W H A T I S bipolar disorder? BASIC FACTS • SYMPTOMS • FAMILIES • TREATMENTS Mental Illness Research, Education and Clinical Center RT P SE A E C I D F Va desert pacific Healthcare Network I A C V long beach Va Healthcare system M R E E N T T N A E L C I L L A education and dissemination Unit 06/116a LN E IC SS IN R CL ESE N & ARCH, EDUCATIO 5901 e. 7th street | long beach, Ca 90822 basic facts bipolar disorder, also known as manic-depression, is a treat- Course of Illness able psychiatric disorder marked by extreme changes in mood, bipolar disorder usually begins in late teens or early adult- thoughts, behaviors, activity, and sleep. a person with bipolar hood. More than half of all cases start before age 25. However, disorder will experience intense emotional states or "mood some people may experience their first symptoms in child- episodes," shifting from mania to depression. The ups and hood or later in life. bipolar disorder is a treatable, chronic ill- downs experienced by someone with bipolar disorder are very ness that requires careful management throughout a person's different from the normal ups and downs that most people ex- life. symptoms vary over time in severity. More than 90% of perience from time to time. These changes in mood can last individuals who have a single manic episode go on to have re- for hours, days, weeks, or months. in between these extremes, current mood episodes, and approximately 60% of manic the person’s mood may be normal. episodes occur immediately before a major depressive Families and society are affected by bipolar disorder as well. episode. bipolar disorder can also negatively affect relation- symptoms of bipolar disorder may result in poor social func- ships, work, school, and the ability to perform day-to-day ac- tioning and poor job or school performance. Many people with tivities. However, in most cases, individuals with the disorder bipolar disorder have difficulty holding a job or caring for are able to function between mood episodes. themselves, so they rely on others for help. sometimes symp- toms may be so severe that an individual with bipolar disorder Bipolar disorder is a treatable, chronic illness that requires may need to be hospitalized for a period of time. There are careful management throughout a person's life. Symptoms of treatments that help improve functioning and relieve many bipolar disorder usually appear in late teens or early adulthood, symptoms of bipolar disorder. recovery is possible! a combi- and severity of symptoms will vary over time. nation of helpful therapies, education in managing one’s ill- ness, and supports to provide assistance and encouragement can lead to experiencing fewer symptoms, improving relation- Causes ships with other people, and achieving meaningful and fulfill- There is no simple answer to what causes bipolar disorder ing life goals. because several factors play a part in the onset of the disorder. These include: a family history of bipolar disorder, environ- Bipolar disorder, also known as manic-depression, is a treatable mental stressors and stressful life events, and biological fac- psychiatric disorder that can affect a person’s mood, thoughts, tors. behaviors, activity, and sleep. research shows that the risk for bipolar disorder results from the influence of genes acting together with environmen- Prevalence tal factors. a family history of bipolar disorder does not nec- about one in every 160 people (0.6%) develop bipolar i dis- essarily mean children or other relatives will develop the order at some point in their life. bipolar disorder affects men disorder. However, studies have shown that bipolar disorder and women at equal rates, and it is found among all ages, does run in families, and a family history of bipolar disorder races, ethnic groups, and social classes. it can affect multiple is one of the strongest and most consistent risk factors for the members within families. individuals with a parent or sibling disorder (see section on prevalence). others believe the envi- who has bipolar disorder are four to six times more likely to ronment plays a key role in whether someone will develop develop the illness compared to individuals who do not have bipolar disorder. For example, sleep deprivation, substance a family history of bipolar disorder. The risk is highest for an abuse, and stressful life events, such as family conflict and loss identical twin of a person with bipolar disorder. The identical of a job or a loved one, increase the likelihood of the disorder. twin has a 40 to 70 percent chance of developing the disorder. an imbalance of the neurotransmitters norepinephrine and serotonin is also linked to bipolar disorder. Neurotransmitters are brain chemicals that communicate information throughout About 1 in every 160 people develop Bipolar I Disorder in the brain and body. The exact role of these neurotransmitters their lifetime. in bipolar disorder is not yet understood. Diagnosis bipolar disorder is a psychiatric disorder that must be diag- Scientists believe bipolar disorder is caused by several factors, nosed by a trained mental health professional. diagnostic in- including: a family history of the disorder, environmental stressors and stressful life events, and biological factors. terviews and medical evaluations are used to determine the diagnosis. There are currently no physical or lab tests that can diagnose bipolar disorder, but they can help rule out other conditions that sometimes have similar symptoms to bipolar disorder (e.g., thyroid dysfunction, brain tumor, and drug use). To make the diagnosis, a trained mental health profes- sional will conduct a comprehensive interview and pay careful attention to the symptoms experienced, the severity of the symptoms, and how long they have lasted. individuals with bipolar disorder can be misdiagnosed with major depression because people are more likely to seek treatment when feeling depressed than when feeling manic. a thorough interview is needed to prevent this misdiagnosis from occurring. Bipolar disorder is a psychiatric disorder that must be diagnosed by a trained mental health professional. WHAT IS BIPOLAR DISORDER - MIRECC - JULY 2014 IS BIPOLAR DISORDER - MIRECC JULY WHAT 2 types of bipolar disorder Bipolar I Disorder Cyclothymic Disorder bipolar i disorder is characterized by the occurrence of one Cyclothymic disorder is characterized by the occurrence or more manic episodes. although most people with the disor- of numerous periods of hypomanic and depressive symp- der also have a major depressive episode during the course of toms over a two year span without ever meeting criteria for their lives, it is not a requirement for the diagnosis. a manic, hypomanic, or depressive episode. These periods of mood disturbance must be present for at least half the time Bipolar II Disorder during the two year period, and the individual cannot be bipolar ii disorder is characterized by the occurrence of at symptom-free for more than two months at a time. least one hypomanic episode and at least one major depressive episode. The main types of bipolar disorder are Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder. symptoms of bipolar disorder What is a Manic Episode? What is a Depressive Episode? a manic episode is defined as a distinct period during which a depressive episode is defined as a distinct period dur- a person abnormally and persistently feels extremely happy or ing which an individual abnormally and persistently feels de- extremely irritable and has increased energy. This period of ab- pressed or loses interest or pleasure in most activities. This normal mood must occur most of the day, nearly every day, for period of abnormal mood must occur most of the day, nearly at least one week (less if hospitalized). during this period of time, every day, for at least two weeks. during this period of time, the the person must also experience at least 3 of the symptoms person must also experience at least 4 of the symptoms below. below (4 of the symptoms below if the mood is only irritable). The mood disturbance and accompanying symptoms must The mood disturbance and accompanying symptoms must be be severe enough to impair social, work, or other areas of severe enough to impair social or work functioning, require hos- functioning. pitalization, or include psychotic features [i.e., hallucinations • significant weight loss when not dieting, weight gain, or (false perceptions, such as hearing voices) and delusions (false a decrease or increase in appetite beliefs, such as paranoid delusions)]. • insomnia or hypersomnia (difficulty falling asleep or • inflated self-esteem or grandiosity (has a high opinion of self staying asleep, waking early in the morning and not and may be unrealistic about his or her abilities) being able to get back to sleep, or sleeping excessively) • decreased need for sleep (e.g., feels rested after only 3 hours • psychomotor agitation (e.g., inability to sit still or pacing) of sleep) or psychomotor retardation (e.g., slowed speech, • More talkative than usual or pressure to keep talking thinking, and body movements) • Flight of ideas or racing thoughts (has too many thoughts at • Fatigue or loss of energy the same time or rapid speech that jumps from topic to topic) • Feelings of worthlessness or excessive or inappropriate • distractibility (attention is easily drawn to unimportant or guilt irrelevant things) • diminished ability to think or concentrate or • increased goal-directed activities (e.g., social, sexual, or at indecisiveness work or school) or psychomotor agitation (purposeless non- • recurrent thoughts of death (not just fear of dying), goal-directed activity) recurrent suicidal ideation without a specific plan, a • excessive involvement in activities with a high potential for specific plan for committing suicide, or a suicide attempt painful consequences (e.g., shopping sprees, driving recklessly, and unsafe sex) Other Common Symptoms There are other psychiatric symptoms that people with What is a Hypomanic Episode? bipolar disorder may experience.