Bipolar Disorder Health Article

Definition

Bipolar, or manic-depressive disorder, is a mood disorder that causes radical emotional changes and mood swings, from manic highs to depressive lows. The majority of bipolar individuals experience alternating episodes of mania and depression. The switch between highs and lows often comes without warning. For instance, a "high" mood can quickly deteriorate into a "low," which causes the sufferer exceptional stress.

Description

An estimate by the National Institute of Mental Health states that more than two million American adults—about 1% of the population age 18 and over in any given year—have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, while others develop them late in life. Very often, bipolar disorder is not recognized as an illness. Many people suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

An even grimmer survey by the National Depressive and Manic Depressive Association (NDMDA) estimates that over 17.4 million adults in the United States suffer with an affective disorder each year (one in seven people). Women are twice as likely as men to experience major depression, while manic depression occurs on an even percentage between the sexes. Onset of major or manic depression can occur at any age, however it most commonly develops between the ages of 25 and 44.

The problem is compounded by inaccurate or no diagnoses in the early stages. A survey taken by the NDMDA reports that half of respondents reported visiting three or more professionals before receiving a correct diagnosis, and over one-third reported a wait of 10 years or more before they were correctly diagnosed.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the diagnostic standard for mental health professionals in the United States, defines four separate categories of bipolar disorder: bipolar I, bipolar II, cyclothymia, and bipolar not-otherwise-specified (NOS).

Bipolar I disorder is characterized by manic episodes, the "high" of the manic-depressive cycle. A bipolar patient experiencing mania often has feelings of self-importance, elation, talkativeness, increased sociability, and a desire to embark on goal-oriented activities, coupled with the characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. Usually this manic period is followed by a period of depression, although a few bipolar I individuals may not experience a major depressive episode. However, these individuals are usually characterized as mild, moderate, or severe without psychotic features. Mixed states, where both manic or hypomanic symptoms and depressive symptoms occur at the same time, also occur frequently with bipolar I patients (for example, depression with the racing thoughts of mania). Also, dysphoric mania is common (mania characterized by anger and irritability). Catatonic features occasionally occur. Two of the following must be present for the bipolar I diagnosis to move into bipolar I with catatonic features:1. motor immobility; 2. excessive, purposeless motor activity that is not caused by external stimuli; 3. extreme negativity or mutism; 4. inappropriate or bizarre postures, movements, mannerisms, or grimaces; 5. repetitive or echoing speech patterns.

Bipolar II disorder is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania. At least one hypomanic instance must occur before the bipolar II criteria are met. Bipolar depression may be difficult to distinguish from a unipolar major depressive episode. Patients with bipolar depression tend to have extremely low energy, retarded mental and physical processes, and more profound fatigue (for example, hypersomnia; a sleep disorder marked by a need for excessive sleep or sleepiness when awake) than unipolar depressives. Catatonic features may also be present in bipolar II disorder.

Cyclothymia refers to the cycling of hypomanic episodes with depression that does not reach major depressive proportions. For this diagnosis, symptoms must be present for at least two years for adults and one year for children and adolescents. During the one and two year diagnosis-gathering period, patients may not be symptom-free for more than a two-month consecutive period. After the initial diagnostic periods, there may be superimposed mixed or manic episodes. In these instances, bipolar I and cyclothymic disorder may be diagnosed simultaneously. A third of patients with cyclothymia will develop bipolar I or II disorder later in life.

A phenomenon known as rapid cycling occurs in up to 20% of bipolar I and II patients. In rapid cycling, manic and depressive episodes must alternate frequently—at least four times in 12 months—to meet the diagnostic definition. In some cases of "ultra-rapid cycling," the patient may bounce between manic and depressive states several times within a 24-hour period. This condition is very hard to distinguish from mixed states.

Bipolar NOS is a category for bipolar states that do not clearly fit into the bipolar I, II, or cyclothymia diagnoses. Examples include:

• Very rapid transitions (a matter of days) between manic and depressed symptoms;
• Recurrent hypomanic episodes without depressive symptoms;
• Manic or mixed episodes that are superimposed on delusional disorder, residual schizophrenia, or psychotic disorder NOS;
• Hypomanic episodes that alternate with depression, but are not frequent enough to qualify for a diagnosis of cyclothymia;
• Situations where it has been assumed that a bipolar condition exists, but a determination cannot be made as to whether it is the primary diagnosis, is substanceinduced, or comes from another medical condition.