Bipolar Disorder

Bipolar Disorder

Bipolar Disorder

Bipolar Affective Disorder (BPAD), previously known as manic depressive illness, is a mood disorder characterized by periods of depression (depressive episodes) and/or episodes of extremely elevated and/or irritable moods (manic episodes).

The duration of episodes can vary from days to weeks. Between highs and lows, people with BPAD can be completely symptom free.

Prevalence

Approximately 1% of the global population has BPAD and the male to female ratio is 1:1. The average age of onset of BPAD is 20 – 25.

Prognosis

The earlier BPAD is diagnosed correctly, the better the long-term prognosis because the person is able to receive the right treatment while symptoms are less severe.

Symptoms of Bipolar Disorder:

The symptoms of a manic episode include:

  • Elevated mood – either euphoric or agitated and irritable
  • Flight of ideas and rapid speech
  • Uncharacteristic amount of increased energy
  • Reduced need and desire for sleep
  • Hyperactivity, multi-tasking
  • Reckless, impulsive actions – like buying costly items on credit or engaging in risky behaviors with no regard to personal safety or other consequences

The symptoms of a depressive episode include:

  • Low mood, sad, anxious
  • Anhedonia— no pleasure in life
  • Reduced energy, tiredness
  • Higher need and desire for sleep, difficulty sleeping
  • Thoughts and feelings of hopelessness, worthlessness, guilt
  • Crying bouts
  • Thoughts of death or suicide
  • Decreased activity, slowed down
  • Inability to focus
  • Forgetfulness
  • Low or high appetite
  • Poor eye contact

An episode with mixed features is when someone has an episode of both manic and depressive symptoms.

Bipolar disorder with psychosis is when a depressive or manic episode is combined with psychotic symptoms of being out of touch with reality, which is sometimes misdiagnosed as schizophrenia.

Cognitive and psychosocial function can decline and possibly remain permanent after the first episode, affecting children more.

Coexisting Conditions

BPAD commonly coexists with other conditions such as substance use disorders, ADHD, personality disorders, schizophrenia, and generalized anxiety disorders.

Diagnosing Bipolar Disorder:

The diagnosis of bipolar disorder is made by a licensed mental health professional. A local doctor can carry out medical tests first to make sure the symptoms are not due to a physical illness before referring a patient on for a full mental health evaluation.

BPAD is characterized as a variation of disorders sharing a common similarity with three specific subtypes:

  1. Bipolar I Disorder: At least one manic episode (see below) is necessary to make this diagnosis. Depressive episodes are common in most cases with bipolar disorder I, but they are not necessary for a diagnosis to be made.
  2. Bipolar II Disorder: One or more hypomanic episodes (see below) and one or more major depressive episodes.
  3. Cyclothymia: A history of at least two years of hypomanic symptoms with periods of depression that do not meet diagnostic criteria for hypomania or major depressive episodes (or a one-year history for children under 18).

Mania

It is called mania if the elated mood episode is:

  • excessive and/or to the degree that a person develops psychosis —such as auditory hallucinations and/or delusional and grandiose beliefs,
and if
  • the symptoms last for seven days (or fewer if hospitalization is required or there is impairment in functioning).

Hypomania

Hypomania — literally “less than mania” — is not as severe or as intense as full-blown mania. Hypomania is characterized by mood elevation (euphoria/frenzy) and persistent lack of self-control. Hypomania is distinct from mania in that there is no significant impairment of functioning. The symptoms of hypomania may only be noticed by family and friends rather than by the individual him/herself.

Causes of Bipolar Disorder:

The causes of BPAD are not fully understood, but both genetic and environmental factors have been implicated.

  • Environmental factors that can increase an individual’s risk of developing BPAD include adverse childhood experiences such as physical and sexual abuse and chronic stress.
  • Inherited genes and family history can raise the chances of a child having BPAD by 7 to 10%.
  • People with BPAD might have a different brain type than those without it. Studies are still being done re this perspective.

Risks factors for Bipolar Disorder:

The risk of suicide is higher for anyone suffering with untreated or undertreated depression, which is part of many mood disorders, including BPAD; and those with BPAD are estimated to have a 20% lifetime risk of suicide.

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Call 911 if you are seriously contemplating or vocalizing thoughts of suicide or self harm.

Treatment of Bipolar Disorder:

While there is no cure for BPAD, the treatment for it includes both medication and talking therapy to give each person the long-term tools necessary to manage and reduce the severity of their symptoms.

  • Talking Therapy – Psychotherapy and psychoeducation are associated with positive treatment outcomes in people with BPAD. This entails providing as much educational information as is known to the person and his or her family to give understanding about the illness and help prevent relapse through their support.
  • Cognitive Behavioral Therapy – helps the person recognize triggers and early symptoms and empowers them with pre-planned strategies to cope. CBT also delves into identifying unhealthy habits and behaviors and choosing alternative healthy behaviors instead.
  • Individual and Family Therapy – for communication skills and supportive techniques
  • Electroconvulsive Therapy(ECT) – is used for treating acute manic and depressive episodes, especially with psychosis (extreme mental unrest) or catatonia (mute stupor or profound psychomotor agitation). It basically shocks the brain out of its episode by sending an electrical current through the brain. Its use is still controversial, but it might be administered when other treatments cannot be used.
  • Transcranial Magnetic Stimulation (TMS) – is a newer treatment (currently in the testing phase) for those who are not good candidates for other treatments or medications.
  • Interpersonal and Social Rhythm Therapy (IPSRT) – helps establish a better daily routine that includes regular mealtimes, exercise, and a sleep schedule. This helps manage mood swings.

Admission – (which may be involuntary) to a psychiatric hospital may be necessary if a person poses a risk to themself and/or to others.


Self-Care and Support

Education – the more you and your family learn about the disorder, the more accepting you can be when symptoms arise and the more competent you can feel about managing them.

Persistence – the more you know, the more hope you have in knowing that managing BPAD is possible; and the more relational skills you learn and adopt, the better your relationships can become.

Support groups – Spending time with others who completely understand and experience what you do can be emotionally empowering. Approx. 25 to 33% of people with BPD are prone to financial, relational and work-related difficulties, with 33% staying unemployed for up to 12 months after being hospitalized for a manic episode. This can be extremely discouraging when recovery goals have been set in place, so choosing to surround oneself with family and community support is vital.

Stress management – Exercise has long been proven to help relax the mind and body. Choose your preferred method of exercise and follow a scheduled regime on your own or in a group. Time spent on hobbies and enjoyable social activities also help.

Medications for Bipolar Disorder:

The medications prescribed for the person with BPAD depend on which aspect of the disorder is being treated — the episode(s) or short- or long-term management.

  • Antipsychotics such as olanzapineor haloperidol are given during acute manic episodes. Antipsychotics can also be given when the person cannot tolerate the prescribed mood stabilizers or they are not responding to them.
  • Mood-stabilizing medicines such as lithium and anti-epileptic drugs (AEDs) such as sodium valproate are used in the short term during manic or hypomanic episodes and in the long term for relapse, suicide, and self-harm prevention, and for depression.
  • Long-term use of lithium can cause peripheral neuropathy, hypothyroidism, or kidney dysfunction, so sodium levels, peripheral nerve function, and thyroid function must be monitored regularly.
  • Antidepressants are often prescribed for depressive episodes and to manage long-term depression, but many mental health professionals prefer to treat bipolar depression with mood stabilizers based on results. Antidepressants sometimes trigger manic episodes so they are usually taken in combination with an antipsychotic and/or a mood-stabilizing medication.
  • Anti-anxiety medications like benzodiazepines can be prescribed for short-term relief of anxiety and for sleep problems.

Because each person responds and reacts to BPAD medications and their combinations differently, and because many of the meds take a few months to take effect, it can take months to find the right combination and dose; but the outcome is worth it.

While bipolar disorder cannot be prevented, seeing a doctor to formulate a care plan when minor symptoms manifest can help lessen the severity of subsequent mania and depression. A life chart can also help those with BPAD track their symptoms better and gauge when to see their doctor to adjust their treatment plan. Because people with BPAD are at increased risk of suicide and self-harm, this can even save lives.

Symptoms of Bipolar Disorder:

The symptoms of a manic episode include:

  • Elevated mood – either euphoric or agitated and irritable
  • Flight of ideas and rapid speech
  • Uncharacteristic amount of increased energy
  • Reduced need and desire for sleep
  • Hyperactivity, multi-tasking
  • Reckless, impulsive actions – like buying costly items on credit or engaging in risky behaviors with no regard to personal safety or other consequences

The symptoms of a depressive episode include:

  • Low mood, sad, anxious
  • Anhedonia— no pleasure in life
  • Reduced energy, tiredness
  • Higher need and desire for sleep, difficulty sleeping
  • Thoughts and feelings of hopelessness, worthlessness, guilt
  • Crying bouts
  • Thoughts of death or suicide
  • Decreased activity, slowed down
  • Inability to focus
  • Forgetfulness
  • Low or high appetite
  • Poor eye contact

An episode with mixed features is when someone has an episode of both manic and depressive symptoms.

Bipolar disorder with psychosis is when a depressive or manic episode is combined with psychotic symptoms of being out of touch with reality, which is sometimes misdiagnosed as schizophrenia.

Cognitive and psychosocial function can decline and possibly remain permanent after the first episode, affecting children more.

Coexisting Conditions

BPAD commonly coexists with other conditions such as substance use disorders, ADHD, personality disorders, schizophrenia, and generalized anxiety disorders.

Diagnosing Bipolar Disorder:

The diagnosis of bipolar disorder is made by a licensed mental health professional. A local doctor can carry out medical tests first to make sure the symptoms are not due to a physical illness before referring a patient on for a full mental health evaluation.

BPAD is characterized as a variation of disorders sharing a common similarity with three specific subtypes:

  1. Bipolar I Disorder: At least one manic episode (see below) is necessary to make this diagnosis. Depressive episodes are common in most cases with bipolar disorder I, but they are not necessary for a diagnosis to be made.
  2. Bipolar II Disorder: One or more hypomanic episodes (see below) and one or more major depressive episodes.
  3. Cyclothymia: A history of at least two years of hypomanic symptoms with periods of depression that do not meet diagnostic criteria for hypomania or major depressive episodes (or a one-year history for children under 18).

Mania

It is called mania if the elated mood episode is:

  • excessive and/or to the degree that a person develops psychosis —such as auditory hallucinations and/or delusional and grandiose beliefs,
and if
  • the symptoms last for seven days (or fewer if hospitalization is required or there is impairment in functioning).

Hypomania

Hypomania — literally “less than mania” — is not as severe or as intense as full-blown mania. Hypomania is characterized by mood elevation (euphoria/frenzy) and persistent lack of self-control. Hypomania is distinct from mania in that there is no significant impairment of functioning. The symptoms of hypomania may only be noticed by family and friends rather than by the individual him/herself.

Causes of Bipolar Disorder:

The causes of BPAD are not fully understood, but both genetic and environmental factors have been implicated.

  • Environmental factors that can increase an individual’s risk of developing BPAD include adverse childhood experiences such as physical and sexual abuse and chronic stress.
  • Inherited genes and family history can raise the chances of a child having BPAD by 7 to 10%.
  • People with BPAD might have a different brain type than those without it. Studies are still being done re this perspective.

Risks factors for Bipolar Disorder:

The risk of suicide is higher for anyone suffering with untreated or undertreated depression, which is part of many mood disorders, including BPAD; and those with BPAD are estimated to have a 20% lifetime risk of suicide.

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Call 911 if you are seriously contemplating or vocalizing thoughts of suicide or self harm.

Treatment of Bipolar Disorder:

While there is no cure for BPAD, the treatment for it includes both medication and talking therapy to give each person the long-term tools necessary to manage and reduce the severity of their symptoms.

  • Talking Therapy – Psychotherapy and psychoeducation are associated with positive treatment outcomes in people with BPAD. This entails providing as much educational information as is known to the person and his or her family to give understanding about the illness and help prevent relapse through their support.
  • Cognitive Behavioral Therapy – helps the person recognize triggers and early symptoms and empowers them with pre-planned strategies to cope. CBT also delves into identifying unhealthy habits and behaviors and choosing alternative healthy behaviors instead.
  • Individual and Family Therapy – for communication skills and supportive techniques
  • Electroconvulsive Therapy(ECT) – is used for treating acute manic and depressive episodes, especially with psychosis (extreme mental unrest) or catatonia (mute stupor or profound psychomotor agitation). It basically shocks the brain out of its episode by sending an electrical current through the brain. Its use is still controversial, but it might be administered when other treatments cannot be used.
  • Transcranial Magnetic Stimulation (TMS) – is a newer treatment (currently in the testing phase) for those who are not good candidates for other treatments or medications.
  • Interpersonal and Social Rhythm Therapy (IPSRT) – helps establish a better daily routine that includes regular mealtimes, exercise, and a sleep schedule. This helps manage mood swings.

Admission – (which may be involuntary) to a psychiatric hospital may be necessary if a person poses a risk to themself and/or to others.


Self-Care and Support

Education – the more you and your family learn about the disorder, the more accepting you can be when symptoms arise and the more competent you can feel about managing them.

Persistence – the more you know, the more hope you have in knowing that managing BPAD is possible; and the more relational skills you learn and adopt, the better your relationships can become.

Support groups – Spending time with others who completely understand and experience what you do can be emotionally empowering. Approx. 25 to 33% of people with BPD are prone to financial, relational and work-related difficulties, with 33% staying unemployed for up to 12 months after being hospitalized for a manic episode. This can be extremely discouraging when recovery goals have been set in place, so choosing to surround oneself with family and community support is vital.

Stress management – Exercise has long been proven to help relax the mind and body. Choose your preferred method of exercise and follow a scheduled regime on your own or in a group. Time spent on hobbies and enjoyable social activities also help.

Medications for Bipolar Disorder can include:

The medications prescribed for the person with BPAD depend on which aspect of the disorder is being treated — the episode(s) or short- or long-term management.

  • Antipsychotics such as olanzapineor haloperidol are given during acute manic episodes. Antipsychotics can also be given when the person cannot tolerate the prescribed mood stabilizers or they are not responding to them.
  • Mood-stabilizing medicines such as lithium and anti-epileptic drugs (AEDs) such as sodium valproate are used in the short term during manic or hypomanic episodes and in the long term for relapse, suicide, and self-harm prevention, and for depression.
  • Long-term use of lithium can cause peripheral neuropathy, hypothyroidism, or kidney dysfunction, so sodium levels, peripheral nerve function, and thyroid function must be monitored regularly.
  • Antidepressants are often prescribed for depressive episodes and to manage long-term depression, but many mental health professionals prefer to treat bipolar depression with mood stabilizers based on results. Antidepressants sometimes trigger manic episodes so they are usually taken in combination with an antipsychotic and/or a mood-stabilizing medication.
  • Anti-anxiety medications like benzodiazepines can be prescribed for short-term relief of anxiety and for sleep problems.

Because each person responds and reacts to BPAD medications and their combinations differently, and because many of the meds take a few months to take effect, it can take months to find the right combination and dose; but the outcome is worth it.

While bipolar disorder cannot be prevented, seeing a doctor to formulate a care plan when minor symptoms manifest can help lessen the severity of subsequent mania and depression. A life chart can also help those with BPAD track their symptoms better and gauge when to see their doctor to adjust their treatment plan. Because people with BPAD are at increased risk of suicide and self-harm, this can even save lives.

Sources MEDICAL NEWS TODAY – Long Term Effects | SUICIDE.org | NIH – Staging Models in Bipolar Disorder | ONLINE LIBRARY WILEY – Cognitive dysfunction in major depression and bipolar disorder | GOOGLE BOOKS – Charney & Nestler’s Neurobiology of Mental Illness | NIH – The Genetics of Bipolar Disorder | NIH – Evidence-based guidelines for treating bipolar disorder | NIH – Lithium: the pharmacodynamic actions of the amazing ion | THE BMJ – Lithium in the prevention of suicide in mood disorders | NIH – Mania and dysregulation in goal pursuit| American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 123–154. | Post, RM (March 2016). “Treatment of Bipolar Depression: Evolving Recommendations”. The Psychiatric Clinics of North America (Review). 39 (1): 11–33. | Anderson IM, Haddad PM, Scott J (December 27, 2012). “Bipolar disorder”. BMJ (Clinical Research Ed.). 345