BIPOLOAR DISORDER AND TREATMENT

INTRODUCTION TO NEUROLOGICAL DISORDER A neurological disorder is a disorder of the body’s nervous system. Structural, biochemical or electrical abnormalities in the brain or spinal cord, or in the nerves leading to or from them, can result in symptoms such as paralysis, muscle weakness, poor coordination, and loss of sensation, seizures, confusion, pain and altered levels of consciousness. There are many recognized neurological disorders. Some relatively common, but many rare. They may be revealed by neurological examination and studied and treated within the specialties of neurology and clinical neuropsychology, Interventions include preventative measures, lifestyle changes, physiotherapy or other therapy neuro rehabilitation, pain management, pain management, medication, or operations performed by neurosurgeons. TYPES OF EPILEPSY:-  ABSENCE EPILEPSY:-             People with absence epilepsy have repeated absence seizures. Absence epilepsy tends to run in families. The seizures frequently begin in childhood or adolescent. If the seizures begin in childhood, they usually stop at puberty.                   Although the seizures don’t have a lasting effect on intelligence or other brain functions, children with absence epilepsy frequently have so many seizures that it interferes with school and other normal activities. TEMPORAL LOBE EPILEPSY:-                   TLE is the most frequent cause of partial seizures and aura. The temporal loge is located close to the ear. It is the part of the brain where smell is processed and where the choice is made to express a thought or remain silent.                   TLE often begins in childhood repeated TLE seizures can damage the hippocampus, a part of the brain that is important for memory and learning. Although the damage progressive very slowly. It is important to treat TLE as early as possible FRONTAL LOBE EPILEPSY:-                    The frontal lobe of the brain lies behind the forehead. They are the largest of the five lobes and are thought to be the centers that control personality and higher thought processes. Including languages and speech.                    Frontal lobe epilepsy causes a cluster of short seizures that start and stop suddenly. The symptoms depend upon the part of the fronted lobe affected. OCCIPITAL LOBE EPILEPSY:-                     The occipital lobe lies at the back of the skull occipital lobe epilepsy is like fronted and temporal lobe epilepsies, except that the seizures usually begin with usual hallucinations, rapid blinding, and other symptoms related to the eyes. PARIETAL LOBE EPILEPSY:-                      The parietal lobe lies between the frontal and temporal lobes. Parietal lobe epilepsy is similar to other types in part because parietal lobe seizures tend to spread to other areas of the brain. CAUSES OF EPILEPSY:- BRAIN CHEMISTRY:-                      Epilepsy may develop because of an imbalance in those chemicals in the brain that help the nerve cells in the brain transmit electrical impulses. These chemicals are called neuron transmitters.                      Researchers think that some people who have epilepsy have too much of a neuron transmitter that increases impulse transmission and other have too little of neuron transmitters that reduce transmission.                      Epilepsy may also cause by changes in brain cells called glia. Glias regulate concentrations of chemicals in the brain that can change the way neurons signal. HEREDITARY CAUSES                    Many types of epilepsy tend to run in families, and some have been traced to an abnormality in a specific gene. These genetic abnormalities can caused subtle changes in the way the body processes calcium, sodium and other body chemicals.                    People who have progressive myoclonus epilepsy are missing a gene that helps break down protein. Those with a severe form of epilepsy called lafora’s disease are missing a gene that helps break down protein. Those with a severe form of epilepsy called lafora’s disease are missing a gene that helps break down carbohydrates.                  Hereditary factors are not always direct cause of epilepsy but may influence the disease indirectly. Genes can affect the way people process drugs or can cause areas of malformed neurons in the brain. OTHER DISORDER                  Epilepsy can be triggered by brain damage. Epilepsy can sometimes be stopped by treating these underlying disorders. In other causes, epileptic seizures will continue after the underlying causes are treated disorder. In other cases, epileptic seizures will continue after the underlying cause is treated. ·        Brain tumors, alcoholism, and Alzheimer’s disease can cause. Epilepsy because they alter the normal working of the brain. ·        Stroke, heart attacks and others conditions that affect the blood supply to the brain (cerebrovascular diseases) can causes epilepsy by depriving the brain of oxygen. About a third of all new cases of epilepsy that develop in older people are caused by cerebrovascular diseases. ·        Infection diseases such as meningitis, viral encephalitis, and AIDS can cause epilepsy. ·        Cerebral palsy, autism and a number of other developmental and metabolic disorders can cause epilepsy. HEAD INJURY:-                      Head injury can cause seizures; if the head injury is severe the seizures may not begin until years later. If the injury is mild the risk is slight. PARANTAL INJURY:-                     In a fetus the developing brain is susceptible to prenatal injuries that may occur if the pregnant mothers has an infection, doesn’t eat properly, smoke or abuses drugs or alcohol. These conditions called cerebral palsy.                    About 20% of seizures in children are caused by cerebral palsy or other nervous system diseases. Sometimes epilepsy is linked to areas in the brain where neurons may not have formed properly during prenatal development. ENVIRONMENTAL CAUSES Epilepsy can be caused by ·        Environmental and occupational exposure to lead carbon monoxide, and certain chemicals ·        Use of street drugs and alcohol ·        Lack of sleep, stress, or hormonal changes ·        Withdrawal from certain antidepressant and anti – anxiety drug EPILEPSY – SYMPTOMS:-              Seizures are the only visible symptom of epilepsy there are different kinds of seizures and symptoms of each type can affect people differently. Seizures typically last from a few seconds to a few minutes. You may remain alert during the seizure or lose consciousness. You may not remember what happened during the seizure or may not even realize you had a seizure.              Seizures that make you fall to the ground or make the muscles stiffen or jerk out of control are easy to recognize. But many seizures do not involve these reactions and may be harder to notice. Some seizures make you stare into spark for a few seconds. Others may consist only for a few twitches a turn of head, or a strange smell or visual disturbance that only you sense.               Epileptic seizures often happen without warning, although some people may have an aura at the beginning of a seizure. A seizure ends when the abnormal electrical activity in the brain stops activity begins to retur4n to normal. Seizures may be either partial or generalized. TREATMENT FOR EPILEPSY:-             Treatment for epilepsy will not normally begin unless you have a second seizure.              This is because it is quite common for a person to have a one – 0ff seizure and nerve have a second one.               However, occasionally someone may have a tests carried out after one seizure such as an EGG test. Once the doctors have carried out their tests and asked for any witness reports, they will then decide whether they feel the person does have epilepsy and is so will need to start treatment. ANTI – EPILEPTIC DRUGS (AED’S)                The majority of people with epilepsy can be successfully treated with medicines known as anti – epileptic drugs (AED’S) AEDs do not cure epilepsy. But they do prevent seizures from occurring.              There are many different AEDs but they all tend to work by either. Altering the electric transmission in your brain in a way that reduces the chance of a seizure, or Altering the chemicals in your brain in a way that reduces the chance of a seizure SIDE EFFECTS ARE COMMON WHEN STARTING TREATMENT WITH AEDs ·        Nausea ·        Abdominal pain ·        Drowsiness ·        Dizziness ·        Irritability, and ·        Mood Changes                 For some people, the side effects will pass within a few days, whereas for others, the effects may persist for many months.                Some side effects, which produce symptoms that are similar to being drunk, occur when the dose of AEDs you are taking is too high. They include. ·        Unsteadiness ·        Poor Concentration ·        Drowsiness ·        Vomiting, and ·        Double vision

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BIPOLOAR DISORDER AND TREATMENT

INTRODUCTION TO BIPOLAR DISORDER:-          Bipolar disorder or manic –depressive disorder is a psychiatric diagnosis that describes a category of mood episodes define by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood and one or more depressive episodes. The elevated moods are clinically referred to as mania or , if milder hypomania. Individuals who experiences manic episodes also commonly experience depressive episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. INTRODUCTION TO MANIA:-       Mania is more than just feeling good or even euphoric with true mania, people can be described by words like “frantic”, “hyperactive” or over –excited often a person’s thought and speech is so “fast” that it tumbles over itself and becomes fragmented by following tangents of thoughts and ideas cycling between mania and depression is the hallmark of bipolar disorder (previously called manic-depression) but there are other possible causes of mania.          Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal and/or energy levels. The word derives from the Greek “caviar” (mania).           In addition to mood disorder’s individuals may exhibit manic behavior as a result of drug intoxication, medication side effect, or malignancy. However mania is most often associated with bipolar disorder, where episodes of mania may alternate with episodes of major depression. The criteria for bipolar do not include depressive episodes and the presence of mania in the absence of depressive episodes is sufficient for a diagnosis. Regardless, even those who never experience depression experience cyclical changes in mood. These cycles are often affected by changes in sleep cycle, diurnal rhythms and environmental stressors.          Mania varies in intensity, from mild mania (known as hypomania) to fall-blown mania with psychotic features including hallucination and delusion naturally, since mania and hypomania have also been associated with creativity and artistic talent. SIGN AND SYMPTOMS        Characteristics of mania include rapid speech, racing thoughts, decreased need for sleep hyper sexuality, euphoria, impulsiveness, grandiosity and an uncontrollably intense interest in goal-directed activities. Some people also have physical symptoms such as sweating, pacing, and weight loss in full-blown mania, the manic person well feel as thought his or her goal trump all else, that his or her goal trump all else, that there are not exercise restraint in the pursuit of what they are after Hypomania is different, as it may cause little or no impairment in function. The hypo manic person’s connection with the external world, and its standards of interaction, remain intact, although intensity of moods is heightened. But those who suffer from prolonged unresolved hypomania do run the risk of developing full mania even realizing they have done so one of the most signatures of mania is what many have described as racing thoughts. There are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli. This experience creates an absent mindedness where the manic individual thoughts totally preoccupy him or her, making him or her unable to keep track of time or be aware of anything besides the flow of thought. Racing thoughts also interfere with the ability to fall asleep.           Mania is always relative to the normal of intensity of the person being diagnosed with it, therefore, an easily-angered person may exhibits mania by getting even angrier even more quickly, and an intelligent person may adopt seemingly “genius” characteristics and an ability to perform and to articulate thought beyond what they can do in a normal mood but perhaps the easiest indicator of mania would be noticeably clinically depressed person becomes suddenly cheerful optimistic happy, and full of energy. Other element of mania may include delusions, hypersensitivity hyper sexuality,  hyperactivity impulsiveness, talkativeness, an internal pressure to keep talking (over-explanation) or rapid speech, grandiose ideas and plans, and decreased need for sleep (e.g. feeling rested after 3 or 4 hours of sleep) In manic and hypo manic cases the afflicted person may engage in out-of character behavior, such as questionable business transactions wasteful expenditures of money, risky sexual activity, recreational drug abuse, abnormal social interaction, or highly vocal arguments uncharacteristic of previous behaviors. These may increase stress in personal risk of relationships. Lead to problems at work and increase the altercation with law enforcement. There is a high risk of impulsively taking part in activity potentially harmful to self and other TREATMENT          Before beginning treatment for mania careful differential diagnosis must be performed to rule out non-psychiatric causes.          Acute mania in bipolar disorder is typically treated with mood stabilizers and antipsychotic medication. Note that these treatment need to be prescribed and monitored carefully to avoid harmful side effect such as neuronleptic malignant syndrome with the antipsychotic medication. It may be necessary to temporarily admit the patient involuntary unit the patient is stabilized. Antipsychotic and mood stabilizers help stabilize mood of those with mania or depression. They work by dopamine and allowing serotonin to still work, but in diminished capacity          When the manic behavior have gone, long-term treatment then focuses on prophylactic treatment to try to stabilize the patient’s mood, typically through a combination of pharmacotherapy and psychotherapy           Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. Anticonvulsants such as valproic acid and carbamazepine are also used for prophylaxis. More recent drug solutions include lamotrigine clonazepam is also used           Verapamil a calcium- channel blocker is useful in the treatment of hypomania and in those cases were lithium and mood stabilizers are contraindicated or ineffective. Verpamil is effective for both short –term and long-term treatment.

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