Bipolar disorder, also

known as “manic
depression”, is a mental
illness that brings severe
high and low moods and
changes in sleep, energy,
thinking, and behavior.
People who have bipolar
disorder can have periods in
which they feel overly happy
and energized and other
periods of feeling very sad,
hopeless, and sluggish. In between those periods, they usually feel normal. You can
think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar"
disorder.
The word "manic" describes the times when someone with bipolar disorder feels overly
excited and confident. These feelings can also involve irritability and impulsive or reckless
decision-making. About half of people during mania can also have delusions (believing
things that aren't true and that they can't be talked out of) or hallucinations (seeing or
hearing things that aren't there).
You can go from the depths of depression to the racing thoughts, extreme energy, and
wired feelings that doctors call “mania.”
"Hypomania" describes
milder symptoms of
mania ( the depths of
depression to the racing
thoughts, extreme
energy, and wired
feelings), in which
someone does not have
delusions or
hallucinations, and their
high symptoms do not
interfere with their everyday life. hypomania can evolve into mania. Or it can switch to
serious depression. And you can’t tell which one might happen, because the pattern isn’t
predictable.
A manic episode is a period of abnormally elevated or irritable mood that includes an
abnormal increase in energy level, and lasts for at least one week. Additionally, a person
experiencing mania may present with changes from their usual behavior, including a
sudden inflation of self-esteem, a decreased need for sleep, a shift to being more talkative
and easily distracted, and an involvement in activities that have high potential for painful
consequences (gambling, heavy spending, sexual indiscretions).
A hypomanic episode refers to a period of abnormally elevated or irritable mood that
includes an abnormal increase in energy level and lasts for at least four consecutive days.
Hypomania is similar to mania in that the disturbance in mood and the change in
functioning are observable by others, but the episode is not severe enough to cause major
impairment in social or occupational functioning or to require hospitalization.

People with bipolar disorder have decreased life expectancy, with the effect most
pronounced when the condition is diagnosed in younger patients.
According to Lars Vedel Kessing, MD, DMSc, of the University of Copenhagen,
Denmark, and colleagues based their findings on data from Danish national registries. In
general, the life expectancy of bipolar patients is 10 years less than the general public,
they reported in the journal Bipolar Disorders.
The reduction is somewhat greater for men (between 8.7 and 12 years) than women
(between 8.3 and 10.6 years). But the biggest differences were in younger patients. At
age 15, bipolar women and men, respectively, had 10.4 and 12.8 less life expectancy
than those without the disorder. By 25 years old, the differences were, respectively, 10.6
and 12.
The difference in life expectancy between bipolar patients and the general public
decreased with age. At age 35, the difference was 9.5 and 10.5 years among men and
women, respectively. But by age 75, the figures were 3 and 2.8 years.
As to why people with bipolar disorder live shorter lives, the researchers said it could be
due to an increased rate of suicide, as well as oxidative stress and unhealthy lifestyle
factors.

A few facts about bipolar disorder you may not know:

- As many as 20% of people complaining of depression to their doctor actually have
bipolar disorder.
- About half of people with bipolar disorder have seen three professionals before
being diagnosed correctly.
- It takes an average of 10 years for people to enter treatment for bipolar disorder
after symptoms begin. This is caused in part by delays in diagnosis.
- Most people with bipolar disorder have additional psychiatric conditions (such as
substance abuse or anxiety) that can make overall diagnoses more challenging.
Who Gets Bipolar Disorder?
When someone develops bipolar
disorder, it usually starts when
they're in late adolescence or
young adulthood. Rarely, it can
happen earlier in childhood.
Bipolar disorder can run in
families.
Men and women are equally
likely to get it. Women are
somewhat more likely than men
to go through "rapid cycling,"
which is having four or more
distinct mood episodes within a
year. Women also tend to spend
more time depressed than men
with bipolar disorder.
Many people with the condition abuse alcohol or other drugs when manic or depressed.
People with bipolar disorder are more likely to have seasonal depression, co-existing
anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder.

Types of bipolar disorder

This condition is diagnosed according to the criteria listed in the diagnostic reference
manual published by the American Psychiatric Association (2013):

Bipolar I Disorder
The essential feature of Bipolar I is that the person experiences one full manic episode
(though the manic episode may have been preceded by and may be followed by
hypomanic or major depressive episodes). Learn more about bipolar depression.
A manic episode is a distinct period during which there is an abnormally, persistently
elevated, expansive, or irritable mood and persistently increased activity or energy that is
present for most of the day, nearly every day, for a period of at least one (1) week (or any
duration if hospitalization is necessary), accompanied by at least three additional
symptoms of mania.
The occurrence of the manic and major depressive episodes is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
DSM-5 Diagnostic Codes for Bipolar Disorder
DSM-5 Codes: Most recent episode manic — Mild, 296.41 (F31.11); Moderate, 296.42
(F31.12); Severe, 296.43 (F31.13)
Most recent episode depressed — Mild, 296.51 (F31.31); Moderate, 296.52 (F31.32);
Severe, 296.53 (F31.4)

Bipolar I disorder

Current or most
recent episode:

manic hypomanic depressed

Mild 296.41 NA 296.51
Moderate 296.42 NA 296.52
Severe 296.43 NA 296.53
With psychotic
features 296.44 NA 296.54
In partial remission 296.45 296.45 296.55
In full remission 296.46 296.46 296.56
Unspecified 296.40 296.40 296.50

Bipolar II disorder
Bipolar II disorder has one diagnostic code: 296.89. Its status with respect to current
severity, presence of psychotic features, course, and other specifiers cannot be coded
but should be indicated in writing (e.g., 296.89 bipolar II disorder, current episode
depressed, moderate severity, with mixed features).
Bipolar II requires occurrence (or history) of one or more major depressive episodes and
at least one hypomanic episode. Additionally, there has never been a full manic episode.
A hypomanic episode lasts for at least four (4) or more consecutive days, and shares the
same symptoms as a full manic
episode.
In both bipolar I and II disorders, a
person can have a mood episode
(i.e., primarily manic or depressed)
with mixed features, wherein a
manic/hypomanic episode there are
significant depressive symptoms, and
in a depressive episode there are
some manic/hypomanic symptoms.

Additionally, both bipolar and depression (i.e., in major depressive disorder) can occur
with anxious distress, with a seasonal pattern, with psychotic features, with peripartum
onset, with melancholia, and with atypical features. See additional information on these
DSM-5 specifiers for bipolar disorder. Cyclothymic disorder is similar to bipolar II disorder,
except for a longer period of time (2 years).
People with this condition may either be rapid cycling through the different mood phases,
or slow cycling. In slow cycling, the person may spend weeks or months experiencing
one type of mood before cycling to the other. In rapid cycling, a person may experience
mood changes in a matter of days or weeks. Effective treatment helps reduce or stop the
cycling altogether (Fink & Kraynak, 2015).
DSM-5 Code: 296.89 (F31.81)
Symptoms
Symptoms vary between people, and according to mood. Some people have clear mood
swings, with symptoms of mania and then of depression each lasting for several months,
or with months of stability between them. Some spend months or years in a "high" or "low"
mood.
A "mixed state" is when a manic and a depressive episode happen at the same time. The
person may feel negative, as with depression, but they may also feel "wired" and restless.

During a manic or hypomanic phase, bipolar symptoms include:

- heightened sense of self-importance

- exaggerated positive outlook
- significantly decreased need for sleep
- poor appetite and weight loss
- racing speech, flight of ideas, impulsiveness
- ideas that move quickly from one subject to the next
- poor concentration, easily distracted
- increased activity level
- excessive involvement in pleasurable activities
- poor financial choices, rash spending sprees
- excessive irritability, aggressive behavior

During a depressed phase, bipolar symptoms include:

- feelings of sadness or hopelessness
- loss of interest in pleasurable or usual activities
- difficulty sleeping; early-morning awakening
- loss of energy and constant lethargy
- sense of guilt or low self-esteem
- difficulty concentrating
- negative thoughts about the future
- weight gain or weight loss
- talk of suicide or death
The main method used to diagnose
bipolar is a thorough clinical interview
with a psychiatrist, psychologist, or
other mental health specialist (Fink &
Kraynak, 2015). Although there are
written methods for documenting the
severity and number of symptoms,
those tests only complement a
complete interview. They do not
substitute for a face-to-face evaluation
by a professional. Like all mental
disorders, there are not yet any blood
tests or other biological tests that can
be used to diagnose bipolar disorder.

An early bipolar symptom may be

hypomania — an emotional state in
which the person shows a high level of
energy, excessive moodiness or
irritability, and impulsive or reckless behavior for at least four (4) consecutive days. The
symptoms associated with hypomania tend to feel good, and so many times the person
seeks to minimize the symptoms to others. Even when family and friends learn to
recognize the mood swings, the individual may deny — or may not even realize — that
anything is wrong.

One of the usual differential diagnoses for this condition is that the bipolar symptoms are
not better accounted for by schizoaffective disorder and is not superimposed on
schizophrenia, schizophreniform disorder, delusional disorder, or other psychotic
spectrum disorders.

And as with nearly all mental disorder diagnoses, the symptoms of manic depression
must cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning. Bipolar symptoms also can not be the result of substance
use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition.
This post has been updated for DSM-5 criteria.
Diagnosis
A psychiatrist or psychologist bases
the diagnosis on criteria set out in
the Diagnostic and Statistical
Manual, fifth edition (DSM-5).
The person must meet certain criteria
for mania and depression, including
an elevated or irritable mood and
"persistently increased activity or
energy levels." These must have
lasted at least 7 days, or less if
symptoms were severe enough to
need hospitalization.
The individual and their family members, colleagues, teachers, and friends can help by
relating experiences of the patient's behavior.
Other healthcare professionals may have detected secondary signs of the condition.
The doctor may carry out a physical examination and some diagnostic tests, including
blood and urine tests.
This can help to eliminate other possible causes of symptoms, such as substance abuse.

Other conditions that may occur with bipolar disorder are:

- use of drugs or alcohol to cope with symptoms
- post-traumatic stress disorder (PTSD)
- anxiety disorder
- attention-deficit hyperactivity disorder (ADHD)
However, these may also mask a diagnosis.
A person is more likely to seek help during a time of depression than during a "high." The
National Institute of Mental Health (NIMH) urge health care providers to look for signs of
mania in the person's history, to prevent misdiagnosis.

If you or someone you know has symptoms of bipolar disorder, talk to your family doctor
or a psychiatrist. They will ask questions about mental illnesses that you, or the person
you're concerned about, have had, and any mental illnesses that run in the family. The
person will also get a complete psychiatric evaluation to tell if they have likely bipolar
disorder or another mental health condition."
Diagnosing bipolar disorder is all about the person's symptoms and determining whether
they may be the result of another cause (such as low thyroid, or mood symptoms caused
by drug or alcohol abuse). How severe are they? How long have they lasted? How often
do they happen?
The most telling symptoms are those that involve highs or lows in mood, along with
changes in sleep, energy, thinking, and behavior.
Talking to close friends and family of the person can often help the doctor distinguish
bipolar disorder from major depressive (unipolar) disorder or other psychiatric disorders
that can involve changes in mood, thinking, and behavior.

Causes
Scientists are learning about the possible causes of bipolar disorder. Most scientists now
agree that there is no single cause for bipolar disorder; rather, many factors act together
to produce the illness.
One of the strongest risk factors for developing bipolar disorder is having a family history
of the illness. Because there is an average 10-fold increased risk among adult relatives
of individuals with bipolar I and bipolar II disorders, researchers have been seeking
specific genes that may increase a person's chance of developing the illness. Studies of
identical twins, who share all the same genes, indicate that both genes and other factors
play a role in bipolar disorder. If bipolar disorder were caused entirely by genetics, then
the identical twin of someone with the illness would always also develop it, and this is not
the case. But if one twin has bipolar disorder, the other twin is more likely to develop the
illness than is another sibling.
In addition, findings suggest that bipolar disorder, like other mental illnesses, does not
occur because of a single gene. It is likely that many genes act together and in
combination with other factors, such as the person's environment. Finding these genes,
each of which contributes only a small amount toward the vulnerability to bipolar disorder,
has been extremely difficult. But scientists expect that advanced research tools will lead
to these discoveries and to new and better treatments.
Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce
bipolar disorder. New techniques allow researchers to take pictures of the living brain, to
examine its structure and activity, without the need for surgery or other invasive
procedures. These techniques include magnetic resonance imaging (MRI), positron
emission tomography (PET), and functional magnetic resonance imaging (fMRI). Imaging
studies have shown that the brains of people with bipolar disorder may differ from those
of healthy individuals. As the differences are more clearly identified and defined through
research, scientists should be able to better understand the underlying causes of the
illness and determine the most effective treatments.
Bipolar disorder does not appear to have a single cause but is more likely to result from
a range of factors that interact.

Genetic factors
Some studies have suggested that there may be a genetic component to bipolar
disorder. It is more likely to emerge in a person who has a family member with the
condition.
Biological traits
Patients with bipolar disorder often show physical changes in their brains, but the
link remains unclear.
Brain-chemical imbalances:
Neurotransmitter imbalances appear to play a key role in many mood disorders,
including bipolar disorder.
Hormonal problems:
Hormonal imbalances might trigger or cause bipolar disorder.
Environmental factors:
Abuse, mental stress, a "significant loss," or some other traumatic event may
contribute to or trigger bipolar disorder.
One possibility is that some people with a genetic predisposition for bipolar disorder may
not have noticeable symptoms until an environmental factor triggers a severe mood
swing.
Treatment
Treatment aims to minimize the frequency of manic and depressive episodes, and to
reduce the severity of symptoms to
enable a relatively normal and
productive life.
Left untreated, a bout of depression or
mania can persist for up to 1 year. With
treatment, improvements are possible
within 3 to 4 months.
Treatment involves a combination of
therapies, which may include
medications and physical and
psychological interventions.
The person may continue to experience mood changes, but working closely with a doctor
can reduce the severity and make the symptoms more manageable.
 Drug treatment
Lithium carbonate is the most commonly prescribed long-term drug to treat long-term
episodes of depression and mania or hypomania. Patients usually take lithium for at least
6 months.
It is essential for the patient to follow the doctor's instructions about when and how to take
their medication in order for the drugs to work.

Other treatments include:

- Anticonvulsants: These are sometimes prescribed to treat mania episodes.
- Antipsychotics: Aripiprazole, olanzapine, risperidone are some of the options if
behavior is very disturbed and symptoms are severe.
Medication may need to be adjusted as moods shift, and some drugs have side effects.
Some antidepressants given to patients before they have a diagnosis of bipolar disorder
may trigger an initial manic episode. A physician who is treating a patient with depression
should monitor for this.
Psychotherapy, CBT, and hospitalization
Psychotherapy aims to alleviate and help the patient manage symptoms.
If the patient can identify and recognize the key triggers, they may be able to minimize
the secondary effects of the condition.
The person can learn to recognize the first symptoms that indicate the onset of an episode
and work on the factors that help maintain the "normal" periods for as long as possible.
This can help maintain positive relationships at home and at work.

Cognitive behavioral therapy (CBT)

as individual or family-focused therapy, can
help prevent relapses.
Interpersonal and social rhythm therapy,
combined with CBT, can also help with
depressive symptoms.
Hospitalization is less common now than in
the past. However, temporary
hospitalization may be advisable if there is
a risk of the patient harming themselves or
others.

Electroconvulsive
therapy (ECT)
may help if other
treatments are not
effective.

Keeping up a regular
routine with a healthy
diet, enough sleep, and
regular exercise can
help the person
maintain stability.
Any supplements
should first be
discussed with a
doctor, as some alternative remedies can interact with the drugs used for bipolar disorder
or exacerbate symptoms.
Bipolar disorder can be treated. It's a long-term condition that needs ongoing care.
Medication is the main treatment, usually involving "mood stabilizers" such
as carbamazepine (Tegretol), lamotrigine (Lamictal), lithium or valproate (Depakote).
Sometimes antipsychotic drugs are also used such
as olanzapine (Zyprexa), quetiapine (Seroquel), lurasidone (Latuda) and cariprazine
(Vraylar), as well as antidepressants. Combinations of medicines are often
used. Psychotherapy, or "talk therapy," is often recommended, too.
People who have four or more mood episodes in a year, or who also have drug or alcohol
problems, can have forms of the illness that are much harder to treat.

Reference:
https://www.webmd.com/bipolar-disorder/mental-health-bipolar-disorder#2-3
https://www.webmd.com/bipolar-disorder/mental-health-bipolar-disorder#1-2
https://www.medicalnewstoday.com/articles/37010.php
https://www.psychologytoday.com/us/conditions/bipolar-disorder
https://psychcentral.com/disorders/dsm-5-diagnostic-codes-for-bipolar-disorder/
Bipolar
Disorder
Submitted by :
Glennizze M. Galvez
MWF 5 – 6 pm
Submitted to :
Mrs. Taclibon