Overview of Bipolar Disorder

Keeping Your Balance

Keeping Your Balance
Module 1
Overview of Bipolar Disorder

Overview of Bipolar Disorder2

Symptom Record Worksheet

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The Diagnosis of Bipolar Disorder

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What Causes Bipolar Disorder?

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Stress-Vulnerability Worksheet

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Module Summary

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Overview of Bipolar Disorder

OVERVIEW OF BIPOLAR DISORDER
Introduction
Bipolar Disorder or Manic Depression is a mood disorder, and is the name given to the experience ofabnormal moods or exaggerated mood swings. This illness is characterised by the experience of extremely“high” moods where one becomes extremely euphoric or elated, and the experience of extremely “low”
moods where one becomes extremely sad and finds it difficult to experience pleasure. The high moods arecalled manic episodes and the low moods are called depressive episodes. These episodes can range frommild to severe and affect how a person thinks, feels, and acts. However, it is important to remember thatsome people may experience different patterns associated with their disorder. For example, some people
may experience only one episode of mania but more frequent episodes of depression.
Bipolar Disorder occurs in approximately 1% of the population, that is, about 1 in every 100 will experience
an episode that will probably require hospital care. This illness affects men and women equally, andtypically begins in their early to late 20s.

Features of Bipolar Disorder
Manic Episodes
Mania is an extreme mood state of this disorder. It describes an abnormally elevated,euphoric, driven and/or irritable mood state. Hypomania is the term given to the more
moderate form of elevated mood. It can be managed often without the need for
hospitalisation as the person remains in contact with reality. However, it is very easy to move
rapidly from hypomania into a manic episode. Symptoms of mania include:
Irritability
Irritability as described in the Oxford dictionary means “quick to anger, touchy.” Many people, when in anelevated mood state, experience a rapid flow of ideas and thoughts. They often find that they are way
ahead of other people in their thinking processes, already onto another idea before people around them
have grasped the first concept. Because of this rapid thought process, they become easily angered whenpeople don’t seem to comprehend their ideas or enthusiasm for some new scheme.
Decreased need for sleep
One of the most common symptoms of mania and often an early warning sign is the increased experienceof energy and lack of need for sleep. This is often because the rapid flow of thoughts and ideas tends tokeep people awake, exploring new schemes and plans.
Rapid flow of ideas
People who are becoming manic experience an increase in the speed at which they think. They move more
quickly from one subject to another. Sometimes thoughts can become so rapid that they begin to make nosense, developing into a jumbled, incoherent message that the listener can no longer understand.
Grandiose ideas
It is common for people who are manic to think that they are more talented than others, or have uniquefor
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Overview of Bipolar Disorder
gifts. As the person’s mood becomes more elevated, these beliefs can become delusional in nature, withpeople often believing they are famous people, or that they have been put on this planet for a special
purpose (often religious beliefs can become very intense, and take more significance that usual).
Uncharacteristically poor judgement
A person’s ability to make rational decisions can become impaired and they may make inappropriate
decisions or decisions that are out of character.
Increased sexual drive
People when they become manic often experience increased libido, and may make less well-judged
decisions about the sexual partners.

Depressive Episodes
Depression is a mood state that is characterised by a significantly lowered mood. Its
severity, persistence, duration, and the presence of characteristic symptoms can distinguish amajor depressive episode, the other extreme mood state of bipolar disorder, from a milder
episode of depression. The most common symptoms of depression include:
Persistent sad, anxious, or empty mood
People often describe depression as an overwhelming feeling of sadness and hopelessness. They may lose
the motivation to eat and experience a loss of enjoyment in the activities of everyday life that they used totake a lot of pleasure in.
Poor or disrupted sleep
A person when they are depressed often experiences sleep disturbances, and this can be due to increased
anxiety. They then find it difficult to fall asleep, or wake up frequently during the night worrying about dayto-day events or wake early in the morning and are unable to get back to sleep.
Feelings of worthlessness or hopelessness
Sometimes people become overwhelmed with a sense of their own inability to be of use to anyone, and canbecome convinced that they are useless and worthless. Thoughts may revolve around the hopelessness ofthe situation and the future.
Decreased interest in sex
As the person becomes more depressed, they gradually become less interested in social activities and sex.
Poor concentration
Thinking can become slowed and the person can have difficulty in making decisions. They find it difficult toconcentrate on reading a book or on the day to day tasks such as shopping. This can often create anxiety
or agitation in a person.
Thoughts of suicide, or suicide attempts
When a person becomes overwhelmed by their feelings of hopelessness and despair, they may havethoughts of ending their lives or make plans to commit suicide.

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Mixed Episodes
A mixed episode is characterised by the experience of both depressive and manic symptoms nearly every
day for a period of time. The person experiences rapidly alternating moods, eg, irritability, euphoria,
sadness, and there may be insomnia, agitation, hallucinations and delusions, suicidal thoughts, etc.

Recording Your Symptoms
What sorts of symptoms do you experience? On the next page is a Symptom Record worksheet. Take afew minutes to write down what you experience when you are feeling well, that is, when you are neither
depressed nor hypomanic or manic. Then think of how you feel, what you think, and what you do or don’t
do when you are depressed or hypomanic or manic and write these symptoms down. The purpose ofrecording you symptoms is so that you can learn to become more aware of them and are ultimately able torecognise any early warning symptoms. We will discuss more about early warning symptoms in Module 3.

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Symptom RecordTo help you fill out this worksheet, you may want to ask yourself the following questions:•••••

What am I like when I’m in a “normal”, non-symptomatic state?
How does my life change when I’m depressed or manic?
How, if at all, does my view of myself, others, and the future change when I’m depressed, manic,
and when feeling fine?
What do other people notice about me when I’m symptomatic?
What sorts of comments do I hear from others?

Depression

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Mania

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The Diagnosis of Bipolar Disorder
Correctly identifying an illness can help you begin to explore the various treatment options available to you
so that you can better manage your illness. As such, having an accurate diagnosis is the beginning ofbecoming well. Remember that a proper diagnosis should only be made by your general practitioner orpsychiatrist, or a trained mental health practitioner. The information provided below is not enough for anaccurate diagnosis to be made by anyone who is not a trained mental health professional or physician.
The following diagnoses are based on the definitions and criteria used in the Diagnostic and Statistical Manualof Mental Disorders (DSM-IV) by the American Psychiatric Association, 1994.
Bipolar I Disorder is the most common and prevalent of the different bipolar mood disorders. It ischaracterised by the experience of full-blown manic episodes and severe depressive episodes. The patternsof abnormal mood states are very varied and different individuals may experience a different course of theillness. Many physicians refer to bipolar I disorder as a relapsing and remitting illness, where symptoms
come and go. It is therefore, important to ensure that treatment is continued even if the symptoms are nolonger present, to prevent an episode relapse.
Bipolar II Disorder is characterised by the experience of full-blown episodes of depression and episodesof hypomania (i.e., with mild manic symptoms) that almost never developed into full-fledged mania.
Cyclothymic Disorder is characterised by frequent short periods of mild depressive symptoms andhypomania, mixed in with short periods of normal mood. Though a patient with cyclothymic disorder does
not experience major depression or mania, they may go on to develop bipolar I or II disorder.
Patients with bipolar I or bipolar II may experience frequent mood cycling. Patients who experience morethan four episodes of hypomania, mania, and/or depression in a year are said to experience Rapid Cycling.
These patients tend to alternate between extreme mood states separated by short periods of being well, if
at all.

What Causes Bipolar Disorder?

No one factor has been identified to cause bipolar disorder, that is, it is not caused by a person, event, orexperience. There are a number of factors that interact with each other that may contribute to thedevelopment of this disorder in some people. In this section, we present to you a way of understanding
how all these factors come together to trigger the onset of this illness – called a stress vulnerability model.
First, we begin by looking at three key factors in this model, namely: genetic vulnerability, biologicalvulnerability and socioenvironmental stress (or life stress).

Genetic Vulnerability
Bipolar disorder tends to run in families. First degree relatives of people with bipolar disorder have anincreased risk of developing bipolar disorder. Children of bipolar patients face an 8% risk of getting theillness versus 1% in the population. Children of bipolar patients also face an increased risk (12%) of getting
unipolar depression (i.e., depression only, without mania). Identical twins are also more likely to bothdevelop this disorder than fraternal twins. While these results indicate to some extent that this disorder isgenetically inherited, they also suggest that there are other factors that may contribute to its development.

Biological Vulnerability
This refers to possible biochemical imbalances in the brain that makes a person vulnerable to experiencing
mood episodes. An imbalance of brain chemicals or an inability for them to function properly may lead toepisodes of “high” or “low” moods.
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Socioenvironmental StressStressful events or circumstances in a person’s life, such as, family conflicts, employment difficulties,
bereavement, or even positive events, such as getting married, having children, moving house, etc, can placeextra demands on the person, leading to them feeling stressed, frustrated, anxious, sad, etc. The
occurrence of bipolar disorder can thus be explained as an interaction of the 3 above factors. A person
who is genetically and/or biologically vulnerable may not necessarily develop bipolar disorder. Thesevulnerabilities are affected by how they cope with stressors in their life. For example, a person who has afamily history of diabetes may not develop diabetes if they are careful with they eat and have enoughexercise. This brings us to a discussion on protective and risk factors.

Protective and Risk Factors
A risk factor is something that will increase the chances of a person who is already vulnerable becoming ill.
Examples of risk factors are: poor or maladaptive coping strategies, alcohol or drug use, irregular daily
routines, interpersonal conflicts, stressful events, etc. Protective factors, on the other hand, are those that
can help to prevent a vulnerable person from becoming ill. Protective factors include good copingstrategies, good social support networks, effective communication and problem solving skills, etc. It iswhen the risk factors outweigh the protective factors, that the chances of developing the disorder are high.
This principle applies when considering the risk of recurrence as well.

Stress Vulnerability
Genetic
Vulnerability

Risk Factors• Noncompliance withmedication

BiologicalVulnerabilityLife StressProtective Factors• Compliance withmedication• Alcohol/drug abuse• Subsyndromal symptoms• Irregular lifestyle• Poor social support• Psychosocial impairment• Inappropriate coping• Regular/balanced lifestyle• Good social support• Appropriate coping Risk of Recurrence Risk of Recurrence

strategies

strategies

Course of Illness

While some patients may experience long periods of normal moods, most individuals with bipolar disorder
will experience repeated manic and/or depressive episodes throughout their lifetime. The ratio of manic
episodes to depressive episodes will vary from one individual to the next, as will the frequency of episodes.
Some individuals may experience only two or three episodes in their lifetime while others may experiencea rapid cycling pattern of four or more episodes of illness per year. Whatever the pattern, it is importantthat bipolar patients learn effective ways of managing their illness and preventing the recurrence of further
episodes.
On the next page is a Stress-Vulnerability Worksheet. This is for you to record factors in your life thatmight increase and decrease the risk of your experiencing an episode recurrence of depression, hypomania,or mania. Being aware of all these factors is the first step towards learning how to minimise the risk factorsand maximise the protective factors so that ultimately you will be able to better manage your illness andprevent episode recurrences.
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Stress-Vulnerability Worksheet
Vulnerability Factors: What factors do you think

Stress Checklist: Were you stressed by anything

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Risk Factors: What things might increase your risk

Protective Factors: What are some of the

might have increased your vulnerability to developing
bipolar disorder or a depressive, hypomanic, or manic
episode?

of experiencing a depressive, hypomanic, or manic
episode?

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happening in your life before you had a depressive,hypomanic, or manic episode?

resources and strengths you might have that might
decrease the risk of your experiencing a depressive,hypomanic, or manic episode?

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Module Summary•

About 1% of the population suffers from bipolar disorder••Bipolar disorder is the experience of exaggerated mood swings, where one can become extremely
euphoric, i.e., a hypomanic/manic episode, or extremely sad, i.e., a depressive episodeSufferers of bipolar disorder can be diagnosed with Bipolar 1 Disorder (severe depression and fullblown mania), Bipolar 11 Disorder (severe depression and hypomania), or Cyclothymic Disorder(brief periods of mild depression and hypomania)•

Frequent mood cycling, ie, more than 4 episodes a year, is known as Rapid Cycling•

Bipolar disorder is not caused by any one factor, but an interaction of factors that may contributeto its development in some people – the three common factors are genetic vulnerability, biologicalvulnerability, and life stress•

The risk of developing the illness and the risk of developing another episode after recovery fromone are affected by risk and protective factors•

Risk factors include: poor coping strategies, low level of social support, alcohol/drug use, irregulardaily routines, interpersonal conflicts, etc•

Protective factors include: good coping skills, good social support networks, effectivecommunication and problem-solving skills•The ultimate aim is to minimise risk factors and maximise protective factors so that episoderecurrence can be prevented

Keep Going ...
In the next module, we will discuss thevarious types of treatments for bipolar
disorder, and briefly evaluate theeffectiveness of each of thosetreatment options.

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