What is Bipolar Disorder?

A mysterious long exposure shot of a dancer

bipolar disorder (also known as manic depression) is an affective disorder that affects approximately 1.5% of the population. With this disorder, a person has periodic mood swings in which they cycle from depression to mania.

Depression may be characterized by having a lack of motivation, difficulty doing tasks, short attention span, decreased appetite, crying spells, difficulty in getting to sleep or sleeping too much, and in the more severe cases thoughts of self harm.

Mania is separated into two types: Full mania and hypomania. Mania may be characterized by a decreased need for sleep, decreased self-control, overspending, increased sexual activity, irritability, rage, risk-taking behaviors, and in the more severe cases psychotic states. Hypomania is described as having the same behaviors, to a less extreme level.

A person can experience symptoms of both states (mania/hypomania and depression) at the same time, in what is known as a mixed state.

There are three types of bipolar that are generally recognized: Bipolar I, Bipolar II, and Bipolar III. Bipolar I means that a person has experienced at least 1 full manic episode and has depressed states. Bipolar II is defined as a person having had only hypomanic episodes and depressed states. Bipolar III indicates that a person has not had any manic episodes, only depressed states, but has a strong family history of bipolar illness.

Many times people with bipolar disorder are not first diagnosed with bipolar, as they do not seek care during a manic/hypomanic state. They generally seek care during a depressed state, and receive a diagnosis of depression. It is later that they will receive a diagnosis of bipolar when their doctor observes a manic/hypomanic state, or when an antidepressant causes a manic/hypomanic state. This occurs due to the fact that many antidepressants can cause these states in the bipolar individual.

There is no test for bipolar disorder. It is a diagnosis made either from the observation of the client, or from a verbal history by the client and/or significant others in their lives. There is no cure for bipolar disorder. However, it can be controlled, and most individuals take medication on a life-long basis for this disorder. Therapy is often used with bipolar patients in order to assist them in adjusting to life without moodswings.

medications for this disorder include lithium, a naturally occuring salt, anti-epileptic medications such as tegretol, depakote, neurontin, and topamax, and anti-psychotic medications such as zyprexa, and the more recently FDA approved zyprasidone (geodon). Other medications may be used for related symptoms.

A related disorder is schizo-affective disorder, in which the client has symptoms of both schizophrenia and bipolar. In this case, they are generally treated with antipsychotic medications as well as medications for the bipolar disorder.

Bipolar and Genetics

It has been found that children of bipolar parents have a higher risk of having bipolar, and twins have a high concordance rate. Areas that have been identified as possibly contributing to bipolar are chromosomes 4, 12, 18, 21 22 and X. The reason that it is passed genetically is that a child receives a chromosome from a parent that is defective. A child of a bipolar parent may also receive a chromosome that is not defective, thus not having bipolar.

If a child does not have bipolar parents, then they may have a mutation in their chromosomes that causes them to have the illness.

Another factor is called penetrance. This means essentially how strongly the gene is expressed. A person with high penetrance has a high probability of developing bipolar when a stressor of sufficient strength is experienced. A person with low penetrance is exposed to that same stressor, they would not develop bipolar. It would require a stressor that was much greater.

Derek Wood is a Nationally Board Certified Psychiatric/Mental Health Nurse, and holds a Master's degree in Psychology. His experience in the online arena of mental health can be traced back to 1997, when he was a host for Online Psych on AOL. He joined Get Mental Help, Inc. as Clinical Content Director for Mental Health Matters. Derek, with his wife Lisa, developed the original version of psychTracker (then called A Mood Journal), after his diagnosis with Schizo-Affective Bipolar, when they could not find a system available that was robust enough to help him effectively manage his symptoms and accurately interpret his charting. Derek has worked in the field of mental health since 2001, as a Unit Manager of an adult long-term treatment facility, a charge nurse in an adolescent short-term inpatient facility and long-term residential facility, and as a School Psychologist. He has also written several articles which are being used as CEU for nurses and educators.

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