|Bipolar disorder illustration|
The cause is not clearly understood, but both environmental and genetic factors play a role. Many genes of small effect contribute to risk. Environmental factors include a history of childhood abuse and long term stress. It is divided into bipolar I disorder if there is at least one manic episode and bipolar II disorder if there are at least one hypomanic episode and one major depressive episode. In those with less severe symptoms of a prolonged duration the condition cyclothymic disorder may be present. If due to drugs or medical problems it is classified separately. Other conditions that may present in a similar manner include attention deficit hyperactivity disorder, personality disorders, schizophrenia and substance use disorder as well as a number of medical conditions. Medical testing is not required for a diagnosis. However, blood tests or medical imaging can be done to rule out other problems.
Treatment commonly includes psychotherapy, as well as medications such as mood stabilizers and antipsychotics. Examples of mood stabilizers that are commonly used include lithium and anticonvulsants. Treatment in hospital against a person's consent may be required at times as people may be a risk to themselves or others yet refuse treatment. Severe behavioral problems may be managed with short term antipsychotics or benzodiazepines. In periods of mania it is recommended that antidepressants be stopped. If antidepressants are used for periods of depression they should be used with a mood stabilizer. Electric shock therapy may be helpful for those who do not respond to other treatments. If treatments are stopped, it is recommended that this be done slowly. Many individuals have financial, social or work-related problems due to the illness. These difficulties occur a quarter to a third of the time on average. The risk of death from natural causes such as heart disease is twice that of the general population. This is due to poor lifestyle choices and the side effects from medications.
About 3 percent of people in the US are estimated to have bipolar disorder at some point in their life. Lower rates of around 1 percent are found in other countries. The most common age at which symptoms begin is 25. Rates appear to be similar in females as males. The economic costs of the disorder has been estimated at $45 billion for the United States in 1991. A large proportion of this was related to a higher number of missed work days, estimated at 50 per year. People with bipolar disorder often face problems with social stigma.
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 appear energetic, excitable, and may be highly productive. As mania worsens, individuals begin to exhibit erratic and impulsive behavior, often making poor decisions due to unrealistic ideas about the future, and sleep very little. At the most severe level, manic individuals can experience very distorted beliefs about the world known as psychosis. A depressive episode commonly follows an episode of mania. The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode or vice versa remain poorly understood.
Mania is a distinct period of at least one week of elevated or irritable mood, which can take the form of euphoria, and exhibit three or more of the following behaviors (four if irritable): speak in a rapid, uninterruptible manner, are easily distracted, have racing thoughts, display an increase in goal-oriented activities or feel agitated, or exhibit behaviors characterized as impulsive or high-risk such as hypersexuality or excessive money 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.
People with mania may also experience a decreased need for sleep, speak excessively in addition to speaking rapidly, and may have impaired judgment. Manic individuals often have issues with substance abuse due to a combination of thrill-seeking and poor judgment. At more extreme levels, a person in a manic state can experience psychosis, or a break with reality, a state in which thinking is affected along with mood. They 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. Approximately 50 percent of those with bipolar disorder experience delusions or hallucinations. This may lead to violent behaviors and hospitalization in an inpatient psychiatric hospital. The severity of manic symptoms can be measured by rating scales such as the Young Mania Rating Scale.
The onset of a manic (or depressive) episode is often foreshadowed by sleep disturbances. Mood changes, psychomotor and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops.
Hypomania is a milder form of mania defined as at least four days of the same criteria as mania, but does not cause a significant decrease in the individual's ability to socialize or work, lacks psychotic features (i.e., delusions or hallucinations), and does not require psychiatric hospitalization. Overall functioning may actually increase during episodes of hypomania and is thought to serve as a defense mechanism against depression. Hypomanic episodes rarely progress to true manic episodes. Some hypomanic people show increased creativity while others are irritable or demonstrate poor judgment. Hypomanic people generally have increased energy and increased activity levels.
Hypomania may feel good to the person who experiences it. Thus, even when family and friends recognize mood swings, the individual will often deny that anything is wrong. What might be called a "hypomanic event", if not accompanied by depressive episodes, is often not deemed as problematic, unless the mood changes are uncontrollable, volatile or mercurial. Most commonly, symptoms continue for a few weeks to a few months.
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 thoughts. In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features. These symptoms include delusions or, less commonly, hallucinations, which are usually frightening and/or intimidating. A major depressive episode persists for at least two weeks, and may continue for over six months if left untreated.
The earlier the age of onset, the more likely the first few episodes are to be depressive. Because a bipolar diagnosis requires a manic or hypomanic episode, many patients are initially diagnosed and treated as having major depression.
Mixed affective episodes
In the context of bipolar disorder, a mixed state is a condition during which symptoms of both mania and depression occur at the same time. Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while at the same time experiencing depressive symptoms such as excessive guilt or feeling suicidal. Mixed states are considered to be high-risk for suicidal behavior since depressive emotions such as hopelessness are often paired with mood swings or difficulties with impulse control. Anxiety disorder occurs more frequently as a comorbidity in mixed bipolar episodes than in non mixed bipolar depression or mania. Substance abuse (including alcohol) also follows this trend.
Please love and understand your family and friends that suffer from this illness. They need you. (And it's REAL!)