Definition

Bipolar Disorder, or Manic-Depressive Disorder as it was previously known, is classified in the DSM-IV as a Mood Disorder. Its characteristic features are episodic mood swings from mania (an elated or irritable state) to depression (a state of low mood and decreased energy and activity). In between these polar states, there may be a period of more-or-less normal, adaptive functioning.

The first episode may be either mania or depression and will likely follow a stressful life event. Recent U.S. epidemiological studies are suggesting that the first episode for males tends to be mania, whereas the first for females is more likely to be depression. Manic episodes can begin abruptly and may last for a few weeks or four to five months. Depression may often continue for several months and sometimes longer in the case of the elderly. The frequency of the episodes and the pattern of remissions and relapses differ from one person to the next; however, the tendency is for remissions to get shorter and depressions to become more common and longer lasting in the absence of treatment.

In addition to these clinical features, Bipolar Disorder is also further categorized as having two presenting types: Bipolar I and II. Bipolar I involves episodes of mania and depression which may be severe in scope. Bipolar II involves short-term episodes of heightened mood and energy (Hypomania) and one or more periods of depression.

There is a near equal incidence of Bipolar I in both sexes, and its prevalence in the population has been estimated at 0.4% - 1.6%; the prevalence of Bipolar II is considered to be about 0.5%. The research literature also suggests that no one racial or ethnic group is more susceptible to the disorder. While there is presently no cure for the disorder, it is highly treatable.

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Symptoms

Manic symptoms range from Hypomania and Acute Mania to Delirious Mania.

Hypomania is not sufficiently severe enough to impair functioning. It is characterized by such things as elevated mood and self-confidence, and increased energy and mental and physical activity. There are also feelings of heightened perception and creativity, as well as a sense of well-being. Sleep is generally disrupted and the individual may appear distracted and suffer from impaired judgements.

AcuteMania is a more protracted period of mania that may engender disjointed and disorganized thinking, hallucinations and delusions. Impulsive behavior may be readily apparent and an individual may be at risk for injury during this phase.

Delirious Mania may continue for some weeks and is characterized by confusion and bewilderment. An individual's condition is likely further exacerbated by poor nutrition and exhaustion at this point. This extreme manic phase has sometimes been mistaken for schizophrenia.

Depressive symptoms include such things as a slowing of activity, low mood, slowing of thoughts and difficulty with decision making. There is also often a negative outlook towards self and others, low motivation and disinterest in completing everyday tasks as well as tasks previously enjoyed. Sleep is also disrupted in addition to appetite and there may be a decrease and/or loss of sex drive.

Cause(s)

A singular cause for Bipolar Disorder is so far unknown. A gene for the disorder has not been identified, but evidence suggests that there is a genetic component. For example, it tends to run in families; however, it is also the case that not all those with a family history of the disorder will suffer from it. Others factors are likely involved; in fact, the role of environmental stressors is insufficiently understood at present. Other evidence that underscores at least a partial genetic explanation is the higher risk for the disorder in twins and first degree relatives.

Course

The age of onset typically occurs in the later teens and early twenties. If left untreated, mood swings will tend to become more severe over time and may occur as often as every few weeks or every few years. With treatment, mood swings can become less frequent, shorter, and less intense. Between episodes, individuals are able to function normally, but about 1/4 of those with the disorder may experience symptoms between episodes.

Treatment

Bipolar Disorder is often treated with medication as well as counseling and, sometimes, electroconvulsive therapy (ECT).

Medication for manic episodes includes mood stabilizers (typically "Lithium"), anticonvulsants, and antipsychotics. Antidepressants are prescribed for depression. Variability of effects, however, may require that different products be tried for optimum effects. Antidepressants may also cause hypomania or mania and are thus frequently prescribed with Lithium. Regular monitoring of prescriptions and dosages is very important.

Several counseling approaches, including cognitive and behavioral psychotherapy, have also proved to have some efficacious value in treating this disorder. The major focus of the aforementioned therapies is to decrease the frequency and severity of episodes, and to identify and modify habitual, maladaptive patterns of thought and/or behavior, in addition to providing support and access to further resources.

In some cases, ECT is also used as an effective treatment for both phases of the disorder. ECT involves the application of a mild electric current to a region of the skull (typically in the right hemisphere) under very controlled conditions. The nightmare media depictions of ECT undertaken in past decades are by no means accurate today. Great steps are taken to ensure that no harm comes to those undergoing this type of therapy. ECT is usually considered as a later resort in difficult cases.

Dealing with Relapse

During a period of stability and wellness, individuals should devise a relapse management plan with their mental health professional and family members or friends that will outline what steps may need to be taken should a relapse occur. The plan will need to identify symptoms that may constitute warning signs and, if they are evident, an agreement should be made by the individual and members of his or her immediate support network to contact the family physician, counselor, or other mental health professional. In addition, methods to reduce stress and stimulation should be established with a counselor so that they can be put into effect pending any relapse.

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