| If you're seriously interested in knowing about bipolar | | | | lucky enough to have only two or three episodes, |
| disorder, you need to think beyond the basics. This | | | | but the average patient has more than 10. Studies |
| informative article takes a closer look at things you | | | | have found that the depressive episodes in bipolar |
| need to know about what it is to be bipolar. | | | | disorder are shorter than the depressive episodes in |
| Bipolar illness has two distinct forms. Bipolar I disorder, | | | | unipolar illness. Unfortunately, however, some bipolar |
| previously called manic-depressive illness, characterizes | | | | patients have chronic depressions. Between 15% and |
| patients who experience episodes of mania and | | | | 20% of bipolar patients experience rapid cycling, |
| depression or mania only. Any single episode can be | | | | defined as four or more episodes of depression, |
| manic, depressive, or mixed. The Diagnostic and | | | | mania, or hypomania in a year. |
| Statistical Manual of Mental Disorders (DSM-IV) gives | | | | Psychological treatment cannot be accomplished |
| specific criteria for both mania and depression. A | | | | when a patient with bipolar illness is in a manic state. |
| diagnosis of mania does not require a set duration of | | | | The patient will be highly talkative, irritating, sexually |
| illness or impairment. For a diagnosis of depression, | | | | aroused, overconfident, expansive, and completely |
| however, the symptoms must last at least two | | | | lacking in insight and good judgment. Because of the |
| weeks. | | | | uplifted mood, the patient will feel no need for |
| A patient who has mainly depressions and a few | | | | treatment and will vehemently refuse assistance. This |
| hypomanic episodes (the same symptoms as for | | | | is particularly evident with respect to a spouse. If in |
| mania but without social impairment) would receive a | | | | your practice you see a spouse who suddenly |
| diagnosis of bipolar II, a form much more common in | | | | becomes extremely derogatory and accusatory |
| women. These illnesses typically start with a | | | | toward the partner, consider the possibility of mania. |
| depressive episode. | | | | A history of depressive episodes will help you make |
| Thirty percent of patients who have bipolar I illness | | | | the diagnosis. Treatment, usually on an inpatient basis, |
| first experience symptoms as teenagers. In the usual | | | | is imperative for a patient with mania. |
| course, episodes of illness are followed by periods of | | | | The best treatment for a manic episode is lithium, |
| wellness (euthymia), at first punctuated by years but | | | | the oldest mood stabilizer. Neuroleptics also are |
| later settling into a pattern that is often seasonal. | | | | extremely helpful for treating mania. How to treat |
| The depression can become very chronic and | | | | the depression, how-ever, is still open to question. |
| unremitting; suicide is the most serious potential | | | | Although most experts agree that it is best to try to |
| consequence. Despite new and successful | | | | avoid antidepressants, or to use them short term, |
| treatments, about 12% of manic-depressives commit | | | | this is difficult to do in practice. The monoamine |
| suicide, almost always during the depressive stage of | | | | oxidase inhibitor tranylcypromine has been shown to |
| the illness. | | | | be more efficacious than the tricyclic antidepressant |
| Research has shown that genetic factors play a | | | | imipramine. The other MAO drugs, phenelzine and |
| significant role in the etiology of bipolar disorder. | | | | isocarboxazid, also seem useful. Patients need to be |
| Biochemical, neurophysiologic, and sleep abnormalities | | | | on a special diet with these drugs. Clearly, patients do |
| also have been reported, but none seems specific to | | | | better in the treatment of their depressive episode if |
| bipolar disorder. It is not known how recurrent | | | | they also take a mood stabilizer. |
| unipolar depression, bipolar I disorder, and bipolar II | | | | In addition to treatment for the mania and |
| disorder are related. In addition, many studies identify | | | | depression, a mood stabilizer is indicated for |
| bipolar patients but do not specify whether the | | | | long-term maintenance. A recent 40-year longitudinal |
| patient is in the depressive, manic, or mixed state, | | | | study of bipolar illness found that mood stabilizers and |
| much less whether the patient is manic or hypomanic | | | | atypical antipsychotics (in this case, mostly clozapine) |
| when studied. | | | | proved to be the best combination to prevent |
| The information about bipolar disorder presented | | | | suicide. |
| here will do one of two things: either it will reinforce | | | | Now you can be a confident expert on bipolar |
| what you know about this disorder or it will teach | | | | disorder. OK, maybe not an expert. But you should |
| you something new. Both are good outcomes. | | | | have something to bring to the table next time you |
| Bipolar disorder is a recurring illness. A few people are | | | | join a discussion on this particular issue. |