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MENTAL HEALTH FACT SHEETS
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Bipolar Disorder
Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide.
The Problem
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. There is good news — bipolar disorder can be treated, and people with this illness can lead full and productive lives.
More than 2 million American adults, age 18 and older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, but one that brings in its wake almost unendurable suffering and, not infrequently, suicide.
Diagnosis Of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be identified physiologically-for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. People with bipolar disorder are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:
Depression: "1 doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…I am haunted…with the total, the desperate hopelessness of it all."
Mania: "The fast ideas become too fast and there are far too many…overwhelming confusion replaces clarity. ..you stop keeping up with it-memory goes. Infectious humor ceases to amuse."
Bipolar disorder causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
What Are The Signs And Symptoms?
Signs and symptoms of mania (or a manic episode) include:
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Spending sprees |
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Extreme irritability |
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Increased sexual drive |
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Racing thoughts |
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Abuse of drugs, particularly cocaine, alcohol, and sleeping medications |
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Jumping from one idea to another |
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Distractibility, can't concentrate well |
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Unrealistic beliefs in one's abilities |
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Provocative and intrusive behavior |
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Poor judgment |
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Increased energy, activity, and restlessness |
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Excessively "high," euphoric mood |
Signs and symptoms of depression (or a depressive episode) include:
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Lasting sad, anxious, or empty mood |
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Sleeping too much, or can't sleep |
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Feelings of hopelessness or pessimism |
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Unintended weight loss or gain |
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Feelings of guilt or worthlessness |
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Chronic pain |
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Loss of interest or pleasure in activities |
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Thoughts of death or suicide |
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Decreased energy, a feeling of fatigue |
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Difficulty concentrating |
Sometimes, severe episodes of mania or depression include symptoms of psychosis. Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. Bipolar disorder may appear to be a problem other than mental illness-for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships.
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.
What Is The Course Of Bipolar Disorder?
Episodes of mania and depression typically recur during an individual's life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic, unremitting symptoms despite treatment. Some people experience multiple episodes within a single week or even within a single day.
People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.
Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders. Drug abuse also may lead to such symptoms.
How Is Bipolar Disorder Treated?
Most people with bipolar disorder-even those with the most severe forms-can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
In treatment, bipolar people have great problems with the establishment of trust. The first problem is some degree of paranoia. They tend to be suspicious of people, they don't trust people's motives, and they feel persecuted. And they are grandiose. The second problem is even harder to deal with: they have no insight. Therefore they cannot tell their personality has changed and they feel nothing is wrong with them, even if they're acting in a bizarre manner. If this is not successfully dealt with, the outcome, both short-term and long-term, will be disastrous. This is very difficult to do. With most bipolar patients, once trust is established, the trust issues will need continuous repair.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to the doctor. Working closely with the psychiatrist and communicating openly about treatment concerns and options can make all the difference in treatment effectiveness.
Medications
Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder, and it is recommended that people with bipolar disorder see a psychiatrist for treatment. Several different types of mood stabilizers are available. In general, some people with bipolar disorder may continue treatment with mood stabilizers for extended periods of time.
• Most bipolar patients are going to need antidepressants. Some may need them all the time and some just occasionally. Prescribing antidepressants should be done only by physicians who have had extensive psychiatric training. Almost all antidepressants when given to bipolar patients will continue working even after the patient has been stabilized. On antidepressants, most bipolar patients will go from depression into mania. This must be watched carefully since it can put patients and their loved ones in danger.
• Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
• Children and adolescents with bipolar disorder generally are treated with lithium; however, researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents.
• Anticonvulsant medications also can have mood-stabilizing effects and may be especially useful for difficult to treat bipolar episodes.
Psychosocial Treatments
As an addition to medication, psychosocial treatments --including certain forms of psychotherapy (or "talk" therapy) --are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved patient functioning.
Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy.
• Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
• Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms.
• Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
Other Treatments
In some situations where medication and psychosocial treatment prove ineffective or work too slowly to relieve severe symptoms, electroconvulsive therapy (ECT) may be considered. However, the potential benefits and risks should be carefully reviewed with the attending psychiatrist.
The Path To Healing
Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists and psychiatric social workers, can assist in providing the person and family with additional approaches to treatment.
Rimrock Foundation has four newly licensed Crisis Stabilization beds available for patients who may need a short-term stay for the purpose of stabilizing them on prescribed medications or who may need a safe place with medical monitoring and evaluation but who do not require the full services of an acute psychiatric facility.
For further information on Rimrock Foundation's treatment of Bipolar Disorder, call Barbara Hansen, Admissions Supervisor at 1-800-227-3953 or 1-406-248-3175, or visit our website at rimrock.org. For more educational information on Bipolar Disorder, contact the Rimrock Foundation Library at 1-800-227-3953 or 1-406-248-3175.
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