Bipolar Disorder

Bipolar disorder is a mental illness characterized by drastic mood swings from very high (manic phase) to very low (depressive phase). The diagnosis of bipolar disorder is usually based on the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (fourth edition) criteria, a tool developed by the American Psychiatric Association for clinicians.

The DSM-IV includes two types of bipolar disorder diagnoses, Bipolar I and Bipolar II. Bipolar I disorder is identified when a person presents with one lifetime occurrence of either a manic episode or a mixed episode. Although bipolar disorder is known for the polarization of moods, a diagnosis of Bipolar I does not require the presence of a depressive state. The manic episode alone can satisfy the criterion for Bipolar I, if the mania is not caused by another mental disorder. A manic person can be described as a normal person in fast-forward. When a patient is experiencing a manic episode, he or she experiences [Page 95]an elevated, irritable, or expansive mood. To meet the diagnostic criterion specified by the DSM-IV, the mood must occur for longer than 1 week and must be accompanied by three or more other symptoms not caused by mood-altering substances, medications, or other medical conditions. Other symptoms may include any of the following: inflated self-esteem or grandiosity, decreased need for sleep, being more talkative than usual or experiencing pressure to keep talking, flight of ideas or subjective experience that one's thoughts are racing, distractibility, increase in goal-directed activity or psychomotor agitation, or excessive involvement in pleasurable activities that have a high potential for painful consequences.

In the other form of Bipolar I disorder, mixed bipolar episodes—the other criterion for Bipolar I—the symptoms of mania and depression occur simultaneously; symptoms include agitation, trouble sleeping, and significant change in appetite, psychosis, and suicidal ideation. A person may feel sad and hopeless, yet extremely energized.

The diagnosis of Bipolar II disorder, according to the DSM-IV, is a clinical course characterized by one or more episodes of major depression and at least one hypomanic episode. In contrast to the manic episode, the depressed pole of bipolar disorder is characterized by extreme sadness. A depressive episode (depression) of bipolar disorder is diagnosed with the same criteria as major depressive disorder. The criteria for diagnosis are the presence of five or more symptoms lasting most of the day for 2 weeks or longer. At least one of the symptoms must include depressed mood or loss of pleasure or interest, and symptoms must not be due to other physiological conditions or substances. The symptoms may include any of the following in addition to depressed mood or loss of interest and pleasure in all or almost all activities: decreased or increased appetite/change in weight; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness, or excessive or inappropriate guilt; diminished ability to think or concentrate, or indecisiveness; or recurrent thoughts of death, suicidal ideation with or without a plan or suicide attempt.

Hypomania, the other element of Bipolar II, is defined as a mild to moderate level of mania. Hypomania may feel good to a person and may be accompanied by good functioning and enhanced productivity, but without treatment it may lead to mania or swing into depression. Also, psychosis or psychotic symptoms may occur in severe cases of mania or depression. Common symptoms include auditory and visual hallucinations and delusions.

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