BIPOLAR DISORDER

Bipolar Disorder

Bipolar Disorders (Manic-Depressive Illness)

Bipolar Disorders have essential features of dramatic shifts in mood, energy, and thinking that differ from the normal ups and downs most people experience. Bipolar I and Bipolar II Disorders require either a euphoric/manic episode or both extremes of the mood spectrum, i.e., euphoria and depression, at least once in the lifetime of the patient. Expert diagnosis is necessary in order to determine the appropriate treatment.


Major depressive episode in Bipolar Disorder:

With the exception that a major depressive episode may occur in both in Bipolar I and II, diagnostic requirements for this condition in Bipolar Disorder are the same as in Unipolar Major Depressive Disorder. Please refer to the description of Major Depressive Disorder for details. Depression associated with Bipolar Disorder may be more difficult to treat than unipolar depression.


Mixed Episode

Individuals with a mixed presentation experience a number of both depressive and manic symptoms over the span of several days. 


Bipolar I and II Disorders affect about 0.6% and 0.8% of the United States population in a given year, respectively. A family history of Bipolar Disorder is one of the strongest risk factors for the disorders, as there is a 10-fold increased risk among adult relatives of patients with Bipolar I and II.


Cyclothymic Disorder is also included in the category of Bipolar Disorders.

Bipolar I Disorder

According to the DSM-5, in Bipolar I Disorder, a manic episode may be preceded or followed by a hypomanic or major depressive episode.


A manic episode is described as:

  1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least 1 week and present most of the day, nearly every day.
  2. During the period of mood disturbance and increased energy or activity, three or more of the following are present:
  3. Inflated self esteem or grandiosity
  4. Decreased need for sleep (feels rested after only 3 hrs of sleep)
  5. More talkative than usual and or pressured speech
  6. Flight of ideas and thought racing
  7. Distractibility (attention easily paid to unimportant irrelevant stimuli)
  8. Increase in goal directed activity (socially, at work or school, or sexually) or psychomotor agitation
  9. Excessive involvement in activities that have a high potential for painful consequences (e.g., buying sprees, sexual indiscretions, foolish investments, etc.)  
  10. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning, or to require hospitalization to prevent harm to self or others, or is marked by psychotic features.
  11. The episode is not attributable to a substance, medication or other medical condition.


If left untreated, Bipolar I Disorder can be debilitating and interfere with the ability to fulfill everyday responsibilities. However, with treatment, including medication, and a healthy lifestyle, many individuals with the disorder have good quality of life.

Bipolar II Disorder

Bipolar II Disorder involves the presence of at least one major depressive episode and at least one hypomanic episode. Compared with individuals with Bipolar I Disorder, those suffering from Bipolar II Disorder are symptomatic for a longer duration, particularly in the depressive phase, which can be severe and/or disabling. 


A hypomanic episode is described as: 

  1. A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, every day. 
  2. During this period of abnormal activity as listed above, at least 3 of the same 7 symptoms described for a manic episode are present. 
  3. The episode is an unequivocal change in functioning and is uncharacteristic of the individual when not symptomatic.
  4. The disturbance is observable by others.
  5. The episode is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.
  6. The episode is not attributable to consumption of a drug of abuse, a medication, or a medical condition.

Cyclothymic Disorder

Cyclothymic Disorder is a chronic, fluctuating syndrome of shifts in mood that do not meet the level of mania, hypomania, or major depression. However, mood symptoms must be present for at least two years.

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