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Bipolar
disorder
Bipolar disorder or bipolar affective disorder (historically
known as manic-depressive disorder)
is a psychiatric diagnosis for
a mood disorder in which people experience
disruptive mood swings that encompass a frenzied
state known as mania (or hypomania)
and, usually, symptoms of depression. Bipolar disorder
is defined by the presence of one or more episodes of abnormally elevated
energy levels, cognition, and mood with
or without one or more depressive episodes.
Signs and symptoms
Bipolar
disorder is a condition in which people experience intermittent abnormally
elevated (manic or hypomanic) and, in many cases, abnormally depressed states
for periods of time in a way that interferes with functioning. Not everyone's
symptoms are the same, and there is no simple physiological test to confirm the
disorder. Diagnosing bipolar disorder is often difficult, even for mental
health professionals. Bipolar disorder can appear to be unipolar depression: what
distinguishes bipolar disorder from unipolar depression is the presence of
mania (or hypomania). While some people with bipolar disorder mainly experience
manic symptoms, others more often feel depressed. Additionally, the younger the
age of onset—bipolar disorder starts in childhood or early adulthood in most
patients—the more likely the first few episodes are to be depression.[1] Because
a bipolar diagnosis requires a manic or hypomanic episode, many patients are
initially diagnosed and treated as having major depression.
Depressive episode
Although
bipolar disorder is marked by a transition depression and mania, depression is
far more common
Signs and symptoms of
the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation,
or hopelessness; disturbances in sleep and
appetite; fatigue and loss of interest in usually enjoyable activities;
problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual
activity; shyness or social anxiety; irritability, chronic pain
(with or without a known cause); lack of motivation; and morbid suicidal
ideation. In severe cases, the individual may becomepsychotic,
a condition also known as severe bipolar depression with psychotic features.
These symptoms include delusions or, less commonly, hallucinations, usually unpleasant. A major
depressive episode persists for at least two weeks, and may continue for over
six months if left untreated.[3]
Manic episode
Mania is the signature
characteristic of bipolar disorder. Mania is generally characterized by a
distinct period of an elevated mood, which can take the form of euphoria. People
commonly experience an increase in energy and a decreased need for sleep, with
many often getting as little as three or four hours of sleep per night, while
others can go days without sleeping.[4] A
person may exhibit pressured speech, with thoughts experienced as racing.[5] Attention
span is low, and a person in a manic state may be easily distracted. Judgment
may become impaired, and sufferers may go on spending sprees or engage in
behavior that is quite abnormal for them. They may indulge in substance abuse,
particularly alcohol or other depressants, cocaine or other stimulants, or sleeping
pills. Their behavior may become aggressive, intolerant, or intrusive. People
may feel out of control or unstoppable, or as if they have been
"chosen" and are "on a special mission" or have other
grandiose or delusional ideas. Sexual drive may increase. At more extreme
phases of bipolar I, a person in a manic state can begin to experience psychosis,
or a break with reality, where thinking is affected along with mood.[6] Some
people in a manic state experience severe anxiety and are very irritable (to the point
of rage), while others are euphoric and grandiose.
To
be diagnosed with mania according to the Diagnostic and Statistical Manual of
Mental Disorders (DSM), a person must experience this state of elevated or
irritable mood, as well as other symptoms, for at least one week, less if
hospitalization is required.[7]
Severity
of manic symptoms can be measured by rating scales such as self-reported Altman Self-Rating
Mania Scale[8] and
clinician-based Young Mania Rating Scale.[9][10]
Sleep
disturbance is the most common prodromal symptom; mood, psychomotor and
appetite change, and anxiety can also occur up to three weeks before a manic
episode develops.[11]
Mixed affective
episode
In the context of
bipolar disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously.
Typical examples include tearfulness during a manic episode or racing thoughts
during a depressive episode. Individuals may also feel incredibly frustrated in
this state, since one may feel like a failure and at the same time have a flight of ideas. Mixed states are often the most dangerous
period of mood disorders, during which substance abuse, panic disorder, suicide attempts, and other
complications increase greatly.
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