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Bipolar Disorder

Bipolar disorder, formally known as manic-depressive disorder is a group of mood disorders distinguished by one or more episodes of abnormally elevated energy levels and mood with or without one or more depressive episodes. These elevated states are known as mania, and in milder cases hypomania. Those who experience manic episodes tend to also go through depressive episodes or a mixed state where both depression and mania symptoms coexist. There are usually “normal” moods separating these unusual states. However, some bounce back and forth to both extremes and this is known as rapid cycling. Severe manic states can cause psychotic symptoms to surface such as delusional thinking and hallucinating.

Bipolar is divided into different types: bipolar I, bipolar II, cyclothymia and bipolar NOS.

The bipolar spectrum is the range of mood experienced by the person with bipolar. Symptoms of bipolar disorder range depending on which end of the bipolar spectrum the patient is currently on. During a depressive episode, one with bipolar may experience sadness, anxiety, guilt, anger, isolation, hopelessness, disturbed appetite and sleep, fatigue, loneliness, self-loathing, social anxiety, irritability, and suicidal ideation. This depressive episode can become severe to the point of being psychotic. This is known as severe bipolar depression with psychotic features and may include delusions, or rarely, hallucinations. A major depressive episode lasts for at least two weeks and may drag on for six months if not treated.

Mania is the signature trait of bipolar disorder and is the deciding factor for classifying the disorder. Mania is usually thought of as a period of hyper elevated mood, which may be described as euphoria. A rush of energy is commonly experienced and a lack of the necessity for sleep. Racing thoughts, low attention span, pressured speech, and impaired judgment are all traits of a manic state. A rise in risk taking behavior such as shopping sprees or drug intake is noted in the manic state. Those in this state may have grandiose ideas such as they have been specially chosen for a secret mission or other delusions. While some may experience euphoria and grandiosity during a manic state, others may be anxious and angry. There is also a less severe version of mania known as hypomania. This is a mild to moderate level of mania that usually does not inhibit functioning as a manic episode would.

A mixed affective episode or a mixed state is when symptoms of mania and clinical depression are both evident simultaneously. Crying during a manic episode or racing thoughts during a depressive episode are the typical traits of this mixed state.

Bipolar disorder is caused by both a genetic and environmental factor. Genetic studies has suggested many particular genes as being a root cause of bipolar disorder, however, their results are not consistent and rarely replicated. For this reason, many believe different genes implicate bipolar disorder in different families, also known as heterogeneity. Advanced paternal age has been linked to a somewhat increased rate of bipolar disorder, most likely because of increased genetic mutations. Those with bipolar disorder report a traumatic childhood at a higher rate than those who do not have the disorder.

There are four types of bipolar disorder. These include bipolar 1, bipolar II, cyclothymia, and bipolar Disorder NOS. Bipolar 1 consists of one or more manic episodes and depressive or hypomanic episode is not required for diagnosis. Bipolar II has no manic episodes but has one or more hypomanic episodes and one or more major depressive episodes. Cyclothymia has hypomanic episodes and periods of depression that do not fit the profile for a major depressive episode. Bipolar NOS or bipolar non otherwise specified is the final category in which the bipolar disorder does not fall under any particular group previously mentioned.

Treatment Options for Bipolar Disorder

This disorder is primarily treated with mood stabilizing medications and other psychiatric drugs. Psychotherapy has also been shown to be helpful, but usually only after the patient has reached stability. This therapy is used to recognize what causes episodes, identify prodromal symptoms of an episode, and teach one to maintain remission. For some very severe cases, involuntary commitment may be applied. This is usually done in the case of severe depression leading to thoughts of suicide or a suicide attempt. Commitment may also be necessary if a manic episode is causing unsafe or reckless behavior.

The first line of treatment for bipolar disorder is a mood stabilizer such as Lithium carbonate and lamotrigine. Lithium has been proven to reduce chance of suicide in bipolar patients and lamotrigine has been instrumental in preventing depressive episodes. Lithium is the most widely used medication for bipolar and sodium valproate is the second. Atypical antipsychotics have been proven useful for managing the mania experienced by the bipolar patient. Antidepressants have not been found to be as useful as antipsychotics and mood stabilizers are for this condition.

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