Bipolar Awareness is critical for adequate therapy of hypomania. Bipolar disorder treatment is possible after proper identification of Bipolar disorder symptoms.

Bipolar Disorder

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Iqra Mazhar

Overview

Bipolar disorder is a chronic disorder that causes a drastic shift in mood, behavior, and energy. The main signs of the condition are manic and hypomanic episodes. In addition, most people with bipolar disorder also suffer from depression. However, it is manageable with the right treatment. For example, medications, lifestyle changes, and talk therapy.

Bipolar disorder (formerly known as manic depression and manic-depressive illness) causes drastic mood swings, loss of energy, and difficulty concentrating and carrying out everyday tasks or chores.&nbsp;

When a person is depressed, they feel sad and hopeless. Moreover, they also lack interest and pleasure in activities that they once enjoyed. When a person&rsquo;s mood switches from mania to hypomania (less extreme compared to mania), they may feel euphoric, highly energetic, and irritable. Their mood swings affect their sleep, daily activity, energy, judgment, behavior, and thinking capabilities.

&nbsp;

Mood swing episodes occur either rarely or multiple times in one year. Moreover, some people experience emotional symptoms between the episodes, while some do not experience them at all.&nbsp;

Although it is a lifelong condition, mood swings and other symptoms can be managed. Bipolar disorder is treated with medications and psychotherapy in most cases. 
&nbsp;

Bipolar disorder is of three types and all of them show clear changes in mood and activity levels. The mood swings vary from being very irritable or energized (manic episodes) to very indifferent and low (depressive episodes). However, if the manic episodes are less severe, they are called hypomanic episodes.

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<h5>Bipolar I Disorder</h5>

Bipolar I disorder is defined by manic episodes or symptoms that last for seven days, are extremely severe, and require immediate hospital care. Depressive episodes are also a symptom and last a minimum of two weeks. Moreover, a combination of depressive and manic symptoms simultaneously is also possible.

&nbsp;

<h5>Bipolar II Disorder</h5>

It is defined by a pattern of depressive and hypomanic episodes. However, the extent of the manic episodes is not as extreme as seen typically in bipolar I disorder.

&nbsp;

<h5>Cyclothymic Disorder (Cyclothymia)</h5>

Cyclothymia is defined by hypomanic symptoms and depressive symptoms, which are usually periodic. It is a rare mood disorder, wherein the emotional ups and downs are not as extreme as those in bipolar I or II disorder, and between these cyclothymic highs and lows, a patient may feel stable and fine.

Sometimes, people experience symptoms of bipolar disorders that are unlike the three categories - manic, hypomanic, and <a href="https://merisehat.pk/disease/depression">depressive</a>. They are referred to as other specified and unspecified bipolar disorders or related disorders. These are essentially mood disorders in which a person doesn&#39;t meet the criteria for bipolar disorder.

The disorder is usually diagnosed during late adolescence years or early adulthood. Moreover, bipolar symptoms can appear in children occasionally and in women who are pregnant or postpartum. The symptoms vary with time but treatment is mostly permanent and aims to reduce the symptoms<a href="#accordion">[1]</a>. A prescribed treatment plan can improve the symptoms and quality of life. 
&nbsp;

Signs And Symptoms

Multiple types of bipolar disorders and related disorders exist. The episodes include mania, hypomania, and depression. The symptoms are unpredictable mood swings and behavior. These symptoms can lead to distress and difficulties. 
&nbsp;

<h5>Bipolar I Disorder</h5>

People with bipolar I disorder experience at least one episode of mania, which is followed by major depressive episodes and hypomania. Moreover, in certain cases, mania can trigger psychosis. 
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<h5>Bipolar II Disorder</h5>

People with bipolar II disorder have had a minimum of one depressive episode and a minimum of one hypomanic episode. However, they never experience manic episodes. 
&nbsp;

<h5>Cyclothymic Disorder</h5>

Patients experience periods of hypomania symptoms and depressive symptoms, however, these symptoms are not as extreme as those in bipolar I or II disorder, and between these cyclothymic highs and lows, a patient may feel stable and fine. Adults can have at least two years of episodes, while children and teenagers can experience these episodes for one year. 
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<h5>Other Types</h5>

Examples of other types include bipolar and related disorders induced by certain drugs/alcohol or due to diseases (e.g., Cushing&#39;s disease, multiple sclerosis, or stroke).

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It is important to bear in mind that bipolar II disorder is not a mild form of bipolar I disorder. These are two separate diagnoses. Furthermore, the manic episodes of bipolar disorder are dangerous and severe, and those with bipolar II disorder can be depressed for long periods, causing a drastic impairment.

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Bipolar disorder can occur at any age and is usually diagnosed during the teenage years or the early twenties. The symptoms vary among people and can change over time.

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<h5>Mania And Hypomania</h5>

Mania and hypomania have the same symptoms, but they are two different types of episodes. Mania is severe compared to hypomania because it has more noticeable symptoms. Both types of episodes can lead to work problems and issues at school and social activities in addition to difficulties in relationships. Mania can also trigger a break from reality (psychosis) and hospitalization may be required to treat it.

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Both manic and hypomanic episodes can present with three or more of the following symptoms:

<ul>
	<li>Abnormally wired, jumpy, upbeat</li>
	<li>Increased agitation, energy, and activity</li>
	<li>Euphoria (sense of well-being and self-confidence are exaggerated)</li>
	<li>The need for sleep is decreased</li>
	<li>Engaging in unusual talkativeness&nbsp;</li>
	<li>Racing thoughts</li>
	<li>Distraction</li>
	<li>Decision-making becomes poor (e.g., increase in taking sexual risks, indulging in shopping sprees, and investing in unnecessary items</li>
</ul>

<h5>Major Depressive Episode</h5>

The symptoms of major depressive episodes are severe and cause difficulties in everyday activities. For example, work, social activities, and school. Major depressive episodes include five or more of these symptoms: 
&nbsp;

<ul>
	<li>Depressed mood, feeling sad, hopeless, empty, or tearful; in children, a depressed mood appears as irritability</li>
	<li>Loss of interest in things and activities that were once fun</li>
	<li>Decreased appetite in children followed by unintentional weight loss; the same applies to adults but sometimes depressive episodes can lead to weight gain for them&nbsp;</li>
	<li>Sleeping either too much or too little</li>
	<li>Restlessness and slowed behavior</li>
	<li>Loss of energy and fatigue</li>
	<li>Guilt and worthlessness</li>
	<li>Decreased concentration and inability to make decisions</li>
	<li>Suicidal ideations and thoughts 
	&nbsp;</li>
</ul>

<h5>Other Features Of Bipolar Disorder</h5>

The signs and symptoms of bipolar disorder may include other features as well, for example, anxiety-based distress, psychosis, and melancholy. Moreover, the timing of the symptoms is mixed or rapid. Bipolar symptoms also occur during pregnancy and change in different seasons. 
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<h5>Bipolar Symptoms In Kids And Teens</h5>

The identification of the symptoms of bipolar disorder is difficult in children and teenagers because it is tough to tell these episodes apart from the regular ups or downs experienced during the adolescent period. Also, it is difficult to differentiate if the symptoms are due to underlying pathology, such as bipolar disorder, or a result of trauma, stress, etc. However, one of the most prominent signs in children and teenagers with bipolar disorder is mood swings that are very unusual compared to their normal mood swings.

Children and teenagers have distinct episodes of manic and hypomanic bipolar disorders, where usually there is a rapid shift in the mood during the episodes. However, there might be a complete absence of mood swings in some children.

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People with bipolar disorder do not realize how these mood swings impact and disrupt their life. Their emotional instability leaves them vulnerable to losing their friends, jobs and loved ones, that is, it has a drastic effect on their life.&nbsp; &nbsp;

If you have any symptoms of mania or depression, seek professional help right away. Bipolar disorder does not get better itself and getting treatment can help in controlling the symptoms. 
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Causes

The exact cause of bipolar disorder is yet to be elucidated; however, several factors could contribute to it.

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<h5>Cognitive Neuroscience&nbsp;</h5>

Physical changes in the brain (thinner cortical gray matter in frontal, temporal, and parietal regions of both brain hemispheres) are seen in people with bipolar disorder<a href="#accordion">[2]</a>. Furthermore, studies of neurocognitive function in bipolar disorder indicate deficits in three core domains: attention, executive function, and emotional processing. These changes are currently being researched to better highlight the underlying causative factor.&nbsp;&nbsp;

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<h5>Genetics</h5>

Bipolar disorder is common in people whose siblings or parents have the condition, that is, it is a heritable disease. Moreover, researchers are trying to look for genes that are involved in causing bipolar disorder<a href="#accordion">[3]</a>. 
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The screening instrument widely used for bipolar disorder is the Mood Disorder Questionnaire.

The Mood Disorder Questionnaire (MDQ) follows the format of a self-report. The questionnaire uses a single page and can be easily filled in by a physician, nurse, or any trained medical staff assistant. MDQ screening is used to screen patients for a lifetime history of manic or hypomanic syndrome. It consists of 13 questions with yes or no options. These questions are derived from the DSM-IV criteria. It also comprises an additional question that asks about whether the symptoms of manic or hypomanic were experienced concurrently. MDQ also assesses the level of functional impairment that results from the symptoms experienced.&nbsp; 
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When at least seven questions in the MDQ are answered positively, it means that the screening for bipolar disorder is positive. MDQ has been used in multiple studies and has been proven to be an excellent tool for the identification of bipolar disorder<a href="http://#accordion">[4]</a>. 
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Diagnosis

If you are suffering from symptoms of bipolar disorder or if someone you know is suffering from them, consult a psychiatrist. They will ask questions about any history of mental illnesses that run in the family and do a complete psychiatric evaluation. These evaluations will help in the diagnosis.&nbsp;&nbsp;

One of the main diagnostic factors for bipolar disorder is the related presenting symptoms. The underlying causes for the mood swings can help distinguish between symptoms due to bipolar disorder or symptoms due to other diseases, e.g., hypothyroidism, or symptoms due to alcohol abuse. The severity, time, and aggravating factors are also important for the diagnosis of bipolar disorder.

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The most common symptoms are high or low moods, changes in sleep patterns, energy, and behavior. Talking to someone you trust or a healthcare provider can help in distinguishing bipolar disorder from any other psychiatric disorder or major depressive disorder. Moreover, people may feel anxious after their diagnosis due to a lack of awareness of the disease, but it is important to bear in mind that an accurate diagnosis can open the way for the right treatment and increase our understanding of the disease.&nbsp;

It is very common for people to remain undiagnosed for bipolar disorder for years and the diagnosis is trickier in children. Their symptoms are like adults but can be confused with ADHD (attention deficit hyperactive disorder) or other behavioral problems.

If you think your child has bipolar disorder, consult a healthcare provider immediately. 
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Treatment

The symptoms of bipolar disorder can get better with the right treatment.&nbsp; While the cornerstone treatment is medication, psychotherapy should also be considered as it can be very helpful for many patients. Therapy can help them in understanding their disease and prescription medications can then be taken to prevent further mood swings.

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The medications used are called mood stabilizers (e.g., lithium). It is the most common medication prescribed for bipolar disorder and it corrects the signaling of the brain which becomes imbalanced. Ongoing treatment is recommended because the symptoms of bipolar disorder and mood swings recur. Moreover, the treatment is individualized for every patient, and different medications are tested before finding what works best.

Electroconvulsive therapy is a medical treatment used for bipolar patients that have not shown improvement with medications and psychotherapy. Brief electrical currents are applied to the patient&rsquo;s scalp in rounds while the patient is under anesthesia. It leads to short and controlled seizures, which remodel the brain&#39;s signaling pathways.

Bipolar disorder can disrupt a person&rsquo;s everyday life, which can be very stressful for the ones suffering from the disease as well as their families. Hence, families can seek help from professional resources to learn coping strategies that apply both ways. It also helps in participating in activities and getting support.

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<h5>Bipolar II Disorder</h5>

At least one major depressive episode and hypomanic episode are required for the diagnosis of bipolar II disorder. In between the episodes, people return to their unusual functioning and often opt for treatment after their first depressive episode. Hypomanic episodes feel pleasurable because of the euphoria experienced, so they usually never opt for treatment during this phase, they only go for it after their depressive episode.

Other mental illnesses, for example, anxiety disorder or substance addiction, can worsen the symptoms of hypomania and depression.

Similar to bipolar I disorder, treatment involves medication and psychotherapy. Mood stabilizers and antidepressants are used mostly. However, if they are ineffective, ECT is used. Healthcare providers always offer individualized treatment plans.&nbsp;

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<h5>Cyclothymic Disorder</h5>

Cyclothymic disorder is mild compared to bipolar Type I and II and involves hypomania and depressive episodes.&nbsp;

The treatment includes medications and talk therapy. Talk therapy helps with mood swings and stress. Keeping a mood journal can also be helpful in observing mood fluctuations. 
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If bipolar disorder is not treated, it can lead to serious problems, which have a drastic effect on people&rsquo;s lives:

<ul>
	<li>Problems linked to alcohol or drug abuse</li>
	<li>Suicidal thoughts and attempts</li>
	<li>Financial and legal problems</li>
	<li>Relationships become damaged</li>
	<li>Children perform poorly at school and adults perform poorly at work</li>
</ul>

<h5>&nbsp;</h5>

<h5>Conditions That Are Co-Occurring</h5>

People who have bipolar disorder may also have other conditions that need to be treated with bipolar disorder. Moreover, some conditions can also worsen bipolar symptoms, leading to unsuccessful treatment:&nbsp;

<ul>
	<li>Eating disorders</li>
	<li><a href="https://merisehat.pk/disease/anxiety">Anxiety disorders</a></li>
	<li><a href="https://merisehat.pk/disease/attention-deficit-hyperactivity-disorder-adhd">ADHD (attention deficit hyperactive disorder)</a></li>
	<li>Drug problems and alcohol problems</li>
	<li>Health conditions, thyroid problems, <a href="https://merisehat.pk/disease/coronary-artery-disease">heart diseases</a>,<a href="https://merisehat.pk/disease/obesity"> obesity</a>, and <a href="https://merisehat.pk/disease/migraines-73">headaches</a></li>
</ul>

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The factors that increase the risk of bipolar disorder are:

<ul>
	<li>Genetics, for example, having a first-degree relative, parent, and sibling who has bipolar disorder</li>
	<li>High-stress periods, for example, the death of someone or another traumatic event</li>
	<li>Alcohol or drug abuse 
	&nbsp;</li>
</ul>

No definitive prevention exists for bipolar disorder, but getting treatment at the earliest can prevent the bipolar disorder from worsening.

The following strategies can help people prevent the minor symptoms of bipolar disorder from becoming severe (manic and hypomanic).

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<h5>Look For Warning Signs</h5>

Addressing the symptoms during the early stage can prevent them from getting worse. Bipolar disorder usually has a pattern and triggers. Identifying these triggers and consulting a healthcare provider at the earliest would be the best course of action.&nbsp; Friends and family can also take steps to educate themselves about the disease, so they can watch out for unusual signs.

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<h5>Do Not Drink Alcohol And Use Drugs</h5>

Recreational drugs and alcohol use can worsen the symptoms.&nbsp;&nbsp;

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<h5>Prescription Medications</h5>

People may be tempted to stop their medications and treatment, but doing that can worsen the condition. Moreover, even self-reduction of the dose can lead to withdrawal effects and symptoms may become worse. Always discuss any concerns about your medication plans with your healthcare provider.&nbsp; 
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FDA has approved Caplyta (lumateperone) for treating bipolar depression in adults<a href="#accordion">[5]</a>. Caplyta is an atypical antipsychotic drug that has been approved for the treatment of depressive episodes of bipolar disorder. Caplyta can be used with lithium or valproate (adjunctive therapy) or alone (monotherapy).&nbsp;

The drug has been consistent considering weight, cardiometabolic parameters, and extrapyramidal symptoms. The approval of this drug is important for adults who suffer from depressive episodes associated with bipolar I or II disorder (bipolar depression). 
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Key Points

<ul>
	<li>Bipolar disorder is a mental health condition that affects your mood and can also lead to depressive episodes.</li>
	<li>It is also called manic depression.</li>
	<li>Patients usually suffer from clinical depression before manic episodes.</li>
	<li>The high and low phases of bipolar disorder are extreme, which hinder a person&rsquo;s lifestyle.</li>
	<li>The use of recreational drugs and alcohol can worsen the symptoms.</li>
	<li>The symptoms of bipolar disorder can get better with the right treatment 
	&nbsp;</li>
</ul>

[1] Silverstone, T. and Romans, S., 1996. Long term treatment of bipolar disorder. Drugs, 51(3), pp.367-382.

[2] Clark, L. and Sahakian, B.J., 2022. Cognitive neuroscience and brain imaging in bipolar disorder. Dialogues in clinical neuroscience.

[3] Escamilla, M.A. and Zavala, J.M., 2022. Genetics of bipolar disorder. Dialogues in clinical neuroscience.

[4] Hirschfeld, R.M., Calabrese, J.R., Weissman, M.M., Reed, M., Davies, M.A., Frye, M.A., Keck Jr, P.E., McNulty, J.P., Lewis, L., McElroy, S.L. and Wagner, K.D., 2003. Screening for bipolar disorder in the community.

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