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Bipolar Disorder

Introduction


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Bipolar disorder, also known as manic-depressive disorder, affects more than 2 million American adults. This condition was once thought to occur only rarely in children. However, it is now clear that this is not the case. According to the American Academy of Child and Adolescent Psychiatry, up to 1.1 million children and adolescents in the United States may have bipolar disorder.

20% of all bipolar disorder patients have their first episode during adolescence and 16% of youth in child psychiatry clinics probably have bipolar disorder. The peak age of onset is between 15 and 19 years of age.

Bipolar disorder is grossly under diagnosed. Only 1/3 of adult patients with bipolar disorder ever receive a formal diagnosis. Only 1/3 of those diagnosed receive treatment, and only a fraction of those receiving treatment are receiving optimal treatment.

In children, the diagnosis is even harder to make. Bipolar disorder is more difficult to recognize in children for a number of reasons. First, the symptomatic criteria in children are not well established. Also, the symptoms can resemble or co-occur along with other common childhood mental disorders. In addition, symptoms of bipolar disorder may easily be confused with the normal labile emotions and behaviors found commonly in children and adolescents.

19% of ADHD children also have bipolar disorder.

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Subtypes

Psychiatrists have divided bipolar disorder into a number of subtypes. This division is helpful for diagnosing and treating the disorder.

Bipolar 1:

This is the classic manic-depressive disorder. Patients with this subtype have full-blown episodes of both mania and depression.

Bipolar II:

In bipolar 2 disorder, patients still have depression, but the symptoms of mania are not as severe. These patients have what is called hypomania. The symptoms are similar to mania, but without the delusions and hallucinations that may accompany full mania. In adolescence, hypomania appears as a markedly elevated or irritable mood accompanied by increased physical and mental energy.

Cyclothymia:

This disorder is characterized by definite mood swings, but without full mania or depression.

Bipolar Disorder NOS (Not Otherwise Specified):

This is a catch all diagnosis given when it is not clear which type of bipolar disorder is emerging.


Mixed States Bipolar Disorder:

There is something called mixed states bipolar disorder that is important to understand. This comes in two types, mixed bipolar disorder and rapid cycling bipolar disorder.

Mixed bipolar disorder is characterized by simultaneous manic and depressive symptoms.

In rapid cycling bipolar disorder the patient experiences frequent switches from depression to mania/ hypomania and back.


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These mixed states are found in bipolar 1, bipolar 2, and cyclothymic disorders. Children and adolescents often have mixed bipolar disorder. These mixed states are often associated with thyroid abnormalities. They do not respond well to lithium, the standard treatment for bipolar disorders.

Symptoms

Bipolar disorder is characterized by an alternating pattern of emotional highs (mania) and lows (depression). The intensity of the signs and symptoms varies. Bipolar disorder can range from a mild condition to a severe condition. Normal people regularly have mood swings, but in bipolar disorder, these changes interfere with daily function.

The symptoms of bipolar disorder depend upon which stage of the disorder the person is experiencing.

Manic symptoms include:

  • Increased energy, activity and restlessness
  • An excessively euphoric mood
  • Severe changes in mood - either extremely irritable or overly silly and elated
  • Overly-inflated self-esteem; grandiosity
  • Increased energy
  • Decreased need for sleep
  • Rapid speech and increased talking
  • Distractibility
  • Poor judgment
  • Increased goal-directed activity or physical agitation
  • Increase in risky behavior

Depressive symptoms include:

  • Persistent sad or irritable mood
  • Loss of interest in activities once enjoyed
  • Significant change in appetite or body weight
  • Difficulty sleeping or oversleeping
  • Physical agitation or slowing
  • Loss of energy
  • Feelings of worthlessness or inappropriate guilt
  • Difficulty concentrating
  • Recurrent thoughts of death or suicide
  • Agitation and irritability

Between the episodes, the person has periods of relative or complete wellness.

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