Description Bipolar disorder explained

This section contains the latest information on bipolar disorder, based on the Black Dog Institute's research and clinical observations. You will find: - A self-test for bipolar disorder - Explanations on the different types of bipolar disorder - Causes of bipolar disorder - The latest on mania and hypomania - Up to date information on bipolar depression - Treatments. For general practitioners, we provide a special comprehensive section on bipolar disorder, incorporating management approaches.

what is bipolar disorder? Bipolar disorder is the name used to describe a set of 'mood swing' conditions, the most severe form of which used to be called 'manic depression'. Bipolar disorder I is the more severe disorder in terms of symptoms- with individuals being more likely to experience mania, have longer 'highs', be more likely to have psychotic experiences and be more likely to be hospitalised. Bipolar disorder II is diagnosed when a person experiences the symptoms of a high but with no psychotic experiences. These hypomanic episodes tending to last a few hours or a few days, but longitudinal studies suggest impairment is often as severe as in bipolar I disorder. The high moods are called mania or hypomania and the low mood is called depression. However, it is important to note that everyone has mood swings from time to time. It is only when these moods become extreme and interfere with personal and professional life that bipolar disorder may be present and a psychiatric assessment may be warranted. other key points about bipolar disorder - Occasionally people can experience a mixture of both highs and lows at the same time, or switch during the day, giving a mixed picture. - Some people may only have one episode of mania once a decade, while others may have daily mood swings. For each individual the pattern is quite distinct. - People with bipolar disorder can experience normal moods in between their swings but the majority experience some low level symptoms between episodes.. - Women and men develop bipolar I disorder at equal rates while the rate of bipolar II is somewhat higher in females. - Bipolar disorder can commence in childhood, but onset is commoner in the teens or early 20s. Some people develop their first episode in mid-to- late adulthood. Many people can go for years before it is accurately diagnosed or treated (see How to tell if you have bipolar disorder) - Women with bipolar disorder have a very high chance of a significant mood disturbance both during pregnancy and in the post-partum period - most commonly in the first four weeks. (Most will have a depressive episode, a significant proportion will have highs, and 10% will have mixed highs and lows.) - With the right treatment, the vast majority of people with bipolar disorder are able to live normal and productive lives. - Some people with bipolar disorder can become suicidal. It is very important that talk of suicide be taken seriously and for such people to be treated immediately by a mental health professional or other appropriate person. Please note that the information in this section (or anywhere on this site) is not intended as a substitute for professional medical advice, so please see a qualified health provider if you have any health concerns. mania & hypomania defined introduction Mania is a state of heightened energy and euphoria - an elevation of mood. It is in direct contrast to depression. Mania can vary in severity from hypomania, where, in addition to mood and energy elevation, the person shows mild impairment of judgement and insight, to severe mania with delusions and a level of manic excitement that can be so exhausting that hospitalisation is required to control the episode. The mood, energy and other related symptoms define both mania and hypomania, with psychotic features being an 'add on' component experienced by a sub- set of individuals. Read about psychotic features. principal features of hypomania and mania Our research has identified six principal features of hypomania and mania: high energy levels, positive mood, irritability, inappropriate behaviour, creativity and mystical experiences. Those with mania or hypomania will have changes in at least 3 of these areas. 1. High Energy Levels: We believe this to be the key feature underlying all states of hypomania and mania. High energy levels are indicated by the individual feeling 'wired' and 'hyper'; finding that their thoughts race; feeling extremely energetic and making decisions in a flash; talking more and talking over people; racing from plan to plan and being constantly on the go; and describing the need for less sleep without feeling tired. 2. Positive Mood: The positive or hedonistic mood is reflected in descriptions such as feeling confident and capable; being extremely optimistic; feeling that one can succeed in everything; being more creative; and perhaps feeling 'high as a kite'. Any general anxiety disappears. 3. Irritability: Is reflected in irritable, impatient and angry behaviours. 4. Inappropriate Behaviour: Can be reflected by becoming over-involved in other people's activities; by increased risk taking (including increased consumption of alcohol and drugs, getting a tattoo impulsively, and gambling excessively); saying and doing somewhat outrageous things; spending more money; having increased libido and getting into relationships that are later regretted; and dressing more colourfully and with disinhibition. 5. Creativity: Can be experienced as 'seeing things in a new light'; 'seeing things vividly and with crystal clarity'; finding one's senses are heightened; and feeling quite capable of writing the 'great Australian novel'. 6. Mystical Experiences: Can be experienced by believing that there are special connections between events; that there is a higher rate of coincidences between things happening; feeling one with nature in terms of appreciating the beauty and the world around, and believing that things have special significance. psychotic symptoms in bipolar disorder - delusions and hallucinations Delusions (fixed, false, irrational or illogical beliefs) and hallucinations (hearing, seeing, or sensing things without there being a stimulus to cause them) can sometimes occur when someone is experiencing an acute manic episode. They can also occur during a severe episode of melancholic depression in people with bipolar disorder, with delusions being a much more common occurrence than hallucinations. These symptoms are commonly referred to as 'psychotic' symptoms and when they occur with other manic symptoms (as outlined above) indicate that the person has a bipolar I disorder. Psychotic symptoms are not seen in hypomania, the key defining mood state of bipolar II disorder. The presence of psychotic symptoms needs to be taken seriously as they reflect a serious episode and the likely need for that person to be admitted into hospital for close monitoring and urgent treatment. If there is a lot of support available by family and/or a community mental health team this can sometimes be avoided. However, a person experiencing these symptoms needs a quiet, calm and controlled environment to keep them safe and this can be hard to achieve in the home environment. The risk is that the person acts on a delusional belief (e.g. they may believe they have the ability to fly and then try to jump out of a tenth floor window) which puts them, or another person in danger. Delusional beliefs are by definition, fixed and held absolutely so that even repeated and persuasive attempts by others to prove that the belief is false, fail. Delusions The types of delusions that can occur during a manic episode are: Grandiose delusions: In this type of delusion the person believes that they possess special and unique gifts or powers that others don't have, or that they have access to information that is hidden to others. This type of delusion is the most characteristic of a mania and is said to be 'mood congruent'. Examples: Having a belief that they are a king, are really Jesus, or that they can cure the sick, that they are really a multi-millionaire or that they have the power of telepathy. Persecutory delusions: In this type of delusion the person believes that people are after him or her, that something really bad is about to happen to them or to someone they know. Although it can occur in mania, this type of delusion can also be seen in other psychotic illnesses and is therefore not diagnostic of bipolar disorder per se. Example: Believing people are following them as they walk down the street, or that someone is out to hurt them or someone they know. Hallucinations Hallucinations are also seen in mania and they can occur in any sense organ (i.e. hearing, taste, sight, sensation). The commonest hallucinations occurring in mania are auditory. Sometimes the experience of having hallucinations can propel the person to seek an explanation for their presence and this can fuel the development of a delusional belief. The different types of hallucinations that can occur are shown below: Auditory Hallucinations Hearing things (e.g. sounds of footsteps or voices). These can be a single voice or several, male or female, be familiar or unfamiliar. The voice(s) can call the person's name, tell them to do things, comment on what the person is doing, or if more than one voice, can talk to each other about the person. Hallucinations are normally perceived as coming from outside the person's head but occasionally people hear them inside the head (similar to the person's own thoughts). Olfactory hallucinations Smelling things. Can be pleasant or unpleasant. This can be a signal that there is another physical problem and would warrant a thorough physical examination and review by a specialist physician. Gustatory Hallucination Having unusual tastes in the mouth. Again this can be a signal that they is another physical problem and would warrant a thorough physical examination and review by a specialist physician. Tactile Hallucinations Feeling sensations on the skin (e.g. something is crawling over them). Again this can be a signal that there is another physical problem and would warrant a thorough physical examination and review by a specialist physician. Commonly this occurs in a drug withdrawal state. Somatic Hallucinations These are feeling sensations deep within the body and can be very unpleasant. Visual Hallucinations Seeing things that aren't really there (e.g. seeing people or shadows). They can become quite complex with people seeing whole scenes but are uncommon in 'pure' mania and are more commonly associated with some underlying physical or organic problem. bipolar depression Bipolar depression is the name given to the depression experienced in those who have bipolar disorder (in other words, they experience depression as well as manic or hypomanic episodes). This is in contrast to those who experience unipolar depression, the form of depression where there are episodes of depression only (and no episodes of mania). The depression that people with bipolar disorder experience is generally of a melancholic or psychotic type and therefore more biological in its nature. The features of melancholic depression are: - a more severely depressed mood (see signs of depression) than is the case with non- melancholic depression - psychomotor disturbance - where movements are slowed and/or agitated, and concentration impaired. Many people describe an inability at such times to get out of bed, to fire up and do basic chores - thus, a very physical state. Melancholic depression has a low spontaneous remission rate. It responds best to physical treatments (for example antidepressant drugs) and only minimally (at best) to non-physical treatments such as counselling or psychotherapy. depression and bipolar I and II The depression experienced by sufferers of bipolar disorder can be equally as severe for people with bipolar II as for people with bipolar I, and with a similar psychomotor disturbance component. However, younger people with bipolar II are more likely to report increased sleep and food cravings rather than insomnia and appetite/weight loss as usually experienced in melancholia. Some recent studies have gone further by showing that depression can be both more frequent and more chronic in the case of bipolar II than with bipolar I, and that there is a comparable suicide risk between bipolar I and II sufferers, (with some researchers even reporting a higher risk for bipolar II sufferers). Therefore, for people with bipolar II, treating depression becomes a vitally important issue. Also, rapid cycling tends to be far more common among sufferers of bipolar II than bipolar I, leading both to difficulties in diagnosis and missed treatment opportunities. depression vs mania As human beings we all experience a wide range of emotions and feelings. How we are feeling at any one time is often called our mood . Two important sets of emotions are those to do with feeling sad and 'down', and those to do with feeling very positive or 'high'. It is only when these emotions are severe and impairing someone's functioning that there may be a 'mood disorder' or illness present. The following table compares depression and mania in bipolar I disorder. Mania Depression Energy Levels Increased energy Loss of energy Activity and projects Activity and interest increased decreased Spend more money Changes in Sleep Pattern Decreased need for sleep Disrupted sleep patterns: - but not feel tired. trouble getting off to sleep or waking in the middle of the night, or waking too early. Sometimes hypersomnia (oversleeping). Thoughts and Feelings Feel good, high Feel down, low, empty, exhilarated. worthless. Think yourself chosen, Think yourself useless, a special, gifted, entitled burden, the cause of all Libido increased. your problems. Thinking speeds up, Libido decreased. disorganised, a flood of Thinking, concentration, ideas. decision making impaired. Speech and Sensations Speech can be pressured In melancholic depression (not enough time to speech can be slowed convey the flow of ideas), down, there is poverty of garrulous, inappropriate. ideas, impaired Perception and sensation concentration and a lack heightened, in the more of interest and pleasure. severe cases, the Perception and sensation experience has an dull. In some cases underlying level of certain senses such as agitation. taste and smell can be abnormally heightened. Delusions, Hallucinations In severe cases there are In severe cases of grandiose delusions, e.g. depression there can be the person believes they 'nihilistic' delusions, e.g. are God, or that they have believing that their body is a plan that can save the rotting. world.

what it's like Bipolar disorder is an illness that can be distressingly difficult to live with - although with the right treatment, and over time, people can become adept in managing the illness and are able to live full and productive lives. People with bipolar disorder (especially bipolar II disorder) can describe the highs associated with the illness as enjoyable. Someone experiencing mania would usually be in very high spirits, and feel terrific, enthusiastic, confident and invincible ('energised' and 'wired'). However, others have a different experience and instead become irritable and aggressive. In a state of mania, the mind works much faster than usual, and ideas come rapidly. Individuals tend to talk more, and much faster than is usual for them. Less sleep is required, and it is as if reserves of energy are discovered, so that they may stay up late to do housework or to begin a new project. In a state of mania, the world can seem to be a wonderful place, and no job or task seeming to be too difficult. A person with mania has described the experience as 'bubbling with plans and enthusiasms'. However, while people having mania seem to have a very positive outlook on life, their perspectives and beliefs about their own abilities are very unrealistic. Judgement is affected in a manic state, and this can cause serious problems for the individual and/or family members. For instance, people may engage in reckless spending sprees, gambling, or in sexual activity they would not normally engage in, without thinking of the consequences. Experiencing a 'high' has been described as a feeling that your brakes have failed - that you are going too far and too fast. Once an episode of mania has passed, people can also feel significant embarrassment or shame about what they did or said to others during their period of mania. They may avoid social contact for a time after their mania has subsided. However, whether or not someone remembers what they did or said during an episode of mania will depend upon the degree of their mania, and, upon any medications that are taken. The lows - or depressive episodes - experienced by people with bipolar disorder can be extremely difficult to cope with and are particularly emotionally painful, reflecting the very biological 'type' of depression. Depression can also lead to suicidal thoughts and feelings in some people. In this instance it is very important to get immediate treatment (see Getting Help). A person who has been depressed may misread the onset of mania as a sign that their depression is lifting, rather than as another part of the illness. causes While we don't yet know exactly what causes bipolar disorder, we do know that it appears to have primarily biological underpinnings. However, its onset is often linked to a stressful life event. And while the causes of bipolar disorder are still unknown, there are a number of factors that are believed to play a role, including genetics, brain chemicals, environmental factors and sometimes medical illnesses. genetics Bipolar disorder is frequently inherited, with genetic factors accounting for approximately 80% of the cause of the condition. If one parent has bipolar disorder, there is a 10 per cent chance that his or her child will develop the illness. If both parents have bipolar disorder the likelihood of their child developing the illness rises to 40 per cent. However, just because one family member has the illness, it is not necessarily the case that other family members will also develop the illness. Other factors also come into play. brain chemicals A recent theory about the cause of bipolar disorder is that it is related to abnormal serotonin chemistry in the brain. Serotonin is one of the neurotransmitters in the brain, and one that strongly affects a person's mood. It is thought that abnormal serotonin chemistry causes mood swings because of its feedback effect on other brain chemicals. It is unlikely, however, that serotonin is the only neurotransmitter involved. environmental While the onset of bipolar disorder may be linked to a stressful life event, it is unlikely that stress itself is a cause of bipolar disorder. Notwithstanding this, people who suffer from bipolar disorder often find it beneficial to find ways of managing and reducing stress in their lives (as do people without the disorder!). Again - while not a cause - seasonal factors appear to play a role in the onset of bipolar disorder, with the chance of onset increasing in spring. The rapid increase in hours of bright sunshine is thought to trigger depression and mania by affecting the pineal gland. medical illness Medical illness is not a cause of bipolar disorder, but in some instances can cause symptoms that could be confused with mania or hypomania. Some medications and certain illicit stimulant drugs can also cause manic and hypomanic symptoms. Antidepressants can trigger manic or hypomanic episodes in susceptible people it is important to report any unusual symptoms to your prescribing doctor while on these medications. pregnancy For women who are genetically or otherwise biologically predisposed to developing bipolar disorder, the postnatal period can coincide with a first episode of bipolar disorder. Read about treatments for bipolar disorder during pregnancy. what is the future for someone with bipolar disorder? Like any other medical condition, such as heart disease or diabetes, bipolar disorder is an illness that requires careful management. While there is no known cure for bipolar disorder, the good news is that its severity and the frequency of episodes can be reduced or prevented with medication and other supports, such as psychological therapies.

Last Date Modified 11/09/2016 Reference http://www.blackdoginstitute.org.au/public/bipolardisorder/bipolardisorderexplain ed/index.cfm Disclaimer The information provided in the library is of a general nature only. It does not take your specific needs or circumstances into consideration. You should look at your own personal situation and requirements before deciding if it is appropriate to you. We recommend you also refer to your safety consultant.

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