Bipolar Affective Disorder

Bipolar affective disorder (BPAD) is a mental health illness which can be severe. It used to be known as manic depression and is characterised by significant mood swings, ranging from manic highs to depressive lows - which usually alternate.

We all experience normal mood variations. On good days our self-esteem is good, and we feel optimistic, energised, sociable and articulate, make good decisions and get work done. We generally enjoy life. On bad days we may feel less sociable, a bit mood or irritable, concentration may be less than usual, slight agitation. In other words, there is a normal variation in our moods that may or may not be in relation to extrinsic circumstances.

Bipolar individuals also experience these normal mood variations. If their mood then starts to dip, they may become mildly or moderately depressed. They may experience feelings of panic and anxiety, experience concentration difficulties and memory problems, thinking may be slowed, appetite diminished. They may feel they need to be alone, sleep may become problematic or they may sleep excessively and everything starts to become a struggle. If their depression becomes severe, they may experience feelings of hopelessness and guilt, thoughts of suicide become prominent, they may feel there is no way out and no chance of recovery. It becomes impossible to do anything. Everything is bleak.

If the opposite happens and their mood elevates and becomes infectious. Individuals become very productive and everything is done to excess (phone calls, writing, smoking, alcohol consumption). The person is more charming and talkative and fun to be around. This is known as hypomania (mild mania) As this progressed, mood becomes euphoric and no longer infectious. There may be inflated self-esteem, rapid thoughts and speech and counterproductive simultaneous tasks. The person may be irritable and more difficult to reason with. Disinhibited behaviour may cause problems (spending money, sexually).
If the person becomes manic they start losing touch with reality. There is loss of judgment, lack of sleep. They may engage in reckless and impulsive spending and sexual behaviour which may be often dangerous. Speech may become incoherent, paranoia may develop, various delusions and hallucination may develop, often of a grandiose nature.

Mania and severe depression usually require treatment in hospital. Sometimes individuals are Sectioned under the Mental Health Act as the have lost the ability to recognise how unwell they are and do not see the need for treatment.

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely "up," elated, and energized behaviour (known as manic episodes) to very sad, "down," or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

Bipolar I disorder is defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible

Bipolar II disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above

Cyclothymic disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode

Other specified and unspecified bipolar and related disorders— defined by bipolar disorder symptoms that do not match the three categories listed above. These may include subthreshold bipolar spectrum disorders which may have manic and depressive symptoms as well, but do not meet strict criteria for any specific type of bipolar disorders despite still being significantly disabled by their symptoms.

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