What is the course of Bipolar Disorder?


























What is Bipolar disorder?

Bipolar disorder, also known as manic-depression, is characterized by alternating periods of extreme moods. A person with Bipolar disorder experiences cycling of moods that usually swing from being overly elated or irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal mood in between.

Different from normal mood states of happiness and sadness, symptoms of manic-depressive illness can be severe and life threatening. However, because many artists, musicians and writers have suffered from bipolar illness, the effect of the illness has sometimes been trivialised, and regarded in some way as beneficial for artistic creativity. In fact, for those afflicted with the illness, it is extremely distressing and disruptive.

The frequency of the swings between these two states, and the duration of the mood, varies from person to person. It is often not recognized at first as a serious disorder, and people who have it may suffer needlessly for years or even decades. This disorder is not a character flaw, and it is not your fault. It is a serious mood disorder that affects a person's ability to function in every day activities. It affects one's work, one's family, and one's social life.With the proper treatment, Bipolar disorder can be effectively managed and a person can lead a normal life.

A person's family history and genetics often play an important role in the greater likelihood of someone having this disorder in their lifetime. Increased stress and inadequate coping mechanisms to deal with that stress may also contribute to the disorder's manifestation. Bipolar disorder is most often experienced as a swing between a manic and a depressed mood, which may often be related to increased stress or other event in a person's normal life. Nearly anything can trigger a person to shift in mood, and sometimes there is no obvious trigger at all. Often, the first manic episode is triggered because of some external stressor the person has experienced. However, the hallmark of Bipolar disorder is that the person's extreme moods often seem to come on of their own accord. Once the person's mood begins to cycle, there is often not an external reason the person can find for feeling the way that he/she does.

Bipolar disorder is the third most common mood disorder after major depression and dysthymic disorder. It affects about 1% of adults during their lifetime. Symptoms typically begin during adolescence or early adulthood, and continue to recur throughout life. Men and women are equally likely to develop this disabling illness. The consequences of the illness can be devastating, and may include marital break-ups, unemployment, alcohol and drug abuse. Bipolar illness is often complicated by co-occurring alcohol or substance abuse. Without effective treatment, bipolar illness leads to suicide in nearly 30% of cases.

What are the symptoms of Bipolar disorder?

Bipolar disorder involves cycles of mania and depression. These two mood states can be thought of as opposite ends of a range. At one end is severe depression; then moderate depression; mild and brief mood disturbances (that many people call 'the blues'); normal mood; hypomania (a mild form of mania); and at the other extreme is mania.

Some people with untreated bipolar disorder have repeated depressive episodes and only an occasional episode of hypomania (bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently.
Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease (destruction of personal relationships, loss of employment, and suicide).

Signs and symptoms of mania include periods of:

Excessively 'high' or euphoric feelings
Increased energy, activity, restlessness, racing thoughts, and increased talkativeness
Overly-inflated self-esteem
Extreme irritability and distractibility
Reduced need for sleep
Unrealistic beliefs in one's abilities and powers
Uncharacteristically poor judgement
A sustained period of behaviour that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behaviour
Denial that anything is wrong

Signs and symptoms of depression include periods of:

Persistent sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of inappropriate guilt, worthlessness, or helplessness
Loss of interest or pleasure in ordinary activities, including sex
Loss of energy, a feeling of fatigue or of being 'slowed down'
Difficulty thinking or concentrating, remembering, making decisions
Restlessness or irritability
Difficulties sleeping, or oversleeping
Loss of appetite and weight, or weight gain

Repeated thoughts of death or suicide; suicide attempts

An early sign of manic-depressive illness may be hypomania, in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behaviour. Hypomania may feel good to the person who experiences it, so even when family and friends learn to recognise the mood swings, the individual often will deny that anything is wrong. In its early stages, bipolar disorder may appear to be a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance. If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.
Severe depression or mania may be accompanied by periods of psychosis.

Psychotic symptoms include: hallucinations (hearing, seeing, or otherwise sensing things which do not exist) and delusions (false beliefs that illogical, held despite evidence to the contrary).

Symptoms of mania and depression may be present at the same time ( mixed state). The symptoms often include agitation, trouble sleeping, a significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.

Symptoms (mania, depression, or mixed state) are usually limited to distinct episodes of illness. These episodes are separated by periods during which the person suffers few to no symptoms. Some episodes can be as long as 1 year whereas others may be as short as several hours, depending on the patient. With time, episodes become more frequent. When four or more episodes of illness occur within a 12-month period, the person is said to have manic-depressive illness with rapid cycling. In most patients, the number of episodes experienced in a lifetime is approximately 8-10, but many patients experience more. In rapid-cycling bipolar disorder, 4 or more episodes can occur in each year-long period.