Bipolar disorder can cause dramatic mood swings, from overly high or irritable (manic) to sad or hopeless (depressed). Hypomania is a milder episode of mania. The swings may not follow a set pattern and depression does not always follow mania. Traditionally, the disorder is thought to have discreet "episodes." However, one may have repeated episodes of one mood before experiencing the other. Complicating matters, there may be rapid switching within minutes or hours from one mood to the next. Also, the severity of the illness may differ from person to person or even within the same person at different times. Newer evidence indicates that the classic form may actually represent a minority of cases. Data seems to suggest that mixed episodes, rapid cycling, or ultradian cycling may account for more cases than previously thought.
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Mania may appear as:
- Excessively high, elevated mood
- Sudden or extreme irritability or rage
- Decreased need for sleep (i.e., may feel rested after only 3 hours of sleep)
- Flight of ideas/rapid speech/racing thoughts—ideas that abruptly change from topic to topic, often expressed loudly and rapidly and difficult to interrupt.
- Hyperactivity—scheduling more events in a day than can be accomplished
- Excessively risky behavior—reckless driving, outlandish spending sprees, foolish business investments, or out-of-character sexual behavior
- Grandiose delusions—individuals imagine they may have special powers or special connections to God, celebrities, or political leaders. May progress to frank psychotic symptoms such as hallucinations.
A manic episode is diagnosed if an elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day for 1 week or longer or if hospitalization is required. If the mood is predominantly irritable, it must be accompanied by 4 other symptoms.
Hypomania differs from mania in that the episodes may last for as short a period as 4 days, although they remain distinctively different from the nondepressed mood. While the symptoms may be observable to others, they are not severe enough to cause marked disturbance in functioning or require hospitalization. Additionally, there are no psychotic features present.
Depression may include:
- Lasting depression or sadness
- Diminished interests or pleasure in all or almost all activities, including sex
- Concentration—impaired, and/or difficulty remembering things or making decisions
- Sleep—either too much or difficulty falling asleep, staying asleep, or waking earlier than desired
- Appetite changes—may be associated with weight loss or gain
- Feelings of worthlessness or excessive or inappropriate guilt
- Recurrent thoughts of death/suicide or suicide attempts
- Fatigue or loss of energy
- Abuse of alcohol or drugs
- Chronic pain symptoms
A major depressive episode is diagnosed if five or more of the above symptoms have been present during the same two-week period and represent a change from previous functioning. At least one of the symptoms present is either the depressed mood or markedly diminished interests.
Bipolar II is differentiated from bipolar I (or classic bipolar), described above, by involving milder episodes of mania, called hypomania, while still experiencing full-blown depressive episodes.
Mixed-state is a form of bipolar that is diagnosed when symptoms of mania and depression exist simultaneously (e.g., impulsivity, depression, and irritability).
Rapid-cycling refers to a form of bipolar that involves more than four episodes in a 12-month period. There could also be several episodes within a week or even within a single day. Rapid-cycling tends to be more common in women, and often develops later in the course of the illness.
Last reviewed on 9/20/2010
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