deletions | additions       diff --git a/Bipolar_I_disorder_is_a__.tex b/Bipolar_I_disorder_is_a__.tex  index 6cf7241..045dbcd 100644  --- a/Bipolar_I_disorder_is_a__.tex  +++ b/Bipolar_I_disorder_is_a__.tex 
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Bipolar I disorder is a “modern understanding of the classic manic-depressive” (Diagnostic and Statistical Manual of Mental Disorders, 2013, p123). Manic episodes are periods of over a week in which there is an abnormally elevated mood and energy levels that cause impairments in social and work life. These often include a decreased need for sleep, and sometimes feelings of euphoria. Hypomania is the milder occurrence of mania, lasting at least four consecutive days and not necessarily causing life impairments. Depressive episodes are periods of two weeks in which a depressed mood or loss of interest occurs. These periods also include the possibility of weight loss, insomnia, fatigue, feelings of worthlessness, diminished ability to think, or thoughts of death.  The primary treatment for bipolar is mood stabilisers, often lithium, although recently anti-convulsants have proved successful to flatten the extreme emotions. Anti-psychotic medication is used to control manic episodes. Anti-depressant medication is used to control the depressive episodes; however anti-depressants can trigger and increase manic episodes (Zhang et al., 2013). In extreme cases, electroconvulsive therapy is the preferred option (Dierckx, Heijnen, van den Broek, & Birkenhäger, 2012). A combination of medication and psychotherapy, usually, has the best results.   Mindfulness, in short, is an awareness of, and a presence in, the now. It derives from the Buddhist meditation practice, involving a focus on the breath, the body, and sensations. In so doing, the practitioner practices self-regulation. In maintaining a focus of attention on the now, they develop a conscious awareness of their thoughts and thought patterns. The practice proposes that there are two distinct kinds of thinking; self-reference in the now and self-reference across time, a theory supported by fMRI studies (Farb et al., 2007).   Bipolar disorder is one of the top 10 most disabling conditions in the world (Kupfer, 2005). It effects an estimated 1% of the population in its classic manic-depressive form (Weissman et al., 1996), also known as the bipolar I subtype. An additional 2% of the population suffer from other subtypes and related disorders (Kupfer, 2005). The pathogenesis of the disorder remains a subject of study, with genetic factors possibly contributing to bipolar risk (Fears, Service, & Kremeyer, 2014). In 1995, the estimated cost of the disorder in the US alone was $45 billion per annum (Wyatt & Henter, 1995). On average, one-fifth of individuals with bipolar die by suicide (Jamison, 1996, p41). It “may account for one-quarter of all completed suicides” (Diagnostic and Statistical Manual of Mental Disorders, 2013, p131).  Episodes of hypomanic and depressive mood and energy levels characterise bipolar and related disorders. Bipolar I disorder is a “modern understanding of the classic manic-depressive” (Diagnostic and Statistical Manual of Mental Disorders, 2013, p123). Manic episodes are periods of over a week in which there is an abnormally elevated mood and energy levels that cause impairments in social and work life. These often include a decreased need for sleep, and sometimes feelings of euphoria. Hypomania is the milder occurrence of mania, lasting at least four consecutive days and not necessarily causing life impairments. Depressive episodes are periods of two weeks in which a depressed mood or loss of interest occurs. These periods also include the possibility of weight loss, insomnia, fatigue, feelings of worthlessness, diminished ability to think, or thoughts of death.  The primary treatment for bipolar is mood stabilisers, often lithium, although recently anti-convulsants have proved successful to flatten the extreme emotions. Anti-psychotic medication is used to control manic episodes. Anti-depressant medication is used to control the depressive episodes; however anti-depressants can trigger and increase manic episodes (Zhang et al., 2013). In extreme cases, electroconvulsive therapy is the preferred option (Dierckx, Heijnen, van den Broek, & Birkenhäger, 2012). A combination of medication and psychotherapy, usually, has the best results.  
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Five of the studies supported the idea that MBCT reduces levels of anxiety co-morbid with bipolar disorder. While this effect does not directly relate to the disorder itself, the effects of a co-morbid anxiety disorder on the prognosis for bipolar is notable. Anxiety disorders are co-morbid in approximately three-fourths of individuals with bipolar disorder (Diagnostic and Statistical Manual of Mental Disorders, 2013, p132). Those individuals who do have a co-mobid anxiety disorder are more likely to relapse, have worse sleep disturbance, are more likely to require medication, and have an increased risk of suicide (Hawke, Provencher, Parikh, & Zagorski, 2013).   In summary, research in this particular field is limited, both in number of studies and sample size. Given the nature of the disorder both in duration and treatment, various potential confounding variables remain uncontrolled. Findings so far are positive for MBCT as a treatment for co-morbid anxiety, but not for the characteristic symptoms of mania and depression with bipolar disorder. This raises some interesting questions on how exactly depression in unipolar and bipolar cases differ and whether the effects of MBCT on brain activity as seen with the neuro-imaging research, can give insight. Future studies would benefit from a control group which, rather than waiting, participated in a non-mindfulness meditative therapy as in Jain et al. (2007), to account for the placebo effect. Despite its lack of effect on bipolar symptoms, MBCT appears to be of some benefit due to its effects on anxiety levels. As such, its continued use with patients with bipolar disorder is beneficial and would give the opportunity to collect additional data and expand the understanding of both the disorder and the therapy itself.