Bipolar I Disorder is a type of Bipolar Affective Disorder, which is a psychiatric illness of mood disorder.  Once experienced it is something never to be forgotten.

The poet Robert Lowell described his mania as "pathological enthusiasm" 

Bipolar I Disorder brings with it:

1. Changes in mood for a distinct period of time - feeling happy, optimistic, euphoric, irritable

2. Changes in thinking - thoughts speeding through one's brain, unrealistic self confidence, difficulty concentrating, grandiose plans, delusions, hallucinations

3. Changes in behavior - increased activity or socializing, immersion in plans or projects, talking very rapidly and excessively, excessive spending, impaired judgement, impulsive sexual involvement

4.  Changes in physical condition - less need for sleep, increased energy, fewer  health complaints

Nine out of ten people with Bipolar I Disorder also experience depression including depressed mood, loss of interest in activities, feelings of worthlessness and hopelessness, lack of appetite, sleep difficulties, lack of energy and thoughts of suicide.  For more about this read my past article Major Depression.

If you suspect, or if others around you have mentioned that you are "higher" than usual, and you are concerned see the Goldberg Mania Inventory by Ivan Goldberg MD at http://mhnet.org/guide/mdquiz.htm.   Use it to help determine if you need to see a mental health professional for diagnosis and treatment of mania or manic-depression or bipolar disorder.

DIAGNOSIS

A diagnosis of Bipolar I Disorder is officially based on the following DSM-IV Criteria 

One or more manic or mixed episodes. 
Commonly accompanied by a history of one or more major depressive episodes, but not required for the diagnosis. 
Mixed episodes cannot be due to a medical condition, medication, drugs of abuse, toxins or treatment for depression. 
Symptoms cannot be accounted for by a psychotic disorder.

Clinical Features 

Greater than 90% of patients who have a mania single episode will have a recurrence. 
Mixed episodes are more likely in younger patients. 
Episodes occur more frequently with age. 
Social and occupational consequences of episodes can be severe (e.g.; violence, child abuse, excessive debt, job loss, divorce). 
Manic episodes are more likely to receive clinical attention compared to Depressive episodes. 
The suicide rate of bipolar patients is 10-15% 
Common co-morbid diagnoses include disorder, mania, manic disorder substance- related disorders, eating disorders, attention deficit hyperactivity disorder bipolar 
Rapid cycling pattern carries a poor prognosis and may effect up to 20% of bipolar patients. 
 

Epidemiology 

The lifetime prevalence is approximately 0.5-1.5% 
Male: female ratio-- 1:1 
The first episode in males tends to be a manic episode, while the first episode in manic females tends to be a depressive episode. 
First degree relatives have higher rates of mood disorder. 
Disorder has a 70% concordance rate among monozygotic twins. 
 

Classification 

Classification of involves describing the current or most recent mood episode - Manic, Hypomanic, Mixed or Depressive. (e.g. Most recent episode Mixed) 
The most recent episode can be further classified as follows: 

Without psychotic features 
With psychotic features 
With catatonic features 
With postpartum onset 
 

Rapid Cycling 

Diagnosis requires the presence of at least 4 mood episodes within 1 year. 
Rapid cycling mood episodes may include 
The patient must be symptom-free for at least 2 months between episodes or the patient must switch to an opposite episode. 

Manic Behavior you might Observe

Generally an episode seems to begin overnight with a sudden and pleasant switch of mood to one of well-being, lightening, happiness and positive energy.  At this stage (known as mild mania or hypomania) the individual is able to function quite well, and this mood may persist at this level for a long period of time without becoming more severe.  In other cases it intensifies day by day into true mania.  This is the state I will discuss here. 

Out of control of emotions and behavior….very distressed

Normally amiable people may become increasingly angry, impulsive, emotional or irritable

Intense euphoria that nothing can disturb, but if their plans are foiled they may become irritable or uncontrollably furious

Some may become hostile

A few manics may become paranoid or violent and assault others verbally or physically

Very rapid speech, incessant and usually in a loud voice

Answer questions at great length and continue talking when others speak

Speech may be riddled with jokes, puns, or irrelevant witticisms

Acting in theatrical roles and ways

Offer money or advice to passing strangers 

Unable to sleep or sit still…often going for days with 2 or3 hrs sleep and not feeling tired

Socially frenetic…throwing  parties, going to bars

Throw aside normal inhibitions and become sexually hyperactive or promiscuous

Due to impaired judgement very poor decision making skills.  Overspending, over commitment, quitting jobs, etc.

In persons with extreme mania you may see some of the following:

Thinking completely illogical

Speech uncontrollable and sometimes incoherent

Unable to distinguish between "real" and "not real"

Delusions, paranoia, hallucinations

Catatonia possible
 

TREATMENT

Medication

Mood stabilizing medications are the hallmark of treatment for individuals diagnosed with Bipolar Disorder.  It wasn't until the late 1960's that the drug Lithium was serendipitously discovered to stabilize mood in North America.  Lithium is still widely used.  To read more about lithium go to Lithium questions and answers at http://www.bipolarworld.net/lith.html

In the 70's and 80's two new drugs joined lithium as effective mood stabilizers.  Carbamazepine (Tegretol) and Valproic Acid (Depakote, Depakene).  An overview of the medications used for bipolar disorder can be found at http://www.bipolarworld.net/medn.html

New medicines are coming to the forefront and are being researched and used for patients with bipolar disorder.  Read about these medications…Gabapentin (Neurontin) at http://www.bipolarworld.net/depression_central_gabapentin.html   Lamotrigine (Lamictal) at http://www.bipolarworld.net/depression_central_lamotrigine.html  and Topirimate (Topamax) at http://www.bipolarworld.net/depression_central_topiramate.html

Electroconvulsive Therapy (ECT):

ECT usually is reserved for those so ill as to need the protections of an inpatient facility. Such cases include those with such severe suicidality that they require continuous protection, those in stupor or inanition, in manic delirious and excited catatonic states…read about Bipolar Disorder and ECT here http://www.schizophrenia.com/ami/meds/moreect.html

ECT is recommended for treatment of severe mania in early pregnancy, when lithium and anticonvulsant medications should be avoided because of the risk of birth defects.  It is said to be effective, although these reports are largely based on uncontrolled studies and anecdotal evidence.

Transcranial magnetic stimulation

This is a recent treatment development.  To find out what it is please visit http://www.mhsource.com/bipolar/bp9802ask.html

Psychotherapy

Psychotherapy alone has not been proven to affect the long-term course of bipolar disorder.  Behavioral, cognitive or dynamic psychotherapies have, however, proven effective in helping bipolars accept, understand and cope with the stresses of both the disorder and every day life. 

Through psychotherapy individuals can learn to restore self-esteem, adapt to a new range of emotions and work out ways to prevent relapses.

Hospitalization

Individuals with severe mania may require hospitalization to prevent harm to themselves or to others.  Poor judgement can lead to personal danger.  There are even rare cases where people with severe mania have died as a result of physical exhaustion.

Maintenance Therapy

How to Help Yourself When Getting Manic

1.  Call your doctor before things get out of hand.

2. Be sure to take your medication regularly as prescribed.

3. Avoid spending money.  Give your cheque-book and credit cards to someone you can trust.

4. Do not make any major decisions.  Put them off until you are feeling calmer.

5. Reduce stress as much as possible.  Stay away from stressful people.

6. Stay in non stimulating surroundings.  Avoid dances and bars.

7. Talk to a support person.  Let them know how you are feeling.

8. Avoid overstimulation.  Restrict your activities to soothing, relaxing ones.

9. Make lists of things to do, or things you need to shop for and stick to them.

10. Learn and practice relaxation techniques.

11. Try to keep your thoughts focused, not rambling or obsessive.

12. Avoid sugar, caffeine and alcohol.

13. Eat nutritious well balanced meals.

14. Do not take on extra commitments until you are feeling better.

15. If you are not sleeping, call your doctor right away.  Lack of sleep exacerbates mania.
 

See http://www.bpso.org/nomania.htm for more tips on how to avoid a manic episode.

 Recovery from a Manic Episode

Some easy steps to Help!

Recovery from a Manic Episode

     1.  Take medications regularly and as prescribed by your doctor 

     2.  Get emotional support from a supportive person. 

     3.  Talk to a therapist or counselor 

     4.  Tell yourself that you have been ill and that the things you said or did while ill                     were not the real "you" 

     5.  Eat regular, nutritious meals. 

     6.  Be kind to yourself. 

     7.  Get plenty of rest. 

     8.  Focus on living one day at a time 

     9.  Use spirituality if desired 

     10. Reduce environmental stress

Impact on Relationships

Bipolar disorder, and mania, often strikes people who are charming, creative and charismatic.  Initially it may be impossible for them and those close to them to admit anything is wrong. 

When their behaviour becomes outrageous...they have run up thousands of dollar in debts and put the family on the verge of, or into bankruptcy, when they have been involved with public brawls and the police, or when their sexual indiscretions become too obvious to ignore....the impact on relationships is enormous.  Separation and divorce is common.  Even the most understanding partner has problems understanding the illness and the symptoms are seen and felt as a personal attack. 

The anger displayed by the manic creates arguments and fights in the home.  The partner finds it nearly impossible to defend himself against these attacks.  Relationships are poor, and even after the mania has abated, it is difficult to pick up the pieces and go on with a relationship. 

Partners must realize that mania is an illness, and that it will get better.  They must try not to take the symptoms of the disease as a personal affront, and to be supportive and protective until the episode is over.  They may need to manage their manic partner....seeing that they take their medications, or getting them to professional help, including hospitalization when necessary.

Conclusion

Mania is a disorder that one cannot manage on his own.  Professional mental health care from a psychiatrist is necessary.  If you or someone you know is experiencing the symptoms of mania get them to appropriate care as quickly as possible, then do all you can to ensure they follow the long-term treatment program prescribed by their doctor.