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Mania / Bipolar Mania / Bipolar Mania / Bipolar Mania / Bipolar Bipolar Disorder Home Study Bipolar Disorder (BD) is a mood disorder February 2017, 1 hour that involves episodes of mania experi- enced in varying degrees of severity. Mood Disorders: People with BD are said to “cycle” be- tween manic, depressed, and normal/ A group of balanced mood states. “several condi- tions in which the BD can have a severe impact on the most critical fea- person’s ability to function, causing prob- ture is a disturb- lems with their relationships as well as ance of mood. their work/job performance. There is also toms for the first time after the age of Most often…with a high suicide rate among people with 40, they are likely experiencing a either depressed BD (15%). mood or mania.” medical condition, a medication side BD affects about 2.6% of the U.S. popu- effect, or another mental illness that lation in any given year. Of those, 82.9% is mimicking BD. are classified as “severe.” (NIMH) Possible mood episodes include: BD affects men and women equally. It hypomania (a low-grade, less intense Mania: typically onsets during late adolescence/ mania), mania, depression, or mixed early adulthood, (the average age of on- An abnormal eleva- episodes (the person experiences set is 21). Although symptoms can begin tion in mood, typi- symptoms of depression and mania at any age, if someone manifests symp- at the same time). cally characterized by elation or irritabil- ity. Bipolar Disorder: Risk Factors and Causes A brain disorder that There appears to be a of BD, including: Fragile nerve cells). These tend causes unusual strong genetic compo- X, Rubenstein-Taybi, to be more concentrated shifts in mood, nent to BD and the mood Klinefelter’s, and Fetal in areas responsible for disorders in general. For Alcohol Syndrome. processing emotions. energy, activity example, it tends to run The frontal lobe, which is Research has consist- levels, and the in families and there is a the part of the brain that ently shown that many ability to carry out 43% prevalence rate allows us to “see our- people with BD have le- day-to-day tasks. among identical twins. selves” — to gauge how sions in the white matter Symptoms are others’ might perceive There are also several of their brains (the fatty severe our behavior, appears to . genetic syndromes asso- coverings that facilitate be affected as well. ciated with higher rates proper working of the Since 1969, Milestone Centers, Inc. has provided programs and services to people with developmental and behavioral health challenges. Mania & Bipolar | Page 2 HCQU Northwest Mania in People with ID There are three basic types of symptoms that supporters, including clinicians, to rely more clinicians consider when assessing for a psy- heavily on interpreting behavioral manifesta- chiatric illness: cognitive, vegetative, and mood tions of symptoms. symptoms. Cognitive symptoms relate to In the following section, each diagnostic criteria changes in how the person processes infor- The brain and identified by the American Psychiatric Associa- mation, including concentration, memory, and tion in their Diagnostic and Statistical Manual of the body are attention. Vegetative symptoms relate to physi- Mental Disorders (DSM-5) is listed, followed by cal functions (such as sleeping, eating, and not separate examples of how that symptom may manifest energy level) that may be impacted by BD. behaviorally in a person with ID. Generally — what Mood symptoms, of course, refer to emotional speaking, a person must meet criteria for a states. affects one minimum of one week, and the symptoms must People with mild-moderate ID will typically dis- represent a change for the person and result in affects the play the full range of symptoms. Those with functional impairment. Beyond the primary severe-profound ID can be somewhat more mood symptom, a minimum of three additional other. challenging to diagnose. They are less likely to symptoms is required for diagnosis — only two be able to describe cognitive symptoms, forcing if the person has an ID. Symptoms of Mania Abnormally elevated or Irritable mood Elevated/Euphoric Mood — an exaggerated sense of happiness, confidence, and well- Diagnostic being not linked to happy/exciting events criteria includes: Irritable mood — angry expressions; assaultive, self-injurious, and/or destructive behaviors; increases in existing stereotypical behaviors Five or more Ninety-one percent of the time, the mood experienced is irritability, particularly as the symptoms illness progresses NOTE: for people with intellectual disability, BD is associated with higher rates of aggres- (only four, if sion, self-injury, disruptive behaviors, and functional impairment than any other psychiatric the person illness Inflated self-esteem or grandiosity has an ID) Exaggerated claims of skill, stature, or social events; Ex.: claims to be/know someone fa- mous Symptoms Decreased need for sleep present for a Engages in daytime activities during the night Increased problem behaviors at night, especially around bedtime minimum of More talkative/displays pressured speech two weeks Does not require spoken word (Ex. singing, humming, any vocal or gestural communica- tion) Symptoms Increased rate or volume; may ask repeated questions or frequently interrupt others Flight of ideas/racing thoughts result in The person may jump rapidly from subject to subject impairment Distractibility of daily Increased agitation with demands for concentration Unexplained skill loss (ex. incomplete ADLs); reduced workshop performance functioning Feelings of worthlessness or excessive guilt Person may make negative self-statements (Ex. “I’m stupid”) Suicidal acts in people Symptoms Person may have unrealistic fears of punishment with ID may seem like are not Person may display an excessive need for reassurance impulsive behaviors (ex. Decreased ability to think, concentrate, or make decisions running into traffic, related to a “falling” down a flight of Decreases in self-care skills or productivity at work substance or stairs) because most do “Spotty” memory not have access to the medical Recurrent thoughts of death or suicide typical means of condition Frequently talks about death/people who have died suicide. Frequent psycho-somatic complaints NOTE: Symptoms of Hypomania are the same as Mania, just less intense. HCQU Northwest Mania & Bipolar | Page 3 Bipolar Depression The “bi-” in bipolar refers to two — in See our Home Study on Depression 3. Leaden Paralysis — a sense of this case, two possible mood states that for a more comprehensive descrip- heaviness in the limbs making it may present: mania and depression. tion of symptoms. harder for the person to motivate themselves to action. This can be A depressed episode involves five or Often, when a person with bipolar is difficult to ascertain in people with more of the following symptoms most of experiencing an episode of depression, ID. the day, nearly every day, for a mini- certain symptoms present atypically: mum of two weeks: 4. The person may have a history of 1. Significant weight gain and/or extreme sensitivity to interper- Depressed mood (feels sad, empty, increase in appetite. The person sonal rejection, evidenced by hopeless) will often crave sweets and carbo- significant social and occupational Markedly diminished interest in pre- hydrates. impairments. The person may need viously-enjoyed activities 2. Presence of hypersomnia. While a lot of reassurance and may make Increase/decrease in appetite most people with depression expe- frequent statements about others Sleep disturbances rience insomnia (trouble falling not liking them. Appear to be “sped up” or “slowed asleep or staying asleep through- In many instances, it is the depres- down” from typical presentation out the night), those with atypical sion, not the hypomania/mania, that Fatigue/loss of energy features may sleep excessively is the trigger for initial psychiatric Feelings of guilt/worthlessness (NOTE: this is not the same thing assessment and intervention. The Diminished ability to think/ as napping during the day or having bipolar disorder may not be diag- concentrate make decisions difficulty waking because of insom- nosed until later, when a manic epi- Recurrent thoughts of death/suicide nia). sode presents or when a history of cycles is recognized. Bipolar Cycles Over 90% of people with BD will have people with intellectual disability, par- more than one mood episode in their ticularly people who are impacted at lifetime. Most are relatively free of the severe/profound level. symptoms between episodes. Some people may cycle so rapidly they A typical manic episode begins abruptly experience extreme mood shifts during and lasts anywhere from two weeks to the course of a week or even within the four-to-five months. Depressive epi- same day. sodes often follow manic episodes. A very small percentage of people will They can develop rapidly or slowly, and have unremitting BD, meaning that typically last an average of six months. they experience on-going symptoms Some people experience rapid cycling, without periods of wellness in between. One day I’m on which is defined as having four or more The presence of cycles alone does not mood episodes in a 12-month period. mean the person has BD. Alternative top of the world & This is more likely to develop later in explanations include seasonal issues the course of the illness and is seen the next I feel like I (allergies, staffing patterns), cluster more commonly in women than men headaches, and a multitude of other don’t even (3:1) and in people with thyroid dys- episodic possibilities. function. It is also more common in deserve to be on it. Rapid Cycling is seen in 54% of people with Intellectual Disabilities who are diagnosed with BD, vs. only about 10- 20% of people in the general population who are diagnosed. Mania & Bipolar | Page 4 HCQU Northwest Co-Occurring Conditions BDs frequently co-occur with other psychiatric illness. This is so common that it has been called, “...the rule, not the exception…” (mentalhealth.com).
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