Bipolar Affective Disorder

What is Bipolar Affective Disorder and who does it affect?

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life.

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and suicide. Bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

• Increased energy, activity, and restlessness 

• Excessively “high,” overly good, euphoric mood 

• Extreme irritability 

• Racing thoughts and talking very fast, jumping from one idea to another 

• Distractibility, can’t concentrate well 

• Little sleep needed 

• Unrealistic beliefs in one’s abilities and powers 

• Poor judgment 

• Spending sprees 

• A lasting period of behavior that is different from usual 

• Increased sexual drive 

• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications 

• Provocative, intrusive, or aggressive behavior 

• Denial that anything is wrong 

What constitutes a Manic Episode?

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

• Lasting sad, anxious, or empty mood 

• Feelings of hopelessness or pessimism 

• Feelings of guilt, worthlessness, or helplessness 

• Loss of interest or pleasure in activities once enjoyed, including sex 

• Decreased energy, a feeling of fatigue or of being “slowed down” 

• Difficulty concentrating, remembering, making decisions 

• Restlessness or irritability 

• Sleeping too much, or can’t sleep 

• Change in appetite and/or unintended weight loss or gain 

• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury 

• Thoughts of death or suicide, or suicide attempts 

What constitutes a Depressive Episode?

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

Types of Manic Episodes:

There are two types of mania separated by the degree to which they interfere with life. A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood range called Euthymia, above which comes hypomania (mild to moderate mania), and then severe mania.

I as a practitioner like to use the -5 to +5 analog scale to visualize the mood range. 

-5    -4    -3    -2    -1    0    1    2    3    4    5

Explanation of the Scale in real world language:

Normal or euthymic range is +3 to -3. On a +3 day you spring out of bed full of energy, dash to the kitchen for breakfast, then dart off to work, or school where you accomplish a great deal and things just seem to fall into place, you come home do the housework / yard work, take a shower and evening meal, watch the news and get caught up on current events, then go to bed and fall asleep easily and sleep soundly until the next day when you awake refreshed and ready for a new day.

On a -3 day: you get up drag yourself out of bed, splash the cold water in your face to wake up, go to work, muddle through the day, come home exhausted and cynical, flop down on the couch and wait for sleep to mercifully take you hoping for a better day tomorrow. 

Both of these moods are within the normal range of mood and a healthy part of the human life experience.

-4 day, is the same as -3 except you loose desire to take care of yourself, may not find enjoyment in things you normally would, and may lack the motivation to work, love, or play. 

-5 begin to have thoughts of death (Morbid thoughts) or worse yet ideas of actually committing suicide. 

+4 same as +3 except when night rolls around, you seem to not need a lot of sleep and your thoughts are so fast coming and clear that it seems as if you are surrounded by incompetence. This is followed by a plunge down to -4 or -5 which is the only reason why +4 would be a "bad thing".

+5 same as +4 except you begin to loose the normal inhibitions and thus partake of risky behavior including increased pleasure taking behavior at times being unable to maintain normal boundaries and at times find later that you get yourself into situations which have adverse consequences such as drinking and driving, excessive spending, or becoming romantically involved with strangers on a whim. All the time feeling as if your are on the road down pikes peak and have no breaks. Your whole attention is focused on staying on the road with little if any thought to the future or future consequences. This is always followed by a crash into the deep pit of depression. 

Sobering Fact:

Untreated, Bipolar disorder has up to a 25% rate of suicide, highest of any known disorder. The real suicide rate is clearly higher than 25% simply because many people in a manic (+5) state are involved in risk taking behavior. The idea is that people are afraid of that if they kill themselves then they will have God mad at them and be dead; if on the other hand they become involved in risk taking behavior and "make God kill them them" then maybe they will not be in so much "hot water".

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