Mental health articles

People with bipolar disorder experience both depression and periods of mania. According to DSM-IV-TR, mania involves at least three of the following symptoms:

inflated self-esteem or grandiosity

decreased need for sleep

more talkativeness than usual or pressure to keep talking

flight of ideas or the experience that thoughts are racing

distractibility

increased activity or psychomotor agitation

excessive engagement in high-risk activities.

Manic individuals move rapidly, talk rapidly and loudly, and their conversation is often fi lled with jokes and attempts at cleverness. Flamboyance is common. Judgement is often poor, and individuals may engage in risky and other behaviours that they regret when less manic. They may also become extremely frustrated by the actions of others, whom they see as preventing them achieving their great plans. Of note is that while many people appear extremely happy while in a manic episode, this may not always be the case. The experience of Christina, who had experienced signifi cant mood swings for many years, illustrates this issue. When she was in a manic phase, she typically wore livid coloured clothes, used bright and excessive make-up, and was generally hyperactive, gregarious and had diffi culty in concentrating on one thing at a time.

DSM-IV-TR described two types of bipolar disorder:

Bipolar disorder I : individuals typically experience alternating episodes of depression and mania, each lasting weeks or months. Some individuals may experience several episodes of either mania or depression, separated by periods of ‘normality’, in sequence. Some people may swing between depression and mania in one day.

Bipolar disorder II : depressive episodes predominate. The individual may swing between episodes of hypomania (an increase in activity over the normal, but not as excessive as mania) and severe depression. In addition, they will not have experienced an episode of mania.

Between 1 and 2 per cent of the adult population will experience bipolar disorder at any one time, with disorder I being the more prevalent. While the overall prevalence among men and women does not differ, women seem to have more depressive and fewer manic episodes than men and to cycle between these episodes more frequently. The fi rst episode of bipolar disorder usually occurs between the ages of 20 and 30 years. Over half of those who have an initial episode of major depression and at least 80 per cent of those who have an initial episode of mania will have one or more recurrences, and over 50 per cent will experience this within the fi rst year of the disorder. Each episode may last days, weeks or, in some cases, years.

The seriousness of the disorder tends to increase over time, although after about ten years there may be a marked diminution in severity. As with major depression, the prevalence of the condition differs according to social and cultural circumstances. Grant et al. found an overall prevalence within the US population of 2 per cent. However, the prevalence was highest among Native Americans, young adults, people who were living alone following separation or bereavement, and those in lower socio-economic groups. Prevalence rates were lowest among Asian and Hispanic people.

Tags: Bipolar Disorder, bipolar symptoms, diagnosis, symptoms