Approximately 5.7 million adults in the U.S. have received a diagnosis of bipolar disorder, or manic-depressive illness, a "brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks," according to the National Institute of Mental Health.
Bipolar I Definition
Of the three types of bipolar disorder--bipolar I, bipolar II and cyclothymic disorder--bipolar disorder I causes the most severe disturbance. Extreme fluctuations in mood mark bipolar I disorder, a serious mental illness. A diagnosis of bipolar 1 disorder requires the presence of one or more manic episodes (and may or may not include depressive episodes).
Diagnosis
Bipolar I disorder does not require depressive episodes for a diagnosis. Many people with this disorder do not seek treatment until either a manic episode creates significant disturbance in their lives, or they experience a depressive episode and seek treatment for that. The onset of bipolar 1 disorder usually occurs by age 25 but may go undiagnosed for some time. "Delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems," according to the National Institute of Mental Health.
Manic Episodes
A manic episode consists of a period of at least one week of markedly elevated, expansive or irritable mood. People with manic episodes usually experience a decreased need for sleep, flights of ideas, racing thoughts, increased activity, talkativeness and feelings of grandiosity. They may experience out-of-control and abnormal behaviors including aggression, sexual acting out, spending sprees and substance abuse. For an episode to qualify as manic, significant disturbance in social, occupational or other important areas of functioning must occur. Manic episodes may include psychosis, or a break with reality.
Depressive Episodes
Depressive episodes frequently occur in the course of the illness although the diagnosis of bipolar I disorder does not depend on them. Depressed mood that lasts at least two weeks marks a major depressive episode. Some may suffer from fatigue, agitation, change in sleeping or eating habits, difficulty concentrating or suicidal thoughts.
Mixed Episodes
Some with bipolar disorder I experience "mixed episodes," which combine depressive and manic symptoms in the same time period. They may occur simultaneously or alternating, but must occur for at least one week. This differs from the diagnosis for bipolar II disorder in that full manic symptoms occur.
Sub-Types of Bipolar I Disorder
The six clinical subtypes of bipolar I disorder include the following:
Bipolar I disorder, single manic episode: Only one manic episode in the person's lifetime. No depressive or manic episodes for at least two months.
Bipolar I disorder, most recent episode hypomanic: Latest episode before diagnosis hypomanic, or milder manic symptoms lasting at least four days. The person has a history of at least one manic or mixed episode.
Bipolar I disorder, most recent episode manic: Latest episode manic, with a history of at least one major depressive, manic or mixed episode.
Bipolar I disorder, most recent episode mixed: Most recent episode mixed, with a history of at least one major depressive, manic or mixed episode.
Bipolar I disorder, most recent episode depressed: Latest episode major depressive, with a history of at least one manic or mixed episode.
Bipolar I disorder, most recent episode unspecified: This designation allows a diagnosis of bipolar I disorder before duration requirements have been met.
