What is bipolar disorder?
There are three main types of bipolar disorder – bipolar I, bipolar II, and cyclothymic disorder.
Bipolar disorder (also called manic-depressive illness or manic depression) is a mental condition that causes unusual and extreme shifts in mood.
It is characterized by periods of deep, profound, and prolonged depression that alternate with periods of an excessively elevated or irritable mood known as mania.
Bipolar disorder does not have a cure but with appropriate medical and psychological intervention, patients can better manage their symptoms and live a more normal life.
What triggers bipolar disorder?
Genetic factors
First-degree relatives of people with bipolar disorder are approximately seven times more at risk.
Biochemical factors
Depletion of certain chemicals in the brain may cause bipolar disorder. This can occur due to hormonal imbalance, certain medication, or drug abuse like cocaine.
Neurophysiologic factors
Changes in the gray and white matter in the brain can lead to bipolar disorder.
Psychodynamic factors
Depression is the manifestation of losses (e.g., loss of self-esteem and the sense of worthlessness). Mania can occur as a defense mechanism against depression.
Environmental factors
Stressors such as:
Pharmacological factors
Antidepressant treatment may trigger a patient into a manic episode.
What are the different types of bipolar disorder?
There are three main types of bipolar disorder – bipolar I, bipolar II, and cyclothymic disorder.
Bipolar I disorder
Bipolar I diagnosis involves having severe manic episodes that last at least seven days or require hospitalization. Depressive episodes are also seen and last for two weeks. There may be periods of normal moods between these two episodes.
Bipolar II disorder
Bipolar II involves a current or past major depressive episode lasting for at least two weeks. The person must also have had a current or past episode of hypomania. Women have a higher risk than men to develop bipolar II disorder.
Cyclothymic disorder
Patients may experience ongoing bipolar symptoms that do not meet the full criteria for a bipolar I or bipolar II diagnosis. Cyclothymic disorder is a less severe form of bipolar disorder. It may cause frequent episodes of hypomanic and depressive symptoms, but they are not severe. Symptoms generally persist for around two years.
How is bipolar disorder diagnosed?
- Clinical and psychological assessment by a physician.
- Mood charting.
- Blood tests to rule out biochemical causes.
- Radiological investigations (computed tomography, magnetic resonance imaging [MRI], functional MRI) to rule out a mass or injury.
How is bipolar disorder treated?
- Oral medications: To balance the mood on a short-term and long-term basis (continued treatment may be required for maintenance).
- Psychological support and counseling
- Stress management
- Treatment of substance abuse: Drug or alcohol addiction exacerbates mental illness
- Adequate diet, rest, and exercise
Does bipolar disorder require hospitalization?
Patients with severe symptoms may require hospitalization. Some indications for hospitalization are:
- Danger to self
- Danger to others
- Delirium
- Psychosis
- Total inability to function
- Total loss of control (e.g., excessive spending, going on dangerous trips)
- Medical conditions that require monitoring (e.g., substance withdrawal/intoxication)
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What is the prognosis of bipolar disorder?
Bipolar disorder has a high morbidity and mortality rate. There is a significant impact on the quality of life, affecting the ability to work, interact with others, and maintain relationships. It can lead to substance abuse, harm to others, and/or self. Bipolar disorder cannot be cured completely but with appropriate medical treatment and psychological support, the symptoms can be controlled, helping the patients to improve their quality of life.
Factors that may worsen the prognosis:
- Poor job history
- Substance abuse
- Psychotic features
- Depressive features between periods of mania and depression
- Evidence of depression
- Male sex
- Pattern of depression-mania-normal state
- Thoughts of death and suicide
- Suicide attempts
Factors that may improve the prognosis:
- Length of manic phases (short duration)
- Late age of onset
- Fewer thoughts of suicide
- Fewer psychotic symptoms
- Fewer medical problems