Bipolar

Bipolar, also known as manic-depressive disorder, bipolar affective disorder, or manic depression, is characterized as a combination of mood issues resulting in one or more episodes of abnormally increased energy levels, mood and cognition, with or without one or more depressive episodes. Clinically, elevated moods are defined as mania, and in milder cases, hypomania. Persons experiencing manic or hypomanic episodes also commonly experience depressive episodes, or mixed episodes, where aspects of both mania and depression occur at the same time. Episodes may be separated by periods of “normal” mood but, in some individuals, mania and depression may rapidly alternate, which is defined as rapid cycling. Extreme manic episodes can sometimes lead to psychotic symptoms such as hallucinations and delusions. Bipolar has been subdivided into three main types: bipolar I, bipolar II and cyclothymia. There are other types of bipolar and are based on severity and nature of mood. This range is often described as the bipolar spectrum.

• Signs of Manic Phase
• Signs of Depressive Phase
• Psychotherapy for Bipolar
• Medical Treatment for Bipolar
• Bipolar in the DSM

Signs of Manic Phase

The manic phase may last anywhere from days to months and may include these symptoms:

• Elevated mood such as lack of self-control, hyperactivity, increased energy, and racing thoughts

• Inflated ego and/or self-esteem (false beliefs in special abilities, delusions of grandeur)

• Irritation or agitation

• Over-involvement in activities

• Little need for sleep

• Inability to control temper

• Reckless behavior(s) such as impaired judgment, sexual promiscuity, binge drinking, binge eating, drug use, and excessive spending

• Easily distracted

**The above manic symptoms are seen in persons affected with bipolar I. In people with bipolar II, similar but less intense symptoms occur.

Signs of Depressive Phase

The depressive phase of both types of bipolar entails serious symptoms of major depression including:

• Difficulty remembering, making decisions or concentrating

• Restlessness or fatigue

• Feelings of worthlessness, hopelessness and/or guilt

• Eating disturbances such as loss of appetite and weight loss or overeating and weight gain

• Loss of or decreased self-esteem

• Persistent thoughts of death

• Suicidal thoughts

• Persistent sadness

• Sleep disturbances such as excessive sleepiness or inability to sleep

• Withdrawal from activities and friends

Psychotherapy for Bipolar

Psychotherapy can help persons affected with bipolar by teaching them how to recognize triggers so they can avoid or understand them, decrease negatively expressed emotions, and practice coping skills that keep the disorder in remission. Other types of psychotherapy such as family-focused and cognitive behavioral therapies are effective in preventing relapses. Although the research clearly demonstrates that often times bipolar has an organic ideology, there is clear clinical evidence that bipolar can be treated through psychotherapy. For example, the grandiose, hypomanic ego state is often fueled by a profound sense of worthlessness, as if ambition and striving for greatness is compensating for low self esteem. Likewise, the depressive ego state can be seen as a protection, as giving up so to avoid failure, and other worthless feelings. 

Medical Treatment for Bipolar

Medical treatment of bipolar ranges from mood stabilizers such as lithium (which helps to reduce suicidal behaviors), to anticonvulsants (which are typically more effective for rapid cycling), to antipsychotic and atypical antipsychotic medications (which are typically effective for manic episodes). Antidepressant use for bipolar is somewhat controversial and, if used alone, they can have adverse side effects. In most cases, antidepressants and mood stabilizers are prescribed together.

Bipolar in the DSM

The DSM defines bipolar disorder (also known as manic-depressive disorder, bipolar affective disorder or manic depression) as a psychiatric disorder that fits in the category of mood disorders. The DSM categorizes bipolar disorder as follows:

• Bipolar disorder NOS (not otherwise specified)

• Bipolar I disorder, most recent episode depressed in full remission, partial remission, mild, moderate, severe without psychotic features, severe with psychotic features, or unspecified.

• Bipolar I disorder, most recent episode hypomanic

• Bipolar I disorder, most recent episode manic full remission, partial remission, mild, moderate, severe without psychotic features, severe with psychotic features, or unspecified.

• Bipolar I disorder, most recent episode mixed full remission, partial remission, mild, moderate, severe without psychotic features, severe with psychotic features, or unspecified.

• Bipolar I disorder, most recent episode unspecified

• Bipolar I disorder, single manic episode full remission, partial remission, mild, moderate, severe without psychotic features, severe with psychotic features, or unspecified.

• Bipolar II disorder

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