Health Checkup: Bipolar disorder
Bipolar disorder, also referred to as manic-depressive disorder, is a psychiatric illness consisting of episodes of elevations in mood, either mania or hypomania. The disorder may better be described as a bipolar spectrum since it is subdivided into different types based on severity and type of mood episodes. Often these mood changes also include depressive episodes. It is estimated that approximately 2 percent of the population suffers from bipolar disorder.
First episodes usually start in the older teen or young adult years. This illness affects men and women equally although women tend to experience more episodes of depression. Although doctors do not completely understand the causes of bipolar disorder, there is likely a genetic component since it tends to run in families.
The hallmark of bipolar disorder is mania. During this mood state, people generally experience elevated or irritable mood, increased energy level, excessive or pressured speech, racing thoughts, decreased need for sleep, distractibility, and engage in risky behaviors such as excessive spending and substance abuse. If the manic episode is severe, people may also experience psychotic symptoms such as grandiose or delusional thinking. Some people may also experience hypomania which is a milder level of mania and does not include psychotic symptoms. The depressive phase of bipolar disorder can include feelings of sadness, hopelessness, difficulty with sleep and appetite, loss of interest in usual activities, and poor concentration and suicidal ideation.
Diagnosis of bipolar disorder is usually accomplished with thorough history taking of signs and symptoms of the illness. Individuals may self report these experiences or family and friends may notice the changes in mood and behavior. Although there is no biological test to diagnose bipolar disorder, a comprehensive physical examination is useful to exclude medical illnesses such as hypothyroidism, hyperthyroidism, infection or drug intoxication which may present with similar symptoms.
Treatment for bipolar disorder includes combination of pharmacology and psychotherapy. Mood stabilizing medication such as lithium and divalproex sodium are key to the treatment of this illness. Medications can effectively treat the acute episode as well as prevent future episodes of mania and depression. More recently, atypical antipsychotic medications such as quetiapine and olanzapine have been approved for treatment of bipolar disorder. Psychotherapy can be helpful for patients in understanding their illness, recognizing symptoms, recognizing triggers to mood changes, and improving interpersonal relationships. It is important to continue taking medication and psychotherapy even when feeling better in order to maintain mood stability and improve prognosis.
Sue DiGiovanni, M.D., is an associate professor of psychiatry at the University of Rochester Medical Center.
