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Bipolar Disorder

Definition of Bipolar Disorder

Bipolar Disorder, or BP, was previously called manic-depression or manic depressive disorder. BP is characterized by extreme moods - highs and lows. Symptoms cycle from clinical or major depression, to mania and manic behavior. Bipolar Disorder is not a case of 'the blues'. It isn't the normal cycle of up and downs we all experience from too much stress, too little sleep, losing the lottery, or breaking up with a boyfriend. Bipolar Disorder can significantly affect a patient's ability to function, and can result in strained or broken relationships, poor job performance, and poor performance in school or group settings. Symptoms do not go away in a week or two. If left untreated, the disorder can even result in suicide. A 1992 Johns Hopkins University survey of patients with schizophrenia and bipolar disorder reported a 19% incidence of threatened or attempted suicide. Other studies indicate that 25%-50% of bipolar patients will attempt suicide at least once during the course of their illness. It is estimated that 15% of the population of patients with bipolar disorder will commit suicide, even with treatment. The suicide rate in untreated bipolar disorder cases is even higher. It is difficult to pinpoint the incidence in untreated cases because many untreated cases are also undiagnosed and, thus, the triggering suicidal event is never determined.

Causes of Bipolar Disorder

Mental health disorders typically stem from more than one cause, and Bipolar Disorder (BP) is no exception to this rule. Research on Bipolar Disorder indicates links to hereditary or genetic factors and environmental factors. Those with a family history of depression, bipolar disorder or other mental disorders seem more likely to suffer from a mental disorder, and specifically from depression or bipolar disorder. Other research indicates a chemical imbalance in the brain of the bipolar patient. In some patients, symptoms appear after a stressful event in the patient's life, e.g. the death of a spouse, a divorce, or the loss of a job. Some people survive these events without consequences, but for others the event will trigger Bipolar symptoms.

Children with Bipolar Disorder

Most cases of Bipolar Disorder are diagnosed in the early years of adult life, but research indicates that some children, diagnosed with Depression, are actually suffering from Bipolar Disorder. Symptoms can begin in early childhood, though they may not occur until adolescence. Up to 3.4 million American children and adolescents, diagnosed with some form of depression, may actually suffer from early-onset bipolar disorder. Symptoms may be episodic, disappearing for a time and then reappearing with vigor. Children with Bipolar Disorder should not be called 'Bipolar Children' or a 'Bipolar Child'. Labels will make the child feel isolated and different. These children are at greater risk for anxiety or mood disorders, and Attention Deficit-Hyperactivity Disorder (ADHD). Other conditions mimic bipolar disorder, and many doctors do not screen children for Bipolar Disorder, so children may go undiagnosed well into their adult years.

Research and Clinical Studies on Bipolar Disorder

About 4.4% of U.S. adults have Bipolar Disorder and the number is growing. Men and women are equally likely to the disorder, and the average age of onset is in the early twenties. Detailed information on Bipolar clinical studies and research results is available on the National Institute of Mental Health website (http://www.nimh.nih.gov), and on the U.S. Government Clinical Trials website (http://www.clinicaltrials.gov)

Symptoms of Bipolar Disorder

There are two types of Bipolar Disorder. Bipolar I is characterized by severe, debilitating symptoms, with extreme episodes, including some or all of the following:

Manic Symptoms

• Agitation, nervousness, irritability, feeling edgy, short-tempered,
• Feeling you can 'do no wrong', inflated sense of self, grandiose feelings, inappropriate or poor judgment
• Increased sex drive or desire, loss of inhibition
• Dressing or speaking in an extreme, or unusual manner
• Inability to focus
• Delusions, hallucinations
• Euphoria, or feeling 'high'
• Heavy use of drugs or alcohol
• Boundless energy, sleeplessness, insomnia
• Rage, aggression or combative behavior
• Racing or disassociated thoughts, extreme talkativeness, rapid speech
• Reckless spending, high speed driving, high risk activities, decisions made without considering consequences

Depressive Symptoms

• Abnormally low, listless mood and energy
• Constant fatigue, increase/decrease in sleep, insomnia, excess sleep
• Feelings of guilt, worthlessness and unworthiness
• Inability to concentrate or focus, or to make everyday decisions
• Excessive drug or alcohol use
• Absence of self-esteem or confidence
• Extreme increase or decrease in appetite or weight
• Sadness, hopelessness, an attitude of 'what's the use?'
• Withdrawal from family, friends, co-workers
• No interest in activities, even normally exciting or interesting tasks
• Self abuse or injury, thoughts, talk, plans or attempts of suicide

Bipolar II is also called Hypomania. Bipolar II or Hypomanic episodes, and symptoms, are significantly less extreme than Bipolar I behaviors.

Diagnosing Bipolar Disorder

Bipolar Disorder should be diagnosed by a psychiatrist, a specialist, equipped to recognize the symptoms. Accurate diagnosis is crucial, because treatment usually includes medication. If the wrong medication is prescribed, symptoms may worsen, or side effects may occur. To diagnose Bipolar Disorder, doctors look for at least two years of numerous periods of hypomanic and depressive symptoms. In children, the duration of symptoms must be at least one year. Symptoms must cause significant impairment in social, work or school or other functional areas.

When Bipolar Disorder is Misdiagnosed

Bipolar Disorder is often misdiagnosed. In children, it is most frequently misdiagnosed as Attention Deficit-Hyperactivity Disorder (ADHD) or Depression. In adults, doctors must rule out other disorders resulting from general medical conditions, and any of the following conditions or disorders:

If Bipolar Disorder is suspected, a professional psychiatric consultation is required. A second opinion is required if some other disorder was diagnosed and the treatment regimen is not working. The patient should mention the possibility of this disorder to the doctor, especially if there is a family history of depression, manic depression, or bipolar disorder. Doctors must rule out any of the following disorders or coincident factors:

Major Depressive, Clinical Depressive or Unipolar Depressive Episode

Some patients describe Clinical Depression as a dark curtain over their life. Some describe overwhelming feelings of fatigue, lack of focus and an inability to function. Others say they feel edgy and cranky. Known as Clinical Depression, or Major or Severe depression, or sometimes Unipolar Depression, this disorder is not a 'state of mind'. Unipolar Disorder is characterized by severe and debilitating depressive episodes. Whereas Bipolar Disorder consists of cycling manic (high) and depressive (low) symptoms, Unipolar Disorder does not. Patients with Unipolar Disorder only have symptoms at one end of the spectrum (the low end). This disorder can significantly affect the patient's ability to function normally.

Cyclothymia or Cyclothymic Disorder

Cyclothymia is characterized by manic and depressive states, but neither state is of significant duration or intensity to warrant a diagnosis of Bipolar Disorder or of Clinical or Major Depression or Unipolar Disorder. Cyclothymic Disorder is diagnosed where there is a history of hypomania, with no previous episodes of mania or severe depression.

Dysthymic Disorder (otherwise known as Dysthymia or Dysthemia)

Dysthymic Disorder symptoms are milder and longer-lasting than those of Major Depression, and they are usually not disabling. This disorder may develop in childhood, but usually emerges in middle age. It is common for dysthymic patients to experience major depressive episodes. Also referred to as neurotic depression, minor depression, or intermittent depression, characteristics include at least a two-year history of depressed moods, with episodes lasting two or more days. Dysthymic Disorder is not severe, has less impact on daily activities, but can last for years, or even decades.

Treatment for Bipolar Disorder

If Bipolar Disorder is diagnosed, a combination of therapies is often used with good results. These therapies can reduce frequency and severity of episodes. Treatment(s) can include:

• Medications (as prescribed by a psychiatrist or other qualified health care professional): lithium, anticonvulsants, medications for extreme manic episodes, and insomnia
• Electroconvulsive Therapy (ECT) in careful application for severe cases of unresponsive Bipolar Disorder
• Education and therapy for the patient and family
• Assessment of patient Bipolar episodes and schedules mitigate damage and teach coping skills
• Psychotherapy
• Cognitive behavioral therapy (CBT)

Bipolar Support Groups

Support groups are available to patients and families coping with Bipolar Disorder at the community and the national level. Local social services and mental health organizations are a good place to look, and you can find resources on the internet. The most highly respected of these groups is the Depression Bipolar Support Alliance. You can call them toll-free at (800) 826 -3632.

How to Help a Loved One with Bipolar Disorder

Here are some simple things you can do to help a patient with Bipolar Disorder.

• Be understanding. This is a medical condition and it should not be looked upon with shame or disdain.
   
• Try to avoid threats. Don't place blame or tell them that they can 'change if they want to change'. If your child suffers from Bipolar Disorder, you may have to take action to protect them from harm if they are acting out, but don't threaten the child because of the behavior. If you exercise discipline with an adult, avoid threats. Remain calm! Tell them what you are doing and why.
   
• Don't expect 100% recovery. Patients may experience a relapse in times of stress and will need your support.
   
• Let the patient do what they can do for themselves. Let them take charge of their illness and be responsible for taking medication. Don't explain or excuse behavior to others or embarrass the patient. Let them speak for themselves.
   
• Offer support and understanding, and consider other resources that may help you and your family member, or friend. You can find free mini-courses and helpful resources at BipolarSupporter.com.

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