Originally BD was called Manic Depressive Illness since it was characterized by episodes of mania and depression, often presenting as discrete episodes of illness with mostly normal intervals in between. The present APA manual of diagnosis defines BD as a mental disorder in which an individual suffers from at least one episode of mania or what is called a mixed episode (mania and depression together) and also usually has had separate episodes of depression, as well. Depression has been defined in a previous blog, so here we will concentrate on the definition of mania and its less serious counterpart known as hypomania.
A manic episode lasts at least a week and is essentially a disturbance during which a person has an unusually elevated, expansive, and/or irritable mood which is not usual for that person. In addition, the person might have at least three or four of the following:
- Too rapid speech
- Less of a need for sleep
- Inflated ideas about himself, called “grandiosity”
- The tendency to be more talkative than usual in a pressured manner and with rapidity
- A feeling of racing thoughts
- Difficulty being followed by others
- Excessive energy
- Distractibility
- Physical agitation
- Involvement in potentially destructive activities like sexual promiscuity or spending too much
- An apparent increase in goal-directed activities at work, socially, sexually, or at home (excessive cleaning that keeps s/he up all night)
- Psychosis, with hallucinations and delusions which are an extension of the mood disturbance like expansively thinking s/he is a world renowned figure from history, a famous athlete, a genius, a great inventor, etc.
Manic episodes can cause marked trouble for the person and can often result in breakdown in work, family, and social functioning. Hospitalization is sometimes necessary.
A hypomanic episode is very similar to a manic episode except it never involves hallucinations and delusions. It must only last four days and not a week to be diagnosed, and it does not cause as great a disturbance in functioning, although others usually notice a difference in behavior.
BD is usually characterized as Bipolar 1, 2, and Cylcothymia. Bipolar 1 Disorder involves at least an episode of mania and often periods of depression, as well. The episodes tend to be distinct but sometimes include mixed episodes of mania and depression. Bipolar 2 disorder is a form of BD with periods of depression and at least one episode of hypomania. Cyclothymia is a mood disorder with periods of abnormal moods that are a bit less than hypomania and have less serious depression, as well. In addition to bipolar types 1 and 2, mixed episodes, and Cyclothymia, many clinicians see varied forms of disordered moods that do not fall into neat categories. These are called “Atypical” bipolar disorders or soft bipolar disorder. In addition, we sometimes see hypomanic or manic episodes which might have been caused by an antidepressant, but this is quite rare. Some researchers say that it is simply a depressed person previously unknown to be bipolar that coincidentally develops the next stage (mania or hypomania) while s/he was being treated with an antidepressant drug.
DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.