Bipolar Disorder in Adults

Bipolar disorder (AKA Manic Depression) is a mental condition that affects the functioning of the brain causing extreme mood swings – from very excited (Mania or Hypomania) to very depressed, some experiencing both, others experiencing one or the other. In more severe cases, the person may experience symptoms of psychosis and loss of touch with reality.

Symptoms of bipolar disorder include becoming over-excited and reckless during the Mania stage and experiencing feelings of helplessness, depression and deficiencies in concentration and decision making.

There are two types of Bipolar disorder, Bipolar disorder I produces more severe symptoms, with sufferers being more likely to experience mania for an extended period. These individuals are more likely to have psychotic experiences. Bipolar II is diagnosed when a person experiences the symptoms of a high, but without the psychotic episodes. Impairment is often as severe as in bipolar I.

What is Mania and Hypomania?

Mania is a state of extreme energy and elevation of mood. Hypomania being more severe, with additional symptoms of impairment of judgement, insight and even delusions; sometimes becoming so exhausting that the sufferer requires hospitalisation.

The key features of Mania and Hypomania are:

• Increased amounts of energy – sufferers report racing thoughts and rash decisions, feeling more talkative, sometimes to the extent of talking over others and the need for less sleep without feeling fatigued.
• Optimistic mood – individuals may feel confident, capable and optimistic; as if they could do anything. Increased creativity and apparent ‘understanding’ (seeing things clearly) and disappearance of any anxiety is also apparent.
• Irritability – Expressions of impatience and anger.
• Inappropriate behaviours – Such as being over-involved in other peoples activities, increased risk taking (drugs, alcohol, gambling), impulsive behaviour and spending and other generally frowned upon activities.
• Delusions – false, illogical and irrational beliefs usually combined with hallucinations. There are two types of delusions that may occur during mania:
  • Grandiose delusions: The individual acts under the belief that they possess special powers, or have knowledge that no one else has, for example they may believe that they are very wealthy or that they can fly.
  • Persecutory delusions: The individual suffers paranoia, believing that people are after them or that something bad is about to happen to them or a close friend or family member.

What causes Bipolar Disorder?

• Genetics – genetic factors account for almost 80% of the causes of bipolar disorder. For women who are genetically predisposed to developing the disorder, the postnatal period is a likely time for the first episode.
• Brain malfunctions – Studies have suggested that bipolar disorder is related to abnormal serotonin chemistry. Serotonin is a neurotransmitter in the brain that affects a person’s mood.
• Drug use/abuse – Some drugs, both medical and illicit can cause manic and hypomanic episodes.

Treatment

Bipolar Disorder can require long term treatment, however symptoms of Bipolar Disorder react well to treatment, most people recovering well from the disorder. Treatment includes a combination of a mood-stabilizing drug paired with psychotherapy – which is vital in helping sufferers cope with the condition. Because Bipolar disorder involves episodes of depression and mania, treatment usually involved two parts:

• Treating the current episode
• Preventing the recurrence of further episodes

Because of the unpredictability of these episodes it is important that patients keep a ‘Daily Mood Graph’ in which the therapist can assess the impact of different treatments on your mood over time. A ‘Wellbeing Plan’ is also important for preventing low level symptoms from becoming full blown episodes. Recognising the patients ‘Relapse Signature’ can also help to indicate when the next possible episode may occur.