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Bi-Polar Disorder

 

     Overview

 

Bipolar disorder goes by many names: manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder are medical terms for the same condition.
Bipolar disorder is classified into four different types: Bipolar I, Bipolar II, Cyclothymic Disorder, or Bipolar Disorder Not Otherwise Specified. Mental health experts separate the condition into these four types because the symptoms of bipolar disorder show up differently in different people. When doctors know what type someone has, they can tailor treatment to that person's specific needs.


Bipolar disorder affects both men and women. About 5.7 million people in the United States have the disorder. There is no racial group that is more afflicted by this disease. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier. It often shows up in adolescence, and even children can have the disorder.


Recent research suggests that kids and teens with bipolar disorder don't always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.


Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just "snap out of it," as if a person who is sick can become well simply by wanting to. Bipolar disorder isn't a sign of weakness or a character flaw; it's a serious medical condition that requires treatment, just like any other condition.

 

Because of the extreme and risky behavior that goes with bipolar disorder, it is very important that the disorder be identified. With proper and early diagnosis, this mental condition can be treated. Bipolar disorder is a long-term illness that will require proper management for the duration of a person's life.

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     Signs and symptoms

 

The symptoms of a manic episode often include elevated mood (feeling extremely happy), being extremely irritable and anxious, talking too fast and too much, and having an unusual increase in energy and a reduced need for sleep. It's also very common for someone to act impulsively during a manic episode, and engage in behaviors that are risky or that they later regret, like spending sprees. And in over half of all manic episodes, people are troubled by delusions or hallucinations. For example, they may think they have a relationship with someone famous, claim to be an expert in an area they really know nothing about, feel paranoid (unusually fearful), or hear voices that are not there. 
The symptoms of a depressive episode often include an overwhelming feeling of emptiness or sadness, a lack of energy, a loss of interest in things, trouble concentrating, changes in normal sleep or appetite, and/or thoughts of dying or suicide. 
A mixed episode includes symptoms that are both manic and depressive. 

A person with bipolar disorder will go through episodes of mania (highs) and at other times experience episodes of depression (lows). These aren't the normal periods of happiness and sadness that everyone experiences from time to time. Instead, the episodes are intense or severe mood swings, like a pendulum that keeps arcing higher and higher.

Symptoms of mania include:

  • racing speech and thoughts

  • increased energy

  • decreased need for sleep

  • elevated mood and exaggerated optimism

  • increased physical and mental activity

  • excessive irritability, aggressive behavior, and impatience

  • poor judgment

  • reckless behavior, like excessive spending, making rash decisions, and erratic driving

  • difficulty concentrating

  • inflated sense of self-importance 

Symptoms of depression include:

  • loss of interest in usual activities

  • prolonged sad or irritable mood

  • loss of energy or fatigue

  • feelings of guilt or worthlessness

  • sleeping too much or inability to sleep

  • drop in grades and inability to concentrate

  • inability to experience pleasure

  • appetite loss or overeating

  • anger, worry, and anxiety

  • thoughts of death or suicide

In adults, episodes of mania or depression usually last for weeks or months, although they can be shorter in length. In children and adolescents, though, these episodes can be much shorter, and a kid or teen can even go back and forth between mania and depression throughout the day. Episodes of mania or depression may happen irregularly and follow an unpredictable pattern or they may be linked, with a manic episode always following a period of depression, or vice versa. Sometimes episodes have a seasonal pattern. Mania in the spring, for example, may be followed by depression in the winter.


Between episodes, a person with bipolar disorder usually returns to normal (or near-normal) functioning. For some people, though, there is little or no "break period" between their cycles. These mood swing cycles can change slowly or rapidly, with rapid cycling between mania and depression being much more common in women, children, and adolescents.


Some people with bipolar disorder turn to alcohol and drugs because they feel temporarily better when they're high. But using alcohol and drugs can have disastrous results for people with bipolar disorder. Substance abuse can actually make the symptoms worse, as well as making the condition hard for doctors to diagnose.

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     Causes

 

The symptoms of bipolar disorder are thought to be caused by an imbalance of key chemicals in the brain. The brain is made up of billions of nerve cells that move a constant stream of information from one to the other. To keep the information flowing, the cells release chemicals known as "neurotransmitters." Two key neurotransmitters that are needed for brain function are dopamine and serotonin, which play a crucial role in emotional health. Many scientists believe that when the levels of these neurotransmitters aren't quite right, it may result in bipolar disorder. For instance, too much dopamine in certain parts of the brain can cause symptoms such as delusions, while too little dopamine in other parts of the brain can cause symptoms such as a lack of emotion and energy.

 

Genes also play a role. If a close relative has bipolar disorder, a person's risk of developing the condition is higher. This doesn't mean, though, that if you have a relative with bipolar disorder you will automatically develop it! Even in studies involving identical twins raised in the same home, one twin sometimes had bipolar disorder whereas the other did not. Researchers are now working on identifying the gene or genes involved in bipolar disorder.

 

Environmental factors may play a role in bipolar disorder. For some teens, stresses such as a death in the family, their parents' divorce, or other traumatic events could trigger a first episode of mania or depression. Sometimes, going through the changes of puberty can set off an episode as well as emotional stress, drug use or an illness. In girls, symptoms can be tied to their monthly menstrual cycle.

 

Not everyone with severe mood swings or a change in personality has bipolar disorder. Mood swings can be caused by other medical conditions that need to be diagnosed and treated properly. Medical diseases and medications that may have symptoms similar to bipolar disorder include the following:

  • Head trauma (blood clot or bleeding in the brain)

  • Thyroid problem (both underactive and overactive)

  • Systemic lupus erythematosus (a condition that may affect various body organs, including the brain)

  • Brain tumor

  • Epilepsy (seizures)

  • Neurosyphilis (a form of the sexually transmitted disease, syphilis, that has gone to the brain because it went untreated too long)

  • AIDS (acquired immunodeficiency syndrome, the ultimate result of infection with the human immunodeficiency virus or HIV)

  • Sodium imbalance (sodium, one of several elements found in body cells that is necessary for their proper function)

  • Diabetes mellitus (a disorder of, among other things, sugar processing in the body)

  • Certain medications that decrease the amount of serotonin or norepinephrine, such as some antihypertensive drugs and some preparations of steroids and birth control pills

  • Psychiatric conditions and drug abuse may also mimic bipolar disorder

  • Attention deficit/hyperactivity disorder (ADHD)

  • Anorexia nervosa

  • Drug abuse (cocaine, methamphetamine use)

  • Bulimia nervosa

  • Panic disorder

  • Posttraumatic stress disorder

  • Social phobia

  • Schizoaffective disorder

  • Schizophrenia

  • Delusional disorder

Most people with bipolar disorder can be helped.  Sadly, many people with the condition are never diagnosed or are not diagnosed properly. Without proper diagnosis and treatment, the disorder can become worse. Some teens with undiagnosed bipolar disorder can end up in a psychiatric hospital or residential treatment center, in the juvenile justice system, abusing drugs, or committing suicide.

 

Because children and teens with bipolar disorder do not usually show the same patterns of behavior as adults who have the condition, a mental health professional will observe a teen's behavior carefully before making a diagnosis. This includes getting a complete history of a person's past and present experiences. Family members and friends can also provide helpful insights into the person's behavior. The doctor may also want a teen to have a medical exam to rule out other conditions.

 

Diagnosing bipolar disorder can be difficult. As yet, there aren't any laboratory tests like a brain scan or blood test that will diagnose it. In teens, bipolar disorder can sometimes be mistaken for illnesses like schizophrenia and posttraumatic stress disorder, attention deficit hyperactivity disorder (ADHD), and other depressive disorders. That's why a complete, detailed history is so important.

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