Bipolar Disorder: Types, Symptoms & Diagnosis

What is Bipolar Disorder?

Bipolar disorder, previously known as manic-depressive illness or manic depression, is a chronic mood disorder and mental health condition characterised by profound changes in mood, energy levels, thought patterns, and behaviour. These alterations can persist for varying durations, ranging from hours to months, and can significantly disrupt day-to-day functioning of affected individuals. The condition has several types, all of which involve substantial mood fluctuations known as hypomanic/manic and depressive episodes. That said, individuals with bipolar disorder do not continuously experience these extreme states; they also have periods of normal mood, referred to as euthymia.

Types of Bipolar Disorder

There are four recognized types of bipolar disorder:

• Bipolar I Disorder: Characterised by one or more manic episodes. Depressive episodes are common, but not necessary for diagnosis. Manic episodes must last at least seven days or require hospitalisation. Mixed states with both manic and depressive symptoms can occur.
• Bipolar II Disorder: Involves depressive and hypomanic episodes, but not full manic episodes as in Bipolar I. This type can be incredibly debilitating due to more frequent chronic depressive episodes.
• Cyclothymic Disorder (Cyclothymia): The condition is defined by a long-term unstable mood state with hypomania and mild depression over at least two years. Periods of experiencing a normal mood are brief, typically lasting less than eight weeks.
• Other Specified and Unspecified Bipolar and Related Disorders: This category includes cases that don't fully meet the criteria for the different types but involve significant abnormal mood elevations.

Manic Episodes in Bipolar I Disorder

A distinctive aspect of bipolar I disorder is the occurrence of manic episodes. To be diagnosed with bipolar I disorder, one must have experienced at least one manic episode lasting a minimum of a week, regardless of whether they have had a depressive episode.

Mania involves a period of abnormally heightened or irritable mood coupled with significant alterations in emotions, thoughts, energy, talkativeness, and activity level. This elevated state of physical and mental activity represents a notable deviation from one's typical behaviour and is observable by others.

Individuals in manic states often engage in behaviours that lead to physical, social, or financial harm, such as impulsive spending or reckless driving. They may also experience psychotic symptoms like delusions and hallucinations, complicating the differentiation between bipolar disorder and other conditions like schizophrenia or schizoaffective disorder.

In cases of bipolar II disorder and similar types, individuals experience hypomania, a milder form of mania. Hypomanic episodes are shorter and less disruptive to daily life compared to full-blown manic episodes.

Depressive Episodes

During depressive episodes, individuals with bipolar disorder exhibit a markedly low or depressed mood and a diminished interest in most activities. These episodes are also marked by other symptoms of depression, including fatigue, appetite changes, feelings of worthlessness and hopelessness, and various other emotional and physical challenges.

Effective depression treatment is crucial in managing these episodes and ensuring the well-being of individuals with bipolar disorder.

Symptoms of Bipolar Disorder

Bipolar disorder presents a range of signs and symptoms that can vary significantly depending on the type of bipolar disorder and the individual. Generally, the symptoms fall into two categories based on the mood episodes: manic/hypomanic episodes and depressive episodes.

Signs and Symptoms of Manic/Hypomanic Episodes

• Increased energy, activity, and restlessness: Excessive high energy and hyperactivity.
• Elevated mood: Excessive happiness, hopefulness, excitement, or feeling "wired."
• Rapid speech and racing thoughts: Jumping quickly between ideas and topics.
• Overconfidence and inflated self-esteem: Unrealistic belief in one's abilities.
• Decreased need for sleep: Feeling rested after very little sleep.
• Distractibility: Inability to focus or concentrate, easily sidetracked.
• Impulsiveness and risky behaviour: Engaging in pleasurable but potentially dangerous activities, like spending sprees, reckless driving, or risky sexual behaviour.
• Poor decision-making: Making unusual or poor decisions without considering the consequences.

Signs and Symptoms of Depressive Episodes

• Persistent sadness or hopelessness: Deep sadness, feeling hopeless or empty.
• Fatigue or loss of energy: Feeling excessively tired, lack of energy.
• Changes in sleep patterns: Oversleeping or insomnia.
• Changes in appetite: Weight loss or gain unrelated to dieting.
• Feelings of worthlessness or guilt: Harsh criticism of perceived faults and mistakes.
• Difficulty Concentrating or Remembering: Inability to focus or make decisions.
• Physical symptoms: Aches, pains, headaches, or digestive problems without a clear cause.
• Thoughts of death or suicide: Frequent thoughts about death, suicidal ideation, or suicide attempts.

Causes of Bipolar Disorder

The precise cause of bipolar disorder remains elusive, yet various factors are believed to play a role, including:

• Biological Variations: Individuals diagnosed with bipolar disorder often exhibit discernible alterations in their brain structure. The importance of these alterations is not fully understood, but they might contribute to understanding the disorder's origins.
• Genetic Factors: There is a higher incidence of bipolar disorder among individuals who have a close family member, such as a parent or sibling, with the condition. This suggests a genetic component, and ongoing research aims to identify specific genes that might be implicated in the development of bipolar disorder.

Risk Factors of Bipolar Disorder

Certain factors can heighten the likelihood of developing bipolar disorder or may precipitate its initial onset, including:

• Family History: An increased risk is associated with having a close family member, like a parent or sibling, who has been diagnosed with bipolar disorder.
• High-stress Situations: Experiencing intense stress, such as coping with the loss of a loved one or undergoing a traumatic event, can be a triggering factor.
• Substance Abuse: The misuse of drugs or alcohol may also increase the risk of triggering bipolar disorder.

Bipolar Disorder Diagnosis

In order to diagnose bipolar disorder, a series of steps may be taken. In severe cases, or for further evaluation and treatment, referral to a bipolar disorder hospital or specialised mental health facility may be recommended.

Physical Examination 

A bipolar disorder specialist might conduct a physical examination and order laboratory tests to rule out other medical conditions that could be causing the symptoms.

Psychiatric Assessment 

The patient may be referred to a psychiatrist, who will engage in a detailed discussion about their thoughts, feelings, and behavioural patterns. Psychological self-assessments or questionnaires might also be utilised. With consent, information from family members or close friends about the patient's symptoms could be sought.

Mood Charting

The patient may be instructed to maintain a daily log of their mood fluctuations, sleep habits, and other relevant factors that could assist in accurate diagnosis and effective treatment planning.

Diagnostic Criteria Evaluation

The psychiatrist may evaluate the patient's symptoms against the criteria for bipolar and related disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This comparison is crucial for a definitive diagnosis.

Bipolar Disorder Treatment

Treatment for bipolar disorder typically involves a combination of medication, psychotherapy, and lifestyle changes aimed at managing symptoms and improving quality of life. The specifics of treatment can vary depending on the individual and the type of bipolar disorder. Common treatment strategies include:

Medications

• Mood Stabilisers: Medications like lithium and certain anticonvulsants are commonly used to stabilise mood swings.
• Antipsychotics: In some cases, antipsychotic drugs may be used, especially if symptoms of mania or depression persist despite treatment with other medications.
• Antidepressants: These are sometimes used to manage depressive episodes but are often prescribed in combination with a mood stabiliser to prevent triggering a manic episode.
• Antidepressant-Antipsychotic: A combination medication that treats both manic and depressive symptoms.

Psychotherapy

• Cognitive Behavioral Therapy (CBT): Helps individuals identify and change harmful thinking and behaviour patterns.
• Family-Focused Therapy: Involves family members and enhances family coping strategies and communication.
• Psychoeducation: Educates the patient about bipolar disorder and its treatment.
• Interpersonal and Social Rhythm Therapy: Aims to stabilise daily rhythms, such as sleep, wake, and meal times, to help manage mood swings.
• Regular Exercise: This can help reduce symptoms and improve overall mood.
• Sleep Hygiene: Maintaining a regular sleep schedule is crucial for people with bipolar disorder.
• Healthy Diet: A balanced diet can support overall well-being.
• Avoiding Alcohol and Drugs: Substance use can interfere with treatment and may exacerbate symptoms.

Electroconvulsive Therapy (ECT)

In severe cases or when other treatments have failed, ECT can be effective, particularly for severe depression or manic episodes that do not respond to medication.

Conclusion

Bipolar disorder is a complex mental health condition characterised by significant mood fluctuations and varying symptoms. Understanding its types, symptoms, and diagnostic processes is crucial for effective management and treatment. For comprehensive support and expert care, consider consulting Max Hospitals, a dedicated resource offering tailored advice and solutions for those affected by bipolar disorder.