Bipolar disorder is characterized by periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.
Alternative Names
Manic depression; Bipolar affective disorder
Causes, incidence, and risk factors
Bipolar disorder affects men and women equally and usually appears between the ages of 15 and 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.
Bipolar disorder results from disturbances in the areas of the brain that regulate mood. During manic periods, a person with bipolar disorder may be overly impulsive and energetic, with an exaggerated sense of self. The depressed phase brings overwhelming feelings of anxiety, low self-worth, and suicidal thoughts.
There are two primary types of bipolar disorder. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder I was called manic depression.
People with bipolar disorder II seldom experience full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of major depression.
A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression, with less-severe mood swings. People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone.
Bipolar Disorder(Doctor-Reviewed information)
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 . Description In the United States alone, bipolar disorder afflicts approximately 2.3 million people, and nearly 20% of this population will attempt suicide without effective treatment intervention. The average age at onset of bipolar disorder is from adolescence through the early twenties. However, because of the complexity of the disorder, a correct diagnosis can be delayed for several years or more. In a survey of bipolar patients conducted by the National Depressive and Manic Depressive Association (NDMDA), one-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 ( DSM-IV ), 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. 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 racing thoughts of mania). Also, dysphoric mania is common (mania characterized by anger and irritability). Bipolar II disorder is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania. 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. Cyclothymia refers to the cycling of hypomanic episodes with depression that does not reach major depressive proportions. One-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. Causes & symptoms The source of bipolar disorder has not been clearly defined. Because two-thirds of bipolar patients have a family history of affective or emotional disorders, researchers have searched for a genetic link to the disorder. Several studies have uncovered a number of possible genetic connections to the predisposition for bipolar disorder. Recent studies emphasize a hereditary connection and early research links several chromosomes, one particularly related to bipolar II, to development of the disorder. A 2003 study found that schizophrenia and bipolar disorder could have similar genetic causes that arise from certain probl
Cyclothymic disorder(Doctor-Reviewed information)
Cyclothymic disorder is a mild form of bipolar disorder characterized by alternating episodes of mood swings from mild or moderate depression to hypomania, in which the person experiences elevated mood, euphoria, and excitement, but does not become disconnected from reality. Reviewer: Paul Ballas, D.O., Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.Date: 11/15/2006
Bipolar Disorder(Doctor-Reviewed information)
A condition (also called manic depression) characterized by extreme mood swings that alternate between depression and mania (a state of exaggerated elation and euphoria). According to the National Institutes of Mental Health (NIMH), bipolar disorder affects an estimated 2 million Americans (roughly 1% of the population). The disease usually begins in the teens or early 20s and affects males and females equally. Children with attention deficit/hyperactivity disorder (ADHD) are at above-average risk for bipolar disorder: about one in four has or will develop it. Within a 10-year period, a person whose bipolar disorder is not treated with medication usually goes through an average of four depression/mania episodes. However, the pattern varies widely: mood swings can occur as frequently as four or more times a month, or as seldom as once every five years. Bipolar disorder is the depressive illness considered most likely to have a biological cause, thought to be an imbalance in the brain's chemistry. The condition has also been associated with the biological clock that synchronizes one's internal body rhythms with external events. Bipolar disorder is often inherited. In one study, 25% of children with one manic-depressive parent inherited the disorder, and 75% of children with two manic-depressive parents became manic-depressive. An episode of psychotic depression in teenagers is twice as likely to be followed by a manic episode within five years if there is a family history of bipolar disorder. Also, bipolar disorder is often shared by identical twins. The depressed cycle of a person with bipolar disorder has the characteristics of major depression. Symptoms include sadness, apathy, and lack of energy. There may also be significant changes in appetite or weight; slowed-down movements; problems with concentration; feelings of worthlessness; guilt feelings; and suicidal impulses. In the manic state, people with bipolar disorder become euphoric: their thoughts race; their speech is rapid and shifts abruptly from one topic to another; they are constantly occupied, attempting to perform many activities at once, and often have trouble sitting still or sleeping; and they also demonstrate an exaggerated sense of self-confidence, manifested by the belief that they can perform extraordinary feats beyond the ability of the average person. Also common are spending sprees, with excessive sums of money spent on frivolous items, and provocative and/or promiscuous sexual behavior. While in a manic phase, persons with bipolar disorder typically resent any criticism of their behavior, and become irritable or angry when others attempt to calm them down, or when they fail to complete all their projects. Hallucinations or delusions may also occur. A symptom of bipolar disorder especially common among teenagers is extreme mood-lability (rapid changes in mood). Adolescents with bipolar disorder develop normally until the illness first manifests itself. Their lives are then severely disrupted by the illness. In fact, bipolar disorder is especially disruptive to adolescents, more so than to other age groups: major milestones, such as dating, may be delayed for years until the disease is under control. Schoolwork also suffers because cognitive functioning is affected and concentration impaired. Teens with manic depression are likely to abuse drugs or alcohol to alleviate the anxiety caused by the condition—roughly two-thirds of all persons with bipolar disorder have substance abuse or dependency problems. Unless it is treated, the illness gets worse with each episode and harder to control. In addition, 15% of those who fail to receive adequate treatment for bipolar disorder commit suicide. Common misdiagnoses of bipolar disorder include schizophrenia, drug or alcohol dependence, unipolar disorder, and personality disorders. It is common to suffer from bipolar disorder for as long as seven to 10 years without having the condition diagnosed and treated
Mania(Doctor-Reviewed information)
Definition Mania is an abnormally elated mental state, typically characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations and other psychotic symptoms. Description Mania typically occurs as a symptom of bipolar disorder (a mood disorder characterized by both manic and depressive episodes). Individuals experiencing a manic episode often have feelings of self-importance, elation, talkativeness, sociability, and a desire to embark on goal-oriented activities, coupled with the less desirable characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. (Note: Hypomania is a term applied to a condition resembling mania. It is characterized by persistent or elevated expansive mood, hyperactivity, inflated self esteem, etc., but of less intensity than mania.) Severe mania may have psychotic features. Causes and symptoms Mania can be induced by the use or abuse of stimulant drugs such as cocaine and amphetamines. It is also the predominant feature of bipolar disorder, or manic depression, an affective mental illness that causes radical emotional changes and mood swings. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ), the diagnostic standard for mental health professionals in the U.S., describes a manic episode as an abnormally elevated mood lasting at least one week that is distinguished by at least three of the following symptoms: inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increase in goal-directed activity, or excessive involvement in pleasurable activities that have a high potential for painful consequences. If the mood of the patient is irritable and not elevated, four of these symptoms are required. Diagnosis Mania is usually diagnosed and treated by a psychiatrist and/or a psychologist in an outpatient setting. However, most severely manic patients require hospitalization. In addition to an interview, several clinical inventories or scales may be used to assess the patient's mental status and determine the presence and severity of mania. An assessment commonly includes the Young Mania Rating Scale (YMRS). The Mini-Mental State Examination (MMSE) may also be given to screen out other illnesses such as dementia . Treatment Mania is primarily treated with drugs. The following mood-stabilizing agents are commonly prescribed to regulate manic episodes: Lithium (Cibalith-S, Eskalith, Lithane) is one of the oldest and most frequently prescribed drugs available for the treatment of mania. Because the drug takes four to seven days to reach a therapeutic level in the bloodstream, it is sometimes prescribed in conjunction with neuroleptics ( antipsychotic drugs ) and/or benzodiazepines (tranquilizers) to provide more immediate relief of mania. Carbamazepine (Tegretol, Atretol) is an anticonvulsant drug usually prescribed in conjunction with other mood-stabilizing agents. The drug is often used to treat bipolar patients who have not responded well to lithium therapy. As of early 1998, carbamazepine was not approved for the treatment of mania by the FDA. Valproate (divalproex sodium, or Depakote; valproic acid, or Depakene) is an anticonvulsant drug prescribed alone or in combination with carbamazepine and/or lithium. For patients experiencing "mixed mania," or mania with features of depression, valproate is preferred over lithium. Clozapine (Clozaril) is an atypical antipsychotic medication used to control manic episodes in patients who have not responded to typical mood-stabilizing agents. The drug has also been a useful preventative treatment in some bipolar patients. Other new anticonvulsants (lamotrigine, gubapentin) are being investigated for treatment of mania and bipolar disorder. Prognosis Patients experiencing mania as a result of bipolar disorder will requ
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