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Bipolar Disorder

Bipolar Disorder or Bipolar affective disorder was also previously know as manic depression or manic-depressive disorder, is a psychiatric diagnosis that is considered a mood disorder.

It can be defined as one or more episodes of abnormally elevated energy levels, elevated cognition, and mood changes with or without one or more depressive episodes.

There is often a mental status of hyper emotions called mania and with added Depression.

4-6 percent of people experience some of the characteristic symptoms at some point in their lives.

This is a very complicated and often misunderstood diagnosis. Often symptoms or problems are clumped together under the name of Bipolar. Diagnosis should be done by a health care or mental health provider.

Large problems with the condition is the social stigma or prejudice against those with symptoms. Spiraling down, self harm, drug abuse, and many other problems can be linked to this diagnosis and some of the social misunderstandings.

Signs and Symptoms

–  Manic states (Hypomanic)
–  Mood changes
–  Daily function problems
–  Depression  (not all individuals will develop this symptom)
–  Lack of sleep
–  Too much sleep
–  Lack of eating
–  Excess eating
–  Impulsive behavior
–  Erratic behavior
–  Pressured speech
–  Racing thoughts
–  Feeling grandiose
–  Anxiety

Classification of some symptoms

Mild to Moderate Level:     The person may feel some levels of energetic and excitability.

Higher Level:    The person may feel some high levels of erraticability and impulsive. They will often make poor decisions due to unrealistic or impossible ideas bout the future. They often have difficulty with sleep.

Highest Level:   The person may feel some severely manic changes. Psychotic behavior that turns to violence.

Additional Classifications

A Mixed State –  This individual can experience manic episodes and experience depressive episodes.

Rapid Cycling –  This individual rapidly alternates from manic to depressive changes.

Severely Manic episodes – This individual can have serious erratic events that can lead to psychotic problems of delusions and hallucinations.

Hypomanic Event – Occurs during Hypomanic Episode. Individual will feel good. Family may notice a mood swing but the individual will note that everything is okay. They feel some Euphoria and feel good about where they are mentally.

1.)  Manic Episode

–  This is the defining feature of this disorder
–  A distinct period of elevated or irritable mood changes
–  Can seem like excitement or euphoria
–  Often last for x 1 week or more
–  Decrease need for sleep during this period  (maybe on 2-4 hours of sleep a night)
–  Sometimes they go for days without sleeping
–  Substance abuse may occur or spending sprees or engage in risky behavior.
–  They may become aggressive or abrasive
–  They may seem rude, unemotional, and lack empathy

2.)  Hypomanic Episode

–  This is a mild or moderate change in mood.
–  Not as significant or extreme as a Manic Episode
–  Individual may seem optimistic
–  They become more productive than usual.
–  Some hyper-sexuality may be seen
–  Often there are no delusions or hallucinations

3.)  Depressive Episode

–  This can be seen in many bipolar individuals
–  Accompanied by sadness, anger, isolation, hopelessness, guilty, shame, and fear.
–  Changes in sleep and appetite can be seen
–  Social anxiety
–  Lack of motivation
–  Self hating or change in what they used to enjoy can be seen.
–  Fatigue
–  Some individuals could have episodes of psychotic behavior.
–  Delusions or Hallucinations can occur.
–  Profound depression can persist from weeks to months.

4.)  Mixed Affective Episode

–  Symptoms of mania and depression occur at same time.
–  Typically seen is manic euphoria and weeping or depression and racing thoughts.
–  This is a very confusing state.
–  Often individuals become upset at themselves for having contradicting thoughts and beliefs.
–  Sometimes they feel they are getting better and worse at the same time.
–  Thoughts of self harm can occur.

Subtypes

1.)  Bipolar I disorder

–  One or more manic episodes
–  A depressive episode is not required for this subtype but it often occurs

2.)  Bipolar II disorder

–  No manic episodes
–  One or more hypomanic episodes + One or more major depressive episodes.
–  Episodes are without psychosis

3.)  Bipolar disorder NOS  (Not otherwise Specified)

–  Inclusive category where a description doesn’t match the others.

4.)  Cyclothymia

–  Hypomanic episodes with depression
–  Depression doesn’t meet the major depressive level.
–  Cycling of mood
–  Functioning may be disrupted.

Causes

–  Genetic factors largely contribute to the likelihood of developing bipolar symptoms.

–  Environmental factors also play a large role or link to symptoms.

–  These factors may include stress, life altering events, traumatic/abusive experiences in childhood, and others.

Diagnosis

This is an extremely difficult area. Diagnosis is done on a compilation of symptoms by the individual and those around them.

The individual must be assigned criteria that define symptoms. Assessment by a licensed provider will help in the process. Physical exam should be done as well.

Treatment

1.)  Management

–  Pharmacological and Psycho-therapeutic options are available.
–  Discussion with your licensed provider should be made to see which options are available.
–  Hospitalization may be required in extreme manic episodes.
–  Voluntary or involuntary hospitalization can be seen depending on state law.

2.)  Medications

Mood stabilizers are used.

The first medication or “gold standard” is often  Lithium Carbonate

–  Used for acute manic episodes
–  Used to prevent relapses
–  More for manic than depressive episodes

Also used is Sodium Valproate  (Valproic Acid or Depakote)

–  Used for acute manic episodes

Also used is Carbamazepine  (Tegretol)

–  Used for acute manic episodes
–  Used for cycling symptoms

Also used is Lamotrigine  (Lamictal)

–  Used in treating bipolar depression
–  Great benefit in severe depression
–  Used to prevent relapses
–  No use in cycling symptoms

Also used is Topiramate  (Topamax)

Other medications used are under classification Atypical Antipsychotics

Such as:

  –  Olanzapine  (Zyprexa)

  –  Quetiapine  (Seroquel)

  –  Risperidone (Risperdal)

  –  Ziprasidone (Geodon)