Nicola Jones

Bipolar Disorder

Behavioral & Mental Health
Diseases & Conditions
Contributed byKrish Tangella MD, MBAApr 01, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Affective Bipolar Psychosis
  • Bipolar Disease
  • Manic Depressive Illness 

What is Bipolar Disorder? (Definition/Background Information)

  • Bipolar Disorder can be generally defined as a chronic disorder of mood; it is a disorder affecting one’s internal emotional state
  • Bipolar Disorder is characterized by periods of elevated mood (mania or hypomania), diminished mood (depression), or an individual can oscillate between each of these states (mixed episode)
  • Physicians and mental health professionals often categorize the disorder into different subtypes based on the severity of the symptoms
    • Bipolar Disorder type I is the most severe type and Bipolar Disorder type II has milder symptoms
    • There is no need to have periods of depressive mood for a diagnosis of Bipolar Disorder type I. The only prerequisite for diagnosis is the occurrence of a single true manic episode
    • Diagnosis of Bipolar Disorder type II is generally made following a history of major depressive episodes and hypomanic episodes; these are times of increased energy and activity that are generally not as severe to qualify, for a full-blown maniac episode
  • Manic episodes last 7 days (1-week) to meet diagnostic criteria and consist of behaviors that cause severe impairment in day-to-day functioning. Hypomanic episodes last 4 days to meet diagnostic criteria and results in less impairment. Depressive episodes last at least 2 weeks, in order to meet diagnostic criteria
  • Bipolar Disorder is typically life-long and manifests during the late teens or early twenties, in a majority of the patients. Having a first-degree relative with Bipolar Disorder is one of the biggest risk factors
  • The signs and symptoms of Bipolar Disorder include symptoms of mania (such as  easy distractibility, decreased need of sleep, increased sexual desire, rapid speech, and increase activity at work etc.), alternating with symptoms of depression (such as diminished mood, sleep problems, excessive guilt, and decrease interest in activities). Though, the most serious complication of Bipolar Disorder is self-injury or suicide
  • The diagnosis of Bipolar Disorder requires a thorough physical examination along with complete evaluation of medical history of both the patients and their family and friends
  • Treatment options for Bipolar Disorder are medications (mood stabilizers and antipsychotics) and psychotherapy 

Who gets Bipolar Disorder? (Age and Sex Distribution)

  • Bipolar Disorder is typically life-long and presents by the late teens or early twenties in a majority of the individuals
  • Both sexes are equally affected with Bipolar Disorder 

What are the Risk Factors for Bipolar Disorder? (Predisposing Factors)

Family history of Bipolar Disorder is one of the biggest risk factor, with a 19% increased risk for individuals with a first-degree relative with this disorder. When both parents are affected, the individuals have a 75% increased risk of the condition.

Other risk factors may include:

  • Stress (work, family, or other)
  • Physical illness
  • The use of certain medications (such as antidepressants)
  • Alcohol or drug abuse
  • Childbirth

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Bipolar Disorder? (Etiology)

  • Presently, there are no specific or established causes for Bipolar Disorder
  • Since, family history is a known risk factor, it is likely that certain inherited genetic factors are involved
  • Non-genetic risk factors, such as stress, illnesses, drug abuse, alcoholism, etc. also probably contribute to the onset of Bipolar Disorder 

What are the Signs and Symptoms of Bipolar Disorder?

The signs and symptoms of Bipolar Disorder are divided into manic symptoms and depressive symptoms. These include:

  • Signs and symptoms of mania include:
    • Easy distractibility
    • Insomnia (less need for sleep)
    • Inflated self-esteem
    • Racing thoughts
    • Rapid speech
    • Increased activity at work, increased social pursuits
    • Increased risk-taking
    • Excessive spending
    • Increased sexual activity
    • And sometimes, psychotic features that include delusions and hallucinations
  • Signs and symptoms of depression include:
    • Diminished mood
    • Loss of interest in pleasurable activities
    • Change in appetite
    • Excessive guilt
    • Changes in sleep pattern
    • Difficulty concentrating
    • Restlessness, fatigue
    • Suicidal ideation
  • In general, those with Bipolar Disorder may describe a history of intense mood swings
  • Occasionally though, individuals will never experience a depressive phase, but may only experience manic phases in between times of normalcy
  • Changes in sleep patterns with a decreased need for sleep and racing thoughts are common indicators of Bipolar Disorder 

How is Bipolar Disorder Diagnosed?

  • A diagnosis of Bipolar Disorder is established by a careful physical examination with study of clinical history
  • Both, the patient and their friends/family members may be interviewed, to help establish an accurate diagnosis
  • There are currently no blood tests or imaging tests that can be used to diagnose the disorder. However, a careful physical examination and certain blood tests may be ordered, in order to help rule-out other disorders

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Bipolar Disorder?

The following complications have been observed in individuals with Bipolar Disorder:

  • The most serious complication is self-injury and suicide. It has been observed that about 10-15% of individuals diagnosed with Bipolar Disorders, die from suicides
  • Alcohol and drug abuse is typically common among those with this disorder
  • Risky behavior may lead to violation of prevailing local laws, imprisonment, and/or even contracting communicable diseases, such as HIV 

How is Bipolar Disorder Treated?

There is no cure for Bipolar Disorder, but there are several medications available that when used properly, will help control the symptoms and decrease the frequency of manic or depressive episodes.

  • Mood stabilizers and antipsychotic medications, such as lithium, valproate, carbamazepine, lamotrigine, haloperidol, olanzapine, and quetiapine. These medications are often used in combinations with one another; like for example, lithium with olanzapine
  • Psychotherapy is another effective way of treating Bipolar Disorder. Various types of psychotherapies include cognitive behavioral therapy, psychoreduction, family therapy, group therapy, etc.
  • Lifestyle changes may be needed, such as a strict sleep schedule and a regular routine, in order to reduce stress
  • Manic episodes are a medical emergency; patients are often hospitalized to ensure a safe environment
  • Electroconvulsive therapy may be provided for individuals who do not respond to medications and other conventional measures 

How can Bipolar Disorder be Prevented?

  • Currently there is no way to prevent an individual from developing Bipolar Disorder
  • Developing a thorough management plan in consultation with your physician and taking the medications regularly, can reduce the frequency of episodes and the severity of symptoms 

What is the Prognosis of Bipolar Disorder? (Outcomes/Resolutions)

  • Bipolar Disorder is considered as a lifelong, chronic disorder; 9 out of 10 individuals, who have one manic episode, will have more over time
  • However, 9 out of 10 such individuals, who experience a manic or depressive episode, will recover completely within about 6 months
  • It has also been observed that statistically, up to 15% of untreated individuals will attempt suicide; whereas, up to 10% of treated individuals attempt suicide
  • There is an increased risk of death due to cardiovascular disease, possibly secondary to increased prevalence of obesity and metabolic syndrome among those with Bipolar Disorder
  • Those with early-onset psychotic features tend to have a poorer prognosis. While individuals with stable sleep/wake patterns and responding well to medications, have a good prognosis 

Additional and Relevant Useful Information for Bipolar Disorder:

  • Manic episode is a period of mood disturbance, during which an individual experiences persistently elevated, expansive, and/or irritable mood, for at least 1 week or longer duration

The following article link will help you understand manic episode:

Friends and family members, who are close to the affected individuals, can come under a considerable amount of stress dealing with their loved one’s illness. This extra stress may have negative consequences on the recovery of individuals with Bipolar Disorder. Caregivers should be mindful of this and may need to find a suitable counselor or local support group.

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