Bipolar disorder, also called bipolar disorder or manic depression, is a serious mental illness. It primarily causes abnormal fluctuations in mood, energy, and mental functioning. It is characterized by recurrent episodes of depressive, manic, and/or mixed symptom states. These symptoms can lead to broken relationships, decreased performance at work or school, and even suicide. The lifetime likelihood of developing this disorder in the general population is about 4%. Approximately 1/3 of patients have an onset before the age of 13, 1/3 between the ages of 13 – 18, and 1/3 after the age of 18. It is clear that this disorder tends to begin in childhood and adolescence.
There is such a famous high school student, 16 years old, usually cheerful and lively, with excellent grades. 2 years ago, due to bad mood, loss of interest, learning ability, poor memory, test scores backward, want to suicide and other depressive manifestations for more than a month to seek treatment in the clinic. After taking medication, her condition stabilized quickly. When he got better, he stopped taking the medication. 1 year ago, the patient began to show manic manifestations such as excitement and talk a lot, excessive optimism, blind self-confidence, feeling good about himself, high energy, good memory, reduced need for sleep, doing things impulsively and adventurously, often skipping classes, and liking to go to and from entertainment places. This patient has both depressive and manic phases, which is typical of bipolar disorder.
Bipolar disorder can cause dramatic mood swings – from sadness and hopelessness to ecstasy and/or temper tantrums, and so on, often with periods of normal mood in between. Severe changes in energy and behavior can occur along with changes in mood. Stages of sadness and hopelessness or euphoria and/or temper tantrums are called depressive or manic episodes, respectively.
The symptoms of a manic episode include, among others
1. dramatic changes in mood – or extreme irritability or euphoria.
2, inattentiveness – constantly shifting from one place to another.
3. increased volume of speech – talking too much, too fast.
4. racing thoughts and accelerated associations – changing topics too quickly; unable to be interrupted.
5.Overestimation or exaggeration of self – holding unrealistic beliefs about one’s abilities and strengths.
6, high energy – not feeling tired, increased activity, difficulty in being quiet or constantly changing plans and activities.
7. reckless behaviour – profligacy, irresponsibility, excessive involvement in risky behaviour or activities
8. reduced need for sleep – sleeping very little or getting by without sleep for several days without feeling tired
9. hypersexuality – enhanced sexual thoughts, feelings or behaviors; use of direct sexual language
10. deterioration of rational judgment.
11, substance abuse, especially alcohol, sleeping pills, etc.
12. not thinking there is something wrong with you.
The main symptoms of a depressive episode include.
1. persistent bad mood – feelings of sadness, grief, anxiety or emptiness
2, loss of interest and unpleasantness – loss of interest in activities once enjoyed and difficulty in doing things with pleasant experiences.
3. loss of energy or sense of fatigue – feeling of low energy, easy fatigue or unresponsiveness
4. psychomotor retardation or agitation – decreased excitability, slow movements, sometimes irritability, and easy temper tantrums.
5. low self-esteem, self-blame, or feelings of guilt – feelings of worthlessness, helplessness, or inappropriate guilt
6. difficulty in association or reduced ability to think consciously – difficulty concentrating, memory loss, difficulty making decisions
7. recurrent thoughts of death or suicidal or self-injurious behavior – frequent thoughts of death or suicide, or attempts to commit suicide
8. sleep disorders – excessive sleep, early awakening or difficulty falling asleep
9, appetite changes – reduced or increased appetite, the
10, weight change – significant weight loss or gain.
11. decreased sexual desire – loss of interest or pleasure in sexual activity
Not chronic pain or other persistent physical symptoms of discomfort caused by physical illness or trauma.
Generally, manic and depressive episodes recur throughout life. Between episodes, most patients with bipolar disorder have symptoms that disappear, but about 1/3 of patients have some residual symptoms, and a small percentage have chronic unremitting symptoms after treatment.
The typical bipolar disorder includes recurrent episodes of mania and depression and is called bipolar I disorder. However, some patients never experience severe mania, but instead have mild mania and depression, a condition known as bipolar II disorder. Some patients experience 4 or more episodes in a year, which is called rapid cycling bipolar disorder. Some patients even experience multiple episodes in a week or a day. The rapid cycling type often arises late in the course of the disease and is more common in women than men. There is another type of episode characterized by a mixture or rapid (i.e., within a few hours) transition of hypomanic, manic, and depressive symptoms, called a mixed bipolar disorder episode.
Bipolar disorder is a very common mental disorder. For various reasons, bipolar disorder is often overlooked or misdiagnosed.
1. Bipolar disorder is sometimes not considered as a disorder.
For example, when a patient has a mild manic episode, he is emotionally high, energetic, feels good about himself, and works efficiently, so he usually does not actively seek medical attention, and people around him do not think he has a mental illness; and when he seeks medical attention for a depressive episode, it is easy to ignore the previous manic symptoms, so this part of patients is often missed or misdiagnosed.
2, due to the complexity and hidden nature of bipolar disorder, and many patients with bipolar disorder have co-morbidities, including obsessive-compulsive disorder, social phobia, somatoform disorder, substance abuse, etc.. This can largely affect the correct diagnosis of bipolar disorder.
It is often misdiagnosed as monophasic depression, anxiety disorders, personality disorders, substance abuse, etc. before the final diagnosis is made, and some patients even have an onset in their late teens and are not diagnosed until they are in their 50s. Generally bipolar disorder takes about 10 years from the onset to the final diagnosis, and the average is 6-7 years.
3. Sometimes, severe manic or depressive episodes include severe psychotic symptoms.
Common psychotic symptoms are hallucinations (auditory hallucinations, visual hallucinations, or other sensory organs perceiving things that are not there) and delusions (strong beliefs that are false and cannot be influenced by logical reasoning or explained by the usual culture). The psychotic symptoms of bipolar disorder are mostly a reflection of the extreme state of mind at the time. For example, exaggerated delusions (beliefs that someone is president or has special powers or wealth) may arise during the manic phase; delusions of self-guilt or worthlessness (beliefs that someone is destroyed or poor or a criminal) may arise during the depressive phase. Patients with bipolar disorder with these symptoms are sometimes misdiagnosed as schizophrenia.
4. Symptoms of bipolar disorder in children and adolescents may initially be mistaken for the normal mood and behavior of children and adolescents.
In contrast to normal mood changes, bipolar disorder significantly impairs school functioning, resulting in inability to perform competently in school or poor grades. Hypersexuality is characteristic of many adolescents with bipolar disorder. They are extremely emotionally unstable, have high tempers, are very impulsive, and exhibit very severe ADHD-like symptoms. This leads to their rejection by peers and friends. Their suicide rate is three to four times higher than that expected in the general population.
The cause of bipolar disorder is not fully understood, and it is generally believed that it may be related to genetic and neurobiochemical, neuroendocrine, and neuroimmune alterations, and that psychological and social factors cannot be ignored. Strictly speaking, bipolar disorder is a lifelong brain disorder. Patients with bipolar disorder are in different mood swings for 19% of their lives, with a high relapse rate and a much higher success rate of suicide in bipolar disorder than in ordinary depressed patients, with 10-20% eventually dying by suicide. We should recognize that bipolar disorder, like hypertension and diabetes, is a long-term condition that requires a lifetime of care and attention.