Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe and can result in damaged relationships, poor job or school performance, and even suicide. There is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

More than two million American adults, or about one percent of the population age 18 and older in any given year have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

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“Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.

“I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do.”
Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6. (Reprinted with permission from Alfred Knopf, - division of Random House, Inc.)

What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes dramatic mood swings from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and Symptoms of Mania (or manic episode) include:
 Increased energy, activity, and restlessness
 Excessively “high”, overly good, euphoric mood
 Extreme irritability
 Racing thoughts and talking very fast, jumping from one idea
to another
 Distractibility, unable to concentrate well
 Little sleep needed
 Unrealistic beliefs in ones abilities and powers
 Poor judgment
 Spending sprees
 A lasting period of behavior that is different from usual
 Increased sexual drive
  Abuse of drugs, particularly cocaine, alcohol, and sleeping
medications
 Provocative, intrusive, or aggressive behavior
 Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, occurring one week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

 Lasting sad, anxious, or empty mood
 Feelings of hopelessness or pessimism
 Feelings of guilt, worthlessness, or helplessness
 Loss of interest or pleasure in activities once enjoyed,
including sex
 Decreased energy, a feeling of fatigue or of being slowed
down
 Difficulty concentrating, remembering, making decisions
 Restlessness or irritability
 Sleeping too much, or insomnia
 Change in appetite and/or unintended weight loss or gain
 Chronic pain or other persistent bodily symptoms that are not
caused by physical illness or injury
 Thoughts of death or suicide, or suicide attempts
 A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression.

People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illnes, for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. These problems in fact may be signs of an underlying mood disorder.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder cannot yet be identified physiologically, for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless". [I am] haunt[ed]"with the total, the desperate hopelessness of it all". Others say, “It’s only temporary, it will pass, you will get over it,” but of course they haven’t any idea of how I feel, although they are certain they do. If I can’t feel, move, think or care, then what on earth is the point?

Hypomania: "At first when I’m high, it’s tremendous... ideas are fast... like shooting stars you follow until brighter ones appear. All shyness disappears, the right words and gestures are suddenly there... uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria... you can do anything... but, somewhere this changes".

Mania: The fast ideas become too fast and there are far too many. Overwhelming confusion replaces clarity... you stop keeping up with it. Your memory goes. Your friends become frightened...everything is now against the grain, you are irritable, angry, frightened, uncontrollable, and trapped".

[Source: National Institute of Mental Health]

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