BIPOLAR I DISORDER

SYMPTOMS, CAUSES AND

TREATMENT

What is Bipolar I disorder?

Bipolar I disorder (also known simply as Bipolar disorder) was formerly
called manic depression. This is due to the two states that are typically
associated with the disorder: mania and depression. However, a
depressive episode is not necessary for a diagnosis of Bipolar I disorder,
and there are also mixed states which combine symptoms of
depression and mania.
Bipolar I disorder is considered just one disorder on a bipolar spectrum
that includes Bipolar II disorder and cyclothymia. According to Richman
(2014):
Bipolar disorder exhibits a spectrum of symptoms, from which
psychiatrists make their diagnosis. One of the factors they examine is
whether the person is in a depressed, manic, or hypomanic state. The
latter is one in which a person experiences a more controlled mania.
The
person may become excessively active and feel elated, but does not
become disorganized or delusional. People with these symptoms may be
cyclothymic, that is they exhibit periods of depression and mania, but for
shorter and less intense durations. (p. 608)

DSM-IV Diagnostic Criteria

Mania

A. A distinct period of abnormally and persistently elevated, expansive, or

irritable mood, lasting at least 1 week (or any duration if hospitalization is
necessary)
B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (4 if the mood is only irritable) and have been
present to a significant degree:
(1) increased self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
(7) excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)" (APA, 2000, p. 362)

Some of this mania is not

the same

Adolescents diagnosed with

bipolar disorder are more likely to
experience dysphoric mania, which
manifests as anger and irritability
rather than euphoria. However, it is
common among bipolar individuals
in other age groups as well.
(Basile & Cataldo, 2012).

DSM-IV Diagnostic Criteria - Depression

Depressed mood and/or loss of interest or pleasure in life activities
for at least 2 weeks and at least five of the following symptoms
that cause clinically significant impairment in social, work, or other
important areas of functioning almost every day.
[ . . .]
1. Depressed mood most of the day.
2. Diminished interest or pleasure in all or most activities.
3. Significant unintentional weight loss or gain.
4. Insomnia or sleeping too much.
5. Agitation or psychomotor retardation noticed by others.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive guilt.
8. Diminished ability to think or concentrate, or indecisiveness.
9. Recurrent thoughts of death (APA, 2000, p. 356).

Bipolar depression Theres a difference

Bipolar depression often presents differently than unipolar

depression.
Individuals experiencing a bipolar disorder depressive episode
often presentswith signs of eating more (hyperphagia), sleeping
more (hypersomnia), very low energy levels, excess weight,
and experience worsening of mood during evening hours.
Unipolar (major) depression usually presents with anxiety,
difficulty sleeping, loss of appetite, loss of weight, and feeling
worse during morning hours, which improves as the day
progresses. (Fundukian, 2010)
Bipolar depression also carries a higher risk of suicide than
unipolar depression. 25%50% of individuals with bipolar
disorder attempt suicide, and 11% complete the suicide
attempt. (Basile & Cataldo, 2012)

It Takes Two to Make a Thing Go Right

Mixed states manifest with symptoms of both

mania and depression.
For example, a person may have racing thoughts
as in a manic state but still feel lethargic and
fatigued as in a depressed state. Rapid cycling
occurs in up to 20% of individuals diagnosed with
bipolar disorder. Rapid cycling involves at least 4
swings from manic to depressive episodes or vice
versa in a 12 month period. Ultra-rapid cycling, in
which an individual experiences manic and
depressed states several times in a 24 hour period,
is difficult to distinguish from a mixed state.

What Causes Bipolar I

disorder?

Genetics Children who have at least one parent

with bipolar disorder have a 15%-30% chance of
developing the disorder themselves. Two bipolar
parents increases the risk of a child developing the
disorder to 50%-75%.
Although genetics may form the basis for an
individuals propensity to develop bipolar disorder,
the first episode is always triggered by external
stressors.
This finding suggests that bipolar disorder may be
preventable if suseptible individuals are intervened
upon early.

Treatment for Bipolar

Disorder

Psychosocial intervention a
combination of psychotherapy and
patient education
Lifestyle modifications stress reduction,
maintaining a regular sleep schedule,
proper diet, exercise
Alternative therapies such as mineral
supplements and acupuncture
Pharmaceuticals

The Biological Model

Pharmaceuticals are considered to be essential

in treating bipolar disorder
Mood stabilizers such as lithium and various
anticonvulsive agents are used.
SSRIs and SSNRIs (e.g. Prozac, Paxil, Effexor,
Cymbalta) can actually provoke manic episodes
in individuals who may or may not have
developed bipolar disorder without
antidepressant treatment
Care must be taken to avoid confusing side
effects with actual symptoms of mental illness

References
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