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Wiki’s description of Bipolar Disorder.

disorder is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of “normal” mood, but in some individuals, depression and mania may rapidly alternate, known as rapid cycling. Extreme manic episodes can sometimes lead to psychotic symptoms such as delusions and hallucinations. The disorder has been subdivided into I, II, cyclothymia, and other types, based on the nature and severity of mood episodes experienced; the range is often described as the spectrum.

Data from the United States on lifetime prevalence vary but indicate a rate of around 1 percent for I, 0.5 to 1 percent for II or cyclothymia, and between 2 and 5 percent for subthreshold cases meeting some but not all criteria. The onset of full symptoms generally occurs in late adolescence or young adulthood. Diagnosis is based on the person’s self-reported experiences, as well as observed behavior. Episodes of abnormality are associated with distress and disruption, and an elevated risk of suicide, especially during depressive episodes. In some cases it can be a devastating long-lasting disorder. In some cases, however, it has been associated with creativity, goal striving and positive achievements.

Genetic factors contribute substantially to the likelihood of developing disorder, and environmental factors are also implicated. disorder is often treated with mood stabilizer medications, and sometimes other psychiatric drugs. Psychotherapy also has a role, often when there has been some recovery of stability. In serious cases in which there is a risk of harm to oneself or others involuntary commitment may be used; these cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with social stigma, stereotypes and prejudice against individuals with a diagnosis of disorder.

Also called manic depression or affective disorder, the current term “” is of fairly recent origin and refers to the cycling between high and low episodes (poles). A relationship between mania and melancholia had long been observed, although the basis of the current conceptualisation can be traced back to French psychiatrists in the 1850s. The term “manic-depressive illness” or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all kinds of mood disorder. German psychiatrist Karl Leonhard split the classification again in 1957, employing the terms unipolar disorder (Major depressive disorder) and disorder.

Signs and symptoms

disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and abnormally depressed states for short, or significant periods of time; in a way that interferes with functioning. disorder has been estimated to affect more than 5 million Americans—about 3 out of every 100 adults. It affects people without regard to age, race, ethnicity, gender, education or occupation. Not everyone’s symptoms are the same and there is no blood test to confirm the disorder. Scientists believe that disorder may be caused when chemicals in the brain are out of balance. disorder can look like depression. Distinguishing the illness is tricky, even for mental health professionals. What makes disorder different is that in addition to depression, a person also experiences the “highs” of a manic phase.

Major depressive episode

Signs and symptoms of the depressive phase of disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation. In severe cases, the individual may become psychotic, a condition also known as severe depression with psychotic features.

Manic episode

Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person’s speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them.

They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant or intrusive. People may feel out of control or unstoppable. People may feel they have been “chosen”, are “on a special mission”, or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood. Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose.

In order to be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM) a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required. According to the National Institute of Mental Health, “A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.”

Hypomanic episode

Hypomania is generally a mild to moderate level of mania, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Some people have increased creativity while others demonstrate poor judgment and irritability. These persons generally have increased energy and tend to become more active than usual. They do not, however, have delusions or hallucinations. Hypomania can be difficult to diagnose because it may masquerade as mere happiness, though it carries the same risks as mania.

Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.

Mixed affective episode

In the context of disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage).

Criteria and subtypes

There is no clear consensus as to how many types of disorder exist.[16] In DSM-IV-TR and ICD-10, disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists four types of mood disorders which fit into the categories: I, II, Cyclothymia, and Disorder NOS (Not Otherwise Specified).

I

In I disorder, an individual has experienced one or more manic episodes with or without major depressive episodes. For a diagnosis of I disorder according to the DSM-IV-TR, one or more manic or mixed episodes are required. A depressive episode is not required for the diagnosis of I disorder but it frequently occurs.

II

II disorder is characterized by hypomanic episodes rather than actual manic episodes, as well as at least one major depressive episode. There has never been a manic episode or a mixed episode. Hypomanic episodes do not go to the full extremes of mania (i.e. do not usually cause severe social or occupational impairment, and without psychosis), and this can make II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression. For both I and II, there are a number of specifiers that indicate the presentation and course of the disorder, including “chronic”, “rapid cycling”, “catatonic” and “melancholic”.

Cyclothymia

Cyclothymia involves a presence or history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning.

NOS

Disorder Not Otherwise Specified is a catch-all diagnosis that is used to indicate illness that does not fit into the other diagnostic categories. If an individual clearly seems to be suffering from some type of disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Disorder NOS (Not Otherwise Specified).

Rapid cycling

Most people who meet criteria for disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.

Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more episodes per year and is found in a significant fraction of individuals with disorder. The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period.[19] There are references that describe very rapid (ultra-rapid) or extremely rapid[20] (ultra-ultra or ultradian) cycling. One definition of ultra-ultra rapid cycling is defining distinct shifts in mood within a 24–48-hour period.

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