Category Archives: What is Bipolar

A description on that is Bipolar Disorder

Diagnosis of Bipolar


Only a medical Doctor – usually a Psychiatrist can diagnose you with Bipolar Disorder. A general practitioner or another specialist can also but it is preferable that a Psychiatrist does it.

A psychologist, herbal practitioner, counselor, priest, nurse, Psychiatric nurse and family member can NOT diagnose you with Bipolar Disorder.

Online testing can give you an indication but cannot be used as an accurate diagnostic tool. There are no tests for Bipolar Disorder other than psychological to give an indication. Medically there are at this stage no tests. Psychiatrists diagnose Bipolar based on feedback, monitoring, experimenting with medication and experience. Bipolar Disorder is one of the most complex disorders there are. Treating it with ignorance and chopping and changing medications without a Doctor’s consent is irresponsible.

It is important to have your diagnosis confirmed and treated by a medical Doctor.

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The Sadness of Joy

The Sadness of Joy

by Herman Le Roux (Co-Founder of BSB)

For a lot of people that suffer from Bipolar disorder or other mental illnesses or disorders, Christmas and New Year can be a very difficult time. There are several reasons for this. Often people with mental illness do not have any friends because they fail at relationships and often families made the choice to have them institutionalized never to visit them again. A lot of people with mental illness do not work and have to come by on a meagre pension or grant. For hundreds of thousands of people the only friend on Christmas day is a computer screen and a keyboard. There will be no cake, no crackers and no presents. Some people in institutions are so ill they do not even know it is Christmas. Some had a life, with a family, maybe even children but due to circumstances beyond their control they lost all of that. Sometimes they lost their jobs and can no longer afford to enjoy some of the finer things in life. In some countries the mentally ill do not even have access to the internet and the Festive Season is a very lonely and depressing time. For a lot of mentally ill people new-year is also a heavy burden. They don’t see a way forward, they don’t see how they will carry on another year.

As is every year the case thousands of lonely and ill people will take their own lives because they cannot cope with the pain and loneliness anymore. Some will start the new year with a lot of hope only to have it crushed again. Some will remember last year’s promise that that Christmas would be the last one alone, only to have that become a lie again.

But…..

There is hope. There is always the chance of meeting that person that truly understand you. There is always the hope that you would become happy and that you would be appreciated. There is a chance for a new medication. There is a chance that out of the hundreds of millions of people on the Internet you will find a soul that will touch your heart and make it smile.

If you know a person that suffers from mental illness make a difference in their live. Make them feel loved and cared for. Make them feel wanted and accepted. There is nothing more healing than being acknowledged.

You can make a difference in someone’s life and also in your own life by knowing one thing. Somewhere there is someone that cares. Somewhere is a place for me.

HHLR

Explaining Bipolar to Children

Explaining to My Child that I Am Bipolar

 

Being a parent can be difficult, and being a parent with bipolar disorder can be even more difficult as it presents its own set of unique challenges. As a parent with bipolar, you may have asked yourself whether you should tell your child/children about your disorder. In my experience in working with children and adolescents I think it is best to tell them. Generally speaking most kids will eventually know that there is something not right with their bipolar parent/s but they often cannot make sense of it. Therefore it is important that you talk with them about the illness, explaining what it is and how it can affect your everyday living.

In dealing with children on any issue it is wise to explain things at an age appropriate level. For instance you would explain your illness to your 5 year old much differently than you would to a 10 year old or a teenager. With a 5 year old you may say something like; “your mommy has an illness that can make her sick sometimes. My illness is called bipolar disorder and it can make mommy sick some days. One day mommy may be ok and feeling good but on another day mommy could feel sick and not be able to do a lot. I take medicine from the doctor to help make me feel better but sometimes the medicine doesn’t always work. It is not your fault that I have this illness and I don’t want you to be sad or worried about it. If I get too sick I may have to go to the hospital but there are doctors and nurses there to help me get better.” As your child/children age their fears and questions will likely be different and will require more elaborate answers from you. If you continue to educate yourself on bipolar disorder not only will you be able to provide some good answers for your children but it will help you better manage your disorder as well.

Basically if you can talk to your child about it like you would any other topic you should be able to help them understand. Your child may have some fears about it and a lot of questions. Try to reassure your child by talking about any fears that they have. If you also let your child know about what you can and cannot do that is often helpful for them, it tends to lessen some of the confusion. It is also a good idea to tell children about your bipolar when you are well. It will be less stressful for you and easier to answer any questions they may have. If they have a question that you are unable to answer it would be wise to be honest and say “I don’t know the answer to that question but I will try and find out for you.” You may have to do some research or talk with others or even a counsellor or your doctor to find the answer out. However in doing so you will show your child that you can now answer their question and that will reassure them that much more.

Unfortunately there is a fair amount of “stigma” in society with regards to mental illness, including bipolar disorder. Because of this many children will be exposed to some inaccurate information and negative comments about any given illness. It is important to explain to children that some people do not understand about your illness and can say some really mean things. Encourage your child to tell you about this if it occurs and it likely will, so be prepared. At least that way you can discuss with your child any confusion or upsetting feelings that they may have as a result of a negative comment about you and/or your illness. Also keep in mind that children can hear negative connotations about mental illness through the media, particularly on television shows and in the movies. Another way to keep the lines of communication open with your child/children is to have weekly family meetings. These meetings do not have to center around your bipolar disorder they can include any topic of conversation that may help everyone in the family with any problems that may have arisen over the course of the week. Encourage your children to openly ask questions about mom or dad’s moods and behavior if there was something that occurred during the week that was related to your bipolar disorder.

When first telling children about your illness it is likely best to talk to them on an individual basis. This will not only increase your bond with each child but will also make it easier for the child to listen and learn about your bipolar. Also each child may respond or react differently while you are explaining things to them. It will be easier for you and the child to discuss things on a one to one basis. In addition the individual time spent should make it easier for your child to come to you in the future with any fears or concerns they may be having regarding your illness.

Other things that you can do to help explain bipolar disorder to children is to use resources such as books and mental health websites. For example there is a book called “The Rainbow Angels” by Madeleine Kelly which is a story that helps explain bipolar disorder to children. You may also want to call a local mental health clinic to see if they can provide any information to you. Sometimes clinics will have fact sheets or brochures on mental illness that can be helpful. Some areas may even have a support group for bipolar parents and/or support groups for the children of bipolar parents. Words of caution if you are looking for information on the internet, not all sites are reliable or accurate. Some sites that may be helpful to you are: the Center for Addiction and Mental Health at http://www.camh.net, it has a section called “Explaining Bipolar Disorder to Children.” Another resource is the National Network of Adult and Adolescent Children Who Have Mentally Ill Parent/s at http://nnaami.org/.

And last but not least be sure to let your child/children know that you love them no matter what, unconditional love will be very beneficial to them especially in times of trouble

by Julie Pryor (permission granted to repost)

Bipolar Disorder Statistics

 

Accurate bipolar disorder statistics reveal the truth about bipolar.

Remember – managing bipolar disorder is easier when you have accurate information about bipolar.

What the bipolar statistics show us is that bipolar disorder is more common than many realize.
BUT – figures on bipolar disorder vary from source to source:

NARSAD, the Mental Health Research Association state that: “More than 2 million American adults or 1 percent of the population age 18 or older in any given year have bipolar disorder.”

A 2005 US community epidemiological study (the National Epidemiologic Survey on Alcohol and Related Conditions), estimated the lifetime risk of bipolar I and bipolar II as ranging from 3-10%.

And according to the latest bipolar statistics quoted by the Depression and Bipolar Support Alliance (DBSA):

“Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year.” (National Institute of Mental Health)

According to Dr Wes Burgess in his book, The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers, Penguin 2006:

“It is estimated that 2 to 7% of people in the United States suffer from bipolar disorder. Almost 10 million people will develop the illness sometimes during their lives. About half of these will never receive the correct diagnosis or treatment.”

IN OTHER WORDS – You are not alone!

– In Australia there are around 238,957 people with bipolar disorder.
– In the United Kingdom it is approximately 723,248 people.
– In Germany, around 989,095 people have bipolar disorder.
– In Canada, bipolar disorder affects around 390,094 people.
– In Iran, bipolar disorder affects around 810,038 people.

And for both India and China, each have somewhere between 12 – 15 million people who are bipolar!

Bipolar disorder statistics from the World Health Organization (WHO), indicate bipolar disorder is the 6th leading cause of disability in the world.

Particularly interesting are the figures from the National Institute of Mental Health (NIMH): The Numbers Count: Mental Disorders in America. Everyone should take a look at this information.

As well as bipolar disorder statistics, you can see the figures for suicides, for common co-morbid conditions such as panic and anxiety and contrast the statistics of different conditions such as schizophrenia.

Who gets bipolar disorder?
The median age of onset for bipolar disorder is 25 years (NIMH). However, bipolar disorder can begin in childhood and sometimes doesn’t manifest until a person is much older – in their 40’s and 50’s.
Bipolar is an equal opportunity disorder, affecting people of all races, ethnic groups and socio-economic backgrounds.

Also according to NIMH, it is an inherited disease. More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression.

When one parent is affected, the risk to each child is 15-30%.

When both parents have bipolar disorder, the risk increases to 50-75%.

Is bipolar a women’s disease?
Despite the stereotypes, men and women are affected in equal numbers. However, research does show some differences in how the disorder develops:

– women are 3 times more likely than men to experience rapid cycling. (Journal of Clinical Psychiatry, 58, 1995 [Suppl.15])
– women may have more depressive episodes and more mixed episodes than men. (Journal of Clinical Psychiatry, 58, 1995 [Suppl.15])

Other interesting research from the Depression and Bipolar Support Alliance (DBSA) in 2000 showed a gender bias – women are far more likely to be misdiagnosed with depression and men are far more likely to be misdiagnosed with schizophrenia.

The bipolar diagnosis disaster
Other DBSA bipolar disorder statistics from 2000 shows that people with the disorder suffer through as long as 10 years of coping with symptoms before getting diagnosed accurately.

Only 1 person in 4 receives an accurate diagnosis in less than 3 years!

According to Dr Wes Burgess in his Bipolar Handbook: “A recent study showed that almost 70% of bipolar patients had been misdiagnosed more than 3 times before receiving their correct diagnosis”.

This high incidence of delayed diagnosis and misdiagnosis may explain why the bipolar disorder statistics around suicide are so appalling:

– the disorder results in 9.2 years reduction in expected life span
– up to 1 in 5 bipolar people completes suicide. (NIMH)

In the book Why am I still depressed? (McGraw-Hill 2006), Dr Jim Phelps states “the suicide rate in Bipolar II is as high as, and in some studies higher than, in Bipolar I”.

According to Dr Wes Burgess in his book, The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers, Penguin 2006:

“30% of individuals with bipolar disorder will attempt suicide during their lives, and 20% will succeed . . . . Suicide is more common in bipolar depression than in unipolar major depression, panic disorder, or even schizophrenia. HOWEVER, THE SUICIDE RATE GOES DOWN DRAMATICALLY WITH ADEQUATE TREATMENT”.

Good news on bipolar!
Success rates for bipolar disorder treatment with lithium vary from highs of 70 to 85% to lows of 40 to 50%. (Surgeon General Report for Mental Health)

Nearly 9 out of 10 consumers with bipolar disorder are satisfied with their current bipolar medication(s), although side effects remain a problem. (DBSA, 1999)

Consumers with bipolar disorder who report high levels of satisfaction with their treatment and treatment provider have a much more positive outlook about their bipolar illness and their ability to cope with it. (DBSA, 1999)

Bipolar statistics show the picture for people adhering to treatment plans, especially mood stabilizers, as actually very positive!

In particular, bipolar statistics show that combining psychotherapy with medications such as lithium is especially effective:

1. Using Family-Focused Treatment (FFT) in addition to bipolar medication produced significantly less relapse (11%) than medication alone (61%) over a 9 month follow-up period

2. A 2001 study showed using Cognitive Behavioral Therapy (CBT) in combination with bipolar medication reduced participants’ depressive symptoms by 7.3% vs a 2.5% increase in the control group

3. This study also found a 60% reduction in bipolar disorder relapse when CBT was used.
(Bipolar disorder statistics on psychotherapy benefits evidence all cited from the book “Bipolar Disorder: the latest treatment and assessment strategies” by Dr Trisha Suppes and Dr Ellen Dennehy, Compact Clinicals 2005.)

Bipolar Health Statistics
No discussion on bipolar disorder statistics is complete without considering the high levels of chronic physical illness that all too often accompany bipolar disorder.

In February 2009, the medical journal Psychiatric Services published findings showing that bipolar disorder can DOUBLE your risk of early death from a range of medical conditions – including those that can be controlled through diet and exercise.

Did you know that:

1. 35% of people with bipolar disorder are obese? This is the highest percentage for any psychiatric illness.
2. People with bipolar disorder are 3 times more likely to develop diabetes than are members of the general population.
3. People with bipolar disorder are 1.5 – 2 times more likely to die from conditions such as heart disease, diabetes and stroke.

It does NOT have to be this way! These particular bipolar disorder statistics can be radically improved.

There is a wealth of research proving that simple diet and lifestyle changes can improve both your mental AND physical health.

a (VERY LONG) note on bipolar….

a (VERY LONG) note on bipolar….
by Herman Le Roux, Co-Found of BSB

Part 1
The stigma of Bipolar

There is a stigma surrounding Bipolar, there is a general misconception about us. There is fear.

These are the facts
People are in fear that we will commit suicide at any moment. People that are not bipolar commit suicide every day, when they get arrested, when they cannot face debt, when they cannot face life anymore. Most of us are still here, and most of us will be here as long as you.

People think we are all cutters. People smoke, they drink, they get addicted to drugs. People cause bodily harm to themselves in more ways than cutting. And if we are cutters then maybe we cut to not feel pain, or to feel alive.

People think we are zombies due to medication. We do know more than the average doctor about our medication. People take medication every day for so many things. Some to stay alive. We take medication to be better.

People thing we have an illness. Most illnesses can be cured. We cannot be cured. We have a disorder. It is part of us an always will be. People that are diabetic are that way, they take insulin, we are they way we are, we take medicine.

People think we are always depressed. We are not. We are not depressed people. We have BI polar which means that we go from mania to depression.

People think that bipolar people cannot function and cannot be successful. Van Gogh, Woolfe, Einstein and many more was just that.

People think when we are manic we are mad. We are not. We accomplish more when we are manic in one day than most people do in one week. We don’t always shop, do silly things. We often achieve the most incredible things when we are manic.

People think there is always a crash after mania. This sometimes happens but not always. We do get down gently, we can be stable after mania.

People think we cannot be treated. We can be, there are so many treatments that show good responses. We can live normal lives and we can accomplish so much.

People think that everyone that does something wrong is bipolar. This is not the case. More often than not Bipolar is used as an excuse and that creates a misconception. In every aspect but one we are as “normal” as the next person.

People think that the Internet will give them a true reflection of who we are. That is not the case. We are as different from each other as the next person.

People think we have mood swings. We don’t. We go from mania to depression. We are not moody people. We cycle between being depressed and being manic.

People think we cannot be stable. We can be. Often people on treatment never shows a sign of bipolar for the rest of their lives. Often people cope so well that you would not say they are bipolar.

People think we have a choice in the matter. We don’t. We were born this way.

People think that we are hyper sexed. We are not. We are not addicted to sex, we just feel much more passion than most people.

People think we are mad. Warmongers, rapists, killers, are mad, we are not.

People think Bipolar is a death sentence. It is not. It is a sentence to a passionate life.

 

Part 2
The reality of Bipolar Disorder

Some people think that Bipolar Disorder is a “tell on Oprah” or “designer” diagnosis”. I have been told by many of my therapists and docs over the years that they actually had patients that “want” to be Bipolar.

There is nothing glamorous or special about having BP. It is an affliction that I would choose to not have if I had any choice in the matter.

The reality of Bipolar Disorder is that it causes pain and suffering. It causes hurt and it takes away from you that are rightfully yours.

So then, for the uniformed. Here are some of the realities that people with Bipolar Disorder deal with.

1. BP causes a mania. That means that you as a sufferer of BP go into a state of being manic. Being manic means that you have energy that is above the energy levels of any normal person. Your thoughts race. You may clean the house. Several times. Some people go on shopping sprees. Sometimes your mania lasts for several days, even weeks. You seem to have boundless energy. You maybe more creative than you have ever been. The unfortunate thing about this seemingly wonderful state is that it is false. It is a state that is induced by the chemical imbalance in our brains. It never lasts and more often than not it is followed by something we as BP sufferers call a “crash”

2. To crash. To crash is something that everyone that suffers from BP fears. It is something that is so devastating that a large % of people commit suicide when they crash. All the hype and all the energy from the mania is taken away from you in mere minutes. Your energy levels are gone, your mood is dark and you feel nothing but utter despair.

3. Depression. Depression stands at the other end of the pole that we call mania. It can last for a few minutes, for days, weeks, months and for some of us it can last several years. In the time that we suffer from depression we loathe everything around us. We have no energy and the world is a very cold and dark place. Depression in BP is not to be confused with “normal” depression or the “blues”. BP depression is something that is severely debilitating and has a massive impact on you and everyone around you.

4. Mixed state. Mixed state means that you feel both mania and depression at he same time. It is a very confusing state to be in and very difficult to treat. It is almost impossible to explain to someone that you feel good and bad at the same time. The best description I have heard for it so far is having an orgasm and burning your hand at the same time. That description does not explain how we feel, but it gives and idea of how confusing it can be.

5. Rapid cycling. Rapid cycling means you go from mania to depression to mania to depression and so on. What makes this so difficult is that this happens in a short period of time. Sometimes the cycling takes place over a few hours, sometimes it can even be every few minutes. Rapid cycling is very tiring and also very difficult for loved ones since you are never sure where the person is at.

6. Medication. There so many medications out there and the average BP sufferer know more about meds than the average doctor. Some respond so well to meds that they live balanced healthy lives. Some have horrible side affects ranging from permanent impotence to bleeding gums to Tardiv Dyskenia. Some cannot afford the exuberant prices of the more “designer”  meds out there and have to accept whatever the state maybe give them. Some do not respond on meds and have to consider electro convulsive therapy. ECT therapy (or brain shocks) is a controversial treatment. For some the results are wonderful. For some permanent memory loss and other side effects are part of the package.

7. Suicide. Suicide  is a reality in the life of someone with Bipolar. For some the battle becomes too great. Some of us loose the fight and we end our lives. For the rest of us that have lost a FB friend or a real friend due to suicide we understand that it was not a cowardly step. We understand that it was just too much to take anymore.

8. Stigma. Even today, in this enlightened age we live with the stigma of being mentally ill. People often blame violent crime or crimes of passion or sexual obsession on people with BP.

9. Loneliness. People with BP are often very lonely. The reason for this is the constant change in their moods or constant depression. It is not easy to cope with someone that is BP and true compassion and understanding is needed.

Bipolar Disorder is not something that we would choose. It is not something that is understood completely. The disorder is complex and causes a great deal of pain for the sufferer and the people he or she loves.

The reality if Bipolar Disorder is that we deal with it every day. The Reality is that we need you. Our friends, our families, our Doctors and our lovers to make the moments that we are stable special, the moments we are manic safe and the moments we are depressed surrounded by support and love.

If you are Bipolar then you will know what I am talking about. If you love someone that is Bipolar then you should know that our reality is what I wrote here.
We are the polar riders.

Part 3
The joke of mental illness

We as people with bipolar or other mental disorders often joke amongst  ourselves about our disorder.
But you?
Who do you think you are saying that I am nuts?
Who do you think you are stating that I am crazy?
-People that make war are crazy.
-People that rape children are crazy.

There are people that see and hear things. That live in a world of their own, they are ill, or they have a disorder. You call them mad, or nuts. You might say they need to be behind bars.

Sometimes people commit crimes and then shout insanity. How dare they? How dare they do that?

Borrow from us what we battle with every single day?

So you laugh at people that have schizophrenia because they hear and see things you don’t. How dare you make a joke about that? Do you have any idea how scared that person must be?

So you say that people that have obsessive compulsive disorder are just plain crazy. Have you ever washed you hands that the skin comes off? Have you ever been so tired that you just fall asleep because you do the same thing over and over?

So you want to laugh at someone that is bipolar because they are moody, because they shop too much.

Have you ever severed the arteries in your arms because you cannot face life? Probably not. People commit suicide out of fear. Bipolar people commit suicide because they do not want to live. Do you want to joke with that?

So you make jokes about people that are autistic. You laugh at people with Asperger syndrome. Have you ever had your world turned upside down because someone re arranged your room?
– Probably not

So you want laugh at us, people with mental illness, with mental disorders. You want to make jokes about us like you joke about the rape of children. You want to ridicule us like you ridicule the disabled and the elderly
– Yes that is you, that is what you do.

But you have never been in my mind, in my heart and you have never and will never hold my soul.
For all my bipolar friends….

Common Triggers

The one thing that comes up on our group is “Triggers” and what are the most common ones.

Here is piece written by one of our members.

Bipolar People are more susceptible to stress than people without the disorder. We react to situations and behaviors with bipolar symptoms. During a crisis situation, the symptoms become so out of control that they appear to be the actual problem. All of the focus goes towards stopping the symptoms, but not the root of the symptoms which are the triggers. Stopping the symptoms is an important part of finding stability but there is also an you can take to prevent the symptoms from going form bad to worse.

Recognize that the symptoms are the fruits of Bipolar and triggers are the seeds. If you treat the seeds before they grow… they won’t get very big and you won’t end up in the hospital with a raging depressive or manic episode.
 
When looking at it this way you can see that symptoms have a trigger point. You need to look at the trigger point and find out what stressed you out in the first place.
 
The key to preventing these symptoms is to learn to modify or stop the triggers in your life. The things that make you ill. Understanding will help you when going into a stressful situation make the right choices to keep yourself safe.
 
COMMON TRIGGERS:
 
Arguments
Travel
Time Change
Work related stress
Caffeine
Drug use, including medications
Alcohol use
Change in general
Social events
Shopping centers
Driving in traffic
Poor diet high in refined foods
Lack of exercise
Unstable family situation
Poor relationship with spouse, family member, friend or co-worker
Lack of balance in life
Poor sleep habits, staying up to late, sleeping all day
Lack of a schedule
Lack of structure
Too many obligations
Constantly on the move
Constantly doing something
Over-Exposure to TV and other media
Hanging out with unstable people
Aggression towards self or other people
Overly stimulated lifestyle
Lack of spirituality
Over-scheduled or over-committed
Listening to negative self-dialogue
Illness or death in the family
Stressful world events
 
It is important to know you can’t avoid all stressful situations. LIFE IS LIFE! But by eliminating a few, limiting a few more and adding a couple things to your life you should be golden!.

Take the time to maintain balance by taking time out for you. Have a hobby, do some yoga; deep breathing & meditation. Exercise more. Spend time with supportive family & friends. Pursue religious & spiritual matters. Read & write more, paint a picture, play with your kids. Take a walk. Anything that brings you joy & peace.
 
We spend so much time wasting our time focusing on what is wrong. Take 1/2 that energy and focus on how to get better.

Mania

Mania

Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression.

The word derives from the Greek “μανία” (mania), “madness, frenzy” and that from the verb “μαίνομαι” (mainomai), “to be mad, to rage, to be furious”.

In addition to mood disorders, individuals may exhibit manic behavior as a result of drug intoxication (notably stimulants such as cocaine or methamphetamine), medication side effects (notably steroids), or malignancy. However, mania is most often associated with bipolar disorder, where episodes of mania may alternate with episodes of major depression. Gelder, Mayou and Geddes (2005) suggests that it is vital that mania is predicted in the early stages because the patient becomes reluctant to comply to the treatment. The criteria for bipolar do not include depressive episodes and the presence of mania in the absence of depressive episodes is sufficient for a diagnosis. Regardless, even those who never experience depression experience cyclical changes in mood. These cycles are often affected by changes in sleep cycle (too much or too little), diurnal rhythms and environmental stressors.

Mania varies in intensity, from mild mania (known as hypomania) to full-blown mania with psychotic features including hallucinations and delusions. Naturally, since mania and hypomania have also been associated with creativity and artistic talent, it is not always the case that the clearly manic bipolar person will need or want medical assistance; such people will often either retain sufficient amount of control to function normally or be unaware that they have “gone manic” severely enough to be committed or to commit themselves (‘commitment’ is actually a euphemism for admission to a psychiatric facility). Manic individuals can often be mistaken for being on drugs or other mind-altering substances.

A manic episode is defined in the American Psychiatric Association’s diagnostic manual as a period of seven or more days (or any period if admission to hospital is required) of unusually and continuously effusive and open elated or irritable mood, where the mood is not caused by drugs or a medical illness (e.g., hyperthyroidism), and (a) is causing obvious difficulties at work or in social relationships and activities, or (b) requires admission to hospital to protect the person or others, or (c) the person is suffering psychosis.

To be classed as a manic episode, while the disturbed mood is present at least three (or four if only irritability is present) of the following must have been consistently prominent: grand or extravagant style, or expanded self-esteem; reduced need of sleep (e.g. three hours may be sufficient); talks more often and feels the urge to talk longer; ideas flit through the mind in quick succession, or thoughts race and preoccupy the person; over indulgence in enjoyable behaviors with high risk of a negative outcome (e.g., extravagant shopping, sexual adventures or improbable commercial schemes). If the person is concurrently depressed, they are said to be having a mixed episode.

The World health organization’s classification system defines a manic episode as one where mood is higher than the person’s situation warrants and may vary from relaxed high spirits to barely controllable exuberance, accompanied by hyperactivity, a compulsion to speak, a reduced sleep requirement, difficulty sustaining attention and, often, increased distractablilty. Frequently, confidence and self-esteem are excessively enlarged, and grand, extravagant ideas are expressed. Behavior that is out of character and risky, foolish or inappropriate may result from a loss of normal social restraint.

Some people also have physical symptoms, such as sweating, pacing, and weight loss. In full-blown mania, often the manic person will feel as though his or her goal(s) trump all else, that there are no consequences or that negative consequences would be minimal, and that they need not exercise restraint in the pursuit of what they are after. Hypomania is different, as it may cause little or no impairment in function. The hypomanic person’s connection with the external world, and its standards of interaction, remain intact, although intensity of moods is heightened. But those who suffer from prolonged unresolved hypomania do run the risk of developing full mania, and indeed may cross that “line” without even realizing they have done so.

One of the most signature symptoms of mania (and to a lesser extent, hypomania) is what many have described as racing thoughts. These are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli. This experience creates an absentmindedness where the manic individual’s thoughts totally preoccupy him or her, making him or her unable to keep track of time, or be aware of anything besides the flow of thoughts. Racing thoughts also interfere with the ability to fall asleep.

Mania is always relative to the normal rate of intensity of the person being diagnosed with it; therefore, an easily-angered person may exhibit mania by getting even angrier even more quickly, and an intelligent person may adopt seemingly “genius” characteristics and an ability to perform and to articulate thought beyond what they can do in a normal mood. But perhaps the easiest indicator of mania would be if a noticeably clinically depressed person becomes suddenly cheerful, optimistic, happy, and full of energy. Other elements of mania may include delusions (of grandeur, potential, or otherwise), hypersensitivity, hypersexuality, hyper-religiosity, hyperactivity, impulsiveness, talkativeness, an internal pressure to keep talking (over-explanation) or rapid speech, grandiose ideas and plans, and decreased need for sleep (e.g. feeling rested after 3 or 4 hours of sleep). In manic and hypomanic cases, the afflicted person may engage in out-of-character behavior, such as questionable business transactions, wasteful expenditures of money, risky sexual activity, recreational drug abuse, abnormal social interaction, or highly vocal arguments uncharacteristic of previous behaviors. These behaviors may increase stress in personal relationships, lead to problems at work and increase the risk of altercations with law enforcement. There is a high risk of impulsively taking part in activities potentially harmful to self and others.

Although “severely elevated mood” sounds somewhat desirable and enjoyable, the experience of mania is ultimately often quite unpleasant and sometimes disturbing, if not frightening, for the person involved and for those close to them, and it may lead to impulsive behavior that may later be regretted. It can also often be complicated by the sufferer’s lack of judgment and insight regarding periods of exacerbation of characteristic states. Manic patients are frequently grandiose, obsessive, impulsive, irritable, belligerent, and frequently deny anything is wrong with them. Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating the ability to think clearly. Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others.

There are different “stages” or “states” of mania. A minor state is essentially hypomania and, like hypomania’s characteristics, may involve increased creativity, wit, gregariousness, and ambition. Full-blown mania will make a person feel elated, but perhaps also irritable, frustrated, and even disconnected from reality.

Cause
Mania is a complex neurophysiological phenomenon. Predisposing factors to develop mania are primarily genetic and are no longer considered to be psychological, although stress triggers to a particular manic episode may include significant psychological and social conflicts. The primary trigger for (and the primary symptom of) acute mania is sleep deprivation. Social problems, medications, or illness may initiate manic hyperarousal but genetic predisposition or brain illnesses are most likely to be the main causations for classic and persistent manic symptoms. Some medications, including all stimulants, may mimic manic symptoms but differ substantially in duration and intensity compared with true manic episodes. The primary mediator of all mood disease is the brain’s limbic system. A full description of the cause of mania is complex and should be referenced elsewhere.

Some medications may cause symptoms that mimic mania. Some medications may trigger a manic episode through hyperarousal of the limbic system and subsequent sleep deprivation. These may include: amphetamines and other stimulants (Provigil, Nuvigil, Adipex), caffeine (caffeine/taurine energy drinks), cocaine and various illegal drugs, serotonin reuptake inhibitors (SSRI, SNRI), tricyclic compounds (TCA,excluding carbamazepine), steroid medications (Prednisone, oral cortisone), serotonin agonists, dopamine agonists (Mirapex, Sinemet), and several other groups of medicines. One common over the counter medication group that can be stimulating in large doses is cough and cold medications that contain agents meant to stimulate blood vessels which shrink nasal mucosa thereby enlarging space for nasal air flow (decongestants).

For example, Phenylpropanolamine (PPA) is a sympathomimetic drug similar in structure to amphetamine which was formerly present in over 130 medications, primarily decongestants, cough/cold remedies, and anorectic agents.

Treatment
Before beginning treatment for mania, careful differential diagnosis must be performed to rule out non-psychiatric causes.

Acute mania in bipolar disorder is typically treated with mood stabilizers and/or antipsychotic medication. Note that these treatments need to be prescribed and monitored carefully to avoid harmful side-effects such as neuroleptic malignant syndrome with the antipsychotic medications. It may be necessary to temporarily admit the patient involuntarily until the patient is stabilized. Antipsychotics and mood stabilizers help stabilize mood of those with mania or depression. They work by blocking the receptor for the neurotransmitter dopamine and allowing serotonin to still work, but in diminished capacity.

When the manic behaviours have gone, long-term treatment then focuses on prophylactic treatment to try to stabilize the patient’s mood, typically through a combination of pharmacotherapy and psychotherapy.

Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. Anticonvulsants such as valproic acid and carbamazepine are also used for prophylaxis. More recent drug solutions include lamotrigine. Clonazepam (Rivotril, Ravotril or Rivatril) is also used.

Verapamil, a calcium-channel blocker, is useful in the treatment of hypomania and in those cases where lithium and mood stabilizers are contraindicated or ineffective. Verapamil is effective for both short-term and long-term treatment.

Medications
The biological mechanism by which mania occurs is not yet known. One hypothesised cause of mania (among others), is that the amount of the neurotransmitter serotonin in the temporal lobe may be excessively high.[citation needed] Dopamine, norepinephrine, glutamate and gamma-aminobutyric acid also appear to play important roles. Imaging studies have shown that the left amygdala is more active in women who are manic and the orbitofrontal cortex is less active.

Antidepressant monotherapy is not recommended for the treatment of depression in patients with bipolar disorders I or II, and no benefit has been demonstrated by combining antidepressants with mood stabilizers in these patients.

Hypomania

Hypomania

Hypomania (literally, below mania) is a mood state characterized by persistent and pervasive elevated or irritable mood, as well as thoughts and behaviors that are consistent with such a mood state. Individuals in a hypomanic state have a decreased need for sleep, are extremely outgoing and competitive, and have a great deal of energy. However, unlike with full mania, those with hypomanic systems are fully functioning, and are often actually more productive than usual. Specifically, hypomania is distinguished from mania by the absence of psychotic symptoms and by its lower degree of impact on functioning. Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder. Hypomania is sometimes credited with increasing creativity and productive energy. A significant number of people with creative talents have reportedly experienced hypomania or other symptoms of bipolar disorder and attribute their success to it. Classic symptoms of hypomania include mild euphoria, a flood of ideas, endless energy, and a desire and drive for success. A lesser form of hypomania is called hyperthymia.

Hypomania is also a side effect of numerous medications, often—though not always—those used in psychopharmacotherapy. Patients suffering from severe depression who experience hypomania as a side effect of (for example) antidepressants, may prove to have a form of bipolar disorder that has previously gone unrecognized. However, drug-induced hypomania is not invariably indicative of bipolar affective disorders. The difference between uni- and bi-polar disorders is essential for analysis of switches. Consequently, it is important for researchers and mental health professionals to distinguish drug-induced hypomania in bipolar patients from drug-induced hypomania in unipolar (non-bipolar) depressives. Nevertheless if antidepressants trigger the first episode of hypomania, it is strongly suggestive of an underlying diagnosis of Bipolar Disorder, particularly if the manic symptoms (mild, moderate or severe) last for a lengthy period of time after they start. In cases of true drug-induced hypomania, cessation of the antidepressant or whichever drug has triggered this mood state – for example steroid therapy or stimulants such as amphetamine – usually causes a fairly swift return to normal mood. It is far less likely to be a side effect in those with pure Clinical Unipolar Depression, unless for example tricyclic antidepressants are given in very high doses. SSRIs are less likely to trigger manic symptoms except in those individuals where there is an underlying Bipolar Disorder, particularly if administered without a mood stabilizer.

Often in those who have experienced their first episode of hypomania (which is a level of mild to moderate mania) – generally without psychotic features – there will have been a long or recent history of depression prior to the emergence of manic symptoms, and commonly this surfaces in the mid to late teens. Due to this being an emotionally charged time, it is not unusual for mood swings to be passed off as hormonal or teenage ups and downs and for a diagnosis of Bipolar Disorder to be missed until there is evidence of an obvious manic/hypomanic phase.

Hypomania may also occur as a side effect of pharmaceuticals prescribed for conditions/diseases other than psychological states or mood disorders. In those instances, as in cases of drug-induced hypomanic episodes in unipolar depressives, the hypomania can almost invariably be eliminated by lowering medication dosage, withdrawing the drug entirely, or changing to a different medication if discontinuation of treatment is not possible.

Symptomatic recognition
The DSM-IV-TR defines a hypomanic episode as including, over the course of at least four days, elevated mood plus three of the following symptoms OR irritable mood plus four of the following symptoms:

* pressured speech; rapid talking but research[which?] shows this feature is not found in 25% of individuals with other manic symptoms.
* inflated self-esteem or grandiosity;
* decreased need for sleep;
* flight of ideas or the subjective experience that thoughts are racing;
* easy distractibility and attention-deficit (superficially[citation needed] similar to attention deficit hyperactivity disorder);
* increase in psychomotor agitation; and
* involvement in pleasurable activities that may have a high potential for negative psycho-social or physical consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, reckless driving, or foolish business investments).

Explanation of common symptoms
* In the hypomanic state, people may feel that they cannot slow their minds down, and that their speeding thoughts are crafted exceptionally well. Some examples are speaking or writing in rhyme or alliteration without planning it first; quick responses to people talking; or the ability to improvise easily.
* People in hypomanic episodes do not have delusions or hallucinations. They do not lose touch with reality in the sense that they know who they are and what is real. What can be a problem, however, is that people in a hypomanic state can sometimes

* Overestimate their capabilities and fail to see the risks involved in their ventures. For example, a person may suddenly decide to expand a business in a way that is not really practical or set up schemes for which he or she is ill-prepared, or pursue an unrealistic love interest.
* Hypomanic individuals may also experience difficulty with decision making, resulting in behavior such as reckless driving, gambling, spending sprees and sexual adventures. To a varying degree, promiscuity, loss of social inhibitions, and risk taking, are all very common in hypomanic episodes. Many have described hypomanic individuals as ‘the life of the party’.

It is unknown to what degree hypomanic symptoms can occur without a depressive component. Patients may be relatively unlikely to seek psychiatric treatment for hypomania alone. However, many hypomanic patients also experience:

* obsessive behavior, whether mild or severe
* excessive risk-taking (e.g., gambling, foolish business decisions)
* general poor judgment
* a decreased need for sleep. Many hypomanic individuals may get at little as 3–6 hours of sleep a night
* uncontrolled, or only partially controllable, impulsivity
* excessive sexual activity or sexual risk taking

Plus other out-of-character behaviors that the person may regret following the conclusion of the mood episode. A more mild form of elevated mood, which has fewer negative behaviors, is hyperthymic temperament.

Hypomania can signal the beginning of a more severe manic episode, and often does result in a more severe manic episode if the hypomanic episode remains untreated. A hypomanic episode can also directly precede a depressive episode.

Possible benefits
Some commentators believe that hypomania actually has an evolutionary advantage. People with hypomania are generally perceived as being energetic, euphoric, visionary, overflowing with new ideas, and sometimes over-confident and very charismatic, yet—unlike those with full-blown mania—are sufficiently capable of coherent thought and action to participate in everyday activities. Like mania, there seems to be a significant correlation between hypomania and creativity. A person in the state of hypomania might be immune to fear and doubt and have little social and sexual inhibition. People experiencing hypomania are often the “life of the party.” They may talk to strangers easily, offer solutions to problems, and find pleasure in small activities. Such advantages may render them unwilling to submit to treatment, especially when disadvantages are minimal.

Relationship with disorders
Cyclothymia is a condition of continued mood fluctuations between hypomania and depressive symptoms that do not meet the criteria for a Major Depressive Episode. These are often interspersed with periods of normal moods.

When a patient presents with a history of one or more hypomanic episodes and one or more depressive episodes that meet the criteria for a Major Depressive Episode, Bipolar II Disorder is diagnosed. If left untreated, hypomania can transition into mania and sometimes psychosis, in which case, Bipolar I Disorder is often diagnosed.

Treatment
Clinical trials of medications for the non-depressive phases of bipolar illnesses generally treat patients for psychotic mania during the initial, or acute, phase of mania. High doses are justified in the case of mania, in order to remove the patient from immediate danger. Hypomania, however, involves different considerations and almost always requires more in-depth clinical judgment. Medications typically prescribed for hypomania include mood stabilizers such as valproic acid and lithium carbonate as well as atypical antipsychotics such as olanzapine and quetiapine.

Symptoms of bipolar disorder

This fact sheet can be on the “Black Dog Institute” website.

The information in this fact sheet is not intended as a substitute for professional medical advice, diagnosis or treatment.

What this fact sheet covers:
• What is bipolar disorder?
• Distinguishing between bipolar I and bipolar II disorder
• The symptoms of bipolar disorder
• Key features of mania and hypomania
• When to seek help for bipolar disorder
• Key points to remember

What is bipolar disorder?
Bipolar disorder is the name used to describe a set of ‘mood swing’ conditions, the
most severe form of which used to be called ‘manic depression’. The term describes
the exaggerated swings of mood from one extreme to the other that are characteristic
of the illness.

People with this illness suffer recurrent episodes of high, or elevated, mood (mania or
hypomania) and of depression. A very small percentage of sufferers of bipolar
disorder only experience the ‘highs’. Most experience both the highs and the lows.
Occasionally people can experience a mixture of both highs and lows at the same
time, or switch during the day, giving a mixed picture. People with bipolar disorder
experience normal moods in between their swings.

The mood swings pattern for each individual is generally quite distinct, with some
people only having episodes of mania once a decade, while others may have daily
mood swings.

Bipolar disorder can commence in childhood, but onset is more common in the teens
or early 20s. Some people develop their first episode in mid‐to‐late adulthood.
It is important to note that everyone has mood swings from time to time. It is only
when these moods become extreme and interfere with personal and professional life
that bipolar disorder may be present and medical assessment may be warranted.

Distinguishing between bipolar I and bipolar II
Bipolar I disorder is the more severe disorder − with individuals being more likely to
experience mania, have longer ‘highs’, and to have psychotic experiences and be more
likely to be hospitalised.

Bipolar II disorder is defined as being less severe, with no psychotic experiences and
with episodes tending to last only hours to a few days; a person experiences episodes
of both hypomania and depression but no manic episodes, and the severity of the
highs does not lead to hospitalisation.

Women and men develop bipolar I disorder at equal rates, while the rate of bipolar II
disorder is somewhat higher in females.

Symptoms of bipolar disorder
Diagnosing bipolar disorder is often not a straightforward matter. Many people go 10
years or more before their illness is accurately diagnosed as bipolar disorder.

There are two starting points for considering whether you might have bipolar
disorder. Firstly, you must have had episodes of clinical depression. Secondly, you
must have had ‘highs’, where your mood is more ‘up’ than usual, or where you feel
more ‘wired’ and ‘hyper’.

If both depression and ‘highs’ have been experienced, then the next thing to consider
is whether you also experience any of the six key features of mania and hypomania.
These are described below.

The Black Dog Institute has developed a self‐test for bipolar disorder which can help
to give you an initial indication of whether you might have this condition. The test is
available on HERE

Some people with bipolar disorder can become suicidal. It is very important that talk
of suicide be taken seriously and for such people to be treated immediately by a
mental health professional or other appropriate person.

Key features of mania & hypomania
What is it that separates normal ‘happiness’ from the euphoria or elevation that is
seen in mania and hypomania? Researchers at the Black Dog Institute have identified
six key distinguishing features:
• High energy levels
• Positive mood
• Irritability
• Inappropriate behaviour
• Heightened creativity
• Mystical experiences.

More extreme expressions of mania (but not hypomania) may have the added
features of delusions and hallucinations.

High energy levels – the individual feels ‘wired’ and ‘hyper’, extremely energetic, talks
more and talks over people, makes decisions in a flash, is constantly on the go, and
feeling less need for sleep.

Positive mood – the individual feels confident and capable, optimistic, that they can
succeed in everything. They are more creative, happier and perhaps feel ‘high as a
kite’.

Irritability – this is reflected in irritable, impatient and angry behaviours.
Inappropriate behaviour – the individual becomes over involved in other people’s
activities, engages in increased risk taking (i.e: by over indulging in alcohol and drugs
and gambling excessively), says and does outrageous things, spends more money,
haves increased libido; dresses more colourfully and with disinhibition.

Heightened creativity – this is experienced as ‘seeing things in a new light’, seeing
things vividly and with crystal clarity, finding one’s senses are heightened and feeling
quite capable of writing the ‘great Australian novel’.

Mystical experiences – these can be experienced by believing that there are special
connections between events, that there is a higher rate of coincidence between things
happening, feeling at one with nature and appreciating the beauty and the world
around, and believing that things have special significance.

A number of symptoms can indicate whether bipolar disorder is likely, particularly for
those under the age of forty. These include:
• racing thoughts (for example, feeling like you are watching a number of
different TV channels at the same time, but not being able to focus on any)
• sleeping a lot more than usual
• Feeling agitated, restless and/or incredibly frustrated.

When to seek help for bipolar disorder
If you have experienced an episode of mania or hypomania, it’s best to seek
professional help as soon as possible. It may indicate that you have bipolar disorder,
which, if left untreated, will likely involve further episodes of mania or hypomania.
bipolar disorder is not an illness which goes away of its own accord, but one which
often needs long‐term treatment. Accurately diagnosing bipolar disorder is a task for
a professional. A first step is to see your local general practitioner, who will likely refer
you to a psychiatrist for assessment and treatment.

Key points to remember
• Bipolar disorder is an illness involving exaggerated mood swings from one
extreme to the other, involving, usually, alternating periods of depression and
mania or hypomania.

• The pattern of mood swings for each individual is quite distinct.
• The six key features of mania and hypomania are
      o High energy levels
      o Positive mood
      o Irritability
      o Inappropriate behaviour
      o Heightened creativity
      o Mystical experiences.
• Accurately diagnosing bipolar disorder is a task for a skilled mental health
practitioner.
• If symptoms of bipolar disorder are suspected it’s best to first see your general
practitioner who will likely refer you to a psychiatrist.
• People with bipolar disorder can become suicidal. Talk of suicide should be
taken seriously and immediate help should be sought from a GP or other mental
health professional.
• For people under the age of forty, some symptoms of bipolar disorder may
include− sleeping a lot more than usual; feeling agitated, restless and/or
incredibly frustrated.

Bipolar disorder in young people

This fact sheet can be on the “Black Dog Institute” website or in our resources section under “Black Dog”.

The information in this fact sheet is not intended as a substitute for professional medical advice, diagnosis or treatment.

Bipolar disorder in young people

What this fact sheet covers:
• Signs of bipolar disorder in young people
• Treatment and management of bipolar disorder
• How you can help a young person with bipolar disorder

Introduction
Bipolar disorder is a neglected health problem in children and adolescents. Formerly
known as Manic Depression, bipolar disorder has only recently been recognised in
children and young people.

The highest rate of bipolar disorder is found in those under the age of 30 years.
Bipolar disorder commonly emerges in mid to late adolescence (15‐18 years old).

Signs of bipolar disorder in young people

Bipolar disorder can be difficult to recognise in young people as the illness can be
‘hidden’ by significant behavioural problems, such as irritability and aggression.

Some common signs of bipolar disorder in young people may include:

• Rapidly changing moods lasting a few hours to a few days
• Explosive tantrums or rages
• Impulsivity or racing thoughts
• Excessive involvement in multiple projects or activities
• Family history (bipolar disorder or depression)
• Poor sleep patterns or nightmares
• Excessive cravings‐ usually for carbohydrates or sweets
• Risky or inappropriate behaviours

Management of bipolar disorder

Bipolar disorder is an illness that requires long term treatment. There are serious risks
to delaying diagnosis and treatment of bipolar disorder in young people. Social‐peer
relations, academic performance, family relationships and psychological maturation
are all affected by bipolar disorder (both highs and lows).

There is currently no known cure for bipolar disorder. However, with proper
treatment bipolar disorder can be effectively controlled.

A good management plan for young people with bipolar disorder may include:

• Medication
• Close monitoring of symptoms
• Education about the illness
• Counseling or psychotherapy for the individual and family
• Stress reduction
• Good nutrition
• Regular sleep and exercise
• Participation in a support network
• Mood charting

The sooner that a management plan is put in place the less frequent and intense the
episodes can be.

How you can help a young person with bipolar disorder

Adolescence can be a tumultuous time for young people. Young people with bipolar
disorder may not understand what is happening to them or may think that the highs
and lows of bipolar disorder are simply part of growing up. Young people may need
help recognising that their mood swings may be related to bipolar disorder.

Talk to the young person‐ let them know that you are concerned
• Help the young person identify possible “contributing factors” for why they
may feel unwell; i.e. stress, exams, drugs, situations at home
• Recommend an assessment by a GP
• Based on a visit to a GP, the young person may be referred to a psychiatrist or
psychologist – remind the young person that they can bring a friend or family
member along for support
• If the young person is prescribed a treatment plan or medication, assist them
in closely following the instructions

Here are some resources

 

New Picture (2)

New Picture (3)

Frequently asked questions about bipolar disorder in children and teens (The Balanced Mind Foundation)

Bipolar Disorder in Children and Teens booklet (National Institute of Mental Health)

Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents (American Academy of Child and Adolescent Psychiatry)

Watch a video about bipolar disorder in children with Dr. Ellen Leibenluft, National Institute of Mental Health.