Up to the year 1994, bipolar II disorder was underrated as a real disorder. According to the American Psychiatric Association (2021), bipolar disorders are brain disorders that result in quick changes in moods and the ability to function correctly. Episodes of depression and manic behavior characterize bipolar disorder II. Compared to bipolar I, bipolar II usually is less severe (APA, 2021). Diagnosis of Bipolar disorder II is typically given after a first major depressive and hypomania episode. Symptoms manifest while an individual is still young, in their teenage years or early twenties.  Diagnosis occur after a deep consideration of an individual’s family history (APA, 2021). The total number of individuals affected by bipolar disorder is approximated to range between 3- 8.3% of the total population (Dell’Aglio et al., 2013; Mcintrye & Calabrese, 2019). The percentage is on a larger scale among individuals who are the first-degree relative of individuals who have been previously diagnosed with bipolar disorder and schizophrenia. The prevalence of Bipolar II disorder ranges between 0.5 – 6% (Dell’Aglio et al, 2013; Mcintrye & Calabrese, 2019). About 90% of hypomanic episodes presented by people with bipolar II disorder develop into recurring episodes of swift mood changes. On the other hand, 60% of manic episodes occur after a significant episode of depression (McIntrye & Calabrese, 2019). The risk of suicide among people diagnosed with bipolar disorder is at 3.9%, and the rate of attempted suicide among bipolar disorder patients is 1.4%. The purpose of this paper is to critically examine bipolar II disorder, its symptoms, cause, treatments, and its implication to society.

Causes of Bipolar II

In truth, no definitive causes of bipolar disorder have been discovered yet. No test can be done on a younger person to determine if he is genetically predisposed to this disorder. Despite this, studies have shown that biological, genetic, and environmental factors influence the onset of the disease.

Genetic Factors

Scientists have found that bipolar disorder has a heritability component to attached it. Studies have shown that bipolar aspects that run in the family include; individuals having the same history of bipolar hospitalizations. Also, individuals having bipolar disorders within the family suffer from obsessive-compulsive disorder. These people exhibit similar onset age, similar number, and frequency of manic episodes. When a parent has the disorder, the child’s chances of having it is 10 – 15%, and the stakes are much higher if both parents have it (30 – 40) % chance (Kerner, 2014). Studies also show that in the case of twins, if one has bipolar disorder, the other has a 40% chance of developing it. The theory behind this occurrence is that identical twins share the same egg; hence the same genetic material is used in building their body structure (Angst et al., 2011).

In investigating genetic markers responsible for the disease, some identifiers are common among people who have the disease. Such include rs1006737, NCAN and ODz4-rs12576775 (Kerner, 2014).

Biological Factors

When investigating the root causes of bipolar disorders, it is not assumed that only genetic variations can lead to the disease. Brain chemistry and structure are also interacting factors.  One of the biological factors that have been found to cause the bipolar disorder is neurotransmitter dysfunctions. When neurotransmitters such as serotonin and norepinephrine are not working correctly, they can bring about the onset of bipolar disorder (Rowland &Marhawa, 2018). Certain medical conditions have also been found to be a predictor of individuals having bipolar disorder. Some of these medical conditions include multiple sclerosis and Cushing syndrome. Lastly, hormonal changes such as those of pregnancy have been found to cause the onset of bipolar disorders. Some studies have directly linked the bipolar disorder to dysregulation of calcium (Rowland & Marhawa, 2018).

Environmental Factors.

Most of the environmental factors interacting to influence bipolar disorder act as tipping points. This means that it acts as the bridge between predisposition and disorder. Alcohol and drug abuse do not necessarily cause bipolar disorders. Still, they can cause relapse and make a bipolar condition even worse because depression is worse in substance abusers and can trigger depression or manic episodes (McCormick, Murray & McNew, 2015). Experiencing a significant loss can be a trigger for bipolar disorder. Depression is closely associated with the grieving process and can be a trigger for bipolar. On the other hand, individuals can try to replace the emptiness of loss with a false sense of comfort.  These changes in regular behavior cycles can make people vulnerable to bipolar disorder and other mental health disorders.

Other conditions of extreme stress can easily lead to bipolar onset. Such extreme life events include having a stressful job, going through a divorce, and having medical conditions such as gastrointestinal disorders that may trigger major depressive episodes and manic episodes (McCormick, Murray & McNew, 2015). During the medication period, some individuals can stop taking their medication when they feel better. Unless by doctors’ advice, such practices can be a trigger for depressive and manic episodes. Some medications such as street drugs, cold medicine, and thyroid medicine are triggers for bipolar disorders.

Symptoms

Extreme mood swings are one of the significant symptoms of an individual suffering from Bipolar II disorder.  Such individuals may exhibit anxiety, sadness, general discontent, guilt, hopelessness, and loss of pleasure in activities (APA, 2021). The transition from one mood spectrum may be too swift to keep up with in terms of behavior individuals suffering from bipolar II exhibit compulsive and impulsive behavior, irritability, restlessness, and even self-harm. In terms of cognitive ability, individuals who have bipolar disorder may lack concentration, slowness in activity, and may battle with suicidal thoughts. They may also exhibit extreme ends of sleeping patterns such as insomnia or excess sleepiness (APA, 2021).

Bipolar II disorder is typically characterized by a major depressive episode and one hypomanic episode. It is rare for an individual suffering from bipolar II to exhibit a manic episode. Bipolar II is not a milder form of bipolar I but rather a separate diagnosis (APA, 2021). Manic episodes are, in a general sense, extreme forms of hypomania.

Hyper mania

During a hypomanic episode, an individual with bipolar II disorder may exhibit some of the following characteristics; being abnormally upbeat, jumpy, and wired; increased activity, energy, and agitation; exaggerated sense of well -being and euphoria; Insomnia; unusual talkativeness; racing thoughts; distractibility and poor decision making such as taking sexual risks, foolish investments and shopping sprees (APA, 2021).

Major Depressive episodes

 During a major depressive episode, individuals exhibit the opposite of what they would do in a hypomanic episode. These include; having a generally depressed mood such as extremely sad, empty, hopeless, tearful, and irritability. Others include loss of interest and pleasure in things that one commonly does; weight loss/gain and increase/decrease of appetite; restlessness and slowed behavior; fatigue and loss of energy; feeling of worthlessness and a lot of guilt; thinking, planning, and attempting of suicide and lack or lot of sleep (APA, 2021).

Many people suffering from bipolar II disorder exhibit depressive episodes more than hypomanic episodes (Angst et al., 2011). People are generally different in how they exhibit these symptoms. Some may cycle back and forth from these episodes, while others may experience a long – normal mood range before getting into a hypomanic or depressive episode.

Treatment

Pharmacotherapy

Pharmacotherapy involves the administration of drugs to help bipolar patients. When an affected individual is receiving acute episodes, psychiatrists aim to reduce the severity of a patient’s symptoms. However, when administering maintenance treatment, psychiatrists aim to prevent recurring episodes in a patient’s daily life (McCormick, Murray & McNew, 2015). There different categories of psychotherapy medication;

Mood Stabilizers

Lithium was among the first mood stabilizers used in trying to improve extreme mood swings exhibited by individuals. Lithium has been the only medication that is not correlated with the risk of suicide, and it is proven very efficient in preventing the reoccurrence of manic episodes. However, the most commonly used mood stabilizer is Sodium valproate. It is preferred over lithium because it has a rapid onset action (McCormick, Murray & McNew, 2015). Another joint mood stabilizer is Lamotrigine. Lamotrigine has the reputation of working well to prevent major depressive episodes in comparison to manic episodes. It cannot be used alone to manage acute manic episodes.

Unfortunately, these mood stabilizers have to be taken with much precaution because they can have huge side effects. While using lithium, one’s sugar levels must be constantly monitored. If not, there is a risk of developing renal insufficiency and thyroid toxicity. Common side effects associated with sodium valproate use include alopecia, tremor, sedation, diarrhea, and weight gain (McCormick, Murray & McNew, 2015). Lamotrigine has side effects such as dizziness, headaches, double visions, rash, and tiredness.

Atypical antipsychotics

They are generally used to mitigate psychosis and deal with insomnia among affected individuals (Maclyntyre & Calabrese, 2019).

Antidepressants

Choosing the type of medication to be given to a patient is directly determined by a patient’s history and the number of episodes they exhibit over time. Other factors that are to be considered during medication administration include; targeted symptoms, individual ability to target information, physical condition, such as whether they are pregnant. According to (Maclyntyre & Calabrese, 2019). Some of the precautions to be taken include;

1. Individual experiencing high ratios of depression to manic episodes needs administration of drugs such as lithium and lamotrigine to be very effective.
2. If an individual experiences medical illness such as renal failure, lithium’s dehydration prescription should be avoided at all costs.
3. Lithium cannot be used in patients who have a history of suicide attempts. A slight overdose could bring a person to the ultimatum of their lives.
4. For individuals who experience a frequent mixture episode, a mixture of drugs is usually the best prescription.
5. Since some of the drugs used can lead to weight gain, proper nutrition and exercise are advised. Exercise can also help try to maintain mood swings as stable as possible. Physical inactivity and poor diet can lead to patients’ low cognitive ability, which can negatively affect their diagnosis. Poor dietary and exercise patterns are a predictor of poor response to pharmacological drugs.

Psychosocial treatments for bipolar disorders

Psychotherapy is a mode of treatment that is commendable for all categories of bipolar treatments. Issues such as anger, suicidal thoughts, and ideation can be easily managed by psychotherapy. Psychotherapy treatment can be offered to individuals or through groups and families People are taught how they can manage suicidal thoughts and anger tendencies while undertaking therapy. During this process, they should know more about their disorder, how they can obtain support, and improve intrapersonal skills.

Studies have shown that psychotherapeutic education is an effective tool in preventing relapse of patients diagnosed with advanced bipolar disorder. When a bipolar individual is subjected to a family form of therapy, they can develop problem-solving and communication skills. Using psychotherapy is very effective on patients who have a reduced number of recurring episodes. Through psychotherapy, people are taught to be able to detect the earliest symptoms of bipolar disorder. In this manner, even the family can quickly form a support system and help the affected individual get early treatment.

Multicomponent Programs

This kind of program is designed to target different aspects of an individual’s life and give a holistic approach towards intervention (Bonnin et al., 2019).  One of such interventions is the Risk Reduction Intervention developed by Frank et al. (2015). The program was developed to constitute 17 sessions of grouping. The seventeen sessions consist of different aspects of care that can be afforded to bipolar patients. Components of such sessions include psychoeducation, nutrition classes, physical exercise sessions, and training to improve sleeping patterns. Some parts of the session include sittings with family members (Bonnin et al., 2019).

The multifaceted approach also takes the pharmacological treatment approach very seriously. This integrated approach ensures that all aspects of bipolar disorder II are taken into account when trying to improve the quality of health of an individual,

Hospital Treatment

Some individuals are termed as high-risk patients. They include people who attempt suicide. It is also inclusive of individuals who, when they are in hypermania episodes they take activities that constantly put their lives in danger.

Conclusion

In truth, people who suffer from bipolar II disorder, in the end, may experience functional decline, cognitive impairment, and a reduction of the quality of life. Early diagnosis and treatment can help in ensuring the quality of life of an affected individual.

References

American Psychiatric Association. (2021). Bipolar Definition and DSM-5 Diagnostic Criteria. https://www.psycom.net/bipolar-definition-dsm-5/

Angst, J., Azorin, J. M., Bowden, C. L., Perugi, G., Vieta, E., Gamma, A.,& BRIDGE Study Group. (2011). Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Archives of general psychiatry, 68(8), 791-799.

Basso, L. A., Argimon, I. I. D. L., & Arteche, A. (2013). Systematic review of the prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. Trends in psychiatry and psychotherapy, 35(2), 99-105.  http://dx.doi.org/10.1590/S2237-60892013000200002.

Bonnín, C. D. M., Reinares, M., Martínez-Arán, A., Jiménez, E., Sánchez-Moreno, J., Solé, B., & Vieta, E. (2019). Improving functioning, quality of life, and well-being in patients with bipolar disorder. International Journal of Neuropsychopharmacology, 22(8), 467-477. https://doi.org/10.1093lijnp/pyxo18

Frank, E., Wallace, M. L., Hall, M., Hasler, B., Levenson, J. C., Janney, C. A., & Kupfer, D. J. (2015). An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: results from a randomized trial. Bipolar disorders, 17(4), 424-437.

Kerner, B. (2014). Genetics of bipolar disorder. The application of clinical genetics, 7, 33. https://doi.org/10.2147/TACG.S39297

McCormick, U., Murray, B., & McNew, B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 27(9), 530-542.https://doi.org/10.1002/2327-6924.12275

McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and unmet needs of a complex disorder. Current medical research and opinion, 35(11), 1993-2005.https://doi.org/10.1080/03007995.2019.1636017

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic advances in psychopharmacology, 8(9), 251-269. https://doi.org/10.1177/2045125318769235