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Understanding Bipolar Disorder

Bipolar disorder is a disorder that is associated with extreme mood disturbances, ranging from depressive to manic moods, with normal mood episodes as well. Depression in most cases tends to be the dominant state. The DSM-V describes Bipolar disorder as a group of brain disorders that cause extreme fluctuation in a person’s mood, energy and ability to function. Bipolar disorder disrupts a person’s life and affects their relationships. It lowers their productivity level in the workplace or school/college.

 

TYPES OF BIPOLAR DISORDERS

Bipolar disorder is of two types- Bipolar I and Bipolar II. People with bipolar disorder have intense mood episodes that occur alternatively and can be categorized as manic, hypomanic and depressive. A person affected by Bipolar I (also known as manic-depressive disorder) has had atleast one manic episode in their life. A manic episode lasts atleast one week during which a person experiences a euphoric state and extreme irritability. During a depressive mood episode, a person experiences a low energy state, and withdrawal from activities. Bipolar II is characterized by a cycle of depressive episodes, followed by hypomanic mood periods. A person with Bipolar II has had atleast one major depressive mood episode once in their life. Hypomanic mood episode is similar to manic episode, but in less severity, and doesn’t necessarily impair functioning, and is usually present in Bipolar II. Often people with bipolar also have other mental disorders such as ADHD, anxiety and substance abuse disorders. The risk of suicide is the highest in people with bipolar disorder, hence it is very important to seek professional help at the earliest.

 

BIPOLAR I

Bipolar I causes extreme mood swings between mania and depression with periods of normal moods in between. A person diagnosed with Bipolar I has at least one manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes. 

A manic mood episode, which lasts at least one week, is marked by feelings of heightened energy, creativity and an overall euphoric mood, people tend to talk a lot, engage in frenetic activity, sleep very little, and be hyperactive, impairing their normal functioning.


A manic episode includes the following symptoms: 

• Grandiosity 

• Lessened sleep requirement 

• Talking loudly and quickly 

• Difficulty to focus on one task 

• Trying to do a lot in a short period of time 

• Increased risky behaviour such as reckless driving, spending too much 


DSM-V CRITERIA

• For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes( criteria given ahead) 

• A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). 

• During the period of mood disturbance and increased energy or activity, 3 (or more) of the following symptoms (4 if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour: 

• Inflated self-esteem or grandiosity 

• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 

• More talkative than usual or pressure to keep talking 

• Flight of ideas or subjective experience that thoughts are racing 

• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed 

• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless, non-goal-directed activity) 

• Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) 

• The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 

• The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or to another medical condition 

 

BIPOLAR II

In Bipolar II, a person had had at least one major depressive episode( mentioned above) and at least one hypomanic episode. 

A hypomanic episode is similar to a manic episode, only the symptoms are less severe and tend to last only four days in a row. They do not lead to impaired normal functioning and do not cause major problems, unlike mania. 

Between hypomanic and depressive episodes, people return to normal functioning. In bipolar II, depression tends to be more severe and people first seek treatment due to depressive symptoms. Bipolar II is often accompanied by anxiety or substance abuse disorder. 

DSM V CRITERIA FOR BIPOLAR II 

  • Criteria have been met for at least one hypomanic episode and at least one major depressive episode 

  • There has never been a manic episode 

  • The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. 

  • The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the criteria for a current or past major depressive episode:

  • A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. 

  • During the period of mood disturbance and increased energy and activity, 3 (or more) of the above symptoms (4 if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree. 

  • The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. 

  • The disturbance in mood and the change in functioning are observable by others. 

  • The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. 

  • The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment).

 

TREATMENT

The severity of bipolar disorder makes apt treatment and management, and timely intervention very important.  Every person experiences Bipolar Disorder slightly differently hence the treatment is individualised, often including combination medications and psychotherapy. Medications are usually mood stabilizers and anti-depressants, depending on how the person experiences the symptoms. Support groups and Cognitive Behavioural Therapy (CBT) is also inculcated in the treatment. Since bipolar is a recurrent disorder, ongoing preventive treatment is recommended. This is a very disruptive and extreme disorder and can affect family relations too, family members are also advised family therapy to help them cope better and be an active part of the treatment. As mentioned above it is important to seek professional help for proper treatment to aid the management of the disorder so that a person is able to restore a balance in their daily functioning.

 

Informational Guide

This guide is for people with bipolar disorder, their families and anyone who wants to understand the basics of this illness and its treatment and management. It is not a substitute for treatment from a doctor or mental health care provider, but it can be used as a basis for questions and discussion about bipolar disorder. This handbook covers many aspects of bipolar disorder and answers frequently asked questions. With respect to drug treatments, new medications are continually being developed, and some current medications may not yet have been available when this guide was published.

Monitor your symptoms

In order to stay well, it’s important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. This is a free resource to help you monitor your symptoms.

 

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Delhi, India

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