Bipolar disorder history and symptoms: Difference between revisions

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==Overview==
==Overview==
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months. Late adolescence and early adulthood are peak years for the onset of the illness. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. Clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with a bipolar depression episode, including information about the patient’s clinical and psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use.
==History and Symptoms==
==History and Symptoms==
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.<ref>
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.<ref>
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</ref> Late adolescence and early adulthood are peak years for the onset of the illness.<ref name ="Christie88">{{cite journal|author=Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ |year=1988 |title=Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults |journal=Am J Psychiatry |volume=145 |pages=971-975 |id=|url=http://www.ajp.psychiatryonline.org/cgi/content/abstract/145/8/971 (abstract) |accessdate = 2007-07-01 }}</ref><ref>Goodwin & Jamison. p121</ref> These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.
</ref> Late adolescence and early adulthood are peak years for the onset of the illness.<ref name="Christie88">{{cite journal|author=Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ |year=1988 |title=Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults |journal=Am J Psychiatry |volume=145 |pages=971-975 |id=|url=http://www.ajp.psychiatryonline.org/cgi/content/abstract/145/8/971 (abstract) |accessdate = 2007-07-01 }}</ref><ref>Goodwin & Jamison. p121</ref> These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.
*The '''manic phase''' may last from days to months. It can include the following symptoms:
 
:*Easily distracted
===Prodrome===
:*Little need for sleep
Prodromal signs and symptoms such as irritability, anxiety, mood liability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of bipolar disorder.
:*Poor judgment
 
:*Poor temper control
===Manic episodes===
:*Reckless behavior and lack of self control
The course of illness in mania may be marked by a sudden onset, and episodes progress quickly over a few days. The duration of manic episodes ranges from weeks to months.<ref name="DSMV3">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
::*Binge eating, drinking, and/or drug use
 
::*Poor judgment
*Involve clinically significant changes in mood, energy, activity, behavior, sleep, and cognition.
::*Sex with many partners (promiscuity)
*Abnormally elevated, irritable, and labile mood is a core symptom required to diagnose mania.
::*Spending sprees
*Classic mania is marked by an unusually good, euphoric, or high mood, which may be accompanied by disinhibition, disregard for social boundaries, expansiveness.
:*Very elevated mood
*Another core diagnostic symptom of mania is persistently increased energy and activity.
::*Excess activity (hyperactivity)
*Increased planning and activity is typically marked by impulsivity, poor judgement.
::*Increased energy
*Patients are often unable to complete the many tasks or projects that are started.
::*Racing thoughts
*Manic patients generally have an exaggerated sense of wellbeing and self-confidence, which may extend to grandiosity of psychotic proportions.
::*Talking a lot
*There is decreased need for sleep.
::*Very high self-esteem (false beliefs about self or abilities)
*Common cognitive symptoms of mania include increased mental activity, racing thoughts, distractibility, and difficulty distinguishing between relevant and irrelevant thoughts; these symptoms result in flight of ideas.
:*Very involved in activities
*In addition, patients may not recall events that occur during manic episodes.
:*Very upset (agitated or irritated)
*Manic speech is generally loud, pressured or accelerated, and difficult to interrupt.
 
<br />
 
===Hypomania <ref name="DSMV4">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===
 
*Hypomanic episodes are characterized by changes in mood, energy, activity, behavior, sleep, and cognition that are similar to those of mania, but less severe.
*psychotic symptoms do not occur in hypomania, and hypomania never necessitates hospitalization.
*The course of hypomania is such that it generally begins suddenly and progresses quickly over one to two days. Episodes typically resolve within several weeks.
 
===Major depression===


*These symptoms of [[mania]] occur with '''bipolar disorder I'''. In people with '''bipolar disorder II''', the symptoms of mania are similar but less intense.
*Episodes of major depression involve clinically significant changes in mood, behavior, energy, sleep, and cognition.
*Bipolar major depression is generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity (eg, speech is slow and soft, and output reduced).
*Interest in pleasurable activities (eg, sex) is minimal, energy is low, and memory and concentration are impaired.
*Appetite is typically diminished and accompanied by weight loss.
*Sleep disturbances (insomnia or hypersomnia) often occur in bipolar depression.
*Other features of major depression include poor eye contact, poor hygiene, messy appearance, feelings of hopelessness and helplessness,


*The '''depressed phase''' of both types of bipolar disorder includes the following symptoms:
<br />
:*Daily low mood or sadness
:*Difficulty concentrating, remembering, or making decisions
:*Eating problems
::*Loss of appetite and weight loss
::*Overeating and weight gain
:*Fatigue or lack of energy
:*Feeling worthless, hopeless, or guilty
:*Loss of pleasure in activities once enjoyed
:*Loss of self-esteem
:*Thoughts of death and [[Suicide (patient information)|suicide]]
:*Trouble getting to sleep or sleeping too much
:*Pulling away from friends or activities that were once enjoyed


*There is a high risk of [[Suicide (patient information)|suicide]] with bipolar disorder. Patients may abuse alcohol or other substances, which can make the symptoms and suicide risk worse.
===Mixed features===


*Sometimes the two phases overlap. Manic and depressive symptoms may occur together or quickly one after the other in what is called a '''mixed state'''.
*Episodes of bipolar mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity, and are referred to as mood episodes with mixed features (eg, major depression with mixed features or hypomania with mixed features).
*Manic or hypomanic episodes with mixed features are characterized by episodes that meet full criteria for mania or hypomania, and at least three of the following symptoms during most days of the episode:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
**Depressed mood
**Diminished interest or pleasure in most activities
**Psychomotor retardation
**Low energy
**Excessive guilt or thoughts of worthlessness
**Recurrent thoughts about death or suicide, or suicide attempt


===Cognition===
*Major depressive episodes with mixed features are characterized by episodes that meet full criteria for major depression, and at least three of the following symptoms during most days of the episode:<ref name="DSMV2">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
Recent studies have found that bipolar disorder involves certain [[cognitive deficit]]s or impairments, even in states of [[remission (medicine)|remission]]. <ref>
**Elevated or expansive mood
{{Citation
**Inflated self-esteem or grandiosity
  | last = Martínez-Arán
**More talkative than usual or pressured speech
  | first = A
**Flight of ideas
  | last2 = Vieta
**Increased energy
  | first2 = E
**Decreased need for sleep
  | last3 = Reinares
  | first3 = M
  | last4 = Colom
  | first4 = F
  | last5 = Torrent
  | first5 = C
  | last6 = Sánchez-Moreno
  | first6 = J
  | last7 = Benabarre
  | first7 = A
  | last8 = Goikolea
  | first8 = JM
  | last9 = Comes
  | first9 = M
  | last10 = Salamero
  | first10 = M
  | title = Cognitive Function Across Manic or Hypomanic, Depressed, and Euthymic States in Bipolar Disorder
  | journal = American Journal of Psychiatry
  | volume = 161
  | issue = 2
  | pages = 262-270
  | year = 2004
  | date = February 2004
  | url = http://ajp.psychiatryonline.org/cgi/content/abstract/161/2/262
}}
</ref><ref>
{{Citation
  | last = Rossi
  | first = A
  | last2 = Arduini
  | first2 = L
  | last3 = Daneluzzo
  | first3 = E
  | last4 = Bustini
  | first4 = M
  | last5 = Prosperini
  | first5 = P
  | last6 = Stratta
  | first6 = P
  | title = Cognitive function in euthymic bipolar patients, stabilized schizophrenic patients, and healthy controls
  | journal = Journal of Psychiatric Research
  | volume = 34
  | issue = 4-5
  | pages = 333-339
  | date = July 2000
  | year = 2000
  | doi = 10.1016/S0022-3956(00)00025-X
}}
</ref><ref>
{{Citation
  | title = Second Biennial Conference of the International Society for Bipolar Disorders, 2–[[4 August]] [[2006]], Edinburgh, Scotland, Thursday, [[August 3]], Cognitive Function in BD
  | journal = Bipolar Disorders
  | volume = 8
  | issue = Supplement 1
  | pages = 2–3
  | date = August 2006
  | doi = 10.1111/j.1399-5618.2006.00379_2.x
}}
</ref>
Deborah Yurgelun-Todd <!--PhD--> of [[McLean Hospital]] in [[Belmont, Massachusetts|Belmont]], [[Massachusetts]] has argued these deficits should be included as a core feature of bipolar disorder.  According to McIntyre et al. (2006), <blockquote>
Study results now press the point that neurocognitive deficits are a primary feature of BD; they are highly prevalent and persist in the absence of overt symptomatology. Although disparate neurocognitive abnormalities have been reported, disturbances in attention, [[visual memory]] and [[executive function]] are most consistently reported.<ref name=cog_[[17 November]]>{{cite journal|author=Roger S. McIntyre, MD, Joanna K. Soczynska, and Jakub Konarski|year=2006|title=Bipolar Disorder: Defining Remission and Selecting Treatment|journal=Psychiatric Times|cite= October 2006, Vol. XXIII, No. 11|url=http://www.psychiatrictimes.com/article/showArticle.jhtml?articleId=193400986}}. </ref>
</blockquote> However, in the April-June 2007 issue of the Journal of Psychiatric Research, Spanish researchers reported that people with bipolar 1 who have a history of psychotic symptoms do not necessarily experience an increase in cognitive impairment.


===Creativity===
*Red flags for mixed features include the presence of clinically significant agitation, anxiety, or irritability.
{{main|Creativity and mental illness}}
*Patients with mixed features are at greater risk for suicidal ideation and comorbid anxiety disorders and substance use disorders.<ref name="pmid23223893">{{cite journal| author=Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM | display-authors=etal| title=Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. | journal=Am J Psychiatry | year= 2013 | volume= 170 | issue= 1 | pages= 31-42 | pmid=23223893 | doi=10.1176/appi.ajp.2012.12030301 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23223893  }}</ref>
*The esponse to treatment is often poorer in mood episodes with mixed features than in pure bipolar major depression or pure mania.<ref name="pmid20368510">{{cite journal| author=Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG | display-authors=etal| title=Longitudinal course of bipolar I disorder: duration of mood episodes. | journal=Arch Gen Psychiatry | year= 2010 | volume= 67 | issue= 4 | pages= 339-47 | pmid=20368510 | doi=10.1001/archgenpsychiatry.2010.15 | pmc=3677763 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20368510  }}</ref>


A number of recent studies have observed a correlation between creativity and bipolar disorder, although it is unclear in which direction the cause lies, or whether both conditions are caused by some third, unknown, factor.
It has been hypothesized that temperament may be one such factor.


==References==
==References==

Latest revision as of 01:28, 5 August 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]

Overview

Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months. Late adolescence and early adulthood are peak years for the onset of the illness. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. Clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with a bipolar depression episode, including information about the patient’s clinical and psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use.

History and Symptoms

Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.[1] Late adolescence and early adulthood are peak years for the onset of the illness.[2][3] These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.

Prodrome

Prodromal signs and symptoms such as irritability, anxiety, mood liability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of bipolar disorder.

Manic episodes

The course of illness in mania may be marked by a sudden onset, and episodes progress quickly over a few days. The duration of manic episodes ranges from weeks to months.[4]

  • Involve clinically significant changes in mood, energy, activity, behavior, sleep, and cognition.
  • Abnormally elevated, irritable, and labile mood is a core symptom required to diagnose mania.
  • Classic mania is marked by an unusually good, euphoric, or high mood, which may be accompanied by disinhibition, disregard for social boundaries, expansiveness.
  • Another core diagnostic symptom of mania is persistently increased energy and activity.
  • Increased planning and activity is typically marked by impulsivity, poor judgement.
  • Patients are often unable to complete the many tasks or projects that are started.
  • Manic patients generally have an exaggerated sense of wellbeing and self-confidence, which may extend to grandiosity of psychotic proportions.
  • There is decreased need for sleep.
  • Common cognitive symptoms of mania include increased mental activity, racing thoughts, distractibility, and difficulty distinguishing between relevant and irrelevant thoughts; these symptoms result in flight of ideas.
  • In addition, patients may not recall events that occur during manic episodes.
  • Manic speech is generally loud, pressured or accelerated, and difficult to interrupt.


Hypomania [5]

  • Hypomanic episodes are characterized by changes in mood, energy, activity, behavior, sleep, and cognition that are similar to those of mania, but less severe.
  • psychotic symptoms do not occur in hypomania, and hypomania never necessitates hospitalization.
  • The course of hypomania is such that it generally begins suddenly and progresses quickly over one to two days. Episodes typically resolve within several weeks.

Major depression

  • Episodes of major depression involve clinically significant changes in mood, behavior, energy, sleep, and cognition.
  • Bipolar major depression is generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity (eg, speech is slow and soft, and output reduced).
  • Interest in pleasurable activities (eg, sex) is minimal, energy is low, and memory and concentration are impaired.
  • Appetite is typically diminished and accompanied by weight loss.
  • Sleep disturbances (insomnia or hypersomnia) often occur in bipolar depression.
  • Other features of major depression include poor eye contact, poor hygiene, messy appearance, feelings of hopelessness and helplessness,


Mixed features

  • Episodes of bipolar mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity, and are referred to as mood episodes with mixed features (eg, major depression with mixed features or hypomania with mixed features).
  • Manic or hypomanic episodes with mixed features are characterized by episodes that meet full criteria for mania or hypomania, and at least three of the following symptoms during most days of the episode:[6]
    • Depressed mood
    • Diminished interest or pleasure in most activities
    • Psychomotor retardation
    • Low energy
    • Excessive guilt or thoughts of worthlessness
    • Recurrent thoughts about death or suicide, or suicide attempt
  • Major depressive episodes with mixed features are characterized by episodes that meet full criteria for major depression, and at least three of the following symptoms during most days of the episode:[7]
    • Elevated or expansive mood
    • Inflated self-esteem or grandiosity
    • More talkative than usual or pressured speech
    • Flight of ideas
    • Increased energy
    • Decreased need for sleep
  • Red flags for mixed features include the presence of clinically significant agitation, anxiety, or irritability.
  • Patients with mixed features are at greater risk for suicidal ideation and comorbid anxiety disorders and substance use disorders.[8]
  • The esponse to treatment is often poorer in mood episodes with mixed features than in pure bipolar major depression or pure mania.[9]


References

  1. Kessler, RC; McGonagle, KA; Zhao, S; Nelson, CB; Hughes, M; Eshleman, S; Wittchen, HU; Kendler, KS (1994), "Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States", Archives of General Psychiatry, 51 (1): 8–19
  2. Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ (1988). (abstract) "Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults" Check |url= value (help). Am J Psychiatry. 145: 971–975. Retrieved 2007-07-01.
  3. Goodwin & Jamison. p121
  4. Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  5. Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  6. Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  7. Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  8. Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM; et al. (2013). "Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis". Am J Psychiatry. 170 (1): 31–42. doi:10.1176/appi.ajp.2012.12030301. PMID 23223893.
  9. Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG; et al. (2010). "Longitudinal course of bipolar I disorder: duration of mood episodes". Arch Gen Psychiatry. 67 (4): 339–47. doi:10.1001/archgenpsychiatry.2010.15. PMC 3677763. PMID 20368510.

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