Bipolar Disorder:Overview

Bipolar disorder is a chronic, frequently disabling condition, previously referred to as manic depression. Bipolar disorder is characterized by mood instability that includes at least one episode of mania or hypomania in conjunction with repeated episodes of major depression. Mania is characterized by at least one week of a high feeling, euphoria and irritability along with four or more the following symptoms: racing thoughts, reckless behavior, very limited need for sleep, distractibility and pressured speech (American Psychiatric Association, 2012). Hypomania is usually characterized by symptoms that are very similar but somewhat less severe than mania. There are several subtypes of Bipolar disorder including Bipolar I and Bipolar II disorder. The Bipolar I subtype is defined by at least one episode of mania or mixed disorder, while the Bipolar II subtype is seen in individuals who never seem to have a complete or full manic episode while having at least one hypomanic episode along with one or more episodes of depression.

Individuals with bipolar disorder often exhibit very different symptom patterns from each other. Some individuals may have only one manic episode along with a long history of major depressive episodes. Others may have some balance of episodes of depression and hypomania or mania. In most cases however, individuals experience more depressive episodes than manic or hypomanic episodes. Some studies have found that individuals with Bipolar I disorder seem to have about 3.5 times as many weeks with symptoms of depression rather than weeks of manic or hypomanic episodes. Bipolar II patients seem to have 38 times more weeks of depression relative to weeks exhibiting hypomanic symptoms.

Functional impairment:

Individuals with Bipolar disorder often have significant impairment as a result of their symptoms and are frequently disabled. The symptoms often impair functioning to the degree that they may have great difficulty in their daily experiences of work, relationships and in general conformity with social expectations. Some studies have found that functional deficits associated with manic episodes such as difficulties in relationships and work continue to be obvious five years after the episode was resolved. Other studies have found that approximately 30% of patients were unable to work and only 21% work at what may be considered their expected level work effectiveness in the six months subsequent to an episode of mania. While medications seem to be very helpful, only 35% of patients utilizing medicine seem to have good function 4 and 1/2 years after the manic episode. Additional studies have found that only about 42% of manic patients were able to work steadily in the 1.7 years after they were hospitalized for a manic episode. Also, very high rates of marital distress, dysfunction and divorce are associated with Bipolar disorder.

Gender:

There is really no gender difference in the presentation of Bipolar disorder as women and men seem to receive this diagnosis at about the same rate. There have been some differences noted however for individuals referred to as rapid cycling (which is when people seem to have four or more episodes in one year), with more women being defined as having the rapid cycling subtype of Bipolar II disorder

Age of Onset:

Bipolar disorder seems to present most often in the late teens to the early twenties. Individuals with earlier onset seem to have a more chronic presentation along with more severe substance abuse and anxiety along with a higher likelihood of suicidal behaviors.

Prevalence:

This disorder is believed to effect approximately 1% and 2% of the population in the United States. However, some studies have found higher rates when considering the entire bipolar spectrum which also includes cyclothymia.

Clinical Course:

Bipolar disorder is most commonly experienced as repeated cycles or episodes of depression and mania or hypomania that are extremely dysfunctional and often disabling. These mood disruptions are also accompanied by family and work difficulties as well as severe problems at work and in social situations. Over a period of 4 to 5 years, most bipolar patients relapse into additional episodes with the most frequent relapse being within the first year of diagnosis. The frequency and related impairment is largely responsible for the role disruption associated with this disorder.

There are many factors associated with the likelihood of a mood episode. One of the more common exacerbating factors seems to be stressful life experiences. Stress has been found to increase the likelihood of a episodes as well as often increasing the level of intensity. Comorbid factors include an increased rate of alcohol or substance abuse and/or high levels of anxiety. These comorbid factors are also known to indicate a poorer rate of recovery as well as increasing the impairment in role functioning as well as a possibly causing a higher frequency of suicide attempts. Bipolar disorder patients are also frequently noncompliant with their medications reducing or impairing their recovery often resulting in more frequent hospitalization. Unfortunately, some individuals with this disorder may experience some level of psychosis especially during the depressive episode, which also lessens the possibility of a full recovery.

Suicide is of great concern among bipolar patients. Some researchers have found that when compared to other psychiatric patients, patients receiving a DSM IV or DSM V diagnosis for bipolar disorder seem to have the highest rate of completed suicide, followed by individuals with major depressive disorder and personality disorders.

Conclusions on bipolar disorder:

Bipolar disorder is easily one of the most severe and disabling of the psychiatric diagnoses. It effects virtually every aspect of personal, family, social and occupational functioning. Individuals suspected of having bipolar disorder absolutely need to have the assessment of a qualified mental health practitioner such as a psychologist, psychiatrist or mental health counselor. They need to have social support to reduce stress and assist in everyday activities as well as maintaining compliance with their medications from family and friends. Medications continue to improve and assist in moderating and stabilizing moods. Also, the assistance of psychotherapy and counseling seems to have some effectiveness in reducing stress, assisting with problem-solving life difficulties, maintaining compliance with medications as well as advocating for the best interest of the individual with bipolar disorder.

By Paul Susic Ph.D. Licensed Psychologist