Bipolar disorder causes abnormal mood swings from overly high called mania to low called depression with varying periods of mood stability in between. Other symptoms such as energy and behavioral changes, anxiety, sleep disturbance and irritability may accompany these periods or episodes of illness.
Symptoms in bipolar disorder vary in severity, duration and which symptoms are present. As a result different clinical presentations may receive different diagnosis all of which still are bipolar disorder. Names you might encounter are Bipolar Mania, Hypomania, Mixed Mania, Bipolar Depressed, Rapid Cycling Bipolar Illness, Cyclothymia, Bipolar I and Bipolar II. Some medical practitioners see these varying diagnoses as degrees of bipolar disorder from extreme high to extreme low. Variations will exist in selection of drug treatment among these categories.
Signs and symptoms of a manic episode in bipolar disorder include:
• Abnormally and persistently elevated mood
• Increased distractibility, poor concentration
• Extreme irritability
• Racing thoughts
• Rapid, pressured speech
• Decreased need for sleep
• Inflated sense of self-worth (grandiose)
• Poor judgment
• Excessive involvement in pleasurable activities such as spending, sexual indiscretions, and drug abuse
• Provocative, intrusive, or aggressive behavior
• Increased motor activity
• Denial that anything is wrong
Signs and symptoms of a depressive episode in bipolar disorder include:
• Loss of interest or pleasure in normal activities
• Persistent depressed, sad, tearful or empty mood
• Feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness
• Decreased sexual desire or pleasure
• Decreased energy, feelings of fatigue
• Difficulty with concentration, memory or decision making
• Restlessness or irritability
• Sleeping too much or unable to sleep (hypersomnia or insomnia)
• Increase or decrease in appetite with unintended weight loss or gain
• Chronic pain or increase in somatic complaints not caused by illness or injury
• Observable psychomotor retardation (‘slowed down’) or agitation
• Suicidal thoughts, feelings or attempts
• Suicide and bipolar disorder
It is important to know that some people with bipolar disorder might have suicidal feelings due to their illness. These symptoms can be successfully treated. If you or someone you know has suicidal feelings you should:
• Call the emergency room, your doctor or 911
• Make sure you or the suicidal person has someone with you
• Prevent access to large amounts of medication, weapons or any item that could be used to inflict harm
Signs and symptoms that may be seen with suicidal feelings are:
• Making a will
• Giving possessions away
• Talking or thinking about suicide
• Putting one self in dangerous situations
• Feeling hopeless, helpless or a burden to friends or family
• Writing a suicide note
• Abusing drugs or alcohol
• Hoarding medications4,8
• Diagnosing bipolar disorder
To understand the various subtypes listed above for bipolar disorder we will look at criteria for diagnosis. The following bipolar disorders are diagnosed when symptoms are not caused by another illness, drug abuse, medication or other treatments.
Bipolar mania is diagnosed when a persistently elevated mood is present, in addition to three other symptoms under the manic episode list. If irritability without elevated mood is present, four other symptoms must be present. Symptoms must be present for at least one week and be severe enough to cause marked impairment in occupational, social, or relational functioning or to require hospitalization for protection of self or others or have psychotic features are present.7,8,9
Hypomania is a mild to moderate level of mania. It is diagnosed when there is a persistently elevated or irritable mood beyond the normal range for a period of at least four days. Again three other symptoms accompany the elevated mood or four in cases where an irritable but not elevated mood is present. Though there may not be marked functional impairment, altered mood and functional change is observable. There are no psychotic features and hospitalization is not required. Patients generally feel they are functioning better and enjoy enhanced productivity. It is important for family and friends to learn to recognize the mood swings as possible bipolar disorder, even though the person may deny that anything is wrong. Without proper treatment hypomania can become severe mania in some people or can switch into bipolar depression.7,8,9
Mixed Episode, Mixed Bipolar Disorder, Mixed Mania are used interchangeably when both manic episodes and major depressive episodes are present, with moods fluctuating rapidly between the two, nearly every day for at least one week. The symptoms are severe enough to cause social, occupational or relational impairment or hospitalization or psychotic symptoms are present.7,8,12
Bipolar, Depressed or Bipolar Major Depressive Episodes are diagnosed when a patient complains of depressed mood or loss of interest or pleasure in all or most activities along with an increase in five or more other symptoms from the depressive episode column for a period of two weeks or more. The symptoms are of a severity that interferes with important every day functioning, has psychotic features or suicidal preoccupation or requires hospitalization. Symptoms are not due to bereavement or other significant cause.7,8,9
Rapid Cycling refers to bipolar disorder characterized by four or more, mania, hypomania, mixed or major depressive episodes within a twelve month period.7,8,9
Cyclothymia refers to a chronic fluctuating mood disorder between hypomania and low level depression, in which the highs are not severe enough in number, duration, or pervasiveness to meet Manic Episode criteria and the depressive episodes are not severe enough in number, duration, or pervasiveness to meet Major Depressive Episode criteria. It is estimated that 15 to 50 % of people with cyclothymia are at risk for developing Bipolar I or II disorder.7,8,9
What is the difference between Bipolar I Disorder and Bipolar II Disorder?
Bipolar I Disorder refers to a patient with bipolar disorder who has experienced a manic episode or mixed episode. Between episodes there might be normal moods or depressed mood.
Bipolar II Disorder – mood fluctuations are present but a manic episode proportions have not been reached. Hypomania may be seen. If Bipolar II disorder is diagnosed and a patient eventually goes onto have a manic episode, the diagnosis is changed to Bipolar I Disorder.
Diagnosis of Bipolar Disorder may take some time. Many of the symptoms found in Bipolar Disorder can be found in other disease states and sometimes other diseases accompany bipolar disorder complicating the diagnostic picture. Other medical illnesses, medications, treatments or illicit drug use must all be ruled out. There are no physiological tests for diagnosis of bipolar disorder and therefore doctors must rely on family history and a record of symptoms. For more information of diagnosis of Bipolar Disorder refer to the Diagnostic and Statistical Manual for Mental Disorders DSM-IV-TR By the American Psychiatric Association.
