficulties in everyday functioning, such as with relationships, jobs, and other daily occurrences that many people take for granted.

“Thirty percent of patients with bipolar disorder have severe impairment in functioning including educational, work and cognitive,” notes Dr. Ayyash. “Other psychiatric disorders are also common among bipolar patients.”

Treatments and Therapies
Mood-stabilizing and antipsychotic medications are the mainstay of treatment for bipolar disorder according to Dr. Ayyash. However, he advises that caution should be practiced with the use of antidepressant medications when depressive episodes are severe and their use may be warranted and indicated.

“Treatment of bipolar disorder is available especially when the diagnosis is satisfactorily established and an agreeable treatment plan is formulated that includes medications, therapy and providing the necessary services and care,” Dr. Ayyash says.
“Patients who are compliant with their treatment and attending to psychiatric care and therapy
stand a better chance of controlling their symptoms, resuming functioning and achieving possible recovery,” he explains.

In emergency situations, Dr. Ayyash advises that crisis centers are available in most counties.

“Outpatient psychiatric care and follow up is recommended at all times. Inpatient psychiatric hospitalization might be needed for safety and medications management and monitoring,” he says.

Dr. Ayyash also suggests getting into contact with the National Alliance on Mental Illness (NAMI) which has local chapters in Pittsburgh and surrounding counties. Visit their website at www.nami.org.

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