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Bipolar Disorder

Bipolar is short for Bipolar Disorder, or Manic Depressive Disorder. Bipolarity is another common word to use.

What Type of Bipolar Disorder Is It?

Each bipolar disorder illness is unique!

Uniqueness of Bipolar DisorderWhen nearly anyone thinks about bipolar disorder, they think of the symptoms of “regular” bipolar disorder.  Not that any person with bipolar disorder is “regular” (and most would not want to be), but there are several different subtypes of bipolar disorder.

One big problem with bipolar disorder is that each illness is unique.  Psychiatrists may classify them into categories – but they don’t always fit.  Here are some case scenarios: (bipolar episodesbipolar groups)

•    Jennifer has episodes where she is extremely agitated and unhappy and never seems to sleep very much.  These periods seem to last for a long period of time – but can alternate with months where she is simply unhappy and doesn’t feel like doing anything.
•    Max has had periods of depression before.  A lot of times, they go away after a couple of months and then he seems normal but recently he “disappeared” for a couple of weeks after some really bizarre behavior.  His friends never knew that he was any kind of bipolar until he told them he had been at the hospital.
•    Ben has periods of depression that can last for several months but when he is not depressed, he is productive and seems quite outgoing.
•    Sandra’s mood state can switch erratically.  One day she is all about shopping and the next time you call her, she is still in bed at noon.   This is a constant issue – and you never know what you are going to get.

These are three examples of bipolar disorder that don’t seem to fit the “normal” pattern.  None of these patients seems to be “regular” bipolar.

Bipolar disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as:

Bipolar Disorder TypeBipolar I Disorder: manic or mixed episodes that last at least 7 days – or if manic symptoms are severe enough to need hospitalization.  This, usually, includes periods of depression that last at least two weeks.
Jennifer and Max both fit into this category.  Even though Max never had a severe manic episode, having a bipolar episode that warrants medical attention, he qualifies for the Bipolar I category.  Jennifer has mixed episodes – rather than euphoria or traditional mania – she has periods of “dysphoria” where she is agitated, irritable and irrational but with an excess of energy.

Bipolar II Disorder: depressive and hypomanic episodes in a pattern – but manic episodes are not severe.
Ben has Bipolar II disorder.  He has periods of depression that are debilitating, but his non-depressed periods are quite productive, and he doesn’t exhibit manic behavior.

Bipolar Disorder Not Otherwise Specified: (Bipolar Disorder NOS) symptoms of illness don’t meet any other group, but the symptoms are clearly not within the standard range.
Sandra has BP-NOS.  She is what is commonly called a “rapid cycler,” meaning that she switches back and forth from mania to depression much faster than other people with bipolar disorder.

There is also a very mild form of bipolar disorder known as cyclothymia.  It is a cyclical pattern of hypomania alternating with periods of mild depression.  Many people would not even realize this is a problem.

Bipolar disorder is hard to classify.  It may be easy to determine that someone has a problem – but the uniqueness of each bipolar case makes it more difficult for even a patient to identify with the diagnosis.  Each type of bipolar disorder is, usually, treated the same medically. With an anti-manic agent (Lithium), anti-epileptic (Lamictal, Depakote) or atypical antipsychotic (Abilify, Zyprexa) – and sometimes with an antidepressant.

Melissa Lind

Lots of People don`t Know they are Bipolar

It seems to be a lot of people that don`t know what bipolar disorder is

There are people that I know that probably are bipolar, but they just don`t know it.
They have never been to counseling at a mental health professional to get diagnosed, because no one has told them that their problems, in fact, can be a mental illness.

Mental Mind SpiralOften-lot, grown-up people (age from 30 years and up) are not informed about what bipolar disorder is all about. They don`t know what it means, what it includes, how to get help and where to get help. Often-lot, not always.
The whole thing started probably when they were young, when bipolar disorder and all other mental illnesses were hush-hush and taboos’.

Of course, taboos and lack of information are not only a concern for those who might be bipolar, but for all kinds of mental illnesses that I know about.

If one suspects that a family member, a close friend or a coworker, has a mental illness, it is not easy to tell the person about what one believe/suspect.

Some people might suspect (themselves) that they have a mental illness, but are too proud to admit it, and for that reason not seek help from a counselor. They will probably never take any advice from others either regarding such sensitive personal things, having all taboos’ fresh in mind.

So, how do we approach these people – what are we supposed to do to let them know about our thoughts? Letting them know that there might be a “solution” to their problems. That it is somehow treatable – using medications. Tell them that it`s not their fault – they have an illness. They may at least feel better just by knowing.

Since IBipolar Mental Illnness suspect that a friend of mine is bipolar, should I contact a mental health professional just to ask for advice about how to approach my friend? I must admit; the thought has crossed my mind in several occasions related to some friends of mine, and especially in the case of member of my family.

I didn`t expect it to happen, but not long ago I got an opportunity to ask this special person in my life (my family member) how he felt about me asking a psychologist questions.

Just to get sorted things out. His answer was: don`t!
He didn`t want me to ask because he meant he had everything under control, and wanted to “mind his own business”. It wasn`t said in a rude way, he wasn`t angry with me, so, since he is an adult, I had to let it go.

Was that the right decision to make? I don`t have an answer to that question right now, so if anyone out there have an input to come with, please do – right here on this site, or on our Facebook page.

Lots of people that don`t know what bipolar disorder is

Bipolar Disorder Research Funding – Poorly Directed

Prepare yourself for a bit of a bipolar rant!

An article entitled “Bipolar Disorder in Youth Not as Chronic as Thought” in Medscape Pharmacists e-newsletter came across my email and while I was initially quite interested, I soon became annoyed.
Bipolar and Borderline (BPD)A recent study done at the University of Pittsburgh School of Medicine shows that bipolar disorder may not always be a chronic condition. While this may look like good news and you might see it pop up in the media as a big positive – cheerleader kind of thing, it really isn’t.

The study followed 413 children and adolescents who were 7 to 17 years of age and diagnosed with bipolar disorder at the time of study enrollment.  The patients and family members were interviewed about every eight months, for eight years.  What they found was that some of the patients were “ill” most of the time, some were “well” most of the time, and some were both ill and well.  Sorry, but that result isn’t astounding.

I find a couple of things wrong with the published results.

  1. They didn’t say whether the patients were stabilized on medication during the study – what medication, whether the medication was changed, whether the patients took the medication – in fact the publication doesn’t mention medication at all.
  2. The data collected was based on “interviews.”  Sorry, but being bipolar inherently predisposes you to lack of complete transparency.  Bipolar patients are likely to hide and lie – whether it is purposefully or subconscious behavior, it is a known problem.
  3. The patients were ages 7 to 17 when entering the study, meaning they were 15 to 25 at the end.  Many of the patients went through puberty during the study and what pubescent child or the post-pubescent adolescent is truly stable…or honest for that matter.  Interviews with the family may have partly balanced this but we also know how “well” our families may know us…some, not at all.

What I did find a little more relevant was that the patients tended to be “well” more of the time if they:

Though true, this is not astounding either.  It is easily recognized that if your family has a history of mental disorder, you are more likely to have a mental disorderBipolar disorder and substance abuse go hand in hand, and sexual abuse makes nothing more manageable.

Incidentally they also showed that patients would be more stable if they:

•    Had less history of severe depression, manic or hypomanic symptoms
•    Had fewer subsyndromal episodes

So basically, if the patients had a history of fewer episodes, they would have fewer episodes……really?
Not discounting the fact that any academic attention given to bipolar disorder, especially in juveniles should be welcome, I am disappointed because the study results didn’t show anything.  This is all information that anyone could guess – and the funding for mediocre “non-results” could have gone elsewhere.

This sort of news can easily lead to an “it will go away” thought process, lack of medication and lack of attention to and acknowledgment of the real and long-term challenges that a bipolar patient can face.  Yes, let’s all believe that bipolar disorder is not a chronic medical condition… let’s undo all the progress that has been made.

Melissa Lind

Academic attention given to bipolar disorder should be welcome!

Bipolar Disorder – Euphoria vs. Dysphoria or Mixed Episode

Most symptoms of Manic Episodes appear to be positive

Manic-depression or Bipolar disorder is usually perceived on of two ways – a person who alternates between depression and euphoria – or a person who alternates between depression and craziness.

Often a person who is told that they are bipolar will identify one of those two states – and will object based on the fact that they have never been “euphoric“, and they have never been actually psychotic or “crazy”.

Bipolar disorder or Manic-Depression is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – “the Bible” of psychiatric disorders – as “…clinical course that is characterized by the occurrence of one or more Manic Episodes…”

7 “points” retrieved from: DSM IV Criteria for Manic Episode – Food and Drug Administration

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. With three or more of:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas, or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

There is another specifier – “The symptoms do not meet criteria for a Mixed Episode” which is left out in a lot of thought processes.

Bipolar - EuphoricOne problem that is often encountered when diagnosing Bipolar disorder – or when trying to convince someone who has Bipolar disorder that they do, indeed have the illness – is that most of the “symptoms” of a Manic Episode appear to be “positive” or “happy.”  If you examine the wording – it looks on the surface and is often described as periods of “Euphoria” or extreme happiness.

In truth, many people with Bipolar disorder don’t have periods of “euphoria,” they don’t have what is perceived as “inflated self-esteem or grandiosity“, and they don’t seek out “excessive involvement in pleasurable activities.”  They may have “dysphoria,” they may believe that they have to do everything themselves, they may experience psychomotor agitation…they may be in a really active bad mood.

This is a state of “dysphoria.”  It is also called a “mixed state” where the Manic Episode and the Depressive Episode occur at the same time.  Features may include the racing thoughts, irritability, lack of sleep, psychomotor agitation of a Manic Episode but also include anhedonia or lack of enjoyment, inappropriate guilt, or suicidal thoughts which are symptoms of depression.

Unfortunately, this disconnects in presentation, and lack of awareness of mixed states (in both the patient and some professionals) often gives the bipolar patient an “easy out” in acceptance of the diagnosis.

Melissa Lind

Mixed Episode or Manic Episode with Mixed Features is given too little attention!

Bipolar Disorder and the Famous

Celebrities and bipolar disorder

Kurt Cobain - Bipolar MusicianKurt Cobain (1967-1994) American “Grunge” Musician – diagnosed with bipolar disorder and known drug abuse, suicide from self-inflicted gunshot wound to the head.
Bipolar disorder can be a devastating disease.  Some people might also claim it is a gift in a sense.  There are a lot of famous people with bipolar disorder – and a lot more who are suspected of having it but have never been diagnosed – or just haven’t admitted it.

Kay Redfield Jamison is one of the most well-known people with bipolar disorder as she has been a pioneer in removing the stigma associated with the disease – and other mental health disorders.  Jamison is the author of the book Touched with Fire which has had resonance with people around the world, but she isn’t the only one.

People alive today that are known to have bipolar disorder

  •  Adam Ant (musician)
  • Russell Brand (comedian, actor)
  • Patricia Cornwell (author)
  • Richard Dreyfus (actor)
  • Patty Duke (actress)
  • Carrie Fisher (actress, author)
  • Mel Gibson (actor, director)
  • Linda Hamilton (actress)
  • Jesse Jackson Jr. (politician)
  • Margot Kidder (actress)
  • Debra LaFave (schoolteacher convicted for having sexual relations with student)
  • Jane Pauley (journalist)
  • Axl Rose (musician)
  • Britney Spears (singer-songwriter)
  • Ted Turner (media mogul)
  • Robin Williams (comedian, actor)
  • Catherine Zeta-Jones (actress)

Deceased

  • Kurt Cobain (musician, songwriter)
  • Ernest Hemingway (author)
  • Margeux Hemingway (actress, granddaughter of Ernest Hemingway)
  • Abbie Hoffman (activist)
  • Vivien Leigh (actress)
  • Marilyn Monroe (actress)
  • Sylvia Plath (poet)
  • Edgar Allan Poe (poet, author)
  • Jackson Pollock (artist)
  • Frank Sinatra (musician, actor)
  • Brian Wilson (musician)
  • Amy Winehouse (musician)
  • Virginia Woolf (writer)

This is only a short list of those who are known to have bipolar disorder as there are many more – and many more than that is suspect, including some who are alive today.  Mostly these are celebrities – known as bipolar only because they are famous.  We can guess who might have bipolar disorder through the news stories about repeated brushes with the law involving drug and alcohol abuse and bizarre behavior.  We can also look at the list of the deceased and see how many of those have died through suicide.

It seems that there are an abnormal amount of celebrities with bipolar disorder – or that more people with bipolar disorder are celebrities.  It is doubtful that either case is true, simply that the bipolar person is a “shiner” – usually amazing in their accomplishments at the best of times, and tremendously tragic at the worst of times.

In many cases, we learn of a famous case of bipolar disorder when a celebrity has a notorious (or repeated) encounter with the law – often involving alcohol or drug abuse.  Also in many cases, these encounters will continue until the person is diagnosed, incarcerated or dead – or a combination of these events.
Substance abuse and bipolar disorder often go hand-in-hand – whether this is because the person is self-medicating or because their brain tells them the rush is good.  Many people – not just celebrities “hide” behind substance abuse as an excuse for wild and unusual behavior.  Think of the celebrities who have gone on very public benders, breaking into houses, repeated visits to jail, long and dangerous rants in public, lewd and dangerous behavior.  This is not normal– even for a drunk.

It is a sad fact that substance abuse is more readily accepted today than a mental disorder – but it is.

Think about that the next time you hear of a celebrity doing something heinous – or a series of something’s heinous – or a celebrity committing suicide.

The Last 48 Hours of Kurt Cobain

Abuse, bizarre behavior and bipolar disorder often go hand-in-hand.

Diagnosis and Symptoms of Bipolar Disorder

Bipolar disorder is difficult to diagnose.

The average bipolar patient will see three mental health professionals before getting the right diagnosis. In fact, one-third of bipolar patients will not be diagnosed with the disorder until more than 10 years after they first seek treatment.

There is a lot of similarity between the symptoms of bipolar disorder and other psychiatric conditions, but that isn’t the only reason why it is so difficult to diagnose. Here are some of the complicating factors:

Bipolar Disorder PatientThe patient only talks about depression – as bipolar disorder is a condition that has periods of depression alternating with manic episodes, many patients present when they are depressed. This is particularly true when a patient seeks treatment for themselves. Manic patients feel good or at least energized and are unlikely to believe that anything is wrong. Either they feel terrific, or they are in a heightened “bad” mood – and likely to blame that on other people or life circumstances. Consequently when they first seek treatment – they only profess to the depression as that is most bothersome.

Bipolar disorder looks like anxiety – in actuality, many, if not most bipolar patients also have some type of anxiety disorder. Consequently it may be very difficult for mental health professional to root out bipolar disorder. If patients are seen as agitated, hyperactive or fidgety, they may be only asked about anxiety or given a self-rating scale for anxiety. This would immediately lead the practitioner to diagnose an anxiety disorder – unless careful investigations were done.

Substance abuse can be complicating the issue – many bipolar patients spend years self-treating with substances of abuse. This includes prescription medications, recreational drugs and alcohol. There is not any particular drug that is more often abused by bipolar people as a whole – some will choose alcohol, some will prefer stimulants, some will choose pain medications – all of which will mask the symptoms to some extent. In some cases, the substance abuse appears to be more problematic than anything else and in cases of addiction; the substance abuse must be treated before an accurate evaluation can occur.

Denial is very common – Denial is a nice way of saying dishonesty. That would be lying. This sounds very harsh but in many cases, bipolar patients will not be honest about difficulties that they have had. It may be subconscious dishonesty in that they, themselves do not really know what the problem is. Lack of awareness is common but outright denial is also common. Many bipolar patients absolutely refuse to accept the diagnosis when it is first presented – even after years of not being treated properly. Oddly, this may make it more likely that the practitioner believes that the patient has bipolar disorder but such outright denial delays treatment.

These are just a few of the reasons why bipolar disorder is so difficult to pin down and, unfortunately, delayed treatment can have huge life implicationsBipolar disorder is one of the riskiest psychiatric illnesses to have and can have severe consequences for the patient who is not properly diagnosed and medicated – including job losses, family disturbance, institutionalization, jail and even death.

Bipolar disorder affects not only the patient himself – but family and loved ones as well.

Why is it so difficult to diagnose bipolar disorder?