BIPOLAR DISORDER

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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.