Bipolar Disorder - The Basics

Bipolar mood disorders are distinguished from "unipolar" mood disorders (such as depression) by periods of emotional highs, the extreme case of which is called a "manic episode."

To be diagnosed with a manic episode, you must have a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting most of the day, every day for a week. Three or more of the following symptoms must be met: 1) inflated self-esteem or grandiosity; 2) decreased need for sleep; 3) more talkative than usual or pressure to keep talking; 4) flight of ideas or racing thoughts; 5) distractability; 6) increase in goal-directed activity (socially at work, or sexually), or psychomotor agitation; 7) excessive involvement in activities that have a high potential for painful consequences.

To be diagnosed with bipolar disorder I, you have to have had at least one manic episode in your life. You do not have to have had any depressed episodes. The manic episode must be what is considered "fully manic" (meeting the criteria above, and generally requiring hospitalization) and not the less elevated state called "hypomanic."  On the other hand, people with bipolar disorder II experience hypomania - never a fully manic state - and they have to also have experienced periods of depression. Bipolar II is more common than bipolar I, but only evolves into bipolar I in 5 to 15 percent of the cases. 

People with bipolar disorder tend to show more mood lability, psychotic features, psychomotor retardation, and substance abuse than people with unipolar mood disorders. Bipolar depression also tends to be much more severe than unipolar depression, and is characterized by more of the "atypical" depression features (i.e. hypersomnia, arms as heavy as lead, mood lability), as described in my post about depression. As I said in my previous post, I generally experience atypical features during my depressive episodes. One time, I even remember sitting at a table looking at a glass of water. I really wanted to drink that water. But my arms were just too heavy to reach over and grab it. 

Usually, an episode - which can be either manic/hypomanic or depressive - occur every 3 to 4 months, with periods of "normal" in between. However, some people rapid cycle, remaining in one state or another almost all the time. They experience at least 4 episodes per year, but generally far more than 4. 

Rapid cycling should not be mistaken for "mixed episode," which is characterized by symptoms of mania both mania and depression for at least one week. In fact, I have been in a "mild mixed state" since the beginning of October, and my symptoms just keep getting worse and worse. During this time, I have experienced intense suicidal ideation mixed with motivation, energy, and impulsivity. I have had mild  dissociative symptoms in which I feel outside myself, and am unable to care about the past or future - which makes the suicidal ideation even more dangerous. I have had bipolar rage - red-in-the-face screaming at people, punching walls, and throwing stuff with little provocation. And I've spent a half hour at a time laughing and crying at 10 second intervals. It's not a fun state to be in. Apparently, my current treatment plan is to dope me up so much during the day and night that I am unable to experience emotions, therefore I'm fairly stable. It works. My mood is so stable right now, it feels like there's no mood there at all. 

"Full recovery" is very rare with bipolar disorder; most people must remain on mood stabilizers for the rest of their lives. The first mood stabilizer, lithium, was discovered 1948 by Dr. John Cade. It is an effective mood stabilizer, but it has several side effects, and it is not very easy to patent a mineral, so lithium is not generally used for the treatment of bipolar disorder. Other mood stabilizing medications are from a group considered to be anti-seizure meds, or from another considered to be anti-psychotic meds. I'm currently on both types. 


This is a series of posts summarizing what I'm learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher's textbook Abnormal Psychology. To read the other posts, follow these links: 

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness - Biology
Contemporary Viewpoints on Treating Mental Illness - Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome - The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression - an Overview
Personality Disorders - Clusters and Dimensions
Personality Disorders - Cluster A
Personality Disorders - Cluster B
Personality Disorders - Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria - Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder - The Basics
Suicide - An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 7: Mood Disorders and Suicide. Abnormal Psychology, sixteenth edition (pp. 212-262). Pearson Education Inc.