BIPOLAR MOOD DISORDER

What is Bipolar Illness?

     In America over ten million persons are affected with bipolar illness and it costs the country billions of dollars in lost productivity and cost of treatment.  However, the personal suffering of those who have the illness is acute.  Typically bipolar illness starts in adolescence and lasts throughout the person’s lifetime.  The person’s mood swings from periods of mania which can include increased activity, pressured speech, wild spending sprees, reckless behaviour, and sexual indiscretions to major depression which is characterized by feelings of hopelessness, sadness, decreased activity, and the risk of suicide.  Bipolar illness is classified into several different categories.  Bipolar I individuals exhibit full blown episodes of mania, whereas Bipolar II individuals experience hypomania which is not as extreme as mania. There also can be mixed states when the person has symptoms of both mania and depression at the same time. However, psychiatrists cannot agree on how many different classifications of bipolar illness exist.

Symptoms of Bipolar Illness

     The U. S. National Institute of Mental Health gives the following information regarding bipolar symptoms:

Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

• Increased energy, activity, and restlessness
• Excessively “high,” overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can’t concentrate well
• Little sleep needed
• Unrealistic beliefs in one’s abilities and powers
• Poor judgment
• Spending sprees
• A lasting period of behaviour that is different from usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
• Provocative, intrusive, or aggressive behaviour
• Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, a feeling of fatigue or of being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Sleeping too much, or can’t sleep
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

Bipolar Risk for Suicide

     It is estimated that 15-20% of untreated bipolar persons will commit suicide.  However, 50% of Bipolar I patients have attempted suicide during a depression. Patients with mixed mania and depression are at particular risk for suicide. Also, studies show that adolescents with bipolar disorder tend to be more acutely ill than adults and 25% of them are significantly suicidal.

Substance Abuse in Bipolar Persons

     Nearly 60% of bipolar sufferers have some form of substance abuse.  Smoking cigarettes is common followed by alcohol consumption.  Sometimes bipolar persons use street drugs such as marijuana or cocaine to try to self-medicate their symptoms.  The risk of substance abuse is higher in men with bipolar illness and those who have mixed episodes.

Impact on the Family Unit

     At www.healthyplace.com it states, “Patients do not work out their negative behaviours (eg., Spending sprees, or even becoming verbally or physically aggressive) in a vacuum.  They have a direct effect on others around them…. . Many patients and their families, therefore, cannot admit that these episodes are part of an illness and not simply extreme, but normal characteristics.  Such denial is often strengthened by patients who are highly articulate and deliberate and can intelligently justify their destructive behaviour, not only to others, but also to themselves.”  The stigma surrounding mental illness often leads relatives to deny that there is a mental illness in the family which delays proper treatment.  If someone is bipolar the earlier they get treated the better the outcome will be.