Bipolar disorders are characterised by extreme fluctuations in mood whereby an individual alternates between states of depression and mania. The term ‘bipolar’ describes the contrasting emotions at different ends of the spectrum of mood. There are three subtypes of bipolar disorders, bipolar I disorder, bipolar II disorder and cyclothymic disorder.
Signs and Symptoms:
The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes. Often, individuals have had one or more major depressive episodes. One episode of mania is sufficient to make the diagnosis of bipolar disorder. Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, drug abuse, or toxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. In addition, the episodes must not be better accounted for by another mental illness.
Bipolar II disorder is a bipolar spectrum disorder characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for bipolar II disorder requires that the individual must never have experienced a full manic episode (unless caused by an antidepressant; otherwise one manic episode meets the criteria for bipolar I disorder).
People with cyclothymia experience both depressive phases and hypomanic phases (which are milder than classic manic phases). The depressive and manic symptoms in cyclothymia last for variable amounts of time due to the unstable and reactive nature of the disorder. The depressive phases are similar to major depressive disorder and are characterized by dulled thoughts and sensations and the lack of motivation for intellectual or social activities.
Co-occurring depression and mania:
A mixed state is a condition during which symptoms of both mania and depression occur simultaneously. Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal. Mixed states are considered to be high-risk for suicidal behaviour since depressive emotions such as hopelessness are often paired with mood swings or difficulties with impulse control.
Twin studies have found a high concordance rate between monozygotic twins compared to dizygotic twins which show there is a genetic component to bipolar disorders. The risk of bipolar disorder is nearly ten-fold higher in first degree relatives of those affected with bipolar disorder when compared to the general population. There is some evidence that the genes responsible for circadian rhythms may play a role in acquiring the disorder.
30–50% of adults diagnosed with bipolar disorder report traumatic or abusive experiences in childhood, which is associated with earlier onset, a higher rate of suicide attempts, and more co-occurring disorders such as post-traumatic stress disorder (PTSD). Familial expectations for achievement have also been found to correlate with manic symptoms (Chen & Johnson, 2012).
Some studies have found that those with bipolar disorders have a heightened sensitivity to reward (Johnson & Jones, 2009). Infrequently illness can lead to bipolar disorders. These include stroke, traumatic brain injury, HIV infection, multiple sclerosis, porphyria, and rarely temporal lobe epilepsy.
CBT can be used to help those with bipolar disorder challenge the negative thoughts and maladaptive behaviour patterns they may have. It may also help the individual rationalise in their manic episodes if they are experiencing feelings of grandiosity.
The most common medication given to treat bipolar disorders are mood stabilisers. The most popular of which is lithium. Lithium is effective at reducing both manic and depressive symptoms. Another mood stabiliser that is sometimes used is sodium valproate which works in a similar way to lithium.
Antipsychotics may be used in cases of psychotic symptoms in bipolar 1. These include olanzapine and risperidone. These alter the levels of serotonin and dopamine in the brain which reduces symptoms.