Bipolar I (A complete guide)

Bipolar I

In this brief guide, Bipolar I will be discussed in detail, along with the diagnostic criteria, types, causes and treatment.

Bipolar Disorder?

Bipolar disorder is described as a condition that causes extreme changes in energy and activity level and mood fluctuations which hinders a person’s daily life.

This disorder is named Bipolar and other related disorders which include bipolar I and II disorders along with cyclothymia.

Before DSM-5, this condition has been as manic depression which is a serious mental condition that has been put in between the depression disorders and psychotic disorders in the Diagnostic Statistical Manual of Mental Disorders.

If it is not treated, it can create a lot of hindrances in relationships, in career and education. In extreme cases, it can lead to suicide.

Bipolar disorder has been found in males and females equally.

It is commonly diagnosed between the ages of 15 and 25 years but the symptoms can occur any time, at any age.

Alternating episodes of mania or extreme euphoria and depression are the main symptoms of Bipolar disorder.

These episodes can be extreme but in between the highs and lows, the mood may stay normal.

Fluctuations in mood are severe, incapacitating and devastating than normal mood swings.

Some people with bipolar disorder might experience having hallucinations as well.

Bipolar I (A complete guide)

Many people refuse to take medication or some stop taking them and their condition gets worse, however, if the patients follow proper treatment, the condition can be controlled and managed, they can work, study and have a productive life.

Studies revealed that people with bipolar disorder are extremely creative but because of their abrupt mood swings make it hard for them to concentrate and stay on a project or plan which results in them having started a lot of projects but nothing finished.

If you want to know more about bipolar, then the blog on Nice bipolar should be read.

Symptoms of Bipolar Disorder

Symptoms of bipolar disorder may be different for each individual according to their mood.

Some people may experience clear mood shifts with manic symptoms and then depressive symptoms, each with months of stability in between shifts and lasting for a few months.

Others might suffer in a high or low mood for months or years. 

When depressive and a manic episode happen simultaneously, it is called a mixed state.

A person may feel restless or weird but also experience negative feelings.

Symptoms of Bipolar disorder can broadly be categorized in:

1.  Mania or Hypomania

2.  Major Depressive Disorder

Mania or Hypomania

Mania and hypomania are terms that refer to a high mood where mania is a severe form than hypomania.

Following are the symptoms of mania/hypomania:

●   A sense of euphoria, being on top of the world, unstoppable

●   Faulty judgment

●   Easily distracted or get bored and shift from one task to another

●   Underperformance, missing school or work

●   Engaging in risky behaviour

●   Inflated self-confidence, self-importance, and self-esteem

●   Belief that nothing is wrong

●   Rapid and excessive talking, jumping from one topic to another

●   Aggressively forthcoming

●   Bizarre ideas on which they might act upon

Examples include spending a lot of money on useless things, taking part in dangerous activities, abusing drugs or alcohol and higher libido.

Bipolar I (A complete guide)

 Depressive symptoms

Symptoms experienced during a depressive episode include:

●   Loss of interest in activities and loss of pleasure

●   Extreme sadness

●   Feelings of hopelessness and despair

●   Sleep disturbances (insomnia or hypersomnia)

●   Anxiety about small meaningless things

●   Physiological symptoms not responding to treatment

●   Eating problems

●   Weight gain or loss

●   Feelings of extreme guilt about everything that appears to be going wrong

●   Concentration and memory problems

●   Irritability triggered by smells, noises, tight clothing, and other trivial things

●   Inability to get up and move about doing normal life chores

●   Extreme fatigue, tiredness and/or restlessness

●   In many cases where the symptoms are severe, the individual suffers from suicidal ideation and some might think about acting on them.

In both manic and depressive episodes, psychosis can occur and the person might not be able to tell the difference between reality and fantasy.

During a person’s high state of manic/hypomanic phase, he might believe that he is famous and has connections with high ranking people.

While in the depressive phase, he might think that he has committed a crime.

Teenagers and children with bipolar disorder are likely to have rapid mood changes, explosive anger, temper tantrums, reckless behaviour and outbursts of aggression.

All the symptoms mentioned above should not be chronic but episodic to make a diagnosis of bipolar disorder and these are manageable with proper treatment.

Types of bipolar disorder

There are three broad types of bipolar disorder according to DSM-5.

1.  Bipolar I disorder

2.  Bipolar II disorder

3.  Cyclothymia

Bipolar I Diagnostic Criteria

Bipolar I disorder is diagnosed when the criteria for manic episode criteria are met along with the hypomanic and depressive episode before the manic episode.

Manic Episode

a.      Persistently elated, elevated, or irritable mood and increased spur of energy, duration is for 1 week and happening for most days in the week.

b.      In the period of extreme escalated mood, three of the following are present:

a.      Grandiosity

b.      Decreased need for sleep

c.      Unusually talkative

d.      Flight of ideas

e.      Distractibility

f.       Increase in goal-directed activity

g.      Excessive involvement in activities that have a high potential for painful consequences

c.      The disturbance is causing discomfort in other domains of life

d.      The symptoms are not because of another drug or substance use.

Bipolar I (A complete guide)

Hypomanic Episode

a.      Persistently elated or irritable mood for the 4 consecutive days

b.      In the period of extreme escalated mood, three of the following are present:

a.      Grandiosity

b.      Decreased need for sleep

c.      Unusually talkative

d.      Flight of ideas

e.      Distractibility

f.       Increase in goal-directed activity

g.      Excessive involvement in activities that have a high potential for painful consequences

c.      The disturbance is causing discomfort in other domains of life

d.      The symptoms are not because of another drug or substance use.

Major Depressive Episode

a.      5 or more of the following symptoms present for at least 2 weeks, having depressed mood or loss of interest

a.      Depressed mood

b.      Lack of interest or pleasure in daily activities

c.      Weight loss

d.      Disturbance in sleep, Insomnia or hypersomnia

e.      Psychomotor agitation or retardation

f.       Fatigue or loss of energy

g.      Feelings of worthlessness or inappropriate guilt

h.      Inability to think or concentrate

i.       Recurrent thoughts of death or suicidal intentions

b.      The symptoms cause disturbance in other domains of life

c.      The symptoms are not because of any drug or substance abuse

Bipolar I Disorder

A.     Criteria for Manic Episode has been met

B.     The manic and depressive disorder episode are not because of another psychological condition.

Conditions of Diagnosis

The diagnosis should be made by the psychologist or a psychiatrist on the bases of the criteria mentioned in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

The criteria must be met for mania and depression for at least 7 days, including the symptoms of irritable or elevated mood and repetitive increased energy or activity levels.

For hypomania, symptoms must be met for at least 4 consecutive days.

Family members, teachers, colleagues and friends of the individual should report their observation of the symptoms.

Secondary signs of the conditions should easily be evident to other healthcare professionals.

Diagnosis should only be made after getting verbal reports from family and friends, clinicians’ observation and interview with the individual, physical examination, urine tests, and diagnostic tests.

Once received the diagnosis of Bipolar disorder, it will stay lifelong.

There might be periods of stability but the condition is not recoverable and a person can experience episode any time in his life again.

Comorbidities

Other conditions that might occur with bipolar disorder are:

●   Attention deficit hyperactivity disorder

●   Anxiety disorder

●   Post-traumatic stress disorder

●   Substance abuse disorders

It is important to understand that these comorbidities might actually be masking bipolar disorder.

As a person is more likely to seek help when he is in a down or low phase than during a high, hence, to prevent misdiagnosis, it is important for the mental health professional to go through a person’s history thoroughly and look for the signs of mania.

Causes of Bipolar Disorder

There is no single cause for Bipolar disorders but multiple factors interact to cause the condition.

These factors include:

●   Genetic factors: if any family member of a person suffers from this condition, he is more likely to have a bipolar emerge

●   Biological traits: physical changes in brains but the link with bipolar disorders is unclear

●   Imbalances of Brain-chemical: In many mood disorder, including bipolar disorders imbalance in neurotransmitters play a key role

●   Hormonal problems can trigger bipolar disorder

●   Environmental factors include significant loss, extreme mental stress or other traumatic event

Sometimes, there is a genetic predisposition in a person for bipolar disorder but only the environmental factors play a role in triggering the symptoms and mood shifts.

Bipolar I (A complete guide)

Treatment

Bipolar disorder can be managed with proper treatment.

The treatment aims to reduce the symptom severity and the frequency of depressive and manic/hypomanic episodes to help the person live a relatively productive and normal life.

If the condition goes untreated, mania or depression can persist for a long time and treatment will need three to four months to make improvements in the patient.

Treatment involves:

●   Combination of therapies

●   Medication

●   Physical and psychological interventions

Even though a person might continue to experience mood shifts but working with a doctor on a regular basis will help reduce the severity of symptoms and make them more manageable.

Medication

To treat long-term episodes of mania/hypomania and depression, the most common long term drug treatment which psychiatrists prescribe is Lithium carbonate.

This medication must be taken for 6 months at least.

The patient should refrain from self-medication, it is important to follow the instructions of a doctor about how and when to take the medication for them to work.

Other medications for bipolar include:

●   Antipsychotics like olanzapine, aripiprazole and risperidone and these are prescribed when the symptoms are severe resulting in disturbing behaviour

●   Anticonvulsants like Depakote are prescribed as a treatment for mania episodes

Drugs have side effects and need to be adjusted with mood shifts. If the patient is misdiagnosed and given antidepressants, it may trigger an episode of mania.

Therapeutic Interventions

To alleviate the symptoms and help patients manage them, psychotherapy is used.

It helps in making the patient identify and recognize the triggers to episodes which makes them able to decrease the secondary effects beforehand.

When the patient is taught to recognize the early symptoms of an episode, he can work on aspects that will help in maintaining the normal phase for as long as possible.

This is important in maintaining healthy relationships at work and home.

Following are the therapies used by therapists or psychologists to manage bipolar disorder:

●   Cognitive Behavioural Therapy (CBT)

●   Family therapy

●   Interpersonal therapy combined with CBT for depressive symptoms

●   Electroconvulsive therapy (ECT) when no other treatment is effective

In bipolar patients, hospitalization has become less common than it was in the past. Nevertheless, it is advisable for the patient to be temporarily hospitalized if he is harmful to themselves or others.

They should have a routine with enough sleep, a healthy diet, and regular exercise to keep them stable.

Bipolar disorder is a mood disorder that has two episodic phases; mania/hypomania and depression.

The person might feel extremely euphoric for months and then extremely sad for other months.

There can be a mixed state where mood shifts are rapid. There are three types of bipolar disorder, bipolar I, bipolar II and cyclothymia.

Even though it is a lifelong diagnosis and interferes with a person’s daily life but it is easily treatable with medication and psychotherapeutic help. Causes of bipolar disorder include a number of factors working together.

Frequently Asked Questions for Bipolar I

What is the difference between bipolar 1 and 2?

The difference between bipolar 1 and 2 is that in the Bipolar 1 disorder, along with manic episode the hypomanic or depressive episode is present, while in bipolar 2 disorder major depressive episode is experienced.

Is Bipolar 1 considered a disability?

Bipolar 1 is considered a disability and granted the benefits designated for disability.

What is the cause of bipolar 1 disorder?

The cause of Bipolar 1 disorder is hormonal imbalance, traumatic experiences and environmental factors.

Does Bipolar worsen with age?

Bipolar will worsen with age if not treated. Person may experience more severe episodes.

References

NIMH

MayoClinic

Medical News Today

Recommended Readings

An Unquiet Mind: A Memoir of Moods and Madness

The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know

Bipolar Disorder: A Guide for Patients and Families (2nd Edition)

The Bipolar Workbook, Second Edition: Tools for Controlling Your Mood Swings

Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability

Daniela Paez

Daniela Paez is a Clinical Psychologist with an MSc. In Clinical Neuropsychology from Bangor University. She has vast experience in working with children with disabilities, adolescents and their families, in extreme conditions of poverty and vulnerability. Additionally, she owns a private practice where she provides neuropsychological evaluation for children and adults, and treatment for mood disorders, anxiety, couple therapy, among other conditions.