Bipolar disorder, formerly known as manic depression, is a serious mental illness affecting millions of people worldwide. It has been identified by the World Health Organization as the sixth most-impairing illness in terms of the years of life lost by its sufferers to premature death or disability. Fortunately, effective treatments do exist, and many of its potentially devastating consequences can be avoided if it is diagnosed and treated early.
Signs and Symptoms
Bipolar disorder is characterized by the occurrence of one or more manic episodes, usually alternating over the course of a person's life with episodes of depression. A manic episode is defined by the American Psychiatric Association's diagnostic manual (DSM-IV-TR) as "a distinct period during which there is an abnormally and persistently elevated, expansive or irritable mood" plus at least three of the following symptoms (if the mood is elevated or expansive; four are required if the mood is irritable):
-grandiosity, i.e., exaggerated notions of self-esteem
-decreased need for sleep
-more talkative than usual or more difficult to interrupt when talking
-an outwardly expressed "flight of ideas" or a subjective experience of racing thoughts
-increased distractibility
-increased goal-directed activity (e.g., in work, school or social life) or increased psychomotor activity (i.e., appearing "hyper," "bouncing off the walls," etc.)
-excessive involvement in high-risk, pleasurable activities (e.g., reckless gambling or spending, sexual promiscuity, etc.)
In order for the diagnosis to apply, these symptoms must persist for at least one week and must either: a) cause a "marked impairment" in occupational or social functioning, including damage to existing relationships, or b) accompany psychotic symptoms such as hearing voices or espousing delusional or bizarre beliefs, often of a grandiose or religious nature.
Bipolar I and II: Mania vs. Hypomania
Hypomania is essentially a manic episode that does not rise to the level of severity necessary to cause significant impairment in functioning or hospitalization. In fact, a state of hypomania can frequently result in improved functioning, as a person in the midst of a hypomanic episode may exhibit enhanced productivity as a result of high levels of energy and enthusiasm combined with unusually quick and creative thinking. However, this same person could start to unravel as her thoughts become too rapid or unhinged from reality to produce anything other than aimless, illogical and at times catastrophically dangerous overactivity.
This does not happen in all cases; a subgroup of people, classified as having bipolar II disorder, experience repeated hypomanic episodes that never progress to full-blown mania, even in the absence of treatment. Unfortunately, the potential for prolific creativity in people with bipolar II comes at a price, as they are more susceptible to debilitating depressive episodes than their bipolar I counterparts; this is on top of the already greatly increased risk for depression and suicide (relative to the general population) conferred upon the group as a whole, according to an article in the March 17, 2007, edition of "The Lancet."
Other Considerations
A person in an apparent manic episode needs to be carefully evaluated by a doctor, as certain drugs such as ecstasy, LSD, PCP, crystal meth and cocaine can all make a person appear manic, as can medical conditions like extreme hyperthyroidism, partial complex seizures, stroke and steroid toxicity. Failure to detect such causes can lead to treatment that is both ineffective and potentially dangerous in terms of the side effects of unnecessary medications and the unmitigated consequences of the untreated underlying condition.
References
- Woods, SW. The economic burden of bipolar disease. Journal of Clinical Psychiatry 2000; 61 Supp 13:38.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. American Psychiatric Association, Washington, DC 2000, pp 357-368.
- Benazzi, F. Focus on bipolar II disorder and mixed depression. Lancet 2007; 369:935.
