Bi-Polar Disorder – WOMEN in RECOVERY

The causes of bipolar disorder have yet to be fully uncovered, but there is strong evidence that brain structure anomalies play a role.

Bipolar disorder or bipolar affective disorder (historically known as manic-depressive disorder) is a psychiatric diagnosis for a mood disorder in which people experience disruptive mood swings. These encompass a frenzied state known as mania (or hypomania) usually alternated with symptoms of depression.

Bipolar disorder is defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes.

At the lower levels of mania, such as hypomania, individuals may appear energetic and excitable. At a higher level, individuals may behave erratically and impulsively, often making poor decisions due to unrealistic ideas about the future, and may have great difficulty with sleep. At the highest level, individuals can show psychotic behavior, including violence.

Individuals who experience manic episodes also commonly experience depressive episodes, or symptoms, or a mixed state in which features of both mania and depression are present at the same time. These events are usually separated by periods of “normal” mood; but, in some individuals, depression and mania may rapidly alternate, which is known as rapid cycling. Severe manic episodes can sometimes lead to such psychotic symptoms as delusions and hallucinations.

The lifetime prevalence of all types of bipolar disorder is thought to be about 4% (meaning that about 4% of people experience some of the characteristic symptoms at some point in their life).

Prevalence is similar in men and women and, broadly, across different cultures and ethnic groups.

Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and environmental factors are also implicated.

Bipolar disorder is often treated with mood stabilizing medications and psychotherapy.

In serious cases, in which there is a risk of harm to oneself or others, involuntary commitment may be used. These cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder. People with bipolar disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having schizophrenia.

The current term bipolar disorder is of fairly recent origin and refers to the cycling between high and low episodes (poles). The term “manic-depressive illness” or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all kinds of mood disorder. German psychiatrist Karl Leonhard split the classification in 1957, employing the terms unipolar disorder (major depressive disorder) and bipolar disorder.

Signs and symptoms

Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) mood states, to a degree that interferes with the functions of ordinary life. Many people with bipolar disorder also experience periods of depressed mood, but this is not universal.

There is no simple physiological test to confirm the disorder.

Diagnosing bipolar disorder is often difficult, even for mental health professionals. In particular, it can be difficult to distinguish depression caused by bipolar disorder from pure unipolar depression. The younger the age of onset, the more likely the first few episodes are to be depressive. Because a bipolar diagnosis requires a manic or hypomanic episode, many patients are initially diagnosed and treated as having major depression.

Manic episodes
Mania is the defining feature of bipolar disorder. Mania is a distinct period of elevated or irritable mood, which can take the form of euphoria, and lasts for at least a week (less if hospitalization is required). People with mania commonly experience an increase in energy and a decreased need for sleep, with many often getting as little as three or four hours of sleep per night. Some can go days without sleeping.

A manic person may exhibit pressured speech, with thoughts experienced as racing. Attention span is low, and a person in a manic state may be easily distracted. Judgment may be impaired, and sufferers may go on spending sprees or engage in risky behavior that is not normal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills.

Their behavior may become aggressive, intolerant, or intrusive.

They may feel out of control or unstoppable, or as if they have been “chosen” and are “on a special mission”, or have other grandiose or delusional ideas.

Sexual drive may increase.

At more extreme levels, a person in a manic state can experience psychosis, or a break with reality, where thinking is affected along with mood. Some people in a manic state experience severe anxiety and are irritable (to the point of rage), while others are euphoric and grandiose.

The severity of manic symptoms can be measured by rating scales such as the Altman Self-Rating Mania Scale and clinician-based Young Mania Rating Scale.

The onset of a manic episode is often foreshadowed by sleep disturbances. Mood changes, psychomotor and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops.

Hypomanic episodes
Hypomania is a mild to moderate level of elevated mood, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Generally, hypomania does not inhibit functioning as mania does. Many people with hypomania are actually more productive than usual, while manic individuals have difficulty completing tasks due to a shortened attention span. Some hypomanic people show increased creativity, although others demonstrate poor judgment and irritability. Many experience hypersexuality. Hypomanic people generally have increased energy and increased activity levels. They do not, however, have delusions or hallucinations.

Hypomania may feel good to the person who experiences it. Thus, even when family and friends recognize mood swings, the individual often will deny that anything is wrong. What might be called a “hypomanic event”, if not accompanied by depressive episodes, is often not deemed as problematic, unless the mood changes are uncontrollable, volatile or mercurial. If left untreated, an episode of hypomania can last anywhere from a few days to several years. Most commonly, symptoms continue for a few weeks to a few months.

Depressive episodes
Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal thoughts. In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant. A major depressive episode persists for at least two weeks, and may continue for over six months if left untreated.

Mixed affective episodes
In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and depression occur simultaneously.

Typical examples include weeping during a manic episode or racing thoughts during a depressive episode. Individuals may also feel very frustrated in this state, for example thinking grandiose thoughts while at the same time feeling like a failure.

Mixed states are often the most dangerous period of mood disorders, during which the risks of substance abuse, panic disorder, suicide attempts, and other complications increase greatly.

Recovery and recurrence

A naturalistic study from first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years.

Within two years, 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery.

Symptoms preceding a relapse (prodromal), specially those related to mania, can be reliably identified by people with bipolar disorder. There have been intents to teach patients coping strategies when noticing such symptoms with encouraging results.A naturalistic study from first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years.

Within two years, 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery.

Symptoms preceding a relapse (prodromal), specially those related to mania, can be reliably identified by people with bipolar disorder. There have been intents to teach patients coping strategies when noticing such symptoms with encouraging results.

Self-help for bipolar disorder

While dealing with bipolar disorder isn’t always easy, it doesn’t have to run your life. But in order to successfully manage bipolar disorder, you have to make smart choices. Your lifestyle and daily habits have a significant impact on your moods.

Read on for ways to help yourself:

• Get educated. Learn as much as you can about bipolar disorder. The more you know, the better you’ll be at assisting your own recovery.
• Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.
• Seek support. It’s important to have people you can turn to for help and encouragement. Try joining a support group or talking to a trusted friend.
• Make healthy choices. Healthy sleeping, eating, and exercising habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important.
• Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.