The phenomenon of bipolar affective disorder has been a mystery since
the 16th century. History has shown that this affliction can appear in
almost anyone. Even the great painter Vincent Van Gogh is believed to
have had bipolar disorder. It is clear that in our society many people
live with bipolar disorder; however, despite the abundance of people
suffering from the it, we are still waiting for definite explanations
for the causes and cure. The one fact of which we are painfully aware
is that bipolar disorder severely undermines its victims ability to
obtain and maintain social and occupational success. Because bipolar
disorder has such debilitating symptoms, it is imperative that we remain
vigilant in the quest for explanations of its causes and treatment.
Affective disorders are characterized by a smorgasbord of symptoms
that can be broken into manic and depressive episodes. The depressive
episodes are characterized by intense feelings of sadness and despair
that can become feelings of hopelessness and helplessness. Some of the
symptoms of a depressive episode include anhedonia, disturbances in
sleep and appetite, psycomoter retardation, loss of energy, feelings of
worthlessness, guilt, difficulty thinking, indecision, and recurrent
thoughts of death and suicide (Hollandsworth, Jr. 1990 ). The manic
episodes are characterized by elevated or irritable mood, increased
energy, decreased need for sleep, poor judgment and insight, and often
reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). Bipolar
affective disorder affects approximately one percent of the population
(approximately three million people) in the United States. It is
presented by both males and females. Bipolar disorder involves episodes
of mania and depression. These episodes may alternate with profound
depressions characterized by a pervasive sadness, almost inability to
move, hopelessness, and disturbances in appetite, sleep, in
concentrations and driving.

Bipolar disorder is diagnosed if an episode of mania occurs whether
depression has been diagnosed or not (Goodwin, Guze, 1989, p 11). Most
commonly, individuals with manic episodes experience a period of
depression. Symptoms include elated, expansive, or irritable mood,
hyperactivity, pressure of speech, flight of ideas, inflated self
esteem, decreased need for sleep, distractibility, and excessive
involvement in reckless activities (Hollandsworth, Jr. 1990 ). Rarest
symptoms were periods of loss of all interest and retardation or
agitation (Weisman, 1991).

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As the National Depressive and Manic Depressive Association (MDMDA)
has demonstrated, bipolar disorder can create substantial developmental
delays, marital and family disruptions, occupational setbacks, and
financial disasters. This devastating disease causes disruptions of
families, loss of jobs and millions of dollars in cost to society. Many
times bipolar patients report that the depressions are longer and
increase in frequency as the individual ages. Many times bipolar states
and psychotic states are misdiagnosed as schizophrenia. Speech patterns
help distinguish between the two disorders (Lish, 1994).

The onset of Bipolar disorder usually occurs between the ages of 20
and 30 years of age, with a second peak in the mid-forties for women. A
typical bipolar patient may experience eight to ten episodes in their
lifetime. However, those who have rapid cycling may experience more
episodes of mania and depression that succeed each other without a
period of remission (DSM III-R).
The three stages of mania begin with hypomania, in which patients
report that they are energetic, extroverted and assertive (Hirschfeld,
1995). The hypomania state has led observers to feel that bipolar
patients are "addicted" to their mania. Hypomania progresses into mania
and the transition is marked by loss of judgment (Hirschfeld, 1995).
Often, euphoric grandiose characteristics are displayed, and paranoid or
irritable characteristics begin to manifest. The third stage of mania
is evident when the patient experiences delusions with often paranoid
themes. Speech is generally rapid and hyperactive behavior manifests
sometimes associated with violence (Hirschfeld, 1995).
When both manic and depressive symptoms occur at the same time it
is called a mixed episode. Those afflicted are a special risk because
there is a combination of hopelessness, agitation, and anxiety that
makes them feel like they "could jump out of their skin"(Hirschfeld,
1995). Up to 50% of all patients with mania have a mixture of depressed
moods. Patients report feeling dysphoric, depressed, and unhappy; yet,
they exhibit the energy associated with mania. Rapid cycling mania is
another presentation of bipolar disorder. Mania may be present with
four or more distinct episodes within a 12 month period. There is now
evidence to suggest that sometimes rapid cycling may be a transient
manifestation of the bipolar disorder. This form of the disease
exhibits more episodes of mania and depression than bipolar.

Lithium has been the primary treatment of bipolar disorder since
its introduction in the 1960's. It is main function is to