Bipolar disorder, once known as manic-depression, is a psychiatric diagnosis referring to a mental health condition defined by periods of extreme, often inappropriate, and sometimes unpredictable mood states.
Bipolar individuals generally experience mania, hypomania or mixed states alternating with clinical depression and euthymic or normal range of mood over varied periods of time. There are many variations of this disorder. A person with bipolar disorder generally tends to experience more extreme states of mood than other people. Moods can change quickly (many times a day) or last for months. Bipolar individuals tend to have very ‘black and white’ thinking, where everything in life is either a positive aspect or a negative. Mood patterns of this nature are associated with distress and disruption, and a relatively high risk of suicide. Bipolar disorder is also associated with a variety of cognitive deficits, in particular, difficulty in organizing and planning. The disorder may also skew the ability to judge others’ emotion, and alter sense of awareness. Bipolar individuals can be overly observant and analytical of their environment, and in some cases paranoid of others.
This disorder is usually treated with medications and/or therapy or counselling.
As well as being linked to disability, studies have suggested a correlation between creativity and bipolar disorder, although it is unclear what the relationship is between the two. Studies have also indicated increased striving for, and sometimes obtaining, goals and achievements more generally.

Aspects

Bipolar disorder is commonly categorised as either Bipolar Type I, where an individual experiences full-blown mania, or Bipolar Type II, in which the hypomanic “highs” do not go to the extremes of mania. The latter is much more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression. Psychosis can occur, particularly in manic periods. There are also ‘rapid cycling’ subtypes. Because there is so much variation in the severity and nature of mood-related problems, the concept of a bipolar spectrum is often employed, which includes cyclothymia. There is no consensus as to how many ‘types’ of bipolar disorder exist (Akiskal and Benazzi, 2006). Many people with bipolar disorder experience severe anxiety and are very irritable (to the point of rage) when in a manic state, while others are euphoric and grandiose.

Types of mood episodes

In bipolar disorder, or bipolar depression, each mood swing is called an “episode.” There are 4 main types of mood episodes that people with bipolar disorder can have:

  • Depression: Depression is when people with bipolar disorder feel very sad. Sometimes this can go on for a long period of time. They may not even want to get out of bed or eat. They don’t enjoy doing things they used to do.
  • Mania: Mania is the other side of bipolar disorder. Mania may start with a good feeling, almost like a “high.” Or it may make a person feel very irritable and angry. People with mania may do very risky things.
  • Hypomania: Hypomania is a milder form of mania. It can make people feel good. They may think they are getting more things done. But the “feel good” stage can change into mania or depression. Hypomania is different from mania because it doesn’t get in the way of things like work or family. It sometimes is not even noticed as a problem.
  • Mixed mood: This is when feelings of mania and depression go back and forth quickly, sometimes even in the same day.

Suicide Risk

Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate in males and females with diagnosed bipolar disorder (0.4%) is 10 to more than 20 times that in the general population.
Individuals with bipolar disorder tend to become suicidal, especially during mixed states such as dysphoric mania and agitated depression. Persons suffering from Bipolar II have high rates of suicide compared to persons suffering from other mental illnesses, including Major Depression. Major Depressive episodes are part of the Bipolar II experience, and there is evidence that sufferers of this disorder spend proportionally much more of their life in the depressive phase of the illness than their counterparts with Bipolar I Disorder (Akiskal & Kessler, 2007).

Divorce Rate

According to Psychology Today, the divorce rate for couples where at least one spouse is bipolar is 90%. For comparison purposes, the general divorce rate is commonly held to be about half as much (around 50%), implying that this illness causes substantial additional burdens on married life.

Diagnosis

Flux is the fundamental nature of bipolar disorder. Both within and between individuals with the illness, energy, mood, thought, sleep, and activity are among the continually changing biological markers of the disorder. The diagnostic subtypes of bipolar disorder are thus static descriptions—snapshots, perhaps—of an illness in continual change, with a great diversity of symptoms and varying degrees of severity. Individuals may stay in one subtype, or change into another, over the course of their illness. The DSM V, to be published in 2011, will likely include further and more accurate sub-typing (Akiskal and Ghaemi, 2006).
There are currently four types of bipolar illness. The Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR) details four categories of bipolar disorder, Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified).
For a diagnosis of Bipolar I disorder according to the DSM-IV-TR, there requires one or more manic or mixed episodes. A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs.
Bipolar II, which occurs more frequently is usually characterized by at least one episode of hypomania and at least one depression.
A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning.
If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified).
Although a patient will most likely be depressed when they first seek help, it is very important to find out from the patient or the patient’s family or friends if a manic or hypomaniac episode has ever been present, using careful questioning. This will prevent misdiagnosis of Depressive Disorder and avoids the use of an antidepressant which may trigger a “switch” to hypomania or mania or induce rapid cycling. Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32) have been developed to assist the quite often difficult detection of Bipolar II disorders.

Treatment

Currently, bipolar disorder cannot be cured, though psychiatrists and psychologists believe that it can be managed.
The emphasis of treatment is on effective management of the long-term course of the illness, which usually involves treatment of emergent symptoms. Treatment methods include pharmacological and psychotherapeutic techniques.

Prognosis and long-term treatment

A good prognosis results from good treatment which, in turn, results from an accurate diagnosis. Because bipolar disorder continues to have a high rate of both under-diagnosis and misdiagnosis, it is often difficult for individuals with the illness to receive timely and competent treatment.
Bipolar disorder is a severely disabling medical condition. However, with appropriate treatment, many individuals with bipolar disorder can live full and satisfying lives. Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes.
Ultimately one’s prognosis depends on many factors, which are, in fact, under the individual’s control: the right medicines; the right dose of each; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive, and warm therapist; a supportive family or significant other; and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times.
There are obviously other factors that lead to a good prognosis, as well, such as being very aware of small changes in one’s energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one’s doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can assist them in predicting changes.
The goals of long-term optimal treatment are to help the individual achieve the highest level of functioning while avoiding relapse.

Relapse

Even when on medication, some people may still experience weaker episodes, or have a complete manic or depressive episode. In fact, a recent study found bipolar disorder to be “characterized by a low rate of recovery, a high rate of recurrence, and poor interepisodic functioning.” Worse, the study confirmed the seriousness of the disorder as “the standardized all-cause mortality ratio among patients with BD is increased approximately 2-fold.” Bipolar disorder is currently regarded “as possibly the most costly category of mental disorders in the United States.”
The following behaviors can lead to depressive or manic relapse:

  • Discontinuing or lowering one’s dose of medication, without consulting one’s physician.
  • Being under- or over-medicated. Generally, taking a lower dosage of a mood stabilizer can lead to relapse into mania. Taking a lower dosage of an antidepressant, may cause the patient to relapse into depression, while higher doses can cause destabilization into mixed-states or mania.
  • Taking hard drugs—recreationally or not—such as cocaine, alcohol, amphetamines, or opiates. These can cause the condition to worsen.
  • An inconsistent sleep schedule can destabilize the illness. Too much sleep (possibly caused by medication) can lead to depression, while too little sleep can lead to mixed states or mania.
  • Caffeine can cause destabilization of mood toward irritability, dysphoria, and mania. Anecdotal evidence seems to suggest that lower dosages of caffeine can have effects ranging from anti-depressant to mania-inducing.
  • Inadequate stress management and poor lifestyle choices. If unmedicated, excessive stress can cause the individual to relapse. Medication raises the stress threshold somewhat, but too much stress still causes relapse.

Relapse can be managed by the sufferer with the help of a close friend, based on the occurrence of idiosyncratic prodromal events. That is, by noticing which moods, activities / behaviours or thinking process / thought content typically occur at the outset of their episodes. They can then take planned steps to slow or reverse the onset of illness, or take action to prevent the episode causing damage to important aspects of their life.

Can Children and Adolescents Have Bipolar Disorder?

Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.
Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.6 Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.
Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms.
For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

New treatments

In late 2003, researchers at McLean Hospital found tentative evidence of improvements in mood during echo-planar magnetic resonance spectroscopic imaging (EP-MRSI), and attempts are being made to develop this into a form which can be evaluated as a possible treatment.
NIMH has initiated a large-scale study at 20 sites across the United States to determine the most effective treatment strategies for people with bipolar disorder. This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5-8 years. For more information, visit the Clinical Trials page of the NIMH Web site.
Transcranial magnetic stimulation is another fairly new technique being studied.
Pharmaceutical research is extensive and ongoing, as seen at clinicaltrials.gov.

Source: www.wikipedia.com, mentalhealth.about.com, www.bipolar.com

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