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BIPOLAR DISORDER

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BIPOLAR DISORDER

Bipolar disorder, the most extreme form of which was previously known as manic depression, is a significant disturbance of mood characterized by ‘mood swings’, euphoria, high levels of energy and productivity. It is possibly the only condition where sufferers actually crave the return of some of the symptoms and it remains one of the most intriguing and disabling psychiatric disorders. Individuals with the disorder have demonstrated remarkable levels of creativity in fields such as literature, visual arts, music, and history.

The disorder was described as early as 1921 by Kraepelin who noted the range of symptoms, pattern of episodes and impairments in functioning. The disorder can have a lifetime prevalence of up to 2% (depending on the type of criteria being used) with many suffering from recurrent multiple and disabling episodes despite the use of mood-stabilizing medications. Although bipolar disorder can (rarely) commence in childhood, onset is commoner in the teens or early 20s. One epidemiological study has suggested a rate of 1% amongst adolescents (Lewinsohn, Klein and Seeley, 1995). The disorder is associated with high mortality and morbidity rates. Lifetime risk for suicide for people with bipolar disorder is 15%. Around one-quarter of people with bipolar disorder will make a suicide attempt (usually related to the depressive component) sometime in their lives. After cardiovascular events, suicide is the most likely cause of death for individuals with bipolar disorder (Angst et al., 2002).

Current conceptualizations of bipolar disorder

There has been considerable debate as to whether unipolar and bipolar disorders are categorical or dimensional constructs. Both the ICD-10 and DSM-IV assert a categorical approach to unipolar and bipolar disorder. However, some studies have argued for continuity between recurrent depressive episodes and bipolar disorder. There is also debate about the classification of the different types of bipolar disorder. Increasingly, however, there has been a move to the development of categories or subtypes of bipolar disorder such as Bipolar I and Bipolar II. The principal types of bipolar disorder, that is Bipolar I and Bipolar II, may be separate sub-types or differ merely dimensionally (e.g. by severity or duration), with the term ‘Bipolar Spectrum’ assuming dimensional differences.

The 

I-Manic Depression
II – Depression + Hypomania
III – Hypomania in association with antidepressant medication (starting up, withdrawing). This is referred to as ‘switching’.
IV – Depression superimposed on ‘hyperthymic temperaments’
V and VI – Other more ‘temperament’ concepts.

Bipolar I and Bipolar II may be distinguished by a number of key characteristics. People with Bipolar I are more likely to experience more ‘severe’ and longer highs or manic episodes (which may include psychotic features) and require treatment in hospital than those with Bipolar II. In contrast, Bipolar II is less severe with no psychotic experiences, and with episodes tending to last only hours to a few days. Symptoms of Bipolar II may not be as obvious as those for Bipolar I. While the highs in Bipolar II, often referred to as hypomania, can also be distressing to sufferers, they are often characterized by periods of intense productivity.

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