Q: Is a bipolar person conscious about what is right and wrong at the time he/she does something wrong?
A:
This is an incredibly difficult question to answer without more contextual information, and depends critically on the individual person, their level of insight, and how severely ill they might have been at the time the behavior occurred.
Many individuals with bipolar disorder (about 60 percent) experience psychotic symptoms at some point in their illness. Psychosis, by definition, involves loss of touch with reality. So during that period, someone with bipolar disorder may be acting under the influence of delusions (false beliefs, such as thinking that someone is plotting against him/her), or hallucinations (false perceptions, such as hearing voices that are not really there). Under those circumstances, most likely the person would not be aware of the legal or ethical implications of his or her actions.
Even for people who are less severely symptomatic, in the context of a manic or depressive episode, one’s judgment can be profoundly impaired.
Causes of Bipolar Disorder - Everyday Health
Researchers believe there are multiple causes of bipolar disorder and are searching for answers in our genes, our environment, and our brains.
By Lisa Baertlein
Like many other mental illnesses, bipolar disorder tends to run in families. People with this condition often have first-degree relatives (parents, siblings, or children) with the same diagnosis, says Dr. Ruth Wolever, a psychologist and clinical director at the Duke Center for Integrative Medicine at the Duke University School of Medicine.
Researchers are using new genetic mapping technology to pinpoint the genes that may play pivotal roles in the development of the illness, and the findings thus far suggest that multiple genes play a role in bipolar disorder. According to Dr. Vishwajit Nimgaonkar, principal investigator for the Bipolar Genetics Research Project at the University of Pittsburgh School of Medicine, "It looks as though there are many, many genetic factors [in bipolar disorder]. It appears that each contributes just a small amount."
But even as they hunt for genetic culprits, researchers agree that genes don't tell the whole story. That's because identical twins — who share the same genes — do not always have bipolar disorder in common (studies in identical twins have found a 60 to 80 percent chance of both being bipolar), a finding that suggests that environmental stressors may be among bipolar-disorder causes.
"My read is that this disease is caused by both genetic and environmental factors," says Dr. Nimgaonkar. Adds Dr. Wolever, "One line of thinking is that people are predisposed because of their genetic picture and something happens in their lives that triggers the genes to turn on."
Stressors could include things like a significant personal loss, an abusive home life, substance abuse, or sleep disturbances. There are many stressors that could act as triggers, says Wolever, who adds that researchers are hoping to identify the environmental factors that may set the disease in motion.
Other Potential Causes
Viruses such as herpes simplex, which causes cold sores, may also be a risk factor for bipolar disorder. In particular, one study suggested that women with a herpes simplex infection during pregnancy may have children with a greater risk of developing bipolar disorder, as well as other psychoses.
Hormones and neurotransmitters — or brain chemicals like serotonin — are also believed to play a role in developing bipolar disorder. People with bipolar disorder have disturbances in the areas of the brain that control mood, but researchers are unsure if that is a cause or a result of the disease. However, new brain-imaging equipment has found structural differences in the brains of people with bipolar disorder, which they hope may point to potential causes and future treatments.
Recognizing Bipolar Disorder Triggers - Everyday Health
Identifying triggers of mania or depression can help prevent a destructive mood swing. Here's what patients and caregivers need to know.
By Regina B. Wheeler
Medically reviewed by Lindsey Marcellin, MD, MPH
Living with bipolar disorder can feel like a rollercoaster ride. The extreme ups and downs of the disease can disrupt the lives of the patient and those around them. To make the disease more manageable, it’s important for the patient and caregivers to know what may trigger episodes of mania and depression.
When one family member has bipolar disorder, it’s as if the whole family has the illness. Primary caregivers may need to help with medications, talk to doctors, and keep a predictable, low-stress household routine. It’s also essential for caregivers to pick up on the sometimes subtle signs that their loved one is slipping into mania or depression.
Bipolar Disorder: Mania and Depression
Bipolar disorder, also known as manic depression, is a serious mental illness that causes marked shifts in mood, energy and activity levels, according to the National Institute of Mental Health. The extreme “high” is called mania. People in a manic phase are usually full of energy, overly excited, and even irritable or jumpy. During an episode of mania, the patient may feel invincible, take risks, engage in impulsive sex, go on huge spending sprees, or even have hallucinations. What’s worse, the bipolar person may not recognize they are manic because they feel so good.
At the other end of the spectrum is depression, which can spiral into talk of, or even attempts at, suicide. Always take talk of suicide seriously. If your loved one threatens to kill himself, call a health care professional or 911 immediately.
Although bipolar disorder is a lifelong illness, it is controllable. Usually patients are treated with a combination of medication, psychotherapy, and lifestyle management. Many people go months or even years between mood episodes and report that they feel good in the meantime.
Bipolar Disorder: Tracking Triggers
Life events, anxiety, and even physical changes can cause a mood swing. What triggers an episode of mania or depression varies from person to person. Here are some typical physical triggers, according to the National Alliance on Mental Illness (NAMI).
Not getting enough sleep
Using alcohol or drugs
Stopping your medicine
Beginning antidepressant medication (this can cause a switch to mania)
Hypothyroidism (low thyroid function, a possible side effect of lithium medication, often used to treat bipolar illness)
Emotional stress and big or small life changes can also cause mania or depression. The Depression and Bipolar Support Alliance gives these examples:
Major life change like moving or starting a new job
Arguing with a friend or loved one
Financial problems
Louisa Sylvia, PhD, a psychologist at the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston says, “Changes in daily routines, such as staying up late studying or flying to another time zone, can cause a mood swing.”
Sylvia explains that bipolar disorder interferes with the body’s circadian rhythm, the 24-hour rhythms, such as the sleep-wake cycle. As a result, bipolar patients are likely to have unregulated daily routines, such as meal and bed times. For instance, they may wake up in the middle of the night or sleep late. They may not eat anything until the afternoon. So, Sylvia says, it’s imperative for the bipolar person, and the rest of the family, to maintain a regular routine to avoid mania or depression.
Since regular sleep is vital to keeping bipolar episodes in check, keep an eye on sleep patterns. Changes and disruptions in sleep are often the first indicator of illness, according to NAMI. Sleep is usually disturbed very early in an episode of mania or depression. If the mood swing is caught early, there’s a better chance it can be stabilized, possibly by adjusting medications.
Bipolar Disorder: Charting Your Moods
Mood charts provide a visual snapshot of changes in mood over the course of a month. Every day, the patient jots down medication, mood level, and significant life events. The patient, family, and doctors may be able to see emerging patterns and pinpoint triggers more accurately. Sylvia says mood charts are an “excellent resource for patients to monitor and be more aware of moods.”
Posted
Mar 07 2011, 09:56 AM
by
Vanessa Matheny