Bipolar Disorder

1.

WHAT IS BIPOLAR DISORDER?

Bipolar disorder, also referred to as manic-depressive illness, is a brain disorder which causes abnormal changes in mood, energy, activity levels, and the ability to handle day-to-day tasks. Symptoms of bipolar disorder are severe. They are generally different from the usual ups and downs that most people go through. Bipolar disorder symptoms can lead to damaged relationships, poor job or school performance, and even committing suicide. Bipolar disorder is usually incredibly distressing and troublesome for those who suffer from this illness, their spouses, family members, friends and employers. That said bipolar disorder can be dealt with, and individuals with this kind of condition can lead full as well as productive lives. Bipolar disorder typically develops in a person’s late teens or early adult years. At least 50 % of all cases start before age twenty five. Many people experience their 1st symptoms during childhood, when others may develop signs and symptoms later in life.

Bipolar disorder isn’t easy to identify when it starts. The symptoms may seem like separate issues, not recognized as elements of a much larger problem. Some individuals suffer for years prior to being properly diagnosed and treated. Even though chemical imbalances in the brain are a key element of bipolar disorder, it really is a complex condition which consists of genetic, environmental, and various other factors.

Numerous people involved with the arts are thought to have suffered from bipolar disorder. A deficit in normal information-processing may be manifested in a critical behavioral disorder, however it may favor creative links between information units or a tendency toward innovation and originality as well. The altered neurological system and performance in the frontal lobe, prefrontal cortex, hippocampus, hypothalamus and cerebellum linked to bipolar disorder may also result in more creative thinking.

Tags: what is bipolar disorder – manic depression

Quick Navigation:

• - What is bipolar disorder?
• - Mood disorders & bipolar disorder
• - Bipolar disorder symptoms
• - What are common symptoms of bipolar disorder in children and teens?
• - What does it feel like to have bipolar disorder?
• - How does bipolar disorder affect a person over time?
• - What illnesses often co-exist with bipolar disorder?
• - What are the risk factors, causes for bipolar disorder?
• - What affects a child’s risk of getting bipolar disorder?
• - How does bipolar disorder affect children and teens differently than adults?
• - Bipolar disorder diagnosis & diagnostic criteria for each type
• - Bipolar Disorder One - Bipolar I Disorder
• - Bipolar Disorder Two - Bipolar II Disorder
• - Cyclothymic Disorder
• - Bipolar Disorder Not Otherwise Specified
• - How is bipolar disorder treated?
• - Medications for bipolar disorder
• - Medications for children & teens
• - Common Side Effects
• - Psychotherapy
• - Other treatments for bipolar disorder
• - What can one with bipolar disorder expect from treatment?
• - How can I help a friend or relative with bipolar disorder?
• - Support for caregivers/parents
• - How can I help myself if I have bipolar disorder?
• - Where to go for help?

2.

MOOD DISORDERS & BIPOLAR DISORDER

Mood Disorders are separated into the Depressive Disorders (unipolar depression), the Bipolar Disorders, and 2 disorders determined by etiology—Mood Disorder As a result of General Medical Condition and Substance-Induced Mood Disorder. The Depressive Disorders are different from the Bipolar Disorders by the fact that there isn’t any record of previously having a Manic, Mixed, or Hypomanic Episode. The Bipolar Disorders (Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified) require the occurrence (or historical past) of Manic Episodes, Mixed Episodes, or Hypomanic Episodes, generally coupled with the existence (or record) of Major Depressive Episodes.

Tags: bipolar mood disorder – bipolar affective disorder

 

3.

WHAT ARE THE SYMPTOMS OF BIPOLAR DISORDER?

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.

A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.

Symptoms of mania or a manic episode include:

- Mood Changes

1. A long period of feeling “high,” or an overly happy or outgoing, confident, sensational mood, believing in having superficial powers, feeling special
2. Extremely irritable mood, agitation, anger, feeling “jumpy” or “wired.”

- Behavioral Changes

1. Talking very fast, jumping from one idea to another, having racing thoughts
2. Being easily distracted
3. Increasing goal-directed activities, such as taking on new projects
4. Being restless
5. Sleeping little
6. Having an unrealistic belief in one’s abilities
7. Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Symptoms of depression or a depressive episode include:

- Mood Changes

1. A long period of feeling worried or empty, hopeless, suicidal thoughts & phantasies
2. Loss of interest in activities once enjoyed, including sex.

- Behavioral Changes

1. Feeling tired or “slowed down”
2. Having problems concentrating, remembering, and making decisions
3. Being restless or irritable
4. Changing eating, sleeping, or other habits
5. Thinking of death or suicide, or attempting suicide.

In addition to mania and depression, bipolar disorder can cause a range of moods; normal or severe depression, balanced mood, hypomania and moderate depression, and severe mania, mild low mood. One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood. At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.

During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person’s extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.

People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it’s not easy to recognize these problems as signs of a major mental illness.

Tags: symptoms for bipolar disorder – symptoms test for bipolar disorder – bipolar disorder symptoms in adults – signs of bipolar disorder – depression – bipolar disorder manic

 

4.

WHAT ARE COMMON SYMPTOMS OF BIPOLAR DISORDER IN CHILDREN AND TEENS?

Youth with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. Symptoms of bipolar disorder are described below.

Tags: symptoms of bipolar disorder in children

Symptoms of mania include:

- Mood Changes

1. Being in an overly silly or joyful mood that’s unusual for your child. It is different from times when he or she might usually get silly and have fun.
2. Having an extremely short temper. This is an irritable mood that is unusual.

- Behavioral Changes

1. Sleeping little but not feeling tired
2. Talking a lot and having racing thoughts
3. Having trouble concentrating, attention jumping from one thing to the next in an unusual way
4. Talking and thinking about sex more often
5. Behaving in risky ways more often, seeking pleasure a lot, and doing more activities than usual.

Symptoms of depression include:

- Mood Changes

1. Being in a sad mood that lasts a long time
2. Losing interest in activities they once enjoyed
3. Feeling worthless or guilty.

- Behavioral Changes

1. Complaining about pain more often, such as headaches, stomach aches, and muscle pains
2. Eating a lot more or less and gaining or losing a lot of weight
3. Sleeping or oversleeping when these were not problems before
4. Losing energy
5. Recurring thoughts of death or suicide.

It’s normal for almost every child or teen to have some of these symptoms sometimes. These passing changes should not be confused with bipolar disorder.

Symptoms of bipolar disorder are not like the normal changes in mood and energy that everyone has now and then. Bipolar symptoms are more extreme and tend to last for most of the day, nearly every day, for at least one week. Also, depressive or manic episodes include moods very different from a child’s normal mood, and the behaviors described in the chart above may start at the same time. Sometimes the symptoms of bipolar disorder are so severe that the child needs to be treated in a hospital.

In addition to mania and depression, bipolar disorder can cause a range of moods. One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.

Sometimes, a child may have more energy and be more active than normal, but not show the severe signs of a full-blown manic episode. When this happens, it is called hypomania, and it generally lasts for at least four days in a row. Hypomania causes noticeable changes in behavior, but does not harm a child’s ability to function in the way mania does.

Tags: childhood bipolar disorder – bipolar disorder in teens

 

5.

WHAT DOES BIPOLAR DISORDER FEEL LIKE? (CITATIONS)

“To me, being hypomanic has to be better than any drug anyone could ever market. Those are the times I stay up all night and work on my websites. I swear I have never had so much fun. I always get scolded the next day for staying up and I always reply “…but I was having so much fun!” Creative?!

My brain is not only creative but it is working in overdrive. Ideas are coming and they are coming so fast that I get frustrated because I cannot keep up with them. I swear this is when I do my best work on my websites. I feel so brilliant during those times.

In fact hypomania is one of the reasons that many people with bipolar disorder do not take their medications. They simply do not want to give up that “high”. To me, that is really juggling with your life. I cannot speak for any one else’s depressions, but mine are full of suicidal ideation. They are absolutely intolerable.”

“I have out of body experiences (detachment), rapid speech, anger and aggression, uncontrollable laughter, uncontrollable verbal vomit, paranoia, increased heart rate …etc.”

“I actually love to be in the mania or hypomania end of things. I am very happy, confident, productive, loving, giving, and stuff like that. I would be very happy if I could be stabilized on the high side and not have to dip way down into the low side as if a price has to be paid for that high.”

“My mania always involved me being irritable and erratic and hyper.”

“I feel like a complete and total looser who doesn’t deserve to live.”

“I had to just give up wondering what “normal” felt like. I’ve decided that if I can find a feeling of “normal” for me, that’s good enough for me.”

“Bipolar disorder for me is ugly. When I am in the up swing life is great. I have this feeling that I can do anything, I take on project after project because I can hey I don’t sleep for days when I am manic. The thing is my mind races and I can’t finish anything I start because I race form thing to thing and can’t finish thoughts or even sentences. So people have learned not to trust me and that hurts. Hurt and regret are a big part of Bipolar for me. I want so desperately to be respected and trusted. It is like there is a thousand radios blaring at you with all this info at you. Normal people can focus on one radio and turn down all the other ones people with bipolar can’t focus and frantically switch from radio to radio getting stressed and frantic. I can grab my husband’s credit card and blow our credit. It has taken us two years getting out of one manic episode. My children call me the fun mom because I will wake them up at two in the morning to bake cookies. We do arts and crafts and crazy stuff like dress up and parade downtown. The thing is I quit cleaning the house gets trashed my husband comes home from work and does the washing and cleaning. In my younger years I have stolen my parents’ car picked up and moved with no money and no job. All because I felt something was calling me and I was so happy. Then boom you crash. All of a sudden you realize the responsibilities you have. My brain feels like it is being squeezed and my eyes want to close. The kids are talking to me and I start to yell. I realize I don’t have very many close friend because it is hard to get close to anyone. I look at my husband and think I have ruined his life. Life is dark and all I want to do is sleep.”

“For me, it’s like being on the absolute wildest roller coaster ride you can possibly imagine … getting pulled this way and that way … going up … going down and thru loop after loop with my head is spinning out of control … and all I want is for the ride to stop! …I wouldn’t wish this on anyone…”

Tags: definition of bipolar disorder – about bipolar disorder – bipolar disorder information – manic bipolar disorder

 

6.

HOW DOES BIPOLAR DISORDER AFFECT SOMEONE OVER TIME?

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

This section includes Bipolar I Disorder, Bipolar II Disorder, Cyclothymia, and Bipolar Disorder Not Otherwise Specified. There are six separate criteria sets for Bipolar I Disorder: Single Manic Episode, Most Recent Episode Hypomanic, Most Recent Episode Manic, Most Recent Episode Mixed, Most Recent Episode Depressed, and Most Recent Episode Unspecified. Bipolar I Disorder, Single Manic Episode, is used to describe individuals who are having a first episode of mania. The remaining criteria sets are used to specify the nature of the current (or most recent) episode in individuals who have had recurrent mood episodes.

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

1. Bipolar Disorder Type I is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
2. Bipolar Disorder Type II is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
3. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year. Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men.

Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.5 Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.

Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

Tags: bipolar disorder mania – bipolar disorder mood swings – symptoms of bipolar disorder – characteristics of bipolar disorder

7.

WHAT ILLNESSES OFTEN CO-EXIST WITH BIPOLAR DISORDER?

Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear.  Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much. Adults with bipolar disorder are at very high risk of developing a substance abuse problem. Young people with bipolar disorder may have the same risk.

Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder. Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted. Many children with bipolar disorder have a history of ADHD. One study showed that ADHD is more common in people whose bipolar disorder started during childhood, compared with people whose bipolar disorder started later in life. Children who have co-occurring ADHD and bipolar disorder may have difficulty concentrating and controlling their activity. This may happen even when they are not manic or depressed. Anxiety disorders, such as separation anxiety and generalized anxiety disorder, also commonly co-occur with bipolar disorder. This may happen in both children and adults. Children who have both types of disorders tend to develop bipolar disorder at a younger age and have more hospital stays related to mental illness.

People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.

Other illnesses can make it hard to diagnose and treat bipolar disorder. People with bipolar disorder should monitor their physical and mental health. If a symptom does not get better with treatment, they should tell their doctor.

8.

WHAT ARE THE RISK FACTORS FOR BIPOLAR DISORDER?

Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.

Tags: cause of bipolar disorder

GENETICS

Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person’s chance of developing the illness. Genes are the “building blocks” of heredity. They help control how the body and brain work and grow. Genes are contained inside a person’s cells that are passed down from parents to children.

Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:

1. Missed work because of their illness
2. Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders
3. Been treated or hospitalized for bipolar disorder.

The researchers also identified certain traits that appeared to run in families, including:

- History of psychiatric hospitalization

- Co-occurring obsessive-compulsive disorder (OCD)

- Age at first manic episode

- Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.

But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person’s environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder. Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain’s structure and activity.

Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with “multi-dimensional impairment,” a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia. This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.

Tags: causes of bipolar disorder – what causes bipolar disorder – bipolar disorder causes

 

9.

WHAT AFFECTS A CHILD’S RISK OF GETTING BIPOLAR DISORDER?

Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness. Compared with children whose parents do not have bipolar disorder, children whose parents have bipolar disorder may be more likely to have symptoms of anxiety disorders and attention deficit hyperactivity disorder (ADHD).

Several studies show that youth with anxiety disorders are more likely to develop bipolar disorder than youth without anxiety disorders. However, anxiety disorders are very common in young people. Most children and teens with anxiety disorders do not develop bipolar disorder.

At this time, there is no way to prevent bipolar disorder. NIMH is currently studying how to limit or delay the first symptoms in children with a family history of the illness.

 

10.

HOW DOES BIPOLAR DISORDER AFFECT CHILDREN AND TEENS DIFFERENTLY THAN ADULTS?

Bipolar disorder that starts during childhood or during the teen years is called early-onset bipolar disorder. Early-onset bipolar disorder seems to be more severe than the forms that first appear in older teens and adults. Youth with bipolar disorder are different from adults with bipolar disorder. Young people with the illness appear to have more frequent mood switches, are sick more often, and have more mixed episodes.

Watch out for any sign of suicidal thinking or behaviors. Take these signs seriously. On average, people with early-onset bipolar disorder have greater risk for attempting suicide than those whose symptoms start in adulthood. One large study on bipolar disorder in children and teens found that more than one-third of study participants made at least one serious suicide attempt. Some suicide attempts are carefully planned and others are not. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that must be treated.

Tags: children with bipolar disorder

 

11.

HOW IS BIPOLAR DISORDER DIAGNOSED?

The first step in getting a proper diagnosis is to talk to a doctor, who may conduct a physical examination, an interview, and lab tests. Bipolar disorder cannot currently be identified through a blood test or a brain scan, but these tests can help rule out other contributing factors, such as a stroke or brain tumor. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation. The doctor may also provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

Tags: diagnosing bipolar disorder – bipolar disorder diagnosis – how to diagnose bipolar disorder – bipolar disorder test

11.1

BIPOLAR DISORDER ONE (1)

Diagnostic criteria for Bipolar I Disorder, Single Manic Episode

A. Presence of only one Manic Episode and no past Major Depressive Episodes.

Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms.

B. The Manic Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified

Diagnostic criteria for Bipolar I Disorder, Most Recent Episode Hypomanic

A. Currently (or most recently) in a Hypomanic Episode

B. There has previously been at least one Manic Episode or Mixed Episode

C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Diagnostic criteria for Bipolar I Disorder, Most Recent Episode Manic

A. Currently (or most recently) in a Manic Episode.

B. There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode.

C. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Diagnostic criteria for Bipolar I Disorder, Most Recent Episode Mixed

A. Currently (or most recently) in a Mixed Episode.

B. There has previously been at least one Major Depressive, Manic Episode, or Mixed Episode.

C. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Diagnostic criteria for Bipolar I Disorder, Most Recent Episode Depressed

A. Currently (or most recently) in a Major Depressive Episode.

B. There has previously been at least one Manic Episode or Mixed Episode.

C. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Diagnostic criteria for Bipolar I Disorder, Most Recent Episode Unspecified

A. Criteria, except for duration, are currently (or most recently) met for a Manic, a Hypomanic, a Mixed, or a Major Depressive Episode.

B. There has previously been at least one Manic Episode or Mixed Episode.

C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The mood symptoms in Criteria A and B are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Tags: bipolar 1 – bipolar disorder 1 – bipolar i disorder

11.2

BIPOLAR DISORDER TWO (2) – (RECURRENT MAJOR DEPRESSIVE EPISODES 

WITH HYPOMANIC EPISODES)

Diagnostic criteria for Bipolar II Disorder

A. Presence (or history) of one or more Major Depressive Episodes.

B. Presence (or history) of at least one Hypomanic Episode.

C. There has never been a Manic Episode or a Mixed Episode.

D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Tags: bipolar disorder type 2 – bipolar ii disorder – bipolar disorder 2 – bipolar 2 disorder

 

11.3

CYCLOTHYMIA

Diagnostic criteria for Cyclothymic Disorder

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year.

B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.

Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).

D. The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

11.4

BIPOLAR DISORDER NOT OTHERWISE SPECIFIED

The Bipolar Disorder Not Otherwise Specified category includes disorders with bipolar features that do not meet criteria for any specific Bipolar Disorder. Examples include

1. Very rapid alternation (over days) between manic symptoms and depressive symptoms that do not meet minimal duration criteria for a Manic Episode or a Major Depressive Episode

2. Recurrent Hypomanic Episodes without intercurrent depressive symptoms

3. A Manic or Mixed Episode superimposed on Delusional Disorder, residual Schizophrenia, or Psychotic Disorder Not Otherwise Specified

4. Situations in which the clinician has concluded that a Bipolar Disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced

The doctor or mental health professional should conduct a complete diagnostic evaluation. He or she should discuss any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professionals should also talk to the person’s close relatives or spouse and note how they describe the person’s symptoms and family medical history.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depressive disorder, which is also called unipolar depression. Unlike people with bipolar disorder, people who have unipolar depression do not experience mania. Whenever possible, previous records and input from family and friends should also be included in the medical history.

Tags: types of bipolar disorder – rapid cycling bipolar disorder – what are the symptoms of bipolar disorder – bipolar disorder quiz

 

12.

HOW IS BIPOLAR DISORDER TREATED?

To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms. This is also true for people with the most severe forms of the illness.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.

To treat children and teens with bipolar disorder, doctors often rely on information about treating adults. This is because there haven’t been many studies on treating young people with the illness, although several have been started recently.

It’s important to know that children sometimes respond differently to psychiatric medications than adults do.

Tags: treatment for bipolar disorder – treating bipolar disorder – help for bipolar disorder – how to treat bipolar disorder – bipolar disorder treatment options

13.

MEDICATIONS – MEDS

Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state’s licensing agency to find out more.

Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.

Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person’s symptoms change or if side effects become serious, the doctor may switch or add medications.

Some of the types of medications generally used to treat bipolar disorder are listed below the next paragraph. Information on medications can change. For the most up to date information on use and side effects contact the U.S. Food and Drug Administration (FDA) at http://www.fda.gov.

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14.

MEDICATIONS FOR CHILDREN & TEENS

Before starting medication, the doctor will want to determine your child’s physical and mental health. This is called a “baseline” assessment. Your child will need regular follow-up visits to monitor treatment progress and side effects. Most children with bipolar disorder will also need long-term or even lifelong medication treatment. This is often the best way to manage symptoms and prevent relapse, or a return of symptoms.

It’s better to limit the number and dose of medications. A good way to remember this is “start low, go slow.” Talk to the psychiatrist about using the smallest amount of medication that helps relieve your child’s symptoms. To judge a medication’s effectiveness, your child may need to take a medication for several weeks or months. The doctor needs this time to decide whether to switch to a different medication. Because children’s symptoms are complex, it’s not unusual for them to need more than one type of medication.

Keep a daily log of your child’s most troublesome symptoms. Doing so can make it easier for you, your child, and the doctor to decide whether a medication is helpful. Also, be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements your child is taking. Taking certain medications and supplements together may cause unwanted or dangerous effects.

To date, lithium (sometimes known as Eskalith), risperidone (Risperdal), and aripiprazole (Abilify) are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder in young people.

Lithium is a type of medication called a mood stabilizer. It can help treat and prevent manic symptoms in children ages 12 and older.21 In addition, there is some evidence that lithium might act as an antidepressant and help prevent suicidal behavior. However, FDA’s approval of lithium was based on treatment studies in adults. In fact, some experts say the FDA might not approve giving lithium to bipolar youth if the agency were to review this treatment today.

COMMON MEDICATION FOR BIPOLAR DISORDER

1. Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anti-convulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

Lithium Poisoning!

Children may be showing early signs of lithium poisoning if they develop the following:

Take your child to the emergency room if he or she is taking lithium and has these symptoms. You should know that the risk of lithium poisoning goes up when a child becomes dehydrated. Make sure your child has enough to drink when he or she has a fever or sweats, such as when playing sports in the hot summer.

Lithium and Thyroid Function

People with bipolar disorder often have thyroid gland problems. Lithium treatment may also cause low thyroid levels in some people. Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.

Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully. A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.

Should young women take valproic acid?

Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20. PCOS causes a woman’s eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid. Young girls and women taking valproic acid should be monitored carefully by a doctor.

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2. Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called “atypical” to set them apart from earlier medications, which are called “conventional” or “fi rst-generation” antipsychotics.

3. Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person’s risk of switching to mania or hypomania, or of developing rapid cycling symptoms.29 To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.

Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.30

Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.

Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.

15.

COMMON SIDE EFFECTS

Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits.

The psychiatrist prescribing the medication or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than earlier treatments. However, everyone responds differently to medications. In some cases, side effects may not appear until a person has taken a medication for some time.

If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to “rebound,” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

FDA Warning on Antidepressants!

Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. The latest information from the FDA can be found at http://www.fda.gov.

The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.

1. Mood Stabilizers

In some cases, lithium can cause side effects such as:

1. Restlessness
2. Dry mouth
3. Bloating or indigestion
4. Acne
5. Unusual discomfort to cold temperatures
6. Joint or muscle pain
7. Brittle nails or hair.

Lithium also causes side effects not listed here. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.

If a person with bipolar disorder is being treated with lithium, it is important to make regular visits to the treating doctor. The doctor needs to check the levels of lithium in the person’s blood, as well as kidney and thyroid function.

 

 

2. Atypical Antipsychotics

Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

1. Drowsiness
2. Dizziness when changing positions
3. Blurred vision
4. Rapid heartbeat
5. Sensitivity to the sun
6. Skin rashes
7. Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol.A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking these medications.

In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug.

Antidepressants

The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:

1. Headache, which usually goes away within a few days.
2. Nausea (feeling sick to your stomach), which usually goes away within a few days.
3. Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
4. Agitation (feeling jittery).
5. Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.

Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.

Should women who are pregnant or may become pregnant take medication for bipolar disorder?

Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant. But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.

Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder. However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk. Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments.

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16.

PSYCHOTHERAPY

In addition to medication, psychotherapy, or “talk” therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. In addition to getting therapy to reduce symptoms of bipolar disorder, children and teens may also benefit from therapies that address problems at school, work, or in the community. Such therapies may target communication skills, problem-solving skills, or skills for school or work. Other programs, such as those provided by social welfare programs or support and advocacy groups, can help as well. Some children with bipolar disorder may also have learning disorders or language problems.Your child’s school may need to make accommodations that reduce the stresses of a school day and provide proper support or interventions. Some psychotherapy treatments used to treat bipolar disorder include:

1. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
2. Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
3. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
4. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.

A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor’s instructions for any psychotherapy will provide the greatest benefit.

Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder. In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans.42 They were also more likely to get well faster and stay well longer.

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17.

OTHER TREATMENTS

1. Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as “shock therapy,” once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.

Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.43

Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a fi rst-line treatment.

ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.

2. Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.

People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Herbal Supplements

In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. An herb called St. John’s wort (Hypericum perforatum ), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder. St. John’s wort can also make other medications less effective, including some antidepressant and anticonvulsant medications.Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder. Study results have been mixed. It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications.

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18.

WHAT CAN PEOPLE WITH BIPOLAR DISORDER EXPECT FROM TREATMENT?

Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year’s time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks.

However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state. If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse. Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.

Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person’s response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.

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19.

HOW CAN I HELP A FRIEND OR RELATIVE WHO HAS BIPOLAR DISORDER?

If you know someone who has bipolar disorder, it affects you too. The first and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment.

To help a friend or relative, you can:

1. Offer emotional support, understanding, patience, and encouragement
2. Learn about bipolar disorder so you can understand what your friend or relative is experiencing
3. Talk to your friend or relative and listen carefully

Listen to feelings your friend or relative expresses—be understanding about situations that may trigger bipolar symptoms

Invite your friend or relative out for positive distractions, such as walks, outings, and other activities

Remind your friend or relative that, with time and treatment, he or she can get better.

Never ignore comments about your friend or relative harming himself or herself. Always report such comments to his or her therapist or doctor.

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20.

SUPPORT FOR CAREGIVERS

Like other serious illnesses, bipolar disorder can be difficult for spouses, family members, friends, and other caregivers. Relatives and friends often have to cope with the person’s serious behavioral problems, such as wild spending sprees during mania, extreme withdrawal during depression, poor work or school performance. These behaviors can have lasting consequences.

Caregivers usually take care of the medical needs of their loved ones. The caregivers have to deal with how this affects their own health. The stress that caregivers are under may lead to missed work or lost free time, strained relationships with people who may not understand the situation, and physical and mental exhaustion.

Stress from caregiving can make it hard to cope with a loved one’s bipolar symptoms. One study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble following the treatment plan, which increases the chance for a major bipolar episode.50 It is important that people caring for those with bipolar disorder also take care of themselves.

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21.

HOW CAN I HELP MYSELF IF I HAVE BIPOLAR DISORDER?

It may be very hard to take that first step to help yourself. It may take time, but you can get better with treatment.

To help yourself:

1. Talk to your doctor about treatment options and progress
2. Keep a regular routine, such as eating meals at the same time every day and going to sleep at the same time every night
3. Try to get enough sleep
4. Stay on your medication

Learn about warning signs signaling a shift into depression or mania

Expect your symptoms to improve gradually, not immediately.

22.

WHERE CAN I GO FOR HELP?

If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.

1. Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
2. Health maintenance organizations
3. Community mental health centers
4. Hospital psychiatry departments and outpatient clinics
5. Mental health programs at universities or medical schools
6. State hospital outpatient clinics
7. Family services, social agencies, or clergy
8. Peer support groups
9. Private clinics and facilities
10. Employee assistance programs
11. Local medical and/or psychiatric societies.

You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

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