The risk factors involved in the development of the bipolar affective disorder (BAD) can include a multitude of components. These can range from basic hereditary predispositions associated with a number of genetic elements contributing to the BAD progression to ontogenesis. The latter is related to one’s overall upbringing and traumatic events, which can significantly shift a person’s gradual development of BAD alongside to sudden changes in his or her psychology. The problem statement is manifested in the fact that an individual’s psychosocial effects and hereditary burden can be considered as two primary risk factors for the occurrence of bipolar affective disorder.
The research methodological approaches need to be conducted on the basis of research questions, which address assessing the risk factors in BAD’s early development process. In addition, they include analyzing preventative measures of preliminary type, which can potentially help to slow down or stop the progression of bipolar disorder. Lastly, it is highly important to understand the results of research through weighted assessment, where it is intended to identify if hereditary factors play a more significant role in determining the risk factors of one’s bipolar affective disorder. These are key research questions, which are critically relevant and plausible to address because the results might give thorough and in-depth comprehension of further and more focused studies. The rationale is built on the basis of the current literature and recent achievements in overseeing the risk factors alongside the therapeutical approaches for prevention, such as pharmacological treatment. It is stated that some forms of bipolar affective disorder are tightly linked to a person’s lower education and physical comorbidities, such as dementia or depression (Murri et al., 2019). In addition, mania symptoms were one of the critical elements of the development of BAD (Kling et al., 2018). This means that the given symptomatic tendencies and features of bipolar affective disorder can be used to determine the methodological approach for the study.
It is also important to understand that hereditary factors need to be thoroughly analyzed in order to properly overview the correlational relationship of BAD and its risk factors. It is stated that applying the genome study of mitochondrial DNA for single nucleotide polymorphisms (SNP) can be useful to find essential hereditary elements (Ryu et al., 2017). This can be highly useful in order to identify whether the genetic burden is linked with bipolar disorder development among the affected people. A person’s irritability and anxiety levels were also linked with bipolar affective disorder, which means that these psychological risk factors need to be analyzed in order to address the given research questions.
Based on the preceding, it is planned to conduct a pilot study of 100 patients with mixed affective disorders at the age of 20-40 years, including 50 women and 50 men who received treatment in a psychiatric institution and had an insufficient response to ongoing antipsychotic therapy with the formation of secondary resistance. Diagnoses analyzed include depressive anxiety disorder, personality disorders, dementia, depressive disorder, and neurasthenia. Affective disorders will be examined using psychometric scores such as the the Montgomery Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS). In addition, the Suicide Severity Scale Columbia University (C-SSRS) and the Hamilton Depression Rating Scale (HAMD) might also be used to assess the risk factors. This approach will assist to thoroughly analyze the potential correlational risk factors of BAD.
In addition, the family history of patients will be acquired, which will help to explain the hereditary burden. Although these studies are currently insufficient, it can still be argued that bipolar disorder can be genetically determined. That is, the risk of bipolar disorder is higher in those people whose family members have suffered or are suffering from this disease. However, stressful situations should be considered the more common cause of BAD. This can be a divorce or breakup, physical, sexual or emotional abuse, serious financial problems, or the death of a close family member. Symptoms of bipolar disorder are commonly thought to arise from changes in the balance of neurotransmitters in the brain, in particular, norepinephrine, serotonin, and dopamine. Some people with bipolar disorder experience only minor mania, but are mostly depressed. That is why they are often given the wrong diagnosis – depression. The mood swings in patients with bipolar disorder are more serious than those that people encounter every day. In between, most people can lead a normal life, but when the symptoms worsen, it becomes almost impossible without professional help.
Moreover, it is highly essential to gather data on the drugs being used by patients in order to treat the symptoms of BAD, such as mania. An instance of mania episode is characterized by an inappropriately elevated mood, which can differ from excessive happiness to almost uncontrolled arousal. The mood boost is interlinked with elevated energy levels, which causes hyperactivity behavior, the lack of sleep and pressure of speech. The symptoms might not lead to severe disruptions in work place or social non-adherence among patients. Sometimes, instead of the regular cheerful mood, irritability increased self-conceit, and impolite behavior can be seen. It is also important to mention that patients can use an antiepileptic drug. The effect of the drug is associated with a decrease in the capability of neurons to sustain a high frequency of generation of continuous action potentials through the inactivation of sodium channels. In addition, the inhibition of the neurotransmitter release by blocking the presynaptic sodium channels and the action potential development is important, which in turn reduces synaptic transmission. The drug has a moderate anti-maniacal, antipsychotic effect, as well as an analgesic effect for neurogenic pain.
Although hypomanic and manic episodes are a key phenomenon in the clinical picture of BAD, most of the time in these patients, it can be observed precisely in a depressive state. Perhaps this explains the fact that BAR II is more often diagnosed in women, and BAR I is equally common in women and men (Murri et al., 2019). Accordingly, the longer the clinically pronounced mania does not fall into the doctor’s field of vision, the longer patients will receive the wrong treatment. It is important to consider the effects of supportive pharmacotherapy of bipolar affective disorder. Prevention of another attack and relapse of BAR is the main task of maintenance therapy since only half of the patients with BAR who have received adequate treatment can achieve remission with high duration, the other half develop relapse of the disease during these periods. Compliance with the regimen of maintenance therapy is the main condition for successful prevention.
It is important to note that a certain number of the patients might not adhere to the prescribed treatment, and the rest follow the doctor’s instructions only partially. It is necessary to take into account the fact that some patients with BAR do not comply with the treatment regimen. In a longer framework, the proportion of patients who violate the treatment regimen may be even higher. The most common reasons for refusing long-term treatment may include weight gain, excessive sedation, poor compatibility with oral contraceptives, young age, and a low level of education (Mertens et al., 2015). Based on this, the additional tasks and goals of maintenance therapy should be to increase adherence to treatment, maintain a satisfactory quality of life, and minimize the risk of unwanted side effects. In addition, it is important to consider the main classes of psychopharmacological drugs used for therapy in the BAR.
Lithium salts are already used in psychiatry and are a recognized treatment for manic conditions. They remain the only reliable normothymic, whose ability to prevent the development of phases of both poles has been proven in numerous, including placebo-controlled studies. For a long time, the use of lithium preparations during pregnancy is kept in registers (Mertens et al., 2015). They do not have significant teratogenicity and can be prescribed in the last months of pregnancy, and at high risk of relapse and in the first trimester under the control of their concentration in blood plasma. In addition, the side effects of lithium salts are well known. These are dyspeptic disorders, especially in the first weeks of admission, hand tremor, dizziness, drowsiness, fatigue, muscle weakness, thirst and polyuria, decreased thyroid function, and changes in metabolism (Alda, 2015). Less commonly observed are skin reactions, weight gain, tooth loss. There is also a deterioration in memory, a constant feeling of tiredness, a decrease in vitality, and initiative.
The detected changes, as well as complaints, may depend not on the side effects of lithium preparations on mental functions, but the elimination of manic states or their insufficient effect in relation to depression. Despite this, the effectiveness of lithium preparations for maintenance therapy in BAR II has been shown. A significant proportion of patients show resistance to lithium. Among the factors indicating the likelihood of unsuccessful prophylaxis with lithium drugs are the fast-cyclic variant of the course of BAR, the absence of light gaps, or intermissions between affective seizures of different poles. This may also include many phases before the start of prophylaxis, the prevalence of dysphoric mania over euphoric, lack of a critical attitude to the disease, anxious disorder in a family or personal history, alcoholism or drug addiction in history, lack of prophylactic effect of lithium preparations in nicknames of patients (Alda, 2015). A connection has long been established between the concentration of lithium in blood plasma and its prophylactic effect. It is shown that with higher content, the prophylactic effect is higher than with a level below this (Alda, 2015). It is important to consider that the toxic effects of lithium can occur at its therapeutic or close concentrations.
In conclusion, the bipolar affective disorder can be associated with various other mental discrepancies. These might include mania, dementia, depression, and suicidal tendencies. The approach will thoroughly analyze a wide range of essential characteristics in order to find correlational relationships of patient’s treatment effects on BAD. The hereditary risk factors will be evaluated by acquiring a family history on the bipolar affective disorder in order to find its significance.
Alda, M. (2015). Lithium in the treatment of bipolar disorder: Pharmacology and pharmacogenetics. Molecular Psychiatry, 20, 661-670.
Kling, L. R., Bessette, K., DelDonno, S. R., Ryan, K. A., Drevets, W. C., McInnis, M. G., … Langenecker, S. A. (2018). Cluster analysis with MOODS‐SR illustrates a potential bipolar disorder risk phenotype in young adults with remitted major depressive disorder. Bipolar Disorders, 20(8), 697-707.
Mertens, J., Wang, Q. W., Kim, Y., Yu, D. X., Pham, S., Yang, B., … Yao, J. (2015). Differential responses to lithium in hyperexcitable neurons from patients with bipolar disorder. Nature, 527, 95-99.