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ipolar
disorder is a mental health disorder that can cause dramatic changes in mood
and energy levels. Symptoms can affect daily life severely. Spotting the signs
of bipolar disorder can help a person to get treatment.
The person's mood can range from feelings of elation and
high energy to depression.
There can also be disruption in sleep and thinking patterns and other
behavioral symptoms.
The extremes of mood are known as manic
episodes and depressive episodes.
Hypomania has symptoms of a manic episode that
are less severe.
According to the National Alliance on Mental
Illness (NAMI), people receive a diagnosis on average at the age of 25 years, but symptoms can appear during
the teenage years, and less commonly, during childhood.
Signs and symptoms
Symptoms of mania include euphoria.
Bipolar disorder is
a condition with mood swings that can range from euphoria to depression.
However, for a diagnosis of bipolar I
disorder, a person only needs to have a manic episode.
In fact, a person with bipolar I disorder may
never experience a major depressive disorder, despite the name bipolar.
Signs of mania
When someone has mania, they do not just feel
very happy. They feel euphoric.
A person with mania may:
·
have a lot of energy
·
feel able to do and achieve anything
·
have difficulty sleeping
·
use rapid speech that jumps between topics and ideas
·
feel agitated, jumpy, or "wired"
·
engage in risky behaviors, such as reckless sex, spending a lot
of money, dangerous driving, or unwise consumption of alcohol and other
substances
·
believe that they are more important than others or have
important connections
·
show anger or aggression if others challenge their views or
behavior
Severe mania can involve psychosis, with hallucinations or delusions.
Hallucinations can cause a person to see, hear, or feel things that are not
there.
People may have delusions and distorted
thinking that cause them to believe that certain things are true when they are
not.
They may believe, for example, that they have
important friends (such as the president of the United States) or that they
descend from royalty.
A person in a manic state may not realize that
their behavior is unusual, but others may notice a change in behavior. Some may
see the person's outlook as sociable and fun-loving, while others may find it
unusual or bizarre.
The individual may not realize that they are
acting inappropriately or be aware of the potential consequences of their
behavior.
They may need help in getting help and staying
safe.
Hypomania
Not everyone will have a severe manic episode.
Less severe mania is known as hypomania. Symptoms are similar to those of
mania, but the behaviors are less extreme, and people can often function well
in their daily life.
If a person does not address the signs of
hypomania, it can progress into a more severe form of the condition at a later
time.
Depression
During a low phase, a person may feel
depressed and unable to do anything.
Signs of a depressive episode are the same as
the symptoms of a major depressive episode.
They may include:
·
feeling down or sad
·
having very little energy
·
having trouble sleeping or sleeping a lot more than usual
·
thinking of death or suicide
·
forgetting things
·
feeling tired
·
losing enjoyment in daily activities
·
having a "flatness" of emotion that may show in the
person's facial expression
In severe cases, a person may experience
psychosis or a catatonic depression, in which they are unable to move, talk, or
take any action.
Although rare, bipolar disorder could occur in
young children and teenagers.
In children
Bipolar disorder is a lifelong condition. It
can be present in young children, although it often does not emerge later,
often in the late teens or early adulthood.
This may happen when a trigger causes clear
signs of mania or depression, but often there is no clear trigger.
It can be hard to detect bipolar disorder in
toddlers or young children, as children of this age often display uncontrolled
behavior until they learn new ways of behaving. This has led to controversy
over the diagnosis of bipolar disorder in young children.
Children with bipolar disorder may have severe
temper tantrums that can last for hours, possibly with signs of aggression.
These may not improve with age, as bipolar disorder makes it harder than others
to learn alternative behaviors.
Parents may also notice periods of extreme
happiness and silly moods in their child.
At this age, the signs of bipolar disorder may
resemble those of another condition, such as attention deficit hyperactivity
disorder (ADHD).
Teens
Teenagers may show some of the more common
signs of bipolar disorder, especially an increase in risky behaviors, such as:
·
reckless sexual activity, drug or alcohol use
·
poor performance in school
·
fighting
·
thinking more about death or suicide
It is important that any young person showing
these symptoms sees a mental health professional.
Learn more here about
how bipolar disorder can affect teens.
Causes
Doctors do not know exactly what causes
bipolar disorder, but the following appear to play a role:
Genetic factors: A person with bipolar disorder may have a parent with
the condition. However, having a parent or even a twin with bipolar disorder
does not mean a person will have it.
Stress: Someone who has a genetic predisposition may experience
their first episode of depression or mania during or after a time of severe stress, for
example, the loss of a job or a loved one.
Should I see a doctor?
It is always a good idea to speak with a
doctor when there is concern about severe mood swings that seem to come and go
or make it difficult to work.
The best person to start with may be a primary
care physician or family doctor. However, they will likely refer someone with
these symptoms to a psychiatrist, or a specialist who cares for people with
mental health disorders.
Someone who notices these symptoms in a friend
or loved one can also speak with their doctor about their concerns. The doctor
can help find local support groups or other mental health resources.
Suicide risk
Risk-taking and thinking about suicide can
pose real dangers for a person with bipolar disorder.
Whenever there is a possibility of harm or
suicide, it is important to address the concern quickly and directly.
If there is an imminent risk, someone should
contact the local police or suicide crisis hotline immediately.
Suicide prevention
·
If you know someone at immediate risk of self-harm, suicide, or
hurting another person:
·
Call 911 or the local emergency number.
·
Stay with the person until professional help arrives.
·
Remove any weapons, medications, or other potentially harmful
objects.
·
Listen to the person without judgment.
·
If you or someone you know is having thoughts of suicide, a
prevention hotline can help. The National Suicide Prevention Lifeline is
available 24 hours a day at 1-800-273-8255.
Related conditions
Bipolar disorder has a number of
comorbidities, or conditions that often occur alongside it.
Other mental health conditions that people
might experience include:
·
anxiety
·
posttraumatic stress disorder (PTSD)
·
ADHD
·
misuse of alcohol and other substances
These can complicate the diagnosis.
It can take time to receive a correct
diagnosis of bipolar disorder, as a doctor may identify one of these
conditions, or a personality disorder, instead.
If the person experiences psychosis, this can
sometimes lead to a misdiagnosis of schizophrenia, a
mental health disorder marked by persistent hallucinations and delusions.
Treating these conditions may make it more
difficult to diagnose or treat bipolar disorder. It can also take time to find
a suitable medication and the correct dose for the individual.
However, once a person receives a correct
diagnosis and appropriate treatment, medication can help to control the
symptoms of bipolar disorder, and these related conditions usually improve as
well.
Types of bipolar
disorder
The Diagnostic and Statistical
Manual of Mental Disorders Fifth Edition (DSM-5) describes four types of bipolar disorder.
1. Bipolar I
disorder
This involves periods of mania that last at
least 7 days, or any duration if the person is hospitalized.
If a person experiences severe manic or
depressive episodes, they may need emergency treatment in the hospital to
prevent harm to themselves or to others, for example through reckless behavior.
2. Bipolar II
disorder
A person with bipolar II disorder has episodes
of depression and hypomania. Hypomania is less extreme than a full manic
episode.
People with bipolar II disorder tend to not
have full mania.
Learn more here about
the differences between type I and II bipolar disorder.
3. Cyclothymic
disorder
Someone with cyclothymic disorder will also
have alternating periods of hypomania and depression lasting for at least 2
years.
The main difference between cyclothymic
disorder and bipolar II is that the symptoms of a person with cyclothymia tend
to be less severe and do not meet the criteria for hypomania and depression.
4. Other specified
and unspecified bipolar disorders
A person may have bipolar disorder that does
not fit within the above patterns. They may receive a diagnosis of either
"other specified bipolar disorder" or "unspecified bipolar
disorder," depending on their symptoms.
Diagnosis
A doctor will talk to the person about their
symptoms and use the DSM-5 criteria to make a diagnosis.
In order to diagnose bipolar disorder, a
healthcare provider should begin with a complete medical interview and a
physical exam to rule out a physical cause for the person's behaviors.
There is currently no blood test or imaging
that can diagnose the condition, but a doctor may suggest tests to rule out
other medical conditions that might have similar symptoms.
If no medical conditions or medicines are
causing the symptoms, the healthcare provider will consider bipolar disorder.
They may refer the person to a mental health specialist.
The best person to diagnose bipolar disorder
is a psychiatrist or psychiatric nurse practitioner who specializes in the care
of people with mental health disorders.
Treatment
Prescribers usually treat bipolar disorder
with a combination of medications and talk therapy, or psychotherapy.
Because bipolar disorder is a lifelong
disease, treatment should also be lifelong.
Medications
Medications for treating bipolar disorder include:
·
mood stabilizers, such as lithium and some antiseizure medicines
·
antipsychotics, to help manage mania and psychotic symptoms
·
antidepressants may be used in some
cases, depending on the person's symptoms and other considerations
It can take time to find a suitable medication
and dose for the individual.
Some people discontinue their medication
because it has adverse effects. If adverse effects occur, it is essential to
speak to the prescriber, who may be able to change the dose or treatment. Discontinuation
of medications for bipolar disorder can result in a return of symptoms.
Some people discontinue the medication because
they miss the "highs" that bipolar disorder brings. They may feel
they are no longer "themselves." People with this condition may be
highly creative during a manic or hypomanic phase, and they may miss this
aspect of their personality.
People with bipolar disorder are more
likely to approach a doctor with depression than with mania.
Some treatments for depression can trigger an
initial manic phase in a person who has the condition. This first experience of
mania may be the first sign that a person has bipolar disorder.
Talking therapy
Counseling or cognitive behavioral
therapy (CBT) can help a person with bipolar disorder, as it
can make them more aware of the negative aspects of their behavior and of
triggers that could sabotage their treatment, such as substance use.
Learning tips for getting enough sleep,
dealing with stress, and establishing a steady work-life balance may all help
to control mood changes.
Electroconvulsive
therapy
If medication and talk therapy are not
effective in managing the symptoms of bipolar disorder, a psychiatrist may
consider electroconvulsive therapy (ECT).
In ECT, a doctor applies a controlled electric
shock to certain areas of the brain in order to cause a seizure. Doctors do not
know exactly how it works, but there is evidence that ECT can help to regulate
mood and other symptoms.
A doctor will only recommend it if symptoms are
severe, if medication and counseling do not work, or if the person is unable to
take or tolerate medication.
Living with bipolar
disorder
Bipolar disorder is a lifelong disorder that
can have a severe impact on the individual and their family and friends.
Getting help early and actively participating
in treatment are the keys to successfully managing this condition.
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