Bipolar disorder is a mental disorder characterized by extreme shifts in mood, as well as fluctuations in energy and activity levels. During these abnormal shifts, the patient commonly finds it difficult to complete everyday tasks.
Bipolar disorder is also known as manic-depressive illness.
Bipolar disorder is a serious mental illness that can destroy relationships, undermine career prospects, and seriously affect academic performance. The American Psychological Association1 says that these emotional shifts can become so overwhelming that individuals may choose suicide.
Contents of this article:
You can find recent developments on bipolar disorder from MNT news at the end of some sections.
What is bipolar disorder?
A patient with bipolar disorder has severe fluctuations in mood (poles) - from depression to mania. Usually, moods are normal in between the peaks and troughs.
Bipolar disorder has nothing to do with the ups and downs we all experience sometimes; it is much more severe, debilitating and incapacitating. Fortunately, it is treatable, and with proper care and the right medication patients can perform well at work and academically and lead full, productive lives.
The National Alliance on Mental Illness2 (MANI) says that over 10 million people have bipolar disorder in the United States. It adds that more than half of all cases start when patients are between 15 and 25 years old. Males and females are affected equally.
Incidence of bipolar disorder in the U.S.
Researchers from the National Institute of Mental Health, Genetic Epidemiology Research Branch, reported in Archives of General Psychiatry that bipolar disorder rates in the USA are higher than anywhere else in the world. About 4.4% of US citizens have had a bipolar disorder diagnosis at some time in their lives, while the world average is 2.4%.
Shifting from Mania to Depression
People with bipolar disorder have alternating episodes of extreme euphoria (mania) and major depression
Mania - this is the period of euphoria, restlessness, energy, recklessness, and much talking.
The patient may go on emotional and mental sprees. It is during this period that the patient is most likely to engage in risky behaviors, including risky sex.
Depression - this is the opposite mood extreme of mania. The patient feels sad, may cry a lot, has a sense of being worthless, energy levels are extremely low, there is loss of pleasure, and sleep problems.
Causes of bipolar disorder
The National Institutes of Mental Health3 says most experts agree that bipolar disorder has no single cause. It is more likely the result of many factors acting together.
Genetics - some small twin studies have indicated that there is a "substantial genetic contribution" to bipolar disorder risk. People with a blood relative who has bipolar disorder have a higher risk of developing it themselves. Currently, scientists are trying to identify which genes are involved.
A study by an international team of scientists reported in the journal Neuron that rare copy number variants, abnormal sequences of DNA, seem to play a major role in the risk of early onset bipolar disorder.
Biological traits - experts say that patients with bipolar disorder often have physical changes that occurred in their brains. Nobody is sure why the changes can lead to the disorder.
Brain-chemical imbalance - neurotransmitter imbalances play a key role in many mood disorders, including bipolar disorder, as well as depression and other mental illnesses. Neurotransmitters are chemicals that facilitate the communication between neurons (brain cells). Examples of neurotransmitters are serotonin, norepinephrine, and dopamine.
Hormonal problems - hormonal imbalances are thought to possibly trigger or cause bipolar disorder.
Environmental factors - abuse, mental stress, a "significant loss", or some other traumatic event may contribute towards bipolar disorder risk. Traumatic events may include the death of a loved one, losing your job, the birth of a child, or moving house. Experts say many things, if the variables are right, can trigger bipolar disorder in some people. They add that we all react differently to environmental factors. However, once bipolar disorder is triggered and starts to progress, it appears to take on a life and force of its own.
Recent developments on bipolar disorder causes from MNT news
A research team at the Albert Luthuli Central Hospital in South Africa found that women who catch the flu during pregnancy are more likely to have a baby who later on develops bipolar disorder. Their study was published in JAMA Psychiatry.
The exact cause of bipolar is unknown but now researchers are one step closer to finding out with the discovery of two new genetic regions that are connected to the disease. Their research was published in Nature Communications.
The incidence of schizophrenia and bipolar among creative individuals has led researchers to speculate there may be a link between creativity and psychiatric illness. Now, a new study finds this link may be partly genetic.
Symptoms of bipolar disorder
As explained in the diagnosis section further on in this article, signs and symptoms vary according to the type of bipolar disorder the person has.
The Bipolar Disorders Clinic4, at the Stanford School of Medicine, says that bipolar disorder is "distinguished from Schizoaffective Disorder by the absence of psychotic symptoms (such as delusions, hallucinations) during periods of stable mood." It also differs from Major Depressive Disorder by having episodes of mania or hypomania.
Below are some features that may be present during episodes of mania or depression.
Symptoms during manic/hypomanic episodes:
- A feeling of being on top of the world, exhilaration or euphoria
- Over-self-confidence, an inflated sense of self-esteem
- The patient's judgment may be impaired
- The patient talks a lot, and very rapidly
- Thoughts come and go rapidly (racing thoughts). Sometimes bizarre solutions come to the patient's mind, and they are acted upon. This may involve, for example, attempting to redo the plumbing in the house, or re-arranging everything that is in the fridge in order to solve a totally unrelated problem.
- In this phase the individual may be extremely forthcoming, sometimes aggressively so
- The sufferer is more likely to engage in risky behavior, including promiscuity (higher libido), abuse illegal drugs and/or alcohol, and take part in dangerous activities
- The patient may squander money on things that are of no benefit to them or their families
- Concentration difficulties; during the manic episode the individual may be easily distracted
- Missing work or school a lot
- Psychosis - including delusions and thinking and believing things that are not real
- Underperforming at work or school.
Symptoms during depressive episodes:
- A feeling of gloom, blackness, despair, and hopelessness
- Extreme sadness
- In severe cases the patient will think about ending his/her own life, and will sometimes try to act on those thoughts.
- Insomnia and sleeping problems - difficulty falling asleep, or falling asleep and waking up during the night and then not being able to get back to sleep, or sleeping much more than usual. It is not uncommon for a patient during this phase to spend most of his or her time in bed.
- Anxiety - becoming anxious about trivial things.
- Guilt - a feeling that everything that goes wrong or appears to be wrong is their fault
- Eating patterns change, some people eat more, while others eat much less
- Weight loss or weight gain
- Extreme tiredness, fatigue, listlessness
- Inability to feel pleasure with activities or interests that were usually enjoyed
- Low attention span. Some patients find it impossible to focus on anything
- Easily irritated, this could be triggered by noises, smells, tight clothing, and other things that would usually be tolerated or ignored
- Some patients are unable to face going to work or school; those that do typically underperform.
Psychosis - in both the manic and depressive episodes there may be psychosis, during which patients cannot differentiate fantasy from reality.
Symptoms of psychosis may include delusions (false but strongly felt beliefs) and hallucinations (hearing or seeing things that are not there).
SAD (Seasonal Affective Disorder) - also known as "winter blues". Some bipolar disorder patients have moods which fluctuate with the seasons - during late spring and summer, they experience mania or hypomania, while in late autumn and winter they are depressive.
Symptoms in pediatric cases of bipolar disorder - children and teenagers are more likely to have temper tantrums, rapid mood changes, outbursts of aggression and explosive anger, and reckless behavior.
It is important to remember that bipolar disorder is a treatable mental illness - it is possible to control the symptoms with proper care and to lead a normal and productive life. If you, or a friend, have signs and symptoms similar to those described above, see your doctor.
Diagnosing the condition
The health care professional, either a psychiatrist or psychologist, bases the diagnosis on self-reported experiences of the patients, behavior abnormalities reported by household members, close friends, working colleagues, and teachers, as well as any secondary signs detected by other health care professionals. He or she goes through a list of criteria during the diagnosis process.
According to the National Health Service5, UK, the depression phase of bipolar disorder is usually diagnosed first.
A series of physical diagnostic tests may be ordered after carrying out a physical exam, including blood and urine tests.
The psychological evaluation is a major piece in the diagnosis process for bipolar disorder.
There are three broad types of bipolar disorder:
1) Bipolar I Disorder
There has been at least one manic episode or mixed episodes (with/without previous depressive episodes). Most patients have had at least one depressive episode.
When making a diagnosis, the health care professional needs to exclude some factors which may induce similar episodes, such as the mood-altering effects of a medication, drug abuse, exposure to a toxin, or a clinical mood disorder which is not associated with bipolar disorder, such as schizophreniform disorder, delusional disorder, or some other psychotic disorder.
2) Bipolar II Disorder
The patient has experienced one or more episodes of depression and at least one hypomanic episode.
A hypomanic state is less severe than a manic one. During a hypomanic episode the patient sleeps much less, is very competitive and outgoing, and is full of energy - but he/she is fully functioning; this may not be the case with manic episodes.
Unlike manic episodes, during a hypomanic state, there are no symptoms of psychosis or grandiosity.
Also known as cyclothymic disorder, is seen as a sub-threshold (milder) form of bipolar disorder. There are numerous mood disturbances, with bouts of hypomanic symptoms which alternate with periods of moderate or mild depression.
At baseline level, a patient with cyclothymia may feel stable, but will go through noticeable fluctuations involving emotional highs during hypomanic episode, with mania-like symptoms (but less severe), and emotional troughs with depressive symptoms, but not severe enough to meet the criteria for major depressive episodes.
The pattern of alternating highs and lows must persist for at least two years with a maximum of two consecutive symptom-free months for a diagnosis of cyclothymia to be made. For pediatric patients, including teenagers, the period is at least 12 months.
Symptoms of bipolar disorder can appear at any time
Signs and symptoms of bipolar disorder may appear at any time during a person's life, but will usually do so during their teen years or young adulthood. Although diagnosing bipolar disorder has improved considerably over the last three decades, many sufferers still live with the illness without a proper diagnosis, and consequently no proper treatment.
Recent developments on diagnosing bipolar disorder from MNT news
Researchers at the University of Pittsburgh reported in the British Journal of Psychiatry that a new brain imaging method that measures blood flow may help diagnose early-stage bipolar disorder.
A series of RNA biomarkers in blood have been discovered by researchers from Indiana University School of Medicine. They say their findings could lead to a blood test to predict who is more likely to commit suicide.
Diagnosing bipolar disorder is a difficult task. No chemical markers are yet known, and prescribing the wrong treatment can be detrimental. A new study makes headway into this complex arena.
A recent study published in the Proceedings of the National Academy of Sciences finds links between sleeping patterns, circadian rhythms, bipolar disorder and specific phenotypes.
On the next page we look at treatments for bipolar disorder and we discuss some of the famous people who have been diagnosed with the condition.