What is bipolar disorder? People with bipolar disorder incline to experience extreme, polar differing states of mood. They can be remarkably high, or ‘‘manic,’’ at one period, then extremely low, or ‘‘depressed,’’ at other intervals. While there is much more to Bipolar Disorder, the extreme mood swings are what people acknowledge most frequently. Bipolar disorder is not someone’s ‘‘fault’’ but it is a brain condition. It does not occur because of childhood upbringing, although it can be triggered or deteriorated by physical or emotional trauma or extreme stress. While it may not be chronic, it is frequently repeated and some symptoms can remain, even when someone with bipolar disorder is not having a full incidence of illness. To variable amounts, these symptoms and episodes can be coped. The most shared treatments are medication, neurotherapies and supportive therapies.
A manic episode is characterized by elevated mood, increased energy, and irritability. Frequently there is a sense of power or importance, rapid thought, talkativeness, a burst of activity, and reduced need for sleep. There may be compromised thinking and psychotic symptoms (delusions and hallucinations). In a manic episode, symptoms are sufficient to cause extensive disruption to daily life and responsibilities. Occasionally hospitalization is required. A hypomanic episode has the same basic structures as a manic episode, only slighter. By definition, hypomanic symptoms do not cause severe incapacity or hospitalization and are not linked with psychosis. A depressive episode is described by sadness or low mood; reduced energy, interest, and joy; more or less appetite for food; disproportionate or poor-quality sleep; and feelings of unimportance or guilt, and even despair. Mood swing is that the episodes of mania and depression swing from one pole to the other. This can occur over and over again. If the shifts happen at least four times a year, the illness is called rapid cycling.
A mixed episode is when mania and depression alter so rapidly that they seem to happen at the same time, or when symptoms that come across the criteria for a manic and a depressive episode essentially do occur at the same time. To be sure, the poles of bipolar disorder are not completely opposites; if you read about the symptoms, you will see they are similar. Sometimes the term mixed mania is used when manic structures prevail but there are also considerable symptoms of depression. Likewise, there are conditions of energetic or agitated depression—in which depression rules but features of mania occur at the same time.
The Two Types of Bipolar Disorder
The generally used official diagnostic criteria for bipolar disorders are given in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Although at first look these standards may seem clear, but in practice a diagnosis of BD is not a simple one to make, mainly because BD is frequently intersects with other disorders with parallel features. Actually, it has been assessed that the average bipolar patient undergoes through ten years of symptoms before getting a precise diagnosis. The DSM-IV-TR and most other official criteria identify several forms of bipolar disorder. The main forms are bipolar 1 and bipolar 2.
Bipolar 1 Disorder
As stated by the DSM-IV-TR, the crucial feature of Bipolar I Disorder is a clinical course that is described by the happening of at least one, and typically more, Manic Episodes or Mixed Episodes. Frequently patients have already had one or more Major Depressive Episodes. Occasionally, the person is experiencing a first episode of illness. Usually, the disorder is repeated. Recurrence is specified by either a shift in the polarity of the episode, from manic to depression or vice versa, or by a break between episodes of at least two months short of symptoms of illness. The illness is said to be enduring if an episode never fully ends, and substantial symptoms continue; it is repeated if there are new episodes of illness disconnected from previous episodes by at least a few months.
Bipolar 1 patients do not just have excesses of mood. They may also left with hallucinations and, more frequently, delusions. Therefore, BD is considered a psychosis. Hallucinations are false sensory insights. In BD, these are usually auditory or visual delusions. Frequently these voices or visions are linked to the episode of illness. They are often steady with the high mood and grandiosity of mania or with hopelessness in depression. Delusions are false and strange views. As with hallucinations, in BD they are frequently steady with the dominant mood. A person who is manic may consider he has special, even superhuman, strength or ability. A person who is depressed may trust he is contaminated or surrounded by demons.
Bipolar 2 Disorder
As stated by the DSM-IV-TR, ‘‘The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.’’ Hypomania can be considered by rich energy, confidence, and other seemingly decent emotions and conditions—or, like mania, it can be linked with alarming irritability. In people distressed by bipolar 2, this mood state often leads an episode of serious depression. A person suffering from bipolar 2 disorder may not seem to be as ‘‘obviously manic-depressive’’ to the witness, particularly when the person just seems to be in a mainly good mood. But it can be just as severe a disorder as bipolar 1, since the depressions can be just as profound.
Most of us have agitated nights when we can’t sleep, days when we feel irritable and sensitive, moments of being thoughtless or doing something that in remembrance seems foolish. For persons with bipolar disorder, though, these common incidences become overstated. People who have bipolar disorder are more likely, when manic, to participate in all kinds of unsafe activities—from having affairs to driving recklessly or quitting required jobs with no thought about the costs.
People with untreated BD may even commit crimes or spontaneously injure themselves or others, as a result of their illness. They may continuously seem to invade privacy—opening your mail or e-mail, listening in on private chats, or asking invasive questions. Strong curiosity can also be a part of bipolar disorder. For some people who have bipolar disorder, selfishness can be great. A bipolar individual might not see his or her perspective as the right one, so much as the only one. You might occasionally find that your feelings, views, wishes, and conversation barely seem to matter. When ill, your partner might seem deliberately selfish. Your partner may also misinterpret things you or others do or say, or give such complex grounds for his own actions or thoughts as to leave you shaking your head.
Even more annoying for their partners, people who have bipolar disorder often don’t acknowledge that their extreme moods and uncommon behaviors are part of an illness—or even abnormal. A bipolar person may not feel concerned or may believe that his distress is only incidental, that a new job or the enhancement of a stressful situation would make the problems vanish. This is called a ‘‘lack of insight.’’ For rest of us, BD is about the actions that go with those symptoms.
Throughout manic episodes, beside increased energy and activity during the day, restlessness is common. Bipolar patients may note not feeling the need to sleep or being kept awake by distressed, racing thoughts. They might even stay awake for days which can cause dangerous physical fatigue and back many other dangerous behaviors.
Frequently extreme irritability is exaggerated responses to real events or irritations; sometimes they’re irrational, and would look that way to any witness. Throughout these times, you or others might be exposed to apparently nonsensical outbursts, blame throwing, and verbal threats or challenges. You may even be subject to unsuitable physical engagements, such as breaking or throwing objects, or even assault. You might also see excessive anger. This is not like the angry feelings most people experience from day to day, but extreme anger, criticism, or illogical fury directed at life in general, a frustrating situation, or you in precisely. You might get blamed for extremely more than you deserve. You may think that you can do nothing right.
Many people who undergo BD talk ceaselessly during manic phases. People who have bipolar 1 may even talk themselves croaky. To a smaller degree, they may become oddly chatty, unaware to the fact that another person who may wish to join in the chat can’t get a word in.
Distractibility, Tangentiality, and Inability to Concentrate
An individual with BD can shift quickly and frequently from one project to another. Psychiatrists describe this distractibility, an apt description. The person may be changing topics quickly or wandering rapidly away from the subject at hand. The speaker might seem to jump from point to point without essentially taking the listener along, which can be confusing if you are seriously trying to follow the racing thought.
Overspending and Excessive Gambling
Wastefulness is a problem often seen in people who have bipolar disorder, and one that can cause chaos in a relationship based on shared finances.
Some people who are bipolar disorder find themselves speechless with sexual thoughts and instincts throughout manic episodes. This can lead to harmful affairs, marital pressures, and breakups.
Substance abuse can be a signal of bipolar disorder. It is vital to be alert that people with BD often use tranquilizers for sleep, alcohol for anxiety, and drugs to raise mood. They are perhaps handling their symptoms.
Psychotic symptoms—delusions of grandeur or persecution—can be very distressing. Throughout a manic episode, persons frequently believe themselves capable of much more than they are. They might abruptly reason they possess great brilliance, vision, or other intellectual abilities or great power or physical skills. Such passion and absolute belief in the truth of what they are saying can be hard to resist, mainly the first time you experience it. It can also be unsafe. Perhaps your partner succeeded to convince you, through such an episode, that your financial problems were over, or that an abundant chance signaled, just over the horizon. You might get cleared up into investing time, interest, or money, only to find yourself frustrated later, when the chance fails to materialize. Delusions can cause the victim to take irrational decisions.
Treatment of Bipolar Disorder
Medication does not treat bipolar disorder. But it can noticeably diminish the occurrence and severity of mood swings. Occasionally extreme moods and other symptoms advance in spite of the medication. These, too, can be treated with diverse medication. People with BD, like people with any illness, frequently repel the idea of medication. Even if they know they require treatment, they are fearful that likely side effects will be worse than living with the disorder itself. The risks and worries of drug treatment are real, but so are the risks and disquiets of untreated illness. When symptoms of BD are unsettling or threatening life, medication is the first and most operational choice for treatment, and will help the victim to live a more steady life. Trying several medications, dosages, or even drug combinations before arriving at the one that best achieves the cure for the symptoms with a minimum of side effects is a routine. This routine will possibly continue to help for many years. Though, even after an operational treatment routine has been found, constant regular checkups and changes over time will be critical to preserving a good balance between beneficial effects and side effects of medication.
Lithium is the first mood-stabilizing medication accepted by the U.S. Food and Drug Administration (FDA) for treatment of mania. It is the medication with the extensive history when it comes to treating mental illness. It can be very powerful in checking the reappearance of both manic and depressive episodes. People who use lithium must go in for routine blood tests and take the medication steadily since lithium levels must be preserved within a fairly narrow range to attain positive effects while avoiding toxic effects. Likewise, to retain lithium levels in the right range, patients must be careful to evade dehydration or excess salt loss. In spite of these problems, many patients who track this routine are well compensated with a striking reduction in bipolar symptoms.
Possible side effects comprise, kidney disorders, increased thirst, water holding, and urination. Lithium can also bring about tremor, stomach upset, diarrhea, nausea, vomiting, and, misperception. Occasionally lithium will decrease the functioning of the thyroid gland; this too is checked by blood tests and can be cured. Many of these side effects can be lessened with variations in dosage or the addition of other medications. Though, the patients must be aware of the costs of trying to treat the side effects with other drugs. Properly used, it is frequently not only well stood and effective, but also inexpensive than other medications.
Psychosocial Therapy Options
Numerous psychotherapy options seem to be effective for the person with BD, comprising cognitive-behavioral therapy, dialectical behavioral therapy, and interpersonal social rhythm therapy.
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy compliments its two approaches—cognitive and behavioral—to assist patients classify and challenge less than helpful ways of thinking, incorrect or inaccurate opinions, and exaggerated or groundless fears. Cognitive therapies deal with methods of thinking and target useful ways to advance thoughts and mood. Depressed patients, for example, sometimes experience what are acknowledged as automatic thoughts which are habitual ideas that are deeply embedded. In such cases, the therapist might ask the patient to truthfully assess whether her life is actually as miserable as she believes; whether she is, in fact, worthless. Frequently there is opposing evidence to these extreme opinions.
Realistic examination helps resolve fears and lets patients to at least anticipate taking positive action. In the case of extreme worry, an active cognitive-behavioral component would likely come into play. The therapist might steer the patient to define her worries in detail, imagining fears coming true. Inspected closely, these principles usually turn out to be excessive, or it becomes vibrant that they could be controlled. Thus, healthier thought leads to healthier feeling and activities.