Bipolar disorder is a brain disorders 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. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.
Bipolar I disorder is diagnosed when a person experiences a manic episode. During a manic episode, people with bipolar I disorder experience an extreme increase in energy and may feel on top of the world or uncomfortably irritable in mood. Some people with bipolar I disorder also experience depressive or hypomanic episodes, and most people with bipolar I disorder also have periods of neutral mood.
A manic episode is a period of at least one week when a person is extremely high-spirited or irritable most of the day for most days, possesses more energy than usual, and experiences at least three of the following changes in behavior:
These behaviors must represent a change from the person’s usual behavior and be clear to friends and family. Symptoms must be severe enough to cause dysfunction in work, family, or social activities and responsibilities. Symptoms of a manic episode commonly require a person to receive hospital care to stay safe.
Some people experiencing manic episodes also experience disorganized thinking, false beliefs, and/or hallucinations, known as psychotic features.
A hypomanic episode is characterized by less severe manic symptoms that need to last only four days in a row rather than a week. Hypomanic symptoms do not lead to the major problems in daily functioning that manic symptoms commonly cause.
A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including at least one of the first two symptoms):
A diagnosis of bipolar II disorder requires someone to have at least one major depressive episode and at least one hypomanic episode (see above). People return to their usual functioning between episodes. People with bipolar II disorder often first seek treatment as a result of their first depressive episode, since hypomanic episodes often feel pleasurable and can even increase performance at work or school.
People with bipolar II disorder frequently have other mental illnesses such as an anxiety disorder or substance use disorder, the latter of which can exacerbate symptoms of depression or hypomania.
It depends. Mood shift frequency varies from person to person. A small number of patients may have many episodes within one day, shifting from mania (an episode where a person is very high-spirited or irritable) to depression. This has been described as “ultra-rapid cycling.”
Not necessarily. Studies have shown that approximately 10 percent of patients have a single episode only. However, the majority of patients have more than one. The number of episodes within a patient’s lifetime varies. Some individuals may have only two or three within their lifetime while others may have the same number within a single year. Frequency of episodes depends on many factors including the natural course of the condition as well as on appropriate treatment. Not taking medication or taking it incorrectly are frequent causes of episode recurrence.
Although it is possible that during the natural course of the illness individual patients may get well without any medication, the challenge is that it is impossible to identify or determine beforehand who those fortunate patients are. Although some patients don’t get well or just have partial response to the best available treatments, on average—and for the vast majority of patients—the benefits of medications outweigh the risks.
The term “mixed episode” was changed to “mixed features” in the last edition of the Diagnostic and Statistical Manual (DSM-5-TR) published by the American Psychiatric Association in 2022. The new term may apply to either episodes of mania with additional symptoms of depression or the opposite, episodes of depression with additional symptoms of mania. The overall idea is that the presence of both symptoms of mania and depression can exist at the same time. Symptoms of mania include elated or irritable mood, decreased need to sleep or racing thoughts. Symptoms of depression can include depressed mood, impaired sleep and feelings of hopelessness or worthlessness.
Outcomes are always better when there is a strong family support network. Think of bipolar disorder as any other severe medical condition. However, also note that in many severe psychiatric conditions, patients may not be aware that they are ill. They may minimize the severity of their condition. The result of these factors may be that patients will not follow through on their treatment. In very severe cases, there may be instances of a lack of behavioral control where family members may not be able to look after their loved ones. In those cases, assistance from providers or crisis services (call the national 988 Suicide and Crisis Lifeline) may be necessary.
©2024. Athma Hospitals. All Rights Reserved.