|Bipolar Disorder -
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
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.
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
Symptoms cannot be accounted for
by a psychotic disorder.
Greater than 90% of patients who
have a mania single episode will have a recurrence.
Mixed episodes are more likely in
Episodes occur more frequently with
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
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.
The lifetime prevalence is approximately
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 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
Diagnosis requires the presence of
at least 4 mood episodes within 1 year.
Rapid cycling mood episodes may
The patient must be symptom-free
for at least 2 months between episodes or the patient must switch to an
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
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
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
Unable to sleep or sit still…often
going for days with 2 or3 hrs sleep and not feeling tired
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,
In persons with extreme mania you
may see some of the following:
Thinking completely illogical
Speech uncontrollable and sometimes
Unable to distinguish between "real"
and "not real"
Delusions, paranoia, hallucinations
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
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 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.
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.
How to Help Yourself When Getting
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
11. Try to keep your thoughts focused,
not rambling or obsessive.
12. Avoid sugar, caffeine and alcohol.
13. Eat nutritious well balanced
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.
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
Take medications regularly and as prescribed by your doctor
Get emotional support from a supportive person.
Talk to a therapist or counselor
Tell yourself that you have been ill and that the things you said or did
were not the real "you"
Eat regular, nutritious meals.
Be kind to yourself.
Get plenty of rest.
Focus on living one day at a time
Use spirituality if desired
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
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
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.
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.