Bipolar disorder

Bipolar disorder (formerly called manic depression) is a mental illness that exists along a spectrum. People with bipolar disorder have episodes of depression that alternate with periods of better mood. 

In bipolar I disorder, these periods of better mood may involve mania: a high-energy state which can cause psychosis, extreme emotions like panic attacks, or euphoria. This feeling is often followed by a period of depression. People with bipolar I disorder switch between these two states.Beentjes TA, Goossens PJ, Poslawsky IE (October 2012). "Caregiver burden in bipolar hypomania and mania: a systematic review". Perspect Psychiatr Care 48 (4): 187–97. doi:10.1111/j.1744-6163.2012.00328.x. PMID 23005586.

In bipolar II disorder, a person never becomes manic or psychotic. Their episodes of depression are often longer and more severe, and they alternate with periods of hypomania. Other disorders on the bipolar spectrum include cyclothymia.

 Symptoms 
 Depression 
In people with bipolar I disorder, depressive episodes can last from a few weeks to several months. In bipolar II disorder, depressive episodes may last many months.

People who are in a depressive state are often sad and pessimistic. They may lose interest in activities they usually like, or become isolated and lonely. Other symptoms include anxiety, hopelessness, changes in sleep, and suicidal thoughts.Muneer A (June 2013). "Treatment of the depressive phase of bipolar affective disorder: a review". J Pak Med Assoc 63 (6): 763–9. PMID 23901682. 

When bipolar disorder develops at a young age, the first few episodes are usually depressive. Because a manic or hypomanic episode is needed to diagnose bipolar disorder, some people are diagnosed with major depression at first.

 Mania 
People in a manic state are often over-confident and very optimistic. This can cause them to take large risks and do things that they usually wouldn't. A person who is manic may talk very quickly with no pauses, have thoughts that change very quickly, or act without thinking. 

They may also experience psychosis, where they cannot tell what is real and what is not. They may think that they are unstoppable or that they are on a mission for God.Knowles R, McCarthy-Jones S, Rowse G (June 2011). "Grandiose delusions: a review and theoretical integration of cognitive and affective perspectives". Clin Psychol Rev 31 (4): 684–96. doi:10.1016/j.cpr.2011.02.009. PMID 21482326. 

Manic episodes last for at least a week, but can last as long as three to six months. They are usually followed by a depressive episode. Mania may become so severe that it can affect the person’s ability to work or interact with others.

 Hypomania 
Hypomania is a less extreme version of mania that never involves psychosis. As described by the Cleveland Clinic:Hypomania is a condition in which you display a revved up energy or activity level, mood or behavior. The new “energized you” is recognized by others as beyond your usual self. Hypomania is a less severe form of mania, and both are commonly part of bipolar disorder.A hypomanic episode may last from a few days to a few months."Bipolar II Disorder Symptoms and Signs". Web M.D. Retrieved December 6, 2010.

 Diagnosis 
Bipolar disorder is an illness that can show in different ways. It is often diagnosed in adolescents or young adults. A few subtypes have been identified; these subtypes mostly describe the nature of the "episodes" of the disease.

A person with bipolar I disorder has had at least one manic episode. They may or may not have episodes of depression.

A person with bipolar II disorder has had at least one major depressive episode, and at least one hypomanic episode.

A person with cyclothymia has had a hypomanic episode, and feels depressed (but not so severely that it qualifies as a major depressive episode). 
 Causes 
The exact cause of bipolar disorder is unknown. 

Genetics definitely play a role. A 2008 study estimated that there is a 71% chance of bipolar disorder passing from parent to child.Edvardsen J, Torgersen S, Røysamb E, Lygren S, Skre I, Onstad S, Oien PA (2008). "Heritability of bipolar spectrum disorders. Unity or heterogeneity?". Journal of Affective Disorders 106 (3): 229–240. doi:10.1016/j.jad.2007.07.001. PMID 17692389. Likewise, if one identical twin has bipolar disorder, there is a significant chance that the other will develop bipolar disorder in their lifetime. 

MRI studies have shown that certain parts of the brain responsible for mood regulation are larger in bipolar patients. Bipolar disorder can be caused by certain conditions that affect the brain - like a stroke, brain injury, or certain infections.Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012.  | 

Bipolar disorder can also be triggered by certain environmental factors, such as stressful life events, overwhelming problems of everyday life, certain medications, and recreational drugs.

 Treatment 
alt=|thumb|Light therapy is one of several approaches to treating bipolar disorder.
Bipolar disorder is treatable. The most common treatment is mood-stabilizing medication. These medicines prevent and control the manic and depressive episodes. Historically, lithium has been one of the most common mood stabilizers used for bipolar disorder.Brown KM, Tracy DK (June 2013). "Lithium: the pharmacodynamic actions of the amazing ion". Ther Adv Psychopharmacol 3 (3): 163–76. doi:10.1177/2045125312471963. PMC 3805456. PMID 24167688. Therapy can also be used to control the symptoms. 

The same treatments and medicines do not work for everyone, and it is not uncommon for people to have symptoms return if they stop taking medication.

 Involuntary treatment 
Sometimes, people need to be treated against their will. Patients may be thinking about or have tried to commit suicide, or they may be unable to see their situation properly. In many cases, teaching people about their disease helps. When they have gone through the phases of the illness a few times, they often see that treatment can make their life easier.

Further reading
Genetics links between five major psychiatric disorders: autism, ADHD, bipolar disorder, depression, and schizophrenia per recent study.doi:10.1016/S0140-6736(08)61345-8
5 Disorders Share Genetic Risk Factors, Study Finds February 28, 2013 The New York Times
Psychiatric Disorders Linked Genetically February 27, 2013 WSJ

References

 .
 . Internet version published in Journal of the ACMS 2004.

 Other websites 
 BipolArt - Proof that a high proportion of bipolar people are creative. A fantastic collection of drawings, paintings, inkings, photographs, music, etc. by artists who share this illness.
 Allpsych

Category:Bipolar disorder