Bipolar Disorder

What is Bipolar Disorder? | Symptoms | Causes & Risk Factors | Diagnosis | Treatment | FAQ

Bipolar disorder is a brain disorder that causes changes in a person’s mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes [1]. Bipolar disorders are classified as the experience of both depression and hypomania or mania. It is marked by the presence of manic or hypomanic episodes, which are nearly always preceded or mood disorders and suicide followed by periods of depression [2].

Depression is the emotional state of extreme sadness and dejection while mania involves abnormally elevated moods and euphoria, often accompanied by sudden outbursts of irritation.

There are three types of Bipolar Disorders – Bipolar I Disorder, Bipolar II Disorder and Cyclothymic Disorder. The three types differ in their intensities and duration of manic and depressive episodes. Manic episodes are periods of extremely “high,” elated, irritable, or energised behaviour. Conversely depressive episodes are “low,” sad, indifferent, or hopeless periods.

Some people with bipolar disorder (Bipolar II) may also experience a less severe form of mania, also known as hypomania.

• Bipolar I Disorder — Defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
• Bipolar II Disorder — Defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
• Cyclothymic Disorder (Cyclothymia) — Defined by periods of hypomanic symptoms and periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Typically, the symptoms of bipolar disorder first appear in adolescence or early adulthood, and are repeated over the patient’s lifetime, expressed as unpredictable recurrences of hypomanic/manic or depressive episodes [3].

Mania and hypomania refers to periods characterised by abnormally ‘high’ moods and behaviour. Typically, a manic or hypomanic episode include three or more of the following symptoms [4]:

• Exaggerated sense of self-esteem or grandiosity
• Abnormally jumpy or agitated
• Increased activity and energy
• Decreased need for sleep
• Unusual talkativeness or pressure to talk constantly
• Racing thoughts
• Problems with focusing and easily distracted
• Making risky or poor decisions — e.g. splurging or taking sexual risks

Mental health professionals link mania and manic behaviour to Type I disorder. Here, patients suffer from abnormally heightened moods, hyperactivity and a reduced inclination for sleep. Hypomania and hypomanic behaviour is linked to Type II disorder; its symptoms are less severe than mania. Unlike hypomania, mania is more likely to cause disruptions and problems at work, in school and for relationships.

Depressive episodes often present similarly to depression, such as Major Depressive Disorder. They include:

• Extreme changes to appetite and weight gain or loss
• Difficulty concentrating, remembering, and making decisions
• Fatigue and decreased energy
• Feelings of guilt, worthlessness and helplessness
• Feelings of hopelessness, sadness and emptiness
• Troubles sleeping, such as insomnia or hypersomnia
• Loss of interest in hobbies and activities that were once enjoyed
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
• Persistent sad or anxious moods
• Restlessness and irritability
• Thoughts of death or suicide, including suicide attempts which can include a specific plan

Though the specific causes of bipolar disorder are unclear, mental health professionals believe that an imbalance of brain chemicals leads to the dysregulated brain activity in the condition. The average age of onset is 25 years old [5].

Bipolar disorder commonly runs in families: 80 to 90 percent of individuals with bipolar disorder have a relative with bipolar disorder or depression, making it one of the strongest and most reliable risk factors for bipolar disorders [5].

For diagnosis of Bipolar Disorder in general, extreme moods must persist for at least a week. In addition, three or more additional symptoms must occur in the same time period. There must also be significant impairment of occupational and social functioning, and hospitalisation is often necessary during manic episodes.

Hypomanic episodes can also occur; these involve milder versions of the same symptoms and last at least 4 days. Although the symptoms listed are the same for manic and hypomanic episodes, there is much less impairment in hypomania, and hospitalisation is not required [2].

The slight differences in diagnosing Bipolar I and II Disorder are listed below:

Psychosis or the lifetime experience of a major depressive episode are not requirements

• Meet the criteria for a manic episode
• Experience periods of depression, but meeting diagnosis criteria for a major depressive episode is not required

Psychosis and/or the lifetime experience of a major depressive episode are requirements

• Meet the criteria for major depression
• Experience periods of hypomania, but meeting diagnosis criteria of full-blown mania is not required

• Experience of hypomanic symptoms that do not meet full criteria of a hypomanic episode along with numerous bouts of depressive symptoms, for at least 2 years (or at least 1 year for children and adolescents).
• Hypomanic and depressive symptoms are present for at least half the time during the 2 year-period (or 1 year-period for children and adolescents) and the period without symptoms does not last longer than 2 months at a time.
• Individual has never met criteria for a major depressive, manic or hypomanic episode.
• Symptoms experienced are not caused by substances that may cause physiological effects – drug abuse or medication.
• Symptoms can impair daily social and occupational functioning.

Mental health professionals usually treat Bipolar Disorder with combination of medication and psychotherapy. They may prescribe Mood stabilisers (i.e. lithium) and antipsychotic medications to treat mania or hypomania. They may also prescribe antidepressants to treat depressive episodes.

Professionals may also use Cognitive Behavioural Therapy (CBT) to help patients better cope with their symptoms, reduce the negative impacts on their relationships and avoid triggers that may bring about manic, hypomanic or depressive episodes.

References:

[2] Butcher, J., Hooley, J., & Mineka, S. (2013). Abnormal psychology (16th ed.)