Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

BiPolar Disorders

bipolar disorderBipolar disorder, once known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

Symptoms of the disorder can be severe. They are different from the normal ups and downs of everyday life.  The symptoms can result in damaged relationships, poor job or school performance, and even suicide.

Bipolar disorder tends to run in families. Children with a parent or sibling who has the disorder are much more likely to develop the illness, compared with children who do not have a family history of  the disorder. Genetics and environmental factors are involved.

One MRI study found that the brain’s prefrontal cortex in adults with bipolar disorder tends to be smaller and function less well compared to adults who do not have bipolar disorder. The prefrontal cortex is a brain structure involved in “executive” functions such as solving problems and making decisions; these disorders tends to emerge during a person’s teen years.

Bipolar disorder can be present even when mood swings are less extreme. Some patients with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, the patient may feel very good, be highly productive, and function well. The patient may not feel that anything is wrong, but family and friends may recognize the mood swings.

Bipolar disorder may also be present in a mixed state in which the patient may experience both mania and depression at the same time. During a mixed state, the patient may have trouble sleeping, experience major changes in appetite, and have suicidal thoughts. Patients in a mixed state may feel very sad or hopeless while at the same time feel extremely energized.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The patient may believe he is a famous person, has a lot of money, or has special powers.

Psychotic symptoms during a depressive episode may result in the patient believing that he is ruined and penniless or has committed a crime. Patients with bipolar disorder who have psychotic symptoms are sometimes misdiagnosed as being schizophrenic.

Patients with bipolar disorder may also abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. It may be difficult to recognize these problems as signs of a major mental illness.

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many patients with bipolar disorder are free of symptoms, but some patients may have lingering symptoms.

Here are three types of bipolar disorder:

  1. Bipolar I Disorder—defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
  2. Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
  3. Cyclothymic Disorder, or Cyclothymia—a mild form of bipolar disorder. patients with cyclothymia have episodes of hypomania as well as mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

A severe form of the disorder is called rapid-cycling Bipolar Disorder. Rapid cycling occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states, all within a year. Rapid cycling seems to be more common in patients who have their first bipolar episode at a younger age. One study found that patients with rapid cycling had their first episode about 4 years earlier than patients without rapid cycling bipolar disorder. Rapid cycling affects more women than men.

Patients with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania.

Substance abuse is very common among patients with bipolar disorder with patients attempting treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.

(This is intended only as an overview. The above was excerpted from multiple sources. The reader is encouraged to read further about these disorders.)

Comments for this post are closed.

Opiates Worsening Depression

When Prescribing Opiates is Problematic “Research indicates (Grattan, A. Sullivan, M. et al. Depression and Prescription …
Read Blog Post

Problems vs. Disorders

The majority of injured workers, especially in Georgia, come from _industrial_ jobs which include the construction industry, …
Read Blog Post

diagnoses II

Diagnoses – Part II

The most common disorder we see among injured workers is what is referred to as an Adjustment Disorder. Stressors for people …
Read Blog Post