What is bipolar disorder?
Individuals
with bipolar disorder classically have cycles of depression alternating
with euphoric/irritable mood states (called mania). There are several
disorders of mood in addition to the depressive disorders that involve
depression as well as manic or hypomanic mood states. The additional mood
disorders are as follows:
A manic
episode is defined as a period of euphoric and/or irritable mood that
lasts at least 4 days; it is characterized by a decreased need for sleep,
racing thoughts, the need to keep speaking, inflated self-esteem or
grandiose thinking, and excess goal-directed activities. The same group
of symptoms also defines a hypomanic episode, but the severity is judged
to be less. Individuals in the midst of a manic episode can become
psychotic and require hospitalization.
In bipolar I disorder, the person must have a history of at least one
manic episode. The number of depressive episodes can be as few as none to
any amount. Classically, an afflicted person alternates between episodes
with normal mood in between. However, cycles can consist of any frequency
of mood states in any order. Bipolar II disorder is comprised of
depressive episodes alternating with hypomanic episodes only (no mania).
In cyclothymia, no major depressive episode has occurred, but mild
depressive episodes alternate with hypomanic states. Mood disorder not
otherwise specified is also a condition of exclusion in that a mood
disorder is considered present, but the criteria have not been met for
the other conditions in the DSM-IV-TR.
In someone presenting with depression, these conditions can only be
excluded by a thorough history of symptoms and episodes in the past.
Sometimes the patient does not recall such episodes, however, such that a
bipolar condition is not learned of until the treatment for depression is
initiated.
