Artificial Intelligence Foundation
ABOUT RICHARD WALLACE:
Dr. Richard S. Wallace is the Chairman of the Board and co-founder of the A.L.I.C.E. Artificial Intelligence Foundation. He is the author of Artificial Intelligence Markup Language (AIML) and Botmaster of A.L.I.C.E. (Artificial Linguistic Internet Computer Entity). Dr. Wallace's work has appeared in the New York Times, WIRED, CNN, Time, ZDTV and in numerous foreign language publications across Asia, Latin America and Europe.
Richard Wallace is a volunteer accountant and programmer for St. Martin de Porres' Chapel, a medical cannabis patient services organization. Wallace was diagnosed with bipolar affective disorder in 1992, and became functionally disabled in 1999.
Bipolar Affective Disorder
WHAT IS BIPOLAR AFFECTIVE DISORDER?
Bipolar Affective Disorder is an abnormal fluctuation in moods, varying between marked highs (mania) and lows (depression) with periods of stability.
Both men and women are affected equally, with the average age of onset said to be 28, yet children, adolescents and seniors can also be affected. Approximately one per cent of the population is believed to have the disorder.
"Bipolar"' refers to the two poles of the continuum with mania being the higher pole and depression being the lower pole. "Affective" means one's mood or emotions.
The dramatic fluctuation in mood is sometimes referred to as an "episode" or as a "mood swing". The frequency, severity and length of the episodes vary from one individual to another. Without treatment and proper care, the frequency and severity of this chronic disorder can increase.
Individuals with bipolar disorder often spend many years seeking professional help and may get from three to four diagnosis from doctors receiving a correct diagnosis. Early diagnosis is important as it can lessen the effects of the disorder on the individual. Individuals with bipolar disorder have an approximately 90 percent risk alcohol and substance abuse. Marital fluctuation, chronic unemployment, and suicide are also prevalent.
It is thought that the more episodes experienced by the individual before receiving a correct diagnosis, the more difficult it is to treat. Individuals who do not respond well to treatment are said to be "refractory".
Many people will continue to lead successful and fulfilling lives after treatment. Revolutionary medications used to treat this disorder, combined with community supports have decreased the effects of the disorder. Some individuals may experience grief and loss over their perceived selves prior to treatment. Most individuals experience feelings of denial: "I am fine: I don't need medication" or "I felt better prior to treatment", "I cannot tolerate the side effects of medication". These are all part of the natural process that leads to acceptance.
HISTORY OF BIPOLAR DISORDER
Bipolar Affective Disorder sometimes referred to, as manic-depression has existed since the beginning of recorded time. Aerates, in the second century A.D., first used the word "mania" to describe patients who would "laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill". He noted that they would later appear "torpid, dull and sorrowful". However, it was Theophile Bonet in 1686 who first connected the two distinct ends of the mood spectrum and coined the term "manico-melancolicus".
In the 1830's Falret and Baillarger isolated and identified symptoms that remain in many of today's books and journals. They also believed that what they considered a "circular insanity" had hereditary factors. They encouraged physicians to experiment with drug therapies in the hopes of finding a cure. In 1904, Emil Kraepelin, a German physician, developed a symptomatic classification for mania and depression.
WHAT CAUSES BIPOLAR DISORDER?
A specific cause for Bipolar disorder has not been identified; there is no diagnostic test and as yet and no cure for this condition. There are a number of factors however, that contribute to its onset. They include physiology, heredity and the environment in which you live and work.
Researchers have discovered that the increase or decrease of certain chemicals, called neurotransmitters, may be involved. The electrical charges in the brain are assisted by the neurotransmitters in the brain to move from one cell to another.
There are many explanations as to how the chemistry of the brain affects our moods. Simply put the brain needs certain chemicals in specific amounts to function "normally". The condition known as bipolar is believed to result from an imbalance in these chemicals. The brain consists of many cells, called neurons that communicate with other cells throughout the body. Neurons are made of three major parts: the cell body, axon, and dendrite. To communicate messages, the neuron transmits electrical impulses that trigger chemicals to be released.
Chemicals, (also known as neurotransmitters) such as norepinephrine, dopamine, Serotonin, and others, are released into a region between two neurons -- called the synapse. Another neuron responds to the chemicals in the synaptic junction by excitement or with inhibition. Once the receiving cell has responded, the chemicals remaining in the synaptic junction are either broken down by monoamine oxidase enzymes or retaken up by the transmitter cell.
Alterations in neuronal cell function can influence psychological behavior. Depression can be caused by decreased chemical levels, especially seratonin and norepinephrine. On the other hand psychosis, Schizophrenia, or other mental illnesses can be caused by increased chemical (mainly dopamine) activity in the synapse. Bipolar disorder may be caused by variable chemical extremes in the synapse and shifting inside the neuron.
Observations have been made that both bipolar and unipolar disorders tend to run in families. Twin, adoption and family studies have shown a strong possibility of a genetic component to these conditions. This seems to be even more prevalent in bipolar disorder where there seems to be a strong connection between the disorder in the individual and their biological parents. Inform your doctor of any family history of bipolar or other conditions such as alcoholism, drug dependence or post partum depression. Include if possible, the types of medications they were treated with and any side effects they may have experienced. This information will be of immense benefit to your doctor and ultimately, you.
CHROMOSOME 22: UNRAVELING THE DNA CODE
Recent breakthroughs in understanding the humane genome have suggested depression, bipolar disorder, schizoaffective disorder, and schizophrenia are all related on a spectrum in chromosome 22. This poses remarkable possibilities for the future of better understanding and fighting bipolar illness.
THE AFFECTIVE DISORDERS SPECTRUM
J. Hudson and H. Pope first proposed the affective spectrum concept. They theorized that individuals with an affective disorder (bipolar, Unipolar, and schizoaffective disorder) tended to have many chronic symptoms of other disorders. They additionally discovered that substance abuse seems to be connected to the affective disorders.
The following is a list of the disorders that are thought to be pathologically linked: affective disorders (bipolar, Unipolar, schizoaffective); attention deficit disorder (ADD & ADHD) (Strong Link); body dysmorphic disorder (altered perception of body shape and appearance); bulimia, and other eating disorders; cataplexy; chronic fatigue syndrome; fibromyalgia; intermittent explosive disorder; irritable bowel syndrome; kleptomania; migraines/severe headaches; narcolepsy; obsessive-compulsive disorder (Strong Link); panic disorder (Strong Link); pathological gambling; pyromania ; tourette disorder.
Bipolar disorder can be difficult to treat if one has a secondary diagnosis such as alcohol or drug abuse or an anxiety disorder. Anxiety disorders are often treated with antidepressants. For individuals who have a primary diagnosis of bipolar disorder, who experience mostly manic symptoms and who have a secondary diagnosis of anxiety disorder, the addition of an antidepressant may be contraindicated. For individuals who have a secondary diagnosis of alcohol or drug dependence, see the next section on Dual Diagnosis.
Does Stress Cause Bipolar Disorder?
Monitor yourself closely, as an increase in stresses could lead to an episode. Studies have confirmed that stress can precipitate manic and depressive episodes. The biochemical imbalance makes individuals more vulnerable to emotional and physical stressors: such as lack of sleep, excessive stimulation, marital tensions and conflicts; or upsetting and traumatic life experiences. During times of stress, the brain chemistry lacks the mechanisms to function properly, triggering the onset or recurrence of an unwanted episode. Despite this reaction, the stress in and of itself is not the cause of the disorder.
Mania can be extremely destructive and cause considerable impairment in social and occupational functioning. People are more likely to seek help when moderately depressed versus when they are experiencing an episode of mania
Mania's main symptom is that of euphoria or an elevated, expansive mood. Everyone has feelings of happiness, pleasure and joy, however, in someone with this disorder, the mood progresses along a continuum from loss of self-control and judgment to psychotic thinking and behavior. Symptoms can effect emotions, thinking, and behavior.
Untreated, moderate to the more severe mania can be extremely destructive and cause considerable impairment in social and occupational functioning. Individuals are not likely to seek help when manic and they may deny that there is anything wrong with them. This can lead to involuntary hospitalizations.
Some typical symptoms of mania are: persistently euphoric or "high" states; irritability or excitability; appetite disturbance; decreased need for sleep; increased activity; increased sexuality; pressured speech or rhyming games; racing thoughts; loss of self-control and judgment; non-completion of tasks; financial extravagance; inflated self-esteem (grandiosity) impulsive behaviors; laughing inappropriately; creative or bizarre thinking; participating in risk taking activities; increased or delusional religious thoughts or experiences.
Everyone has feelings of sadness and disappointment. Depression's main symptom is that of intense, pervasive, persistent feelings of sadness, hopelessness, and frustration that cause considerable impairment in social and occupational functioning. Untreated, moderate to the more severe depression can lead to suicide attempts or psychotic thinking and behavior. People are more likely to seek help when moderately depressed versus when they are experiencing an episode of mania.
Some typical symptoms of depression are: poor appetite and weight loss or marked increase in appetite and associated weight gain; sleep disturbance; loss of energy, excessive fatigue or tiredness; slow speech and movements; change in activity level; loss of interest or pleasure in usual activities; decreased sex drive; diminished ability to think or concentrate; indecisiveness; withdrawal and isolation from family; decreased memory function and lack of concentration; disorganization; highly critical of self; low self-esteem feelings of worthlessness or excessive guilt which may reach delusional proportions; recurrent thoughts of death or self harm contemplating or attempting suicide; heightened or changed perceptions.
CLASSIFICATIONS OF BIPOLAR DISORDER
Individuals diagnosed with Bipolar I have experienced at least one manic episode and almost always have experienced depression. They may have experienced psychotic symptoms (delusions, hallucinations) during either a manic or depressive episode.
At there most severe, individuals diagnosed with Bipolar 11 experience moderate mania (hypomania), however they have not experienced psychotic symptoms (delusions and hallucinations) during either a manic or depressive episode.
Dr's. Ronald Fieve and David Dunner first coined the term "rapid cycling" to refer to individuals who experience four or more episodes, in any combination of manic, hypo manic mixed or depressive episodes in a one year span. Approximately five to 15 percent of individuals with bipolar disorder will experience rapid cycling. It is thought that some antidepressants can contribute to rapid cycling while others such as Wellbutrin don't. This form of bipolar disorder generally responds better to anticonvulsant drug therapy, as opposed to lithium therapy. Electro convulsive therapy may be another treatment option for individuals with this form of the disorder.
There are a small percentage of patients who seem to be trapped in the transitional phase where mania switches to depression, and as a result, simultaneously display symptoms of both depression and mania. These individuals are said to be in a "mixed state". Correct diagnosis is important to ensure proper treatment. Though this condition is statistically small, it is one of the most common problems seen at Hospitals.
Cyclothymia is a milder form of bipolar disorder. Cycles of depression and hypomania are shorter, irregular, and less intense. Episodes typically last for days rather than weeks. Mood states can change rapidly so that an individual can experience a distinct change in mood from day to day. About 50 percent of these patients respond to lithium therapy.
"Dual diagnosis" is defined as having a severe mental illness associated with dependence on alcohol, or other substances. There are two subgroups of patients: major substance abuse disorder coupled with another major psychiatric disorder; and abuse of alcohol, and/or other drugs in ways that affect the course of treatment of the mental disorder.
Surveys have shown that one third of Dual diagnosis psychiatric patients will abuse, or depend on alcohol and that one third of individuals suffering from alcohol abuse will be additionally diagnosed with a psychiatric disorder. Fifty percent of individuals who abuse drugs other than alcohol will be dually diagnosed.
For individuals who experience mania, the lifetime risk for developing alcoholism is six times greater than compared to the general population while major depression carries a risk of twice the average. Individuals who are dually diagnosed may have slower rate of recovery than individuals without major substance abuse. Currently, there are few comprehensive, integrated, recovery programs for these individuals, although research is continuing. A moderate lifestyle will help control the illness.
Unipolar Disorder or Major Depressive Disorder
Unipolar Affective Disorder is an abnormal fluctuation in moods, varying lows (depression) with periods of stability. Unlike bipolar disorder, individuals with unipolar disorder do not experience the high end of the continuum (mania). Although unipolar disorder usually occurs in adulthood, adolescents and seniors can also be affected, however, it is more difficult to recognize and diagnose in these groups.
The symptoms for unipolar disorder are the same as for bipolar disorder depression. There are several subtypes of this disorder. However, there are a few sub types of this disorder: melancholia; psychotic depression and Dysthymic disorder.
This is a very severe depression, having a number of major symptoms such as sleep and appetite disturbance, weight loss and social withdrawal.
This is also a very severe class of depression including the symptoms of melancholia, but also includes psychotic symptoms such as hallucinations or delusions.
This is a long-term mild depression that lasts for at least two years. This can be a debilitating form of depression that can span over several decades and can have an adverse effect on personality.
Seasonal Affective Disorder
This disorder is marked by the seasonally of the symptoms that sets it apart from all the other mood disorders. Individuals with this disorder experience an assortment of symptoms at the same time of year but not necessarily every year. Although some individuals may experience this during the summer months, the majority of people will suffer during the long winter months when the hours of darkness exceeds the hours of daylight. These people are said to have 'Winter SAD".
Their symptoms often begin in September and become pronounced in October during the autumnal equinox. For the individual, the feelings -- or symptoms -- might be subtle, or intensely obvious. Symptoms may include months of unbearable hopelessness, fatigue, weight gain, and powerful carbohydrate cravings. Treatment for this particular mood disorder can include antidepressant drug therapy or light therapy. If you wish further information on light therapy, or seasonal affective disorder, you are encouraged to call The Canadian Sleep Institute or your local hospital. Revolutionary new light therapies can help alleviate the symptoms of this disorder. General Practitioners are now capable of prescribing this therapy.
As a warning and much like antidepressants, phototherapy can cause rapid cycling and manic states in some bipolar individuals.
ANXIETY AND PANIC DISORDERS
Although anxiety disorders can leave its victims virtually disabled, they are among the most common and treatable forms of mental disorders. You do not have an anxiety disorder if you experience brief anxiety over a specific stressful event like speaking in public. This is called "reactive anxiety".
Physical (Somatic) Symptoms of Anxiety Disorders:
* Muscle aches
* Cold and clammy hands
* Racing heart
* Dry mouth
* Feeling of a loss of control
TYPES OF ANXIETY DISORDERS
Phobias with Panic Attacks Phobias are experienced as a dread, or panic, that overwhelms the sufferer when they are faced with a feared object, situation or activity. Many common phobias are familiar such as a fear of snakes, enclosed spaces (claustrophobia), airplanes, and heights. Other phobias are not as well known: such as agoraphobia, the fear of being in public with no avenue of escape, like a shopping mall or a concert. Agoraphobia can be debilitating, completely isolating an individual in his/her own home.
Panic disorders are distinguished by an intense overwhelming terror for no apparent reason. The fear is often accompanied by physical symptoms of a racing heart, sweating, hot or cold flashes, choking or smothering and feelings of unreality. If the symptoms are severe, the individual will often believe that they are about to have a heart attack, or even die. The attacks are short in duration, lasting about one hour. The attacks, however, can be frequent. One study has indicated that 1 in 3 individuals with bipolar disorder will be diagnosed with OCD. This diagnosis is not often made unless specifically screened for.
Post Traumatic Stress Disorder
This disorder can affect anyone who has survived a severe and extreme physical or emotional trauma. Rape victims, survivors of war and crime victims may develop this disorder. Some individuals find themselves re-experiencing the traumatic event through nightmares, night terrors or flashbacks. Others become emotionally numb.
Anxiety disorders are more common in women than men. However, OCD seems to be equally common in both. Often the first symptoms are experienced during adolescence or early adulthood. The exceptions to this are phobias that generally begin in childhood and disappear as the child ages.
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