Bipolar Disorder
Men and women are equally likely to
develop this disabling illness, which affects approximately 1 percent
of American adults ages 18 to 54 in a given year.
Different from normal mood states of
happiness and sadness, symptoms of bipolar disorder can be
severe and life threatening.
Bipolar disorder, which tends to run
in families, typically emerges in adolescence or early adulthood and
continues to flare up across the life course, disrupting work, school,
family, and social life. |
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What Are the
Symptoms of Bipolar Disorder?
Episodes of Depression:
Symptoms include a persistent sad mood; loss of interest or pleasure
in activities that were once enjoyed; significant change in appetite
or body weight; difficulty sleeping or oversleeping; physical slowing
or agitation; loss of energy; feelings of worthlessness or
inappropriate guilt; difficulty thinking or concentrating; and
recurrent thoughts of death or suicide.
Episodes of Mania: Abnormally and persistently elevated (high)
mood or irritability accompanied by at least three of the following
symptoms: overly-inflated self-esteem; decreased need for sleep;
increased talkativeness; racing thoughts; distractibility;
goal-directed activity done to excess such as spending money; physical
agitation; and excessive involvement in risky behaviors or activities.
Episodes of hypomania, or mild mania, include symptoms such as
increased energy, elevated mood, irritability, and intrusiveness,
which may cause little impairment in functioning but are noticeable to
others.
Psychosis: Sometimes, severe depression or mania is accompanied
by periods of psychosis. Psychotic symptoms include: hallucinations
(hearing, seeing, or otherwise sensing the presence of stimuli that
are not there) and delusions (false personal beliefs that are not
subject to reason or contradictory evidence and are not explained by a
person's cultural concepts). Psychotic symptoms associated with
bipolar disorder typically reflect the extreme mood state at the time.
About
5.7 million American adults or about 2.6 percent of the population age
18 and older in any given year, have bipolar disorder.
"Mixed" state: Symptoms of
mania and depression are present at the same time. The symptom picture
frequently includes agitation, trouble sleeping, significant change in
appetite, psychosis, and suicidal thinking. Depressed mood accompanies
manic activation.
Episodes of mania, depression, or mixed state typically recur
and become more frequent across the life span. These episodes,
especially early in the course of illness, are separated by periods of
wellness during which a person suffers few to no symptoms. When four
or more episodes of illness occur within a 12-month period, the person
is said to have bipolar disorder with rapid cycling. Bipolar disorder
is often complicated by co-occurring alcohol or substance abuse.
What Treatments Are
Available for Bipolar Disorder?
A variety of medications are used to
treat bipolar disorder. But even with optimal medication treatment,
many people with bipolar disorder do not achieve full remission of
symptoms. Certain forms of psychotherapy, in combination with
medication, often can provide additional benefit. These include
cognitive-behavioral therapy, psychoeducation, and family therapy.
Lithium has long been used as a first-line treatment for
bipolar disorder. Anti-convulsant medications, particularly valproate
and carbamazepine, have been used as alternatives to lithium in many
cases. Newer anticonvulsant medications, including lamotrigine and
gabapentin, are being studied to determine their efficacy as mood
stabilizers in bipolar disorder. Some research suggests that different
combinations of lithium and anticonvulsants may be helpful.
During a depressive episode, people with bipolar disorder commonly
require treatment with antidepressant medication. The relative
efficacy of various antidepressant medications in this disorder has
not yet been determined by adequate scientific study. Typically,
lithium or anticonvulsant mood stabilizers are given along with an
antidepressant to protect against a switch into mania or rapid
cycling, which can be provoked in some people with bipolar disorder by
antidepressant medications.
In some cases, the newer, atypical antipsychotic drugs such as
clozapine or olanzapine may help relieve severe or refractory symptoms
of bipolar disorder and prevent recurrences of mania. Further research
is necessary, however, to establish the safety and efficacy of
atypical antipsychotics as long-term treatments for bipolar disorder.
A manic episode is diagnosed if elevated mood occurs with three or
more of the other symptoms most of the day, nearly every day, for 1
week or longer. If the mood is irritable, four additional symptoms
must be present.
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