In the previous posts I mentioned that bipolar disorder always has two extreme poles , the hypomania and mania though it consists of four states namely
highs, lows, mixed states and rapid cycling. However there are three types of bipolar disorders which are bipolar I, bipolar II and cyclothymic disorder.
Bipolar I Disorder is diagnosed when one experiences at least one manic or high episode that has affected the normal social and occupational functioning of a person. The manic episodes according to the Diagnostic Statistical Manual 5 (DSM V), must at least last for a week. The person diagnosed may or may not have a history of depression or psychotic symptoms.
Bipolar II Disorder is diagnosed when at least there is one major depressive episode lasting for at least 2 weeks and at least one hypomanic or low episode lasting for at least 4 consecutive days, according to the DSM 5.
The severity of the symptoms during energised stages of bipolar are often the markers of distinguishing the difference between bipolar I and bipolar II disorders. I have heard people say bipolar II is a milder form of bipolar I or the classic bipolar disorder. This assumption is a misconception and is incorrect. The depressive symptoms in bipolar II disorder can be as severe as the manic symptoms in bipolar I disorder.
Cyclothymic Disorder is diagnosed when there are mild hypomanic symptoms alternating with mild depressed moods for at least 2 years with no more than 2 months symptom free. The depressive episodes must not meet the criteria for major depressive episode and the energised symptoms must not meet the hypomanic or manic episode criteria. The mood symptoms in cyclothymic disorder are chronic hence similar to persistent depressive disorder (dysthemia) except that there is occurrence of hypomanic symptoms. If these mood symptoms become severe it is possible that they will meet the bipolar II criteria. (Sue, Sue, Sue, Sue 2016).
Hypomania (Depressive lows) is a mild form of mania expressing increased levels of activity and goal oriented behaviour combined with elevated , expansive or irritable mood. Expansive mood is when a person feels extremely confident, self-important and acts impulsively. Elevated mood is when one has exaggerated confidence, energy and sense of well being. People with bipolar symptoms are distractible, easily irritated. They may be talkative, and may talk about different scattered topics. All the above characteristics will be out of the individual’s normal behaviour.
Mania (Manic highs)is a state when one experiences exaggerated activity and emotion which range from extreme excitement (euphoria), irritability, or hostility. The manic episode is marked with dysfunction in social and occupational areas of the individual’s life that may display psychosis. Psychosis is the condition which shows distorted view or loss of reality.
As in depression hypomania and mania involve emotional, psychological , behavioural and cognitive symptoms. I will explain more on the various symptoms in an upcoming topic BIPOLAR AND RELATED DISORDERS.
Mixed States is associated with comorbid symptoms of bipolar where full symptomatic images of mania and hypomania are seen either intermixed or alternating within a few days or when depressive episodes occur predominating over manic episodes. Mixed features involve three or more symptoms of hypomania/mania or depression occurring during an episode from the opposite poles. This can be either be experienced in bipolar I or bipolar II. I will also talk more on comorbidity in the topic BIPOLAR AND RELATED DISORDERS.
Rapid Cycling is when a person with bipolar has four episodes per year in any combination of mania , hypomania, mixed and depressive episodes. A switch to opposite poles or to a remission of at least two months may occur. This pattern is common in those who develop bipolar symptoms in their early stages in life. Other comorbid conditions such as anxiety , substance use disorders, attention deficit /hyperactivity may be experienced. More on this will be discussed in BIPOLAR AND RELATED DISORDERS. Rapid cycling is triggered by factors such as sleep deprivation and taking of antidepressants.
I hope this will clarify a bit on what bipolar disorders are in a nutshell. I will be posting more articles on bipolar and any related topics this week as we celebrate Mental Health Awareness week and also looking forward to celebrating Bipolar Awareness Day which will be our launching day for our Bipolar Zebra Campaign by the ASAC Trust Team.
Bipolar Awareness Days:
30th March World Bipolar Day
26th May Bipolar Awareness Day
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