Specialization

Bipolar Disorder

Overview

Bipolar disorder is a common mental health problem where mood fluctuations may occur in months, weeks, days and at times even for hours within a day. The mood swings in bipolar disorder range from an extreme heightened emotional state called mania to a low emotional state called depression. Hypomania, a condition also associated with bipolar disorder, is characterized by an altered emotional state in which there is heightened emotion than usual but less than mania.

Bipolar disorder is an episodic illness in which hypomanic, manic and depressive episodes occur in various combinations. The frequency and duration of episodes vary significantly among individuals and in the same individual, from one episode in many years to multiple episodes in a single year.

During the hypomanic episodes, patients feel overtly cheerful, euphoric, irritable, and increased energy and activity with indulgence in risky behaviours.

During a depressive episode, the patient may experience sadness in moods, loss of interest and pleasure in previously pleasurable activities, reduced energy, and disturbance in biological functions like sleep, appetite, and sexual behaviour.

Although bipolar disorder is a chronic and lifelong disease, the episodes can be managed well with treatment with complete inter-episodic recovery.

Key Features

Bipolar disorder is a common disorder affecting both males and females
The usual age of onset is adolescent and young adult but can occur at any age
Hypomanic, manic and depressive episodes occur in various combinations, which requires different management strategies
Severe cases are associated with high risk owing to self-injurious and suicidal thoughts/acts. Such issues may need active management with hospitalization.

Symptoms

Symptoms of bipolar disorder depend upon the nature of the episode, whether the person is suffering from a hypomanic, manic or depressive episode

Hypomania and Mania

Hypomania and mania are usually characterized by similar symptoms but are two distinct types of episodes that vary in severity. Hypomanic episodes are milder than manic episodes, whereas mania is more severe and causes more pronounced and noticeable difficulties in the workplace, school, interpersonal relationships and other social activities. Extreme manic episodes may be associated with psychotic symptoms and may require hospitalization.

A manic and a hypomanic episode are diagnosed based on the following symptoms:

Increased talk, inability to stop talking
Increased activity, energy or agitation
Tall claims, increased sense of self-importance and self-confidence
Exaggerated sense of well-being and self-confidence (euphoria)
Decreased need for sleep
Racing thoughts and pressure of speech
Distractibility, poor attention and concentration
Irritability and anger outbursts
Poor decision-making capacity and indulgence in high-risk behaviours like increased spending, reckless investments, risky sexual behaviours etc.

Depressive Episode

A major depressive episode is an area of primary concern. Symptoms are often crippling and severe enough to cause significant difficulty in routine daily activities, including self-care, educational and academic performance, and occupational and social activities.

An episode of depressive disorder may present with the following symptoms:

Depressed mood, like the feeling of sadness, hopelessness or tearfulness (depressed mood can appear as irritability in children and adolescents)
Marked loss of interest and pleasure in previously pleasurable activities
Significant weight loss or weight gain, decrease or increase in appetite
Difficulty in sleeping (insomnia) or increased sleep
Significantly reduced activity, slowness and sluggishness or agitated behaviour
Fatiguability, loss of energy
Feelings of helplessness
Feelings of worthlessness
Inappropriate and excessive guilt over unrelated or trivial things
Inability to think, poor attention and concentration, or indecisiveness
Slowing and lack of thoughts
Suicidal thoughts, plans and acts, acts of self-injurious behaviours

Types of Bipolar Disorder

Bipolar I disorder

When there is at least one manic episode that may or may not be preceded or followed by any major depressive or hypomanic episodes.

Bipolar II disorder

when there are major depressive and hypomanic episodes in the course of illness but never had a manic episode.

Cyclothymic disorder.

Many periods of hypomania symptoms alternate with periods of depressive symptoms (less severe than major depression) for at least two years.

Other types

bipolar and related disorders induced by substances, drugs or due to another medical condition.

The usual age of presentation of bipolar disorder is adolescent and young adults, but it can occur at any age. Symptoms of bipolar disorder change over time in the same individual and may vary from person to person.

Symptoms in children and teens

Symptoms of bipolar disorder can be challenging to identify and diagnose in children and adolescents. It’s difficult to tell whether these are normal fluctuations induced by trauma or stress or indicate a mental health condition which requires proper attention.

Children and adolescents may have distinct manic, hypomanic or major depressive episodes, but the presentation can differ from that of adults with bipolar disorder. In children and adolescents, moods rapidly shift during episodes associated with irritability and agitation.

The most significant and prominent indicator of bipolar disorder in children and adolescents includes rapid mood swings that are different from their usual ones.

Need for Treatment

People with bipolar disorder often fail to recognize their illness. They fail to understand their emotional instability, disruptions in their lives, interpersonal conflicts it creates and hardships it brings in their lives and the lives of their loved ones. Before they come for treatment, they lose many years of their productive lives to the illness.

Near and dear ones better recognize symptoms and signs of bipolar disorders, and educating them to recognize the symptoms may help bring the patient under treatment.

Bipolar disorder is not a self-limiting disease and doesn’t get better by itself. Getting proper treatment from a mental health expert is needed in all such cases. Treatment helps reduce the duration and severity of each episode, the number of episodes, and the chronicity of the illness, thereby reducing the time spent on the disease and improving the quality of life.

If you, your near and dear ones, friends, colleagues or neighbours are experiencing symptoms of mania or depression, consulting an expert mental health professional with experience treating bipolar disorders can help get symptoms under control.

If case you are having a mental health issue, make an appointment to see your mental health professional at the earliest. If you’re hesitant to seek treatment, talk to a friend or dear one, or someone else you trust.

Call Divyansh Neuropsychiatry Centre at +91 7543976796/+91 7759945555 and speak to any of our office staff to schedule an appointment. Or visit our website to book an appointment – https://divyanshneuro.com/.