Bipolar disorder is often characterized by unpredictable mood swings, but the illness is more complex than that. It has a spectrum of symptoms and varying types that range from mild to severe.
Bipolar Disorder Symptoms
The most characteristic symptom of bipolar disorder is the dramatic mood swing from mania to depression.
Patients with bipolar disorder exhibit symptoms of depression that include anxiety, sadness, irritability, incessant crying, loss of energy, increased sleepiness, inability to make decisions, change in appetite and thoughts of suicide or death.
This may be followed by episodes of mania that include overexcitement, excessive happiness, irritability, increased energy, high sex drive, decreased need for sleep, grandiose thoughts and restlessness.
The severity of symptoms can be classified into the different types of bipolar disorder. Bipolar types include: Bipolar I, Bipolar II, Rapid Cycling and Mixed Bipolar.
Patients with bipolar I are diagnosed if they had at least one episode of mania, described as an episode of a highly elevated mood that affects functions of daily living.
Bipolar II patients have symptoms similar with bipolar I, but their episodes of mania are not as intense.
The rapid cycling type, which affects about 10 to 20 percent of bipolar patients, is the diagnosis if a patient undergoes four or more episodes of depression or mania in the span of one year.
The mixed bipolar type includes patients that have alternating moods of mania to depression over time. The differentiating factor is that patients have both mania and depression in rapid sequence or simultaneously.
The following types of bipolar disorder must be carefully differentiated from patients with cyclothymia. Cyclothymia is also a mood disorder but its symptoms are milder compared to that of bipolar disorder.
Bipolar Disorder Cause
The cause for bipolar disorder is not yet known, but experts believe that factors such as genetics, neurotransmitters and biological differences hugely contribute to its development.
Bipolar Disorder Diagnosis
Aside from thorough history-taking and physical examination, doctors suspecting patients with bipolar disorder would initiate a psychological evaluation and mood charting. Signs and symptoms are carefully compared with the criteria in the Diagnostic and Statistical Manual of Mental Disorders to come up with the proper diagnosis.
The psychological evaluation would include a psychological self-assessment and consented interview with friends and family members about episodes of depression and mania.
To better understand the patient's moods, mood charting is carried out by health practitioners. Daily sleep and mood swing patterns are noted and factored in to help in the diagnosis process.
Children are particularly difficult to diagnose with bipolar disorder because the "ups" and "downs" of emotions could be due to a pressing stress or trauma, other mental health problems such as attention-deficit hyperactivity disorder (ADHD) or part of their growing-up phase. Similarly, the symptoms of bipolar disorder in children have a different pattern compared to adults.
If they have it when they were young, diagnosis usually comes during the teenage years or early 20s.
Through a careful examination of signs and symptoms and their length, frequency and severity, a proper treatment plan based on an accurate diagnosis can be carried out.
Bipolar Disorder Treatment
The course of treatment for patients with bipolar disorder is best done by psychiatrists with expertise on the field to ensure a holistic care plan. Patients with bipolar disorder are highly advised to undergo psychotherapy (psychological counseling) and medications.
The treatment process may include mood-stabilizing medications to balance the mood swings before a long-term treatment is initiated. Since bipolar disorder requires lifelong treatment, a maintenance medication would also be introduced to prevent the relapse of symptoms.
The type and dosage of medication would depend on the severity of the symptoms. Medications may include mood stabilizers such as lithium or carbamazepine. If mania or depression continues, some patients benefit from the addition of antipsychotics like olanzapine.
To manage depression, an antidepressant is also prescribed but ideally in combination with a mood stabilizer or an antipsychotic because it often causes a manic episode.
Symbyax, a combination of antipsychotic olanzapine and antidepressant fluoxetine, is approved by the Food and Drug Administration (FDA) as specific treatment for episodes of depression in patients with bipolar I disorder.
After passing three controlled clinical trials, Vraylar (cariprazine) was also approved by the FDA as a treatment for patients with bipolar I and schizophrenia.
Anti-anxiety drugs like benzodiazepines may alleviate anxiety and improve sleep but they are best for short-term treatments only.
If symptoms are controlled already, some patients would require day treatment programs that include counseling and support.
To help manage the symptoms, patients who abuse substances and alcohol are also subject to substance abuse treatment. Those with suicidal tendencies or are psychotic (detached from reality) are recommended to be hospitalized to keep moods in check and prevent major depressive or manic episodes.
Psychotherapy is part and parcel of the treatment process of bipolar disorder. It may include cognitive behavioral therapy to help patients identify their negative and unhealthy beliefs and transform them to positive and healthy ones. The process allows the therapists, along with the patients, to identify the factors that trigger an attack and develop ways on how to properly cope with those situations.
Psychoeducation is advised so that patients and their loved ones can have a better understanding of the disease. This would help patients get the right support from their family.
Following a consistent routine of eating, exercise and sleep greatly benefits patients with bipolar disorder. This can be achieved through interpersonal and social rhythm therapy or IPSRT.
Additional therapies may be warranted if patients find it difficult to adjust or control their mood swings. Therapies may include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
Warning Signs
These therapy sessions with family and friends would help patients and practitioners in diagnosing and treating patients with bipolar disorder. Support systems that have a better understanding of the illness can help patients and doctors during the treatment process.
"Bipolar disorder is often misunderstood. Awareness-raising is absolutely crucial to reduce the stigma that surrounds it, we know many people with mental illness say the discrimination and prejudice they face can be worse than the illness itself," said Nia Charpentier of London-based charity Rethink Mental Illness.
It is also important to note that patients with bipolar disorder, in manic or depressive state, have a suicidal risk of 10 to 15 percent.
According to the Royal College of Psychiatrists in the UK, bipolar disorder is quite common, occurring in one in every 100 adults. It can occur at any age but is particularly apparent from ages 18 to 24.
Photo: Ryan Melaugh | Flickr
