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Bipolar Disorder: Diagnosis and Causes

Behaviour, Depression, Mental Health | December 8, 2014 | Author: The Super Pharmacist

mental health, depression, mental

Bipolar Disorder: Diagnosis and Causes

All of us experience changes in our moods. Some days, we may feel irritable and frustrated. On other days, we are happy and excited. Individuals with bipolar disorder, however, experience much more extreme mood states that impair their daily life and negatively affect their relationships.

Bipolar disorder is a complex, chronic, recurrent life-long illness causing profound individual suffering and societal costs. Bipolar disorders affect about 2% of the world’s population, with subthreshold forms of the disorder affecting another 2%. Even with treatment, about 37% of patients relapse into depression or mania within 1 year, and 60% within 2 years.

Psychiatric diagnosis

Bipolar disorder is a psychiatric diagnosis defined in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. It is a disorder characterised by periods of extreme, often inappropriate, and sometimes unpredictable mood states. In the past, this disorder was called manic-depression. The term, 'manic-depression' was coined to describe the high emotional states of mania and depression that were experienced.

Bipolar DisorderBipolar individuals experience alternating periods of manic episodes (joyful or excited states) and depressive episodes (very sad, hopeless or empty states). Mood episodes may also include symptoms of both mania and depression (a mixed state).

There are many variations of this disorder. A person with bipolar disorder tends to experience more extreme states of mood than other people. Moods can change quickly (many times a day) or last for months.

Bipolar individuals tend to have very 'black and white' thinking, where everything in life is either a positive aspect or a negative.

Mood patterns of this nature are associated with distress and disruption, and a relatively high risk of suicide. Bipolar disorder is also associated with a variety of cognitive deficits, particularly in organising and planning. The disorder may also skew the ability to judge others' emotions and alter sense of awareness. Bipolar individuals can be overly observant and analytical of their environment, and in some cases,
paranoid of others.

Different Types of Bipolar Disorder

The latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, adult bipolar disorder now has five possible diagnoses:

  • Bipolar I Disorder
  • Bipolar II Disorder
  • Cyclothymic Disorder
  • Substance-Induced Bipolar Disorder
  • Bipolar Disorder Associated with Another Medical Condition
  • Bipolar Disorder Not Elsewhere Classified

Diagnosing Bipolar I Disorder 

The qualifying event for a diagnosis of bipolar I disorder is a single episode of mania (not drug-induced).

A depressive episode is not required for the diagnosis although the vast majority of people who experience mania also have episodes of major depression. A manic episode is defined as a profound mood disturbance characterised by elation, irritability, or expansiveness of at least 1 week duration and at least 3 of the following symptoms:

  • Grandiosity (an exaggerated sense of one's importance)
  • Decreased need for sleep
  • Excessive talking or pressured speech
  • Racing thoughts or flight of ideas
  • Distractibility
  • Increased level of goal-focused activity at home, at work or sexually
  • Engaging in activities with a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Diagnosing Bipolar II Disorder 

Bipolar II disorder is defined as one or more major depressive episodes, at least one hypomanic episode, and the absence of manic episodes.

Diagnosing Bipolar II Disorder During a major depressive episode, the individual demonstrates a depressed mood or a loss of interest or pleasure in daily activities consistently for at least 2 weeks.

This mood represents a change from the person’s normal mood and significantly impairs social, occupational, educational or other important functioning.  

A major depressive episode is characterised by at least 5 of the following:

  • Depressed mood
  • Markedly diminished pleasure or interest in nearly all activities
  • Significant weight loss or gain or significant loss or increase in appetite
  • Hypersomnia or insomnia
  • Psychomotor retardation or agitation
  • Loss of energy or fatigue
  • Feelings of worthlessness or excessive guilt
  • Decreased concentration ability or marked indecisiveness
  • Preoccupation with death or suicide; patient has a plan or has attempted suicide

A major depressive episode is generally not diagnosed when the same symptoms could be attributed to bereavement (normal feelings of sadness after the loss of a loved one). Hypomanic episodes are characterised by an elevated, expansive, or irritable mood of at least 4 consecutive days’ duration with the presence of at least 3 of the following symptoms:

  • Grandiosity or inflated self-esteem
  • Diminished need for sleep
  • Pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work, or sexually
  • Engaging in activities with a high potential for painful consequences

A hypomanic episode is associated with a change in functioning that is uncharacteristic of the person. For example, the individual may be far more productive or outgoing and sociable than they usually are. This change in functioning and in mood is noticeable by others (usually friends or family members). Hypomanic episodes have the same symptoms as manic episodes with two important differences: (1) the mood is not severe enough to cause serious impairment in social or occupational functioning or necessitate hospitalisation; (2) there are no psychotic features present in a hypomanic episode. The observable symptoms of a hypomanic episode must not be due to medication or substance abuse or caused by a general medical condition (eg, hyperthyroidism or diabetes).

Diagnosing Cyclothymic Disorder 

Diagnosing Cyclothymic Disorder Cyclothymic disorder is a type of chronic mood disorder widely considered to be a milder or subthreshold form of bipolar disorder.

Cyclothymia is characterised by numerous mood disturbances, with periods of hypomanic symptoms that do not meet the criteria for a hypomanic episode, alternating with periods of mild or moderate symptoms of depression that do not meet the criteria for a major depressive episode.

Causes of Bipolar Disorder

The modern understanding of bipolar disorder is that it is primarily a biological illness with genetic, biochemical, hormonal and environmental influences.

Observations of family histories have long confirmed that a strong genetic component to bipolar disorders. In all, about 80-90% of people diagnosed with bipolar disorder have a family history of either bipolar disorder or major depression. First-degree relatives of people with bipolar disorder are approximately 7 times more likely to develop bipolar disorder than the general population. Although bipolar disorder has a heritable basis, genetics is not the whole story. Studies of identical twins (who share 100 percent of the same genes) show that if one twin has bipolar disorder, the other twin does not develop bipolar disorder 20 percent or more of the time.

Clearly, other factors must be involved. Imbalances in brain neurochemistry and hormonal factors have been implicated. Environmental stressors may also serve to trigger an underlying genetic or biochemical predisposition.

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