Bipolar and related Disorder

Bipolar disorder is a brain disorder that causes changes in a person's mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.

People without bipolar disorder experience mood fluctuations as well. However, these mood changes typically last hours rather than days. Also, these changes are not usually accompanied by the extreme degree of behavior change or difficulty with daily routines and social interactions that people with bipolar disorder demonstrate during mood episodes. Bipolar disorder can disrupt a person’s relationships with loved ones and cause difficulty in working or going to school.

Bipolar disorder is a category that includes three different diagnoses: bipolar I, bipolar II, and cyclothymic disorder.

Bipolar disorder commonly runs in families: 80 to 90 percent of individuals with bipolar disorder have a relative with bipolar disorder or depression. Environmental factors such as stress, sleep disruption, and drugs and alcohol may trigger mood episodes in vulnerable people. Though the specific causes of bipolar disorder within the brain are unclear, an imbalance of brain chemicals is believed to lead to dysregulated brain activity. The average age of onset is 25 years old.

People with bipolar I disorder frequently have other mental disorders such as anxiety disorders, substance use disorders, and/or attention-deficit/hyperactivity disorder (ADHD). The risk of suicide is significantly higher among people with bipolar I disorder than among the general population.

Bipolar I Disorder

Bipolar I disorder is diagnosed when a person experiences a manic episode. During a manic episode, people with bipolar I disorder experience an extreme increase in energy and may feel on top of the world or uncomfortably irritable in mood. Some people with bipolar I disorder also experience depressive or hypomanic episodes, and most people with bipolar I disorder also have periods of neutral mood.

Symptoms of Bipolar I Disorder:

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

· Abnormally upbeat, jumpy or wired

· Increased activity, energy or agitation

· Exaggerated sense of well-being and self-confidence (euphoria)

· Decreased need for sleep

· Unusual talkativeness

· Racing thoughts

· Distractibility

· Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

· Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

· Marked loss of interest or feeling no pleasure in all — or almost all — activities

· Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

· Either insomnia or sleeping too much

· Either restlessness or slowed behavior

· Fatigue or loss of energy

· Feelings of worthlessness or excessive or inappropriate guilt

· Decreased ability to think or concentrate, or indecisiveness

· Thinking about, planning or attempting suicide

Bipolar II Disorder

A diagnosis of bipolar II disorder requires someone to have at least one major depressive episode and at least one hypomanic episode (see above). People return to their usual functioning between episodes. People with bipolar II disorder often first seek treatment as a result of their first depressive episode, since hypomanic episodes often feel pleasurable and can even increase performance at work or school.

People with bipolar II disorder frequently have other mental illnesses such as an anxiety disorder or substance use disorder, the latter of which can exacerbate symptoms of depression or hypomania.

Cyclothymic Disorder

Cyclothymic disorder is a milder form of bipolar disorder involving many "mood swings," with hypomania and depressive symptoms that occur freqquently. People with cyclothymia experience emotional ups and downs but with less severe symptoms than bipolar I or II disorder.

Cyclothymic disorder symptoms include the following:

• For at least two years, many periods of hypomanic and depressive symptoms, but the symptoms do not meet the criteria for hypomanic or depressive episode.
• During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months.

"Mixed features" refers to the occurrence of simultaneous symptoms of opposite mood polarities during manic, hypomanic or depressive episodes. It's marked by high energy, sleeplessness, and racing thoughts. At the same time, the person may experience hopeless, despairing, irritable, and suicidal feelings. 

Rapid-cycling is a term that describes having four or more mood episodes within a 12-month period. Episodes must last for some minimum number of days in order to be considered distinct episodes. Some people also experience changes in polarity from high to low or vice-versa within a single week, or even within a single day, meaning that the full symptom profile that defines distinct, separate episodes may not be present (for example, the person may not have a decreased need for sleep). Sometimes called "ultra-rapid" cycling, there is debate within psychiatry as to whether this phenomenon is a valid or well-established feature in bipolar disorder. A pattern of rapid cycling can occur at any time in the course of illness, although some researchers believe that it may be more common at later points in the lifetime duration of illness. Women appear more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts. Antidepressants may sometimes be associated with triggering or prolonging periods of rapid cycling. However, that theory is controversial and is still being studied.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

· Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

· Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.