The Consequence of Not Treating Bipolar Disorder

Introduction

Psychological well-being is one of the key indicators of a healthy lifestyle. However, diseases like bipolar disorder are not only responsible for psychological problems but also associated with other comorbid conditions. As a result, early diagnosis and treatment can be useful in such cases; however, if patients refuse to take proper medical interventions, that may lead to deterioration of the condition.

What Is Bipolar Disorder?

Bipolar disorder is a psychological illness characterized by major or rapid changes in emotions and mental status. This condition is also called manic-depressive illness or manic depression. This is one of the major causes of psychological disabilities in the world, along with mental problems.

1. Pathophysiology: The exact causative factors involved in bipolar disorder are not known. According to some researchers, the neurobiological changes in the brain are responsible for such pathologies. In most cases, genetic factors are involved in such conditions. Changes in genes like CACNA1C, ODZ4, and NCAN. Also, chromosomal changes and changes in the DNA are associated with it. Apart from this, the effects of external factors like stress, trauma, and drugs play a pivotal role in the pathogenesis of this disorder. All these factors lead to changes in the body. Changes in neurotransmitters like serotonin and dopamine are seen in this condition. Also, the functioning of the neurons is altered. In bipolar disorder patients, the low-level and dysfunctioning activity of gamma-amino-butyric acid (GABA) is observed. Apart from this, changes in the other factors like brain-derived neurotrophic factor, nerve growth factor, neurotrophin-3, and neurotrophin-4

2. Symptoms: The symptoms of bipolar disorder are numerous. However, such symptoms usually appear during the late teenage years. Symptoms may vary according to the type of bipolar disorder the person is suffering from. The person may experience emotional imbalance characterized by anxiousness, irritability, sadness, and frequent changes in emotions. Also, symptoms like sleep irregularities, hunger problems, and inactivity can be observed. Based on symptoms, different types of bipolar disorders are;

• Bipolar I Disorder: In this condition, patients may experience manic episodes. Such episodes may last more than seven days. Also, symptoms of depression may be present in such cases. In a year, there should be four or more episodes of mania or depression.

• Bipolar II Disorder: In this condition, symptoms of depression are observed.

• Cyclothymic Disorder: In this condition, recurrent episodes of hypomanic and depressive symptoms are seen. However, symptoms are not severe in such cases.

What Are the Pathophysiology of Untreated Bipolar Disorder?

The change in the symptoms of bipolar disorders is attributed to the neurophysiological changes in the body. The outside stimuli and the external factors associated with bipolar disorder are often termed allostatic load. In untreated cases, these external factors cause progressive changes in the hypothalamic-pituitary-adrenal (HPA) axis. These changes are attributed to the presence of an increased amount of inflammatory mediators like cytokines in the body. Increased oxidative stress caused by these inflammatory mediators is responsible for damage to the brain structure and neurons. Gradually, brain-derived neurotrophic factors (protein necessary for the survival of neurons) are deficient, and an increased level of cortisol (steroid hormones produced by adrenal glands) in the blood is observed. With progressive episodes, gradual and permanent changes in the brain can be observed. These changes are;

1. Less cerebral blood flow is seen bilaterally in anterior temporal regions, as well as the left parietal area.

2. A decrease in prefrontal cortical metabolism and an increase in subcortical metabolism is observed. A decreased blood flow in the medial prefrontal cortex is observed in patients suffering from bipolar disorder I. Such patients enhanced subcortical activation in the amygdala, thalamus, and basal ganglia.

3. In patients with bipolar disorder, a decreased functioning of dopamine receptors in the frontal lobe is seen. Also, in some cases, a decrease in serotonin receptors is observed.

4. A huge amount of white matter hyperintensities are one of the most common findings in patients suffering from untreated bipolar disorder. These structural hyperintensities are caused by several factors like demyelination (damage of the protective layers of the nerve), astrogliosis (a defense mechanism in which an increased number of astrocytes is seen due to destruction of nerves), or axonal loss (loss of axons in the nerve cells).

What Are the Symptoms of Untreated Bipolar Disorder?

These progressive symptoms associated with untreated bipolar disorder show

Sensitization or increase in pathological behaviors. Often, these conditions are compared with malignancy as things gradually become worse. Types of sanitization seen in such cases are;

1. Stress Sanitization: The onset of bipolar episodes is often related to the timing and length of stressors. History of traumatic events and physical or sexual abuse are also related to episodes of bipolar disorder. However, in untreated cases, vulnerability to future episodes rises, and spontaneous episodes might lead to bipolar symptoms.

2. Substance Abuse Sensitization: Dependence on various drugs like cocaine and alcohol. In such cases, the clinical circumstances become increasingly challenging due to the combination of additional stressors, episodes, and instances of substance abuse, along with their cross-sensitization.

3. Episode Sanitization: Patients with unipolar or bipolar depression may experience more frequent episodes with shorter periods of feeling normal, as well as more severe symptoms that are harder to treat. Additionally, having more past episodes can lead to more cognitive issues.

The clinical manifestations of untreated patients of bipolar disorder are;

1. Episodes of bipolar symptoms are rapid and appear at a faster pace. The normal state of mind duration between two episodes is progressively reduced.

2. The stress factor and effect of outside stimuli for initiating bipolar symptoms are gradually becoming less evident. In some severe cases, symptoms usually appear without any stress factors.

3. Reduction in the cognitive functions after each successive episode. Also, there is a loss of progressive brain functions.

4. The gradual development of symptoms like poor self-management and memory loss can be observed.

5. Increase in neuroanatomical abnormalities.

6. Patients start responding slowly to the therapeutic approaches.

7. Gradually, symptoms of other systemic disorders like cardiovascular complications appear.

What Are the Treatment Options?

Treating patients who have not received treatment for bipolar disorder is difficult. This is due to the complexities of the symptoms and the presence of various comorbid conditions. Psychological counseling and convincing the patient to undergo any kind of treatment are the primary goals. N-acetylcysteine can be used in patients with substance abuse and suffering from conditions like post-traumatic stress disorder, depression, and autism. Acetyl-L-carnitine helps treat peripheral neuropathy. Valproate, which is one of the main drugs for bipolar disorder, can be used in patients having anxiety disorders and anger issues. Other than this, drugs like Gabapentin and Modafinil can also be used.

Conclusion

Bipolar disorder is a serious psychological disorder. Early diagnosis and medical interventions are required for the proper well-being of the patients. However, in certain cases, patients refuse to take any medical interventions. This may lead to serious complications and increase the severity of the condition. Permanent damage to the brain structures is seen in such cases.