Bipolar affective disorder is a mental disorder that manifests itself in the form of conditions such as: manic, hypomanic, and depressive.
The episodes can have a duration from several weeks to three-six months.
The duration of the cycle (from one episode to another) can vastly differ among patients. Only a small number of people experience a rotation of both mania and depression in each cycle; in most cases, one somewhat prevails over the other. Some patients have occasional episodes, arguably only a few in their lifetime, while others have a form of quick cycles (usually more than four episodes/year).
Patients may attempt or commit suicide. Suicide among patients with bipolar disorder is estimated to be at least fifteen times higher than in the rest of the population.
Bipolar disorders are classified as:
Bipolar disorder type I: It is defined by at least one full (meaning disturbing normal social and professional activity) manic episode and recurrent depressive episode. Bipolar disorder type I is a state in which the patient experiences constant manias, meaning overexcitement, excited inadequate behavior, manic psychosis, as well as severe depression.
Bipolar disorder type II: is characterized by severe depressive episodes and at least one hypomanic episode, however without a full manic episode. Short periods of hypomania and severe depressive episodes are characteristic of bipolar disorder type II. Hypomania is a pre-manic state that is less severe than mania.
Manic episode
A manic episode is a period of more than one week of consistent elevated, expansive, or irritable mood, energetic or constant enhanced goal-oriented activity with at least three of these extra symptoms:
- Ego boost or delusions of grandeur
- Less need for sleep
- Much more talkative than usual (chattiness)
- Blue skies thinking and ideas
- Absent-mindedness
- Increased work activity
- Excessive engagement in activities with a high risk of unfortunate outcomes (extreme purchasing activity, irrational monetary investment).
- Patients with the manic disorder can actively, excessively, and impulsively engage in risky events (gambling games, dangerous sports, messy sexual life).
- Symptoms are so serious that they are not able to engage in their primary activity (work, school, housework). Irrational investments increased expenses, and other personal desires can lead to unsolvable consequences.
- In manic episodes, patients can be very energetic, and dress flashy, and bright, they also have a dominant demeanor with a fast and unstoppable flow of speech. Patients may have word associations based on audible similarities.
- In this state, patients are easily distracted, jumping from one topic to another. However, patients believe this is their best mental state.
- A lack of self-criticism and an increase in business activity often lead to compulsive behavior, which can be a dangerous combination.
- Interpersonal conflicts can lead patients to develop the idea that they are being undeservedly and wrongfully persecuted. Eventually, patients can endanger themselves and others. Active mental activity occurs as chaotic thoughts and flight of ideas.
Manic psychosis
Manic psychosis is the most subtle form of the disorder with strong psychotic symptoms that are hard to distinguish from schizophrenia. Patients may develop delusions of persecution, sometimes with hallucinations.
- Activity level significantly increases; patients may run around and yell, curse, or yell.
- Mood lability is increased, often with increased irritability. Severe delusions (delusional mania) can be developed with a total loss of coherent mindset and behavior.
Hypomanic episode
A hypomanic episode is a less pronounced version of mania, in which a particular episode lasts more than four days (notably, the patient’s behavior is vastly different from behavior in a non-depressive, usual state) and includes more than three additional symptoms mentioned in mania’s description.
- During the hypomanic episode mood increases, less need for sleep, and boost in psychomotor activity.
- In some patients, hypomanic episodes are adaptive because they provide high energy levels, creativity, self-confidence, and uncanny social performance.
- Many people don’t want to lose the pleasing, euphoric state.
- Some functions are good enough and in the majority of cases functioning decreases subtly.
- Nonetheless, some patients are struggling with bad attention span, irritability, and emotional lability, which causes the patient and others slight problems.
Depressive episode
The depressive episode has aspects of major depression, the episode has to include more than five following symptoms during a one or two-week-long period, and one of them has to be low mood or loss of interest or pleasure.
- Depressed mood for most of the day
- Noticeable decrease meant in interest or pleasure from all or almost all kinds of activities during most of the day
- Significant (> 5%) weight loss/gain or reduced/increased appetite
- Insomnia (often connected to an inability to maintain sleep) or hypersomnia
- Psychomotor arousal or inhibition observed by others (not self-esteem)
- Weariness or loss of energy
- The feeling of uselessness or excessive or groundless guilt
- Decreased ability to think or concentrate, or indecisiveness
- Recurring thoughts about death or suicide, suicide attempts, or a very specific plan to commit suicide
- Psychotic traits are more characteristic of bipolar depression rather than monopolar
Mixed episode
- An episode of mania or hypomania is called a mixed episode if ≥ 3 depressive symptoms are present on most days during the episode.
- This type of disorder is often challenging to diagnose and it can be masked as a constant cyclic state; the estimation is worse than a pure manic or hypomanic state.
- The risk of suicidality is especially high during mixed episodes.