Bipolar and related disorders are characterized by shifts of mood with severe highs (mania) and extreme lows (depression). The individual may be overactive, over-talkative and have a great deal of energy in a manic episode. While in a depressed episode, the individual may have any or all of the symptoms of a depressive. Either a manic episode or a depressive episode may be the first symptom of bipolar disorder, followed by repeated manic or depressive episodes, which are separated by periods. However, patients may continue to experience some symptoms and decreased functioning even during these "euthymic" periods. The timing of the recurrent episodes and their polarity, duration, and severity are highly variable between patients and can also be different in the same patient. The symptoms typically have a severely debilitating impact on the patient's functioning, education， employment and quality of life, and they can substantially elevate the risk of suicide, particularly during depressive episodes.
Types of Bipolar and Related Disorders
There are seven diagnoses included in the bipolar and related disorders section according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), including bipolar I disorder, bipolar II disorder, cyclothymia, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder. Below are the three main types of bipolar and related disorders.
Individuals with bipolar I disorder experience at least one manic episode in their lives. Most youth experience major or minor episodes during their lifetime. The episodes aren't due to a medical condition or substance use.
Individuals with bipolar II have at least one hypomanic episode and at least one major depressive episode. Hypomania is a lesser form of mania. There are no manic episodes, but the individual may experience a mixed episode.
Characterized by changing low-level depression along with periods of hypomania, cyclothymic disorder is primarily a chronic, fluctuating mood disturbance. The symptoms must be present for at least two years (one year in children and adolescents) before a diagnosis can be made. Adults may have symptom-free periods that last no longer than two months while about a month for children and teens.
Causes and Risk Factors
The exact cause of bipolar disorder is not clear, but several factors may be involved: 1) biological differences, such as physical changes in the brains, which are still uncertain but may eventually help pinpoint causes; 2) Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Risk factors that may increase the risk of developing bipolar disorder include having a first-degree relative with bipolar disorder, periods of high stress, alcohol or drug abuse.
Diagnosis and Treatment
Getting an accurate diagnosis is the first step in the treatment of bipolar disorder, but it isn't easy. The mood swings of bipolar disorder can be difficult to distinguish from other problems, such as major depression, attention deficit hyperactivity disorder (ADHD) and borderline personality disorder. For many people with bipolar disorder, it takes time before the problem is correctly identified.
Typically, treatment entails a combination of three main classes of medication: mood stabilizers, antipsychotics, and antidepressants. Lithium carbonate and valproic acid are the most widely used drugs for the treatment of bipolar disorder. Lithium carbonate is very effective in reducing mania and may also prevent the recurrence of depression, but its value seems greater against mania than depression. Therefore, it is often used with other medicines against depression, sometimes including antidepressants. Valproic acid is a mood stabilizer that helps treat the manic or mixed phases of bipolar disorder, along with carbamazepine, an antiepileptic medication. These drugs may be used singly or in combination to control symptoms. Moreover, lamotrigine, another antiepileptic drug, is valuable for preventing depression and, to a lesser degree, manias or hypomanias.
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