TABLE OF CONTENTS:
Bipolar Mood Disorders - Overview:
Symptomatology:
Subtypes of Bipolar Affective Disorder:
Bipolar Mood Disorders:
Bipolar mood disorders are mental health conditions characterized by episodes of depression and episodes of mania/hypomania. These episodes can have various symptoms such as changes in sleep patterns, reduced emotional reactivity, weight changes, and psychomotor retardation.
Bipolar disorder can greatly impair one's ability to take initiative and make decisions. Negative thinking is common. People with bipolar disorder also have an increased risk of suicide.
Many individuals with bipolar disorder also experience somatic complaints.
During manic episodes, individuals may engage in excessive spending, damage relationships, and participate in risky sexual behavior. Irritability, anger, delusions of grandeur, and grandiose plans can occur.
People with bipolar disorders often do not exhibit signs of mental illness between episodes.
Treatment involves mood stabilizing medications, psychoeducation, and therapy tailored to the individual. Antipsychotics are used for manic episodes, while antidepressants are used for depressive phases. Prevention is important through medication and psychotherapy, with a focus on self-management.
Symptomatology:
Bipolar affective disorders are conditions that affect the entire body. However, it is the psychological and behavioral symptoms that are most noticeable in the clinical presentation. These symptoms can be depressive, hypomanic, manic, or a combination of depressive and manic/hypomanic symptoms. The diagnosis and classification are determined based on the severity, duration, type (depression or hypomania/mania), and episodic course of these symptoms.
MANIA:
During the manic phase, patients experience an excessively good mood, elevated self-esteem, a reduced need for sleep and a lack of criticism.
They engage in impulsive actions such as extravagant spending and risky business transactions. This can lead to financial losses and unwanted pregnancies.
The lack of criticism also puts them and others in potentially life-threatening situations.
Their thinking is characterized by a flight of ideas and difficulty sticking to one topic.
They may become irritable, restless, and unable to carry out constructive actions.
In extreme cases, they may speak incessantly and disruptively, and some may have delusions of grandeur. This behavior affects their work performance, relationships, and social obligations.
Their dress style may change drastically.
Despite their illness, they often lack insight and resist treatment.
HYPOMANIA:
Hypomania is a milder version of mania, where individuals experience manic symptoms, but to a lesser extent.
They have reduced need for sleep, increased work capacity, and heightened joy, while still maintaining some self-control.
They are able to accomplish more and exhibit greater creativity, humor, enthusiasm, and drive. Increased spending may occur but not to the point of severe financial distress.
Unlike mania, functioning remains reasonably normal during hypomania, allowing individuals to work and fulfill social and family obligations.
During a hypomanic phase, individuals become more social and outgoing. Even shy individuals may engage in small talk and display a sense of humor. They are perceived as pleasant and witty, and may also experience increased sexual arousal.
DEPRESSIVE EPISODE:
The symptoms of the depressive phase in bipolar disorder are similar to depression caused by other factors, but with certain differences: Typically, patients with bipolar disorder have a medical history that includes at least one depressive episode that meets the criteria for a somatic syndrome (melancholia).
Work becomes more challenging, decision-making becomes difficult, and there is a reduced level of motivation.
Many people feel physically exhausted, experience fatigue and a loss of energy, and have a decrease or loss of interest.
Individuals become less social, withdraw from contact, and may experience anxiety or restlessness.
Sleep disturbances are common, with poor sleep throughout the night and some individuals waking up earlier in the morning.
Cognitive functions are impaired, with difficulties in concentration, attention, and memory.
Patients may also have self-critical attitudes, feelings of inadequacy, and blame themselves for their perceived inadequacy and incompetence.
Paranoid delusions, visual and auditory hallucinations, and psychomotor retardation can also occur.
Obsessive symptoms and substance abuse are not uncommon.
SOMATIC SYNDROME (MELANCHOLIA)
The depressive phases in bipolar disorders have distinct characteristics that differentiate them from non-biological forms of depression.
These characteristics, known as the "somatic syndrome" in ICD-10, reflect an impact on biological functions, particularly the hypothalamus and brainstem.
This impact leads to disruptions in circadian rhythm regulation and food intake regulation.
Therefore, depression in bipolar disorder is often described as "vital," "autonomous," or "physiological." The DSM system refers to the same condition as "melancholia."
Typical symptoms of somatic syndrome include mood variation throughout the day (lighter in the evening), reduced emotional reactivity, and slowed movement. In some cases, significant weight loss due to decreased appetite can occur.
SYMPTOMS OF SOMATIC SYNDROME:
BODILY SYMPTOMS OF BIPOLAR DISORDER:
Bipolar disorder affects the whole body and can lead to various physical symptoms and complaints. These physical issues are an integral part of the disorder and can make diagnosing bipolar disorder more challenging.
During a bipolar depressive episode, individuals may notice changes in their physical sensations.
Some patients might describe uncomfortable feelings like tingling and other skin-related discomforts that could make doctors suspect nerve problems.
They might also have problems like blurry vision, a burning feeling in their mouth, or a one-sided numbness sensation.
Stomach issues like functional dyspepsia are common too.
Many people experience widespread bodily pain, especially in their arms and legs. Interestingly, those in the depths of bipolar depression often seem to tolerate pain better than people with other types of depression, showing impressive endurance despite feeling tired.
These physical symptoms are thought to be linked to changes in how the central nervous system functions in bipolar disorder.
Sometimes, these physical symptoms can be so prominent that they overshadow the underlying severe bipolar depression. In some cases, patients may strongly believe they have a physical illness, leading to extensive medical tests and investigations.
PHYSICAL SYMPTOMS OF BIPOLAR DISORDERS:
SUBTYPES OF BIPOLAR AFFECTIVE DISORDER
BIPOLAR DISORDER TYPE 1
Bipolar disorder type 1, the classic form of the condition, involves distinct cycles of intense depression and manic episodes. These episodes can vary in severity over time.
Around 75% of individuals with bipolar disorder type 1 will have at least one episode that's perceived as psychotic.
While manic episodes are serious and disruptive, depressions represent the majority of the time when patients are unwell and pose the biggest treatment challenge in bipolar disorder type 1.
Studies reveal that patients with this disorder spend three times as much time in a depressed state as in a manic one. Therefore, it's essential to recognize that bipolar disorder type 1 is primarily characterized by recurring depressions with intermittent periods of mania. This understanding is crucial for diagnosis when evaluating patients seeking help for depression.
BIPOLAR DISORDER TYPE 2
In bipolar disorder type 2, patients experience pronounced depressive periods accompanied by hypomanic symptoms instead of full manic episodes. Those with bipolar disorder type 2 spend more time in depressive phases and less in hypomanic states. These hypomanic periods are usually seen as entirely positive for patients and may not always impair their functioning, especially if they have insight into their condition.
Managing hypomanic periods in bipolar disorder type 2 may sometimes be possible without medication, provided the patient has awareness of their condition and cooperates well with their doctor. However, this decision requires close monitoring by both the patient and their relatives to detect any signs of progressing towards full mania.
In contrast, depressive episodes in bipolar disorder type 2 can significantly reduce functioning and quality of life and can be severe, sometimes with psychotic features similar to bipolar disorder type 1.
In essence, bipolar disorder type 2 is a lifelong mood disorder characterized by recurring depressions, occasionally interspersed with periods of increased energy, creativity, and enthusiasm for life.
BIPOLAR DISORDER TYPE 3
When someone with severe, often deeply sad depressions that start to shift into hypomania when they're taking antidepressants, it's sometimes called bipolar disorder type 3.
Some people also include cases where individuals experience repeated depressive phases, even if they haven't had hypomanic episodes. This happens especially when there's a pattern of bipolar disorders in the family.
CYCLOTHYMIA
Cyclothymia is a condition where people have unstable mood swings, going back and forth between feeling low (depressive) and having bursts of high energy (hypomanic), but these mood swings fall just short of meeting the complete criteria for hypomania or major depression.
The patient must have encountered the mood swings for a minimum of 2 years to get the diagnosis.
Cyclothymia usually begins during adolescence or early adulthood.
People with this condition also experience shifts in their sleep patterns, going from needing a lot of sleep to needing less sleep.
Their mood can go from being quiet and introverted to very outgoing and talkative in different phases.
RAPID CYCLING BIPOLAR DISORDER
In Rapid Cycling Bipolar Disorder, individuals experience four or more mood episodes within a single year.
These episodes can be manic, hypomanic, or depressive and can shift rapidly, making it challenging to find stability.
MIXED FEATURES BIPOLAR DISORDER
Mixed Features Bipolar Disorder is marked by mood episodes that include elements of both mania or hypomania and depression simultaneously.
This subtype can be particularly challenging to diagnose and treat.
Understanding the different subtypes of bipolar disorder is a vital step in managing this complex condition. Each subtype presents it's unique challenges and requires a tailored treatment approach. If you or a loved one is living with bipolar disorder, seeking professional help and support is essential.
By acknowledging the diversity of the disorder and working with healthcare providers, individuals can better navigate the challenges and lead fulfilling lives despite their diagnosis.
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