Most of us have experienced periods of extreme sadness and extreme happiness from time to time. If losing a job or loved one makes us sad for days, then getting a promotion or winning a lottery makes us joyful for days. However, mood disorders involve much more severe alterations for longer periods of time. In such cases, the disturbances of mood must be severe enough to interfere with occupational and social functioning. People with a bipolar disorder experience both the lows of depression and the highs of mania. Let us explain a few terms which will ease our understanding of the disorder. • Depression involves feelings of extraordinary sadness and dejection, and a loss of interest in previously pleasurable activities. The symptoms, which include sleeping too much or too little; change in appetite; loss of energy; psychomotor retardation; feeling worthless and guilty; and difficulty in concentrating and thinking, must persist for a period of two weeks for a diagnosis to be made. A depressive episode is characterized by feelings of misery and emptiness, loss of initiative, less active and productive, decreased speech and motor movements, holding a negative view of self, hopelessness, pessimism, and complaints of headaches and pain. • Mania is a state of intense elation or irritability accompanied by symptoms of increase in psychomotor activity, rapid speech, flight of ideas, increased self-esteem, decreased sleep, distractibility, and excessive involvement in risk-taking behaviour. For a diagnosis, these symptoms must last for a week and often hospitalization is required. During manic episodes, people act in ways that are highly unusual for their typical self, attract attention, do not recognize any personal or social limits, need constant excitement, show poor judgment and planning, are flamboyant and grandiose, feel extremely energetic and are oblivious to disastrous consequences of their behaviour. • Hypomania, as the name suggests, is less extreme than mania. The above symptoms are present to a milder degree and must last for four days for a diagnosis to be made. There is low impairment of social and occupational functioning and rarely requires hospitalization. According to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM 5), bipolar disorders are classified into three categories. 1. Bipolar I Disorder – The occurrence of at least one full-blown manic episode or mixed episode for one week. A mixed episode is characterized by symptoms of mania and major depression. 2. Bipolar II Disorder – The occurrence of one hypomanic episode as well as one major depressive episode. 3. Cyclothymic Disorder – This is a milder version of bipolar II disorder as extreme symptoms and psychotic features are not present. A person has frequent but mild symptoms of depression, alternating with symptoms of mania, both of which do not meet the criteria of full blown mania and major depression. The symptoms must be present for, at least, a period of two years for the diagnostic criteria to be met. Due to depression being the most common psychological disorder, bipolar disorders are often misdiagnosed. Thus, it is difficult to estimate the prevalence of bipolar disorder. Bipolar disorders usually have a sudden onset, between the ages of 18 and 25 years. The occurrence is equal between men and women; however, women experience more episodes of depression than men. The etiology of bipolar disorders is organized mainly into biological and psychosocial factors. Biological factors include genetic, neurochemical, hormonal, neurophysiological, neuroanatomical, and biological rhythm influences. Psychosocial factors such as stressful life events, poor social support, certain personality traits and cognitive styles have been identified. The treatment of bipolar mood disorders is focused on a combination of medication and psychotherapy. Mood stabilizing drugs, sometimes along with antidepressant drugs, are prescribed for recovery from manic and depressive episodes, as well as to reduce the frequency of future episodes. Psychotherapy along with pharmacological interventions has proven to be more effective treatment. Cognitive therapy or interpersonal therapy or family therapy is often employed to address issues of medication management, social skills and interpersonal relationships, and solving the occupational and family problems caused by bipolar episodes. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Butcher, J.N., Mineka, S., & Hooley, J.M. (2004). Abnormal Psychology. Fifteenth Edition. New York: Pearson Education, Inc.
What is Bipolar Disorder