What is bipolar disorder? Bipolar Disorder, also known as manic depression, is a mental disorder with periods of depression and periods of elevated mood. During mania, an individual behaves or feels abnormally energetic, happy or irritable. Individuals often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced during manic phases. During periods of depression there may be crying, a negative outlook on life, and poor eye contact with others.
Signs and Symptoms
Mania is the defining feature of bipolar disorder, and can occur with different levels of severity. With milder levels of mania, known as hypomania, individuals are energetic, excitable, and may be highly productive. As hypomania worsens, individuals begin to exhibit erratic and impulsive behavior. Often makes poor decisions due to unrealistic ideas about the future, and level of sleep is reduced. At the extreme, manic individuals can experience distorted or delusional beliefs about the universe, hallucinate, hear voices, to the point of psychosis. A depressive episode commonly follows an episode of mania.
Mania is a distinct period of at least one week of elevated or irritable mood. It range from euphoria to delirium, and those experiencing hypo- or mania may exhibit three or more of the following behaviors:
- Speak in a rapid, uninterruptible manner
- Short attention span
- Racing thoughts
- Increased goal-oriented activities
- Agitation, or
- May exhibit impulsive behavior
- High risk behaviour such as hypersexuality or excessive spending
To meet the definition for a manic episode, these behaviors must impair the individual’s ability to socialize or work. If untreated, a manic episode usually lasts three to six months.
Hypomania is the milder form of mania, defined as at least four days of the same criteria as mania. It does not cause a significant decrease in the individual’s ability to socialize or work. It lacks psychotic features such as delusions or hallucinations, and does not require psychiatric hospitalization. Overall functioning may actually increase during episodes of hypomania. It is thought to serve as a defense mechanism against depression by some. Hypomanic episodes rarely progress to full blown manic episodes. Some people who experience hypomania show increased creativity while others are irritable or demonstrate poor judgment.
Symptoms of the depressive phase of bipolar disorder include;
- Persistent feelings of sadness,
- Irritability or anger,
- Loss of interest in previously enjoyed activities,
- Excessive or inappropriate guilt,
- Sleeping too much or not enough,
- Changes in appetite and/or weight,
- Body fatigue,
- Problems concentrating,
- Self-loathing or feelings of worthlessness, and
- Thoughts of death or suicidal ideation.
In severe cases
The individual may develop symptoms of psychosis, a condition also known as severe bipolar disorder with psychotic features. These symptoms include delusions and hallucinations. A major depressive episode persists for at least two weeks, and may result in suicide if left untreated. Children and teenagers with bipolar disorder are more likely to have temper tantrums, rapid mood changes, outbursts of aggression, explosive anger, and reckless behavior.These features must be episodic rather than chronic to receive a diagnosis of bipolar disorder.It is possible to manage all these symptoms with appropriate treatment.
A psychiatrist or psychologist bases the diagnosis on criteria set out in the Diagnostic and Statistical Manual, fifth edition (DSM-5).
The person must meet certain criteria for mania and depression, including an elevated or irritable mood and “persistently increased activity or energy levels.” These must have lasted at least 7 days, or less if symptoms were severe enough to need hospitalization.The individual and their family members, colleagues, teachers, and friends can help by relating experiences of the patient’s behavior.Other healthcare professionals may have detected secondary signs of the condition.The doctor may carry out a physical examination and some diagnostic tests, including blood and urine tests.
This can help to eliminate other possible causes of symptoms, such as substance abuse.
Other conditions that may occur with bipolar disorder are:
- use of drugs or alcohol to cope with symptoms
- post-traumatic stress disorder (PTSD)
- anxiety disorder
- attention-deficit hyperactivity disorder (ADHD)
However, these may also mask a diagnosis.
A person is more likely to seek help during a time of depression than during a “high.” Health care providers should look for signs of mania in the person’s history, in order to prevent misdiagnosis.
Types of bipolar disorder
The person may receive a diagnosis of one of three broad types of bipolar disorder.
Bipolar I disorder
For a diagnosis of bipolar I:
- There must have been at least one manic episode
- The person must also have had a previous major depressive episode
- The doctor must rule out disorders that are not associated with bipolar disorder, such as schizophrenia, delusional disorder, and other psychotic disorders.
Bipolar II Disorder
For a diagnosis of bipolar II, the patient must have experienced one or more episodes of depression and at least one hypomanic episode.
- Some people experience a mixed state, in which they may feel depressed but also restless.
- Some people experience a mixed state, in which they feel depressed but also restless.
- A hypomanic state is less severe than a manic one.
Features of a hypomanic episode include sleeping less than normal and being competitive, outgoing, and full of energy.However, the person is fully functioning, which may not be the case with manic episodes.Bipolar II can also involve mixed episodes, and there may be symptoms of mood-congruent or mood-incongruent psychotic features.
A mood-congruent psychosis would involve features that match the mood. For example, if a person is experiencing depression, mood-congruent psychosis could have a theme of sadness.
Cyclothymia involves episodes of low-level depression that alternate with periods of hypomania. The DSM-V classifies it separately from bipolar disorder, because the mood changes are less dramatic.
A person who receives a diagnosis of bipolar disorder has a lifelong diagnosis. They may enter a period of stability, but they will always have the diagnosis.
Treatment aims to minimize the frequency of manic and depressive episodes, and to reduce the severity of symptoms to enable a relatively normal and productive life.Left untreated, a bout of depression or mania can persist for up to 1 year. With treatment, improvements are possible within 3 to 4 months.
Treatment involves a combination of therapies, which may include medications and physical and psychological interventions.The person may continue to experience mood changes, but working closely with a doctor can reduce the severity and make the symptoms more manageable.
Lithium carbonate is the most commonly prescribed long-term drug to treat long-term episodes of depression and mania or hypomania. Patients usually take lithium for at least 6 months.
It is essential for the patient to follow the doctor’s instructions about when and how to take their medication in order for the drugs to work.
Other treatments include:
- Anticonvulsants: such as carbamazepine; are sometimes prescribed to treat mania episodes.
- Antipsychotics: Olanzapine, risperidone, aripiprazole are some of the options if behavior is very disturbed and symptoms are severe.
- benzodiazepines, a type of anti-anxiety medication such as alprazolam that may be used for short-term treatment
Medication may need to be adjusted as moods shift, and some drugs have side effects.
Some antidepressants such as fluoxetine-olanzapine given to patients before they have a diagnosis of bipolar disorder may trigger an initial manic episode. A doctor/clinician who is treating a patient with depression should monitor for this.
Psychotherapy, Cognitive behavioral therapy (CBT) and hospitalization
Aims to alleviate and help the patient manage symptoms.
If the patient can identify and recognize the key triggers, they may be able to minimize the secondary effects of the condition. The person can learn to recognize the first symptoms that indicate the onset of an episode and work on the factors that help maintain the “normal” periods for as long as possible.This can help maintain positive relationships at home and at work.
Cognitive behavioral therapy (CBT),
This can be done as individual or family-focused therapy, can help prevent relapses. Interpersonal and social rhythm therapy, combined with CBT, can also help with depressive symptoms.
Temporary hospitalization may be advisable if there is a risk of the patient harming themselves or others.
Electroconvulsive therapy (ECT)
This may help if other treatments are not effective.
Keeping up a regular routine with a healthy diet, enough sleep, and regular exercise can help the person maintain stability.Any supplements should first be discussed with a doctor, as some alternative remedies can interact with the drugs used for bipolar disorder or exacerbate symptoms.
Bipolar disorder the1re no single cause but is more likely to result from a range of factors that we interact with;
Some studies have suggested that there may be a genetic component to bipolar disorder. It is more likely to emerge in a person who has a family member with the condition.
Patients with bipolar disorder often show physical changes in their brains, but the link remains unclear.
Neurotransmitter imbalances appear to play a key role in many mood disorders, including bipolar disorder.
Imbalances in hormones trigger or cause bipolar disorder.
If a person may have been abused or had mental stress, a “significant loss,” or some other traumatic event may contribute to or trigger bipolar disorder.One possibility is that some people with a genetic predisposition for bipolar disorder may not have noticeable symptoms until an environmental factor triggers a severe mood swing.