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Bipolar disorder is the name of a group of mood disorders characterized
by alternation between periods of high energy, known as mania, and periods
of depression. These emotional highs and lows are much more
extreme than the mood changes that most people experience. There are
three major subtypes of bipolar disorder:
episode, with or without an episode of depression.
Bipolar disorder I (BPI): The person has had at least one manic
of depression and at least one hypomanic episode. Hypomania is a
milder form of mania that does not interfere with the person
daily functioning.
Bipolar disorder II (BPII): The person has had at least one episodes
which the person
two types.
Cyclothymia: Cyclothymia is a mild form of bipolar disorder ins highs and lows are not as extreme as in the first

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People with bipolar disorder alternate between periods of high energy or
irritability in which they may have difficulty sleeping, act impulsively,
and make ambitious plans alternating with periods of depression in which
they may feel guilty and hopeless, feel unable to accomplish anything,
and consider suicide. Some patients have a mixed state, in which the
high energy of the manic phase of the disorder is combined with the
blue mood of the depressed phase. The mixed state is more common
in children or adolescents with the disorder than in adults.
A person who has four or more episodes of
alternating between manic and depressive phases
within a twelve-month period is said to have
rapid cycling bipolar disorder. Rapid cycling is
more likely to develop later in the disorder. Some
people with rapid cycling have several episodes of
mood changes within a week or even within a
single day.
Bipolar disorder takes a heavy toll on a young
and relationships. In fact, it is often misdiagnosed
because people tend to attribute the person
depression and other mood changes to failed relationships
or trouble in school rather than seeing
the mood disturbances as the cause of these problems.
In some cases, the person with bipolar disorder
may be misdiagnosed as having a drug or
alcohol problem.
Most people with bipolar disorder are able to
function normally between episodes once they
get treatment. A small minority, however, have
chronic symptoms that do not improve in spite
of treatment.
s educational development, employment,s
The National Institute of Mental Health (NIMH)
estimates that about two million Americans over
the age of eighteen have bipolar disorder and
that the disorder costs the country about $15.5 billion every year. About
0.8 percent of the general adult population has BPI and 0.5 percent has
BPII. Most people develop symptoms of the disorder in the late teen
years or early twenties, but some begin to show signs of the disorder
in childhood and others may develop symptoms in their later years. In
general, however, a person who has their first manic episode after age
fifty should be examined for a medical disorder first before being diagnosed
with bipolar disorder.
Men and women are at equal risk of developing BPI, although
women are more likely than men to have rapid cycling. Women are at
greater risk than men of developing BPII. Bipolar disorder occurs with
equal frequency in all races and ethnic groups, as far as is known.
Causes and Symptoms
The causes of bipolar disorder are not completely understood, although
the disorder is known to run in families. The disorder is not caused by
one gene, however, because identical twins of patients diagnosed with the
disorder do not always develop it.
Some doctors think that patients with bipolar disorder may have
chemical imbalances in the brain that affect moods and emotions, while
others think that there may be structural differences in these patients
brains as well. Still other researchers think that bipolar disorder may be
triggered by a combination of genetic factors and life experiences, as episodes
of mania in some patients are known to be triggered by changes in
medications, by thyroid disorders, or by inadequate sleep.
The symptoms of the manic phase of bipolar disorder may include:
Unusually high levels of energy
self-esteem, poor judgment
Euphoria (exaggerated sense of well-being), unrealistically high
Rapid speech, racing thoughts, insomnia
drive, drug or alcohol abuse
Risky or aggressive behavior, spending sprees, increased sexual
Easily distracted, unable to concentrate
The symptoms of the depressive phase may include:
Generally jumpy or agitated
Thoughts of suicide
Feelings of sadness or hopelessness
Anxiety and guilt
Loss of appetite
Loss of interest in friends or normally pleasurable activities
Some patients with bipolar disorder have psychotic episodes, which
means that they have hallucinations and other signs of losing contact
with reality. These patients are frequently misdiagnosed as having schizophrenia,
another severe mental illness.
There is no way to diagnose bipolar disorder through a blood test or
through imaging studies of the brain. The diagnosis is made on the basis
of the patient
The doctor will give the patient a complete physical examination to rule
out such physical disorders as diabetes or anemia, and a blood test to rule
out thyroid disease. The patient will also be given several psychological
tests to help the doctor evaluate their feelings and behaviors. Family
members and friends may also be asked about the patient
and behavior.
s symptoms and their history, including a family history.s recent symptoms

Treatment of bipolar disorder is a complicated and lifelong process. It is
important for patients to have regular appointments with a psychiatrist, a
doctor who is licensed to prescribe medications for mental disorders as
well as provide psychotherapy. Patients must see the psychiatrist even
when they are feeling better between episodes in order to prevent
relapses. In addition, psychiatrists are knowledgeable about the many different
drugs that can be used to treat bipolar disorder and can replace a
drug that is not working well for a particular patient with one that may
be more helpful or has fewer side effects. Sometimes patients may have
one set of drugs to take during a manic episode and a different set to take
during the depressive phase of the illness. The groups of drugs most commonly
prescribed for patients with bipolar disorder are mood stabilizers,
antidepressants, anti-seizure drugs, tranquilizers, and drugs to treat psychotic
In addition to medications, patients with bipolar disorder usually
work with a social worker or a psychotherapist because the disorder
affects so many areas of life. Learning about the illness and how to cope
with it is a crucial part of treatment; patients may be taught stress management
techniques or relaxation techniques in order to help them cope
more effectively with mood swings.
In some cases family therapy may be recommended so that the
blame themselves for causing it. In addition, families are often angry
at the patient because they may have to deal with the consequences of
the patient
abuse, and the family members may need help in managing their anger.
Patients with bipolar disorder may be hospitalized for treatment if
they are judged to be a danger to themselves or others. They can be
treated with electroconvulsive therapy (ECT) in the hospital if they are
having a severe episode of depression. Most treatments for bipolar disorder
can be given on an outpatient basis, however.

The prognosis for patients with bipolar disorder is generally good as long
as they keep in regular contact with their psychiatrist and follow all treatment
recommendations. Men, however, appear to have a somewhat
worse prognosis than women, as do patients with a history of alcohol and
drug abuse.
Patients with either BPI or BPII should report all changes in mood
to their doctor at once so that their treatment plan can be adjusted.
Keeping a daily chart of moods and feelings that can be shared with the
doctor is often helpful. Most patients are able to maintain a good quality
of life in spite of the disorder; however, about 11 percent will eventually
succeed in committing suicide.
There is no known way to prevent bipolar disorder, because the causes of
it are not yet fully understood.
The Future
The NIMH is presently conducting several clinical trials of new medications
and treatment strategies for bipolar disorder. Some of these are
known as
not hospitalized and are living productive lives. The newest large-scale
study sponsored by the NIMH is called the Systematic Treatment
Enhancement Program for Bipolar Disorder, or STEP-BD.
real-worldclinical trials, because they enroll patients who are
Depression; Stress
For more information
Abramovitz, Melissa.
Jamison, Kay Redfield.
New York: Alfred A. Knopf, 1995. This is the autobiography of a clinical
She is presently regarded as one of the foremost experts on the disorder.
Mondimore, Francis Mark.
Baltimore, MD: Johns Hopkins University Press, 2006.
Bipolar Disorder: A Guide for Patients and Families.
Charlie Rose.
(aired October 26, 1999; accessed April 28, 2008). This is a 17-
minute video of an interview with Dr. Jamison about her work with bipolar
disorder and suicide.
National Alliance on Mental Illness (NAMI).
Available online at http://www.nami.org/Template.cfm?Section=By_
23037 (updated October 2006; accessed April 28, 2008).
National Institute of Mental Health (NIMH).
PDF format at http://www.nimh.nih.gov/health/publications/bipolardisorder/
nimhbipolar.pdf (updated January 2007; accessed April 28, 2008).
PBS Online NewsHour.
Transcript available online at http://www.pbs.org/newshour/bb/health/janjune04/
drell_ex.html (accessed April 28, 2008). This is the transcript of an
interview with a 24-year-old man diagnosed with bipolar disorder. The
interviewee emphasizes the importance of working closely with one
and combining medications for the disorder with healthful lifestyle changes.

An Interview with Kay Redfield Jamison. Available online at http://About Mental Illness: Bipolar Disorder.Bipolar Disorder. Available inInterview with Christopher Drell, May 28, 2004.s doctor
Bipolar Disorder. Detroit, MI: Lucent Books, 2005.An Unquiet Mind: A Memoir of Moods and Madness.s struggle with bipolar disorder, which almost claimed her life.
s family members can better understand the illness and nots behavior, such as wild spending sprees or arrests for drug
Chronic pain without an obvious physical cause

Bipolar Disorder