Mental health articles

Bipolar Disorder Along with Major Depression, bipolar, or manic de- pressive disorder, represents a major mood disorder. “Bipolar” refers to the fact that patients may experi- ence two clinical poles: depression, and mania or hy- pomania. Most bipolar patients experience multiple cycles of depression interspersed with mania or hypo- mania. Less than 10% of bipolar patients tend to only experience manic-type episodes and not depression. However, any patient who experiences at least one hypomanic episode, that is not explained by another disorder, is conventionally described as bipolar.

 A manic episode may be thought of as the flip side of a depressive episode. Instead of patients feeling de- pressed, they may feel euphoric and on top of the world. However, as the manic episode evolves, panic and dysphoria may be common features. Instead of feeling fatigued and lacking in energy, the manic pa- tient has more energy than he can handle, and may need very little sleep or no sleep at all. Rather than feeling bad about himself like the patient in a depres- sive episode, the manic patient may be quite grandi- ose. Likewise, anhedonia in the depressed patient is replaced by an increase in goal-directed activity in which the patient may try to accomplish too much and have extremely unrealistic goals. There is often a certain impulsivity that may get manic patients into trouble in business and legal transactions as well as interpersonally. Their judgment tends to be impaired during manic states. For example, they may impul- sively spend their life savings on a foolish business venture, or take a flight on the impulse that it would be nice to be in a different country. Manic patients may lose contact with reality, become floridly psy- chotic, and experience hallucinations as well as para- noid or grandiose delusions. A formal thought dis- order characterized by disorganized, tangential, or circumstantial thought may be more common in mania than it is in schizophrenia. More rarely, impul- sive criminal acts may occur during a manic state.

Violent acts are sometimes carried out that are un- characteristic of the patient. By convention, manic episodes must last at least i week but tend to average 8 to 16 weeks. Bipolar patients may have manic and depressive episodes that occur four or more times a year (rapid-cycling bipolar illness), but more com- monly the episodes are separated by 6 months to a year as the illness progresses. Patients who experience full manic episodes as opposed to hypomanic periods are said to suffer from Bipolar I Disorder. About 10 manic episodes in a lifetime is the mean for bipolar I patients, but many patients suffer from more frequent episodes.

Bipolar I Disorder may begin in childhood, but more commonly begins in early adulthood. The ear- lier the onset, the worse the prognosis tends to be. The mean age of onset is approximately 30 years old. The index or first mood disturbance in bipolar pa- tients tends to be Major Depression. This depression can precede the advent of manic episodes by many years.

Bipolar disorder is characterized by episodic cycles with a relative remission of symptoms between episodes. Sometimes, bipolar patients will have episodes with features of depression and mania simultaneously. For example, they may describe high energy and de- creased need for sleep, but complain of severe depres- sion and suicidal thoughts. These episodes are re- ferred to as mixed episodes and appear less common than manic, hypomanic, or depressed episodes. A hypomanic episode, on the other hand is a grade below mania in its presentation. It may have a shorter duration than a typical manic episode (4 days or longer), is not characterized by psychosis, and is not of sufficient intensity that the patient requires hospi- talization. The symptoms of hypomania are otherwise like the symptoms of mania including increased en- ergy, hyperverbal speech, grandiosity, increase in goal directed activity, and so on, but of lower severity.

Some bipolar disorders are characterized only by hy- pomanic episodes interspersed with Major Depres- sion and are called Bipolar II Disorder, to distinguish them from classic or Bipolar I Disorder in which the patient has full blown manic episodes.

Bipolar II Disorder, like Bipolar I, often begins in early adulthood with a major depressive episode. The hypomanic episodes tend to be briefer than manic epi- sodes, and rapid cycling appears to be more common than in Bipolar I Disorder. Cyclothymia often evolves into Bipolar II Disorder, and in turn, bipolar II some- times evolves into bipolar I. C. Dysthymic Disorder Dysthymic Disorder is a low-grade depression lasting at least 2 years and often a lifetime. Like Major De- pression, it is characterized by depressed mood.

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