BIPOLAR DISORDER
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes
unusual shifts in a person's mood, energy, and ability to function. Different from the
normal ups and downs that everyone goes through, the symptoms of bipolar disorder are
severe. They can result in damaged relationships, poor job or school performance, and
even suicide. But there is good news: bipolar disorder can be treated, and people with this
illness can lead full
and productive lives.
More than 2 million American adults, or about 1 percent of the population age 18 and
older in any given year, have bipolar disorder. Bipolar disorder typically develops in late
adolescence or early adulthood. However, some people have their first symptoms during
childhood, and some develop them late in life. It is often not recognized as an illness, and
people may suffer for years before it is properly diagnosed and treated. Like diabetes or
heart disease,
bipolar disorder is a long-term illness that must be carefully managed throughout a
person's life.
1. MANIC-DEPRESSION
Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the
basis of rational thought, and too often erodes the desire and will to live. It is an illness that
is biological in its origins, yet one that feels psychological in the experience of it; an illness
that is unique in conferring advantage and pleasure, yet one that brings in its wake almost
unendurable suffering.
WHAT ARE THE SYMPTOMS OF BIPOLARS
Bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad
and hopeless, and then back again, often with periods of normal mood in between. Severe
changes in energy and behavior go along with these changes in mood. The periods of highs
and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
Increased energy, activity, and restlessness
Excessively "high," overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can't concentrate well
Little sleep needed
Unrealistic beliefs in one's abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping
medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms
most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional
symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
Lasting sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed, including sex Decreased energy, a
feeling of fatigue or of being "slowed down"
Difficulty concentrating, remembering, making decisions
Restlessness or irritability
Sleeping too much, or can't sleep
Change in appetite and/or unintended weight loss or gain
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or
injury
Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if 5 or more of these symptoms last most of the day,
nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the
person who experiences it and may even be associated with good functioning and enhanced
productivity. Thus even when family and friends learn to recognize the mood swings as
possible bipolar disorder, the person may deny that anything is wrong. Without proper
treatment, however, hypomania can become severe mania in some people or can switch into
depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or
psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or
otherwise sensing the presence of things not actually there) and delusions (false, strongly
held beliefs not influenced by logical reasoning or explained by a person's usual cultural
concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at
the time. For
example, delusions of grandiosity, such as believing one is the President or has special
powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as
believing that one is ruined and penniless or has committed some terrible crime, may
appear during depression. People with bipolar disorder who have these symptoms are
sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or
continuous range. At one end is severe depression, above which is moderate depression and
then mild low mood, which many people call "the blues" when it is short-lived but is
termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above
which comes hypomania (mild to moderate mania),and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is
called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble
sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may
have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness—
for instance, alcohol or drug abuse, poor school or work performance,
or strained interpersonal relationships. Such problems in fact may be signs of an
underlying mood disorder.
Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be
identified physiologically—for example, through a blood test or a brain scan. Therefore, a
diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when
available, family history. The diagnostic criteria for bipolar disorder are described in the
Diagnostic and Statistical Manual for Mental Disorders, fourth
edition (DSM-IV).
Suicide
Some people with bipolar disorder become suicidal. Anyone who is thinking about
committing suicide needs immediate attention, preferably from a mental health
professional or a physician. Anyone who talks about suicide should be taken seriously. Risk
for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing
bipolar disorder early and learning how best to manage it may decrease the risk of death
by suicide.
Signs and symptoms that may accompany suicidal feelings include:
Talking about feeling suicidal or wanting to die
Feeling hopeless, that nothing will ever change or get better
Feeling helpless, that nothing one does makes any difference
Feeling like a burden to family and friends
Abusing alcohol or drugs
Putting affairs in order (e.g., organizing finances or giving away
Possessions to prepare for one's death)
Writing a suicide note
Putting oneself in harm's way, or in situations where there is a danger of being killed
If you are feeling suicidal or know someone who is:
Call a doctor, emergency room, or 911 right away to get immediate help, make sure you,
or the suicidal person, are not left alone.
Make sure that access is prevented to large amounts of medication,weapons, or other items
that could be used for self-harm.
While some suicide attempts are carefully planned over time, others are impulsive acts that
have not been well thought out; thus, the final point in the box above may be a valuable
long-term strategy for people with bipolar disorder. Either way, it is important to
understand that suicidal feelings and actions are symptoms of an illness that can be treated.
With proper treatment, suicidal feelings can be overcome.
What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar disorder through several kinds
of studies. Most scientists now agree that there is no single cause for bipolar
disorder—rather, many factors act together to produce the illness.
Because bipolar disorder tends to run in families, researchers have been searching for
specific genes—the microscopic "building blocks" of DNA inside all cells that influence
how the body and mind work and grow—passed down through generations that may
increase a person's chance of developing the illness. But genes are not the whole story.
Studies of identical twins, who share all the same genes, indicate that both genes and other
factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes,
then the identical twin of someone with the illness would always develop the illness, and
research has shown that this is not the case. But if one twin has bipolar disorder, the other
twin is more likely to develop the
illness than is another sibling.
In addition, findings from gene research suggest that bipolar disorder, like other mental
illnesses, does not occur because of a single gene. It appears likely that many different
genes act together, and in combination with other factors of the person or the person's
environment, to cause bipolar disorder. Finding these genes,each of which contributes only
a small amount toward the vulnerability to bipolar disorder, has been extremely difficult.
But
scientists expect that the advanced research tools now being used will lead to these
discoveries and to new and better treatments for bipolar disorder.
Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce
bipolar disorder and other mental illnesses. New brain-imaging techniques allow
researchers to take pictures of the living brain at work, to examine its structure and
activity, without the need for surgery or other invasive procedures. These techniques
include magnetic resonance imaging (MRI), positron emission
tomography (PET), and functional magnetic resonance imaging (fMRI).
There is evidence from imaging studies that the brains of people with bipolar disorder may
differ from the brains of healthy individuals.
As the differences are more clearly identified and defined through research, scientists will
gain a better understanding of the underlying causes of the illness, and eventually may be
able to predict which types of treatment will work most effectively.