Bipolar disorder, also called manic depression, is a mental health condition characterized by extreme high and low moods that can be intercepted by periods of symptom-free , “normal” mood.

Symptoms can occur between the two poles of depression and mania:

DepressionDysthymia (low-grade depression)- Euthymia (normal mood)- Hypomania (low-grade mania)- Mania

There are two main types of bipolar disorder: Bipolar Disorder I and Bipolar Disorder II.

Bipolar I Disorder:

  • A major depressive episode is not required for a diagnosis
  • Involves at least one episode of severe mania. A manic episode is defined as:
    • A distinct period characterized by an unusually and persistently high (euphoric) mood that lasts for at least one week (unless the person is hospitalized, in which case it can last for less than a week)
    • Three other symptoms must be experienced from the following list:
      • Inflated self-esteem or grandiosity (sense of being better or more important than others)
      • Decreased need for sleep
      • Non-stop, fast talking
      • Distractibility
      • Increased agitation or aimless activity (e.g., starting many different projects and not really getting anything done)
      • Risk-taking behaviors (excessive involvement in activities that have a high potential for painful consequences e.g., buying sprees, sexual indiscretions or dangerous sexual encounters, and bad financial investments)
      • Racing thought/ flight of ideas (these are more than thinking fast. They are a constant succession of thoughts that cannot be quieted)
    • Represents a marked impairment in social or occupational/professional functioning
    • May necessitate hospitalization to prevent harm to self or others
    • May include psychotic features i.e., loss of touch with reality such as hallucinations (seeing something others don’t see, hear, or smell) or delusions (false, illogical, strongly-held beliefs that cannot be explained by cultural or religious beliefs)
    • May not be attributable to the physiological effects of substance use or a medical condition

Bipolar II Disorder:

  • A major depressive episode is required for a diagnosis
  • Involves at least one episode of less severe mania (hypomania) called hypomanic episode and defined as:
    • 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, nearly every day
    • At least three other symptoms must be experienced (four if the mood is only irritable) and represent a noticeable change from usual behavior:
      • Inflated self-esteem or grandiosity (sense of being better or more important than others)
      • Decreased need for sleep
      • Non-stop talking
      • Distractibility
      • Increased agitation or activity (e.g., able to achieve more)
      • Risk-taking behaviors (excessive involvement in activities that have a high potential for painful consequences e.g., buying sprees, sexual indiscretions or dangerous sexual encounters, and bad financial investments)
      • Racing thoughts (in hypomania, these thoughts may be described as crowded but not to the same extent as in mania; they may be described as creative)
    • Change in functioning is observable by others
    • The episode is not severe enough to cause marked impairment in social or occupational/professional functioning and may even lead to improved functioning (e.g., having more energy and so being able to get more things done)
    • Does not necessitate hospitalization
    • May not be attributable to the physiological effects of substance use or a medical condition

*Some individuals experience both depression and mania simultaneously, leading them to feel both energetic and sad and hopeless at the same time. This is known as a mixed episode and can be very confusing for the individual.

Causes:

  • Biological Factors
    • There is a strong genetic component to bipolar disorder
    • It is important to know if someone in your family has been diagnosed with bipolar disorder.
  • Stress Triggers
    • Stressful life events and the way a person copes with these stresses are the main factors that lead to the onset of bipolar disorder (e.g., death of a loved one, loss of a job, or birth of a child).
    • These triggers may not be precisely defined as what is stressful for one person may not be stressful for another.

Treatment:

The mood shifts that occur in bipolar disorder are much more severe than the normal ups and downs that everyone experiences in life. They can result in damaged relationships, poor work or school performance, self-harm, or even suicide. Like diabetes, heart conditions, and many other physical conditions, bipolar disorder is a life-long illness that is manageable with ongoing treatment.

Treatment Options:

  • Medication and life-long medication management in combination with psychotherapy
  • Types evidence-based Psychotherapy:
    • Cognitive Behavioral Therapy (CBT): focuses on how you think and act in the present and the connection between your thoughts, behaviors, and emotions. It has been proven effective in the treatment of depression.
    • Dialectical Behavior Therapy (DBT): is a specific type of cognitive behavioral therapy (CBT) developed for the treatment of borderline personality disorder, which shares many symptoms with bipolar disorder (e.g., problem regulating emotions, impulsivity, unstable relationships, unhealthy coping strategies) and is therefore effective with the treatment of bipolar disorder. DBT Skills:
      • Core Mindfulness Skills: help people live in the present, know themselves better, be aware of their emotions, thoughts, and feelings
      • Distress Tolerance Skills: help people get through crisis situations in a healthy way
      • Emotion Regulation Skills: help people understand their emotional reactions and how to control them
      • Interpersonal Effectiveness Skills: enable people to communicate more effectively, achieve a balance between what they are giving and gaining in a relationship, and overall achieve more relationship satisfaction
    • Interpersonal Social Rhythm Therapy (IPSRT): was modified from interpersonal therapy (IPT), which looks at how your mood is affected by relationships and changes in the roles you play in your life. IPSRT is IPT with the addition od educational elements regarding bipolar disorder, cognitive and behavioral interventions, and self-monitoring of social interactions or daily routines.
    • Self-Care:
      • Sleep hygiene
      • Healthy nutrition
      • Exercise
      • Social contacts

 

 

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