The DSM-5 describes Bipolar disorder as a mental health issue and a mood disturbance characterized by extreme mood swings that include manic episodes and hypomanic episodes along with major depression. Bipolar is different from disorders such as cyclothymic disorder (which is similar to bipolar disorder, but involves less intense mood swings), attention-deficit hyperactivity disorder, post-traumatic stress disorder, schizophreniform, and obsessive-compulsive disorder in that bipolar depression and mania affect mood. Although co-occurring disorders such as attention-deficit hyperactivity disorder (ADHD) may complicate the final diagnosis of an affective disorder such as bipolar, the presence primarily of manic and also depressive symptoms are an important clue that the patient will require treatment for bipolar disorder. Other complicating factors in diagnosing this disorder include substance abuse and personality disorders that involve features such as inflated self-esteem. Substance abuse is common in people with this mood disorder who attempt to self-medicate using street drugs.
People with bipolar disorder often experience symptom-free periods known as euthymia between mood episodes that involve either mania or depression. Despite the occurrence of normal mood episodes, patients with bipolar disorder still need mood stabilizers to avoid depressive and manic episodes.
The DSM-5 gives bipolar disorders their own chapter which are categorized between depressive disorders and schizophrenia spectrum disorders because of their relationship with both of these categories of mental illness. Though bipolar is primarily a disorder involving mood irregularities, it isn’t uncommon for psychotic symptoms to exist. A family history of either bipolar disorder or schizophrenia is a predisposing factor in the development of manic-depressive illness. Often, the symptoms of bipolar disorder are misdiagnosed because of the cyclical nature of this mental illness. From the onset of symptoms, it takes bipolar patients an average of 10 years to get the correct diagnosis for their mood disorder.
What is Bipolar Disorder?
Mania or hypomania are the primary symptoms that psychiatrists look for to diagnose bipolar disorder and distinguish this mental illness from depressive disorder. Manic symptoms are the key feature that differentiate bipolar spectrum disorders from major depressive disorder. It’s important to differentiate between bipolar spectrum disorders and depressive disorders because a misdiagnosis of depressive disorder and the treatment for bipolar disorder using only anti-depressants can have serious consequences for patients. Mood swings to manic episodes are more likely when bipolar patients are treated with only an antidepressant.
Psychiatrists diagnose bipolar disorder by looking for symptoms that exist over a specific period of time. There are several different types of bipolar disorder that have been recognized as clinically significant. These include bipolar I disorder, bipolar II disorder, cyclothymic disorder, rapid cycling bipolar disorder, and mixed episode disorder. The DSM-5 also contains a label designated “other specified bipolar and related disorders” to encourage more research into bipolar-like phenomena.
Manic Depression
Doctors identified the mood disturbance known as “bipolar disorder” as far back as the 1st century A.D. but the term “bipolar” is a relatively recent label for the disorder. Between the 1950’s and the 1980’s, people referred to bipolar disorder as manic-depressive disorder. In the 1980’s, experts renamed mental illness and called it “bipolar disorder” and since that time scientists did intensive research and created sub-categories of manic-depressive illness including the differentiation between bipolar I and bipolar II, rapid-cycling bipolar disorder, cyclothymic disorder, and mixed episode bipolar disorder. Despite the adoption of a new label by psychologists and psychiatrists, some people with bipolar disorder still prefer the label “manic-depressive illness” because they feel it captures the experience of this disorder more accurately.
Bipolar Symptoms
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The primary diagnostic feature of bipolar disorder is a manic episode that lasts at least one week. Symptom-free periods or periods of hypomania or depression follow the manic episode. by an episode of hypomania or depression. Because patients tend to seek treatment for bipolar disorder during a depressive episode rather than during a manic episode, manic-depressive illness can easily be misdiagnosed as major depression.
Mania
You can identify a manic episode by a distinct period of unusually high activity and energy levels in people with bipolar disorder. Symptoms that meet the criteria for mania must be present for at least one week and they must be observable nearly every day for most of the day. A sustained, elevated, expansive, and sometimes irritable mood state that features at least three of the following symptoms is characteristic of mania:
1. Accelerated or pressured speech
2. Grandiosity or an inflated self-esteem
3. Diminished need for sleep
4. Distractibility
5. Rapid succession of ideas and increased talkativeness with the shifting of topics quickly and abruptly
6. Increased goal-directed activity and purposeless activity
7. Significant involvement in high-risk behaviors
Hypomania
A hypomanic episode is similar to a manic episode. As with mania, an expansive, elevated, or irritable mood is characteristic of hypomania but hypomania is less intense than mania and it only lasts for four consecutive days (mania lasts for a week or longer). During a hypomanic episode, people with bipolar disorder will also demonstrate elevated levels of energy and activity, though this mood disturbance is less pronounced and less intense than a manic episode. People with bipolar disorder who are in the midst of an episode of hypomania may be extremely productive and high-functioning in fact, which can contribute to difficulties identifying the presence of the mood disorder. The following symptoms of hypomania are nearly identical to the symptoms of mania except they are less severe:
1. Accelerated or pressured speech that doesn’t take into consideration other people’s desire to communicate
2. Grandiosity or an inflated self-esteem
3. Diminished need for sleep and diminished desire for sleep
4. Distractibility
5. Rapid succession of ideas and increased talkativeness with the shifting of topics quickly and abruptly
6. Increased goal-directed activity and purposeless activity
7. Significant involvement in high-risk behaviors
Depression
Psychiatrists misdiagnose about one-third of bipolar patients with major depression because depressive disorder is more common than bipolar disorder and patients may be embarrassed about their behaviors during manic episodes and fail to mention them during therapy. Patients may also experience mania or hypomania as ego-syntonic (consistent with their self-image) and therefore they may not be able to identify the mania as unusual or out-of-the-ordinary. To add to the difficulty in correctly diagnosing bipolar disorder, the criteria for diagnosing major depression is the same as the criteria for diagnosing depression in bipolar disorder.
Five of the following criteria must be present for at least two weeks nearly every day in order to diagnose a major depressive episode:
1. Depressed mood every day that lasts for most of the day
2. Reduced pleasure or interest in the day’s activities
3. Sleep disturbances: difficulty sleeping (insomnia) or difficulty staying awake (hypersomnia)
4. Feelings of inappropriate guilt or worthlessness
5. Appetite and weight changes including significant weight loss not due to dieting, significant weight gain, or a significant increase or decrease in appetite
6. Either psychomotor agitation or psychomotor retardation
7. Inability to concentrate; indecisiveness
8. Thoughts of suicide or death or a suicide attempt
Other Bipolar Symptoms
During a manic episode, though the general tenor of a bipolar person’s attitude may be energetic, expansive, or irritable, people with bipolar disorder may experience rapid mood shifting (lability). In other words, a person with an expansive, elevated mood (mania) may experience feelings of hopelessness for short periods of time and vice versa. Increased energy and activity levels may occur at unusual times of the day or night corresponding to the disrupted sleep patterns seen in both manic episodes (which often involve a decreased need for sleep) and major depressive episodes (during which some patients experience insomnia).
Bipolar I vs. Bipolar II
Psychiatrists differentiate between bipolar I disorder and bipolar II disorder by determining whether the patient has a history of manic episodes or not. While bipolar I disorder requires that the patient show symptoms of mania as well as symptoms of depression, bipolar II disorder only requires patients to show symptoms of hypomania and depression.
Bipolar 1
Bipolar I disorder is the classic form of manic-depressive illness. This is also the most severe version of bipolar disorder. Psychiatrists can diagnose bipolar I when a patient has experienced at least one manic episode. On the average, psychiatrists diagnose patients with bipolar I at age 18, though the onset of this disorder can happen at any age. About two-thirds of bipolar I patients function normally at work between manic and depressive episodes.
Bipolar 2
Bipolar II can be diagnosed when a patient has experienced a hypomanic episode and at least one episode of depression. This diagnosis often precedes a diagnosis of bipolar I disorder but bipolar II is a diagnosis reserved for patients who, at the time of their diagnosis, have never experienced a full-blown manic episode.
Bipolar II patients tend to be diagnosed later than bipolar I patients, with the average age of onset in the mid-twenties. Approximately 15% of people with bipolar II disorder experience mood disturbances between manic and depressive episodes.
Bipolar Test
https://www.youtube.com/watch?v=S9pGYsZXr4E
Psychiatrists typically oversee and coordinate the treatment of bipolar disorder and they act as a liaison with other involved parties such as social services and health care providers such as general practitioners and the family. There are a variety of treatment strategies available for people with bipolar disorder including psychotherapy as well as medication therapies. Often, psychiatrists prescribe medication along with psychotherapeutic treatments such as cognitive-behavioral therapy.
Psychiatrists use three classes of medication to treat bipolar disorder. These include:
Anti-psychotics including second-generation antipsychotics including asenapine
Mood stabilizers
Anti-depressants
The most popular psychotherapeutic options for the treatment of bipolar disorder include:
Cognitive-behavioral therapy
Interpersonal/social rhythm therapy
Family therapy
Group therapy
Non-pharmacological options for the treatment of bipolar disorder include:
Electroconvulsive therapy (ECT)
Vagus or Vagal Nerve Stimulation (VNS)
Transcranial Magnetic Stimulation (TMS)
Light therapy
Education
Family support
Lifestyle management (such as maintaining a healthy diet and exercising each day)
Bipolar Medication
The foundation for bipolar disorder treatment is medication which could include anti-psychotics, mood stabilizers, or anti-depressants.
Common medications used to treat bipolar disorder include:
Lithium
Valporate
Carbamazepine
Lamotrigine
Olanzapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone
Bipolar Disorder: What You Need to Know
If you or someone you love is showing signs of bipolar disorder, be sure to see a doctor. Though a diagnosis of bipolar disorder is serious, it’s important to realize that there are a variety of effective treatments and medications that are available to manage the disorder. Patients with bipolar disorder can lead a normal life with the appropriate therapeutic interventions, family support, and lifestyle management.
Sources
Severus, E., Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5. Retrieved March 1, 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230313/
Smith, M., Segal, J. Segal, R. (2018). Bipolar Disorder Treatment: Treatment and Therapy for Managing Bipolar Disorder. Retrieved March 1, 2018 from https://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-treatment.htm
Healthline (2018). Diagnosis Guide for Bipolar Disorder. Retrieved March 1, 2018 from https://www.healthline.com/health/bipolar-disorder/bipolar-diagnosis-guide
Juvenile Bipolar Research Foundation. Diagnosis by DSM. Retrieved March 1, 2018 from https://www.jbrf.org/diagnosis-by-the-dsm/
Mental Health Foundation of New Zealand (2018). Bipolar Disorder: Identifying and Supporting Patients in Primary Care. Retrieved March 1, 2018 from https://www.mentalhealth.org.nz/assets/Uploads/Bipolar-disorder-Identifying-and-supporting-patients-in-primary-care-BPJ-2014.pdf
American Psychicatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition DSM-5. Retrieved March 1, 2018 from https://media.mycme.com/documents/168/dsm-5_bipolar_and_related_diso_41789.pdf
