What is bipolar disorder?
Bipolar disorder is a disorder of mental function in which the person’s mood can swing between two (‘bi’) poles ranging from the elated hyperactivity of mania on the one hand to the flatness of depression on the other. It was previously called manic-depressive illness.
How common is it and who gets it?
About 1 in 100 people in the population suffer from bipolar disorder. It tends to run in families, and men and women are equally likely to develop it. The usual age of onset is in the late teens or 20s (especially). It tends to develop in some women after childbirth or during menopause.
What causes bipolar disorder?
The cause is believed to be a combination of factors including genetics, biochemistry, and stress. Studies point to genetic transmission, including the observation that children of parents with it have an increased risk. There is thought to be a chemical imbalance in the brain, which can be corrected with appropriate medication. Stress may be responsible for triggering the problem in some cases.
What is normal and abnormal?
A normal person has a fluctuation or swinging of moods varying from moderate liveliness to moderate lethargy, depending on circumstances from day to day or month to month. It is normal to feel flat sometimes and elated at others. However, people with bipolar disorder have extreme moods unrelated to external events. They are prone to exhibit behavior that is uncharacteristic and not usually socially acceptable.
They may have periods of normal human behavior lasting for a short time or for many months sandwiched in between the two extremes of mania and depression. The degree of bipolar disorder can range from mild to severe. Some people may only experience episodes of mania or hypomania, without sliding into depression. Most sufferers are able to lead relatively normal lives.
What are the symptoms?
The mania ‘pole’: This phase is where the mood is mainly elevated, irritable, and argumentative. Close relatives or associates are more likely to recognize the beginning of the manic phase than the sufferer, who may have no insight into their condition. It usually begins with a less severe degree of mania (called hypomania) which may stay at this stage or progress to the manic stage.
- Stage 1: Hypomania
- Increasing activity and restlessness; ‘high’
- Reduced sleep, early waking.
- Leaping out of bed early and vigorously.
- Talkative; fast speech.
- Easily distracted.
- Decreasing work performance
- Enthusiastically starts (rarely finishes) new projects.
- Increased sexual drive and activity.
Stage 2: Mania
- ‘High as a kite’
- Reckless behavior (e.g. spending sprees, running up debts, sexual promiscuity)
- Wild, garrulous speech
- Grandiose ideas and plans
- Impaired judgment/lack of insight
- Hasty decisions (e.g. job resignation, marriage)
- Paranoia
- Racing thoughts; flights of ideas the person may be out of touch with reality, such as having delusions (false beliefs) or hallucinations. Behavior may include singing, dancing or laughing for no reason.
The depression ‘pole’: There are typical depressive symptoms but with a tendency to be more severe with bipolar disorder. The onset is gradual, and sufferers become increasingly withdrawn and lose interest in things that they normally enjoy. There is a slowing down of many basic functions such as energy, appetite, sex drive, speech, and movement. Sleep is affected. Problems multiply with pessimism, guilt feelings and reduced self-esteem and confidence. Some feel unable to face the world and that life is not worth living and may stay shut in their room. Thoughts about death and suicide are common and indicate the need for urgent attention.
What should be done?
Since the illness is most easily treated in its early stages, it is best to see or speak to a psychiatrist as soon as possible if you suspect that either you or an acquaintance is bipolar. Doctors often rely heavily on information from people other than the patient to make the diagnosis. Sufferers tend to lack insight, fail to realize their problem, and tend to conceal it from their doctors. There are no available diagnostic laboratory tests.
What is the treatment of bipolar disorder?
The good news is that it responds well to modern medications, which aim to correct an apparent chemical imbalance in the nervous system. Antidepressants are used for the depressive phase. The treatment should be carefully supervised so that relapses can be prevented. Supportive psychotherapy is also important. Patients with severe episodes, especially the first one, usually require hospitalization. With appropriate treatment and support, most people with bipolar disorder can lead full and productive lives.
References
- Murtagh’s patient education, sixth edition © mcgraw-hill
- Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991.
- Norman Vincent Peale, The Power of Positive Living, Vermilion, London, 1996.
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