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Bipolar disorder : All about the diagnosis

Part 1

bipolar disorder
Bipolar disorder is a common, chronic, and often severe mood disorder characterized by fluctuations in mood, energy, and behavior. (Photo: Envato Elements)
Despite being a relatively common mood disorder, bipolar disorder is highly misunderstood and often confused with other mood disorders such as major depressive disorder (MDD) and schizophrenia. While this disorder is a lifelong condition, proper education and treatment can help manage the condition and allow the diagnosed individual to better function.اضافة اعلان

Today, we will be covering some basic criteria and statistics to show the nature of bipolar disorder medically.

Exact reports on the prevalence of bipolar disorder internationally vary and are likely an underestimate of the true prevalence. In the US, bipolar disorder affects 4.5 percent of the population.

In Jordan, there are no reports on the prevalence of bipolar disorder, but it is nonetheless present.

What is bipolar disorder?

Bipolar disorder is a common, chronic, and often severe mood disorder characterized by fluctuations in mood, energy, and behavior. Bipolar disorder tends to present around late adolescence or early adulthood, although the majority (over two-thirds) develop symptoms before the age of 18.

The main features of bipolar disorder are episodes of depression, mania, or hypomania. Due to the fact that bipolar disorder is a cyclic disorder, an individual will routinely cycle between these features and may or may not have periods of normal mood, also known as euthymia, between episodes.

These fluctuations in mood may also be sporadic. Fluctuations may occur and continue for months, or after one episode, symptoms can disappear for years without any recurrence.

Diagnosing bipolar disorder

Under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to be diagnosed with bipolar, fluctuations in mood cannot be attributed to other medical conditions, substance use or abuse, or a separate psychiatric disorder.

Three main defining features must be present for a bipolar disorder diagnosis: depression, hypomania, and mania. Their presentation dictates the subtype. Each feature is further defined by the DSM-5 as follows:

Depression: The features of depression in bipolar disorder follow the same criteria as MDD. Symptoms of depression must be present for at least two weeks on most days and must be associated with depressed mood or loss of interest or pleasure in normal activities. Additionally, there must be at least five of the following symptoms:

Depressed, sad mood in adults or an irritable mood in children.

Decreased interest and pleasure in normal activities.

Decreased or increased appetite; weight loss or weight gain.

Insomnia (lack of sleep) or hypersomnia (excessive sleeping)

Psychomotor impairment (slow thinking or moving) or agitation (restlessness)

Decreased energy or fatigue

Feelings of excessive guilt or worthlessness

Impaired concentration or indecisiveness

Recurrent thoughts of death, suicidal thoughts, or attempts

Hypomania and mania: The criteria between hypomania and mania are similar and largely overlap. The main difference is the duration of the episode. However, mania may be more associated with violent tendencies, both to the individual and to others, in comparison to hypomania.
To be diagnosed with bipolar, fluctuations in mood cannot be attributed to other medical conditions, substance use or abuse, or a separate psychiatric disorder.
Both are described as abnormally and persistently elevated mood (described as expansive or irritable) and energy. In mania, symptoms must be present for at least one week, whereas symptoms for hypomania need to be only present for at least four days. In order to fit the criteria of hypomania or mania, an individual must have three of the following symptoms or four if the mood is only irritable:

Grandiosity or inflated self-esteem

Decreased need for sleep

Increased talking

Racing thoughts or flight of ideas

Getting easily distracted or having poor attention

Increased goal-directed activity or psychomotor agitation

Excessive involvement in activities that are pleasurable but have a high risk for serious consequences

When discussing activities that are pleasurable but have a high risk for consequences, this can look like spending sprees, sexual indiscretions, or poor judgment in business ventures. This risky behavior can be self-destructive and negatively impact those around the individual.

Generally, the length and severity of a mood episode, as well as the interval between episodes, vary from individual to individual. Manic episodes tend to be shorter and end more abruptly than depressive episodes.

Different mood episodes can occur regularly at similar times every year.

Classifying bipolar disorder

There are two main subtypes of bipolar disorder: bipolar I and bipolar II. There are also subtypes designated for those who do not quite meet the threshold for bipolar disorder. More people tend to be classified as bipolar II than bipolar I.

Bipolar I is defined as manic episodes with or without major depressive or hypomanic episodes. Bipolar II is defined as major depressive episodes with or without hypomanic episodes.
Cyclothymic disorder is defined as chronic fluctuations between depression-like symptoms.
Although bipolar II is slightly more common, roughly 5–15 percent of those with bipolar II will develop a manic episode within five years. Once there has been a single instance of mania, the diagnosis changes from bipolar II to bipolar I.

The two main subtypes for those who do not meet the criteria for bipolar I or II are: cyclothymic disorder and unspecified bipolar and related disorder.

Cyclothymic disorder is defined as chronic fluctuations between depression-like symptoms. This means depressive episodes that do not meet the criteria for major depression and hypomania. For adults, these fluctuations must be present for at least two years, and in children and adolescents, symptoms must be present for at least one year.

Although cyclothymic disorder does not meet the threshold for bipolar disorder, individuals with this disorder have a 15–50 percent risk of developing bipolar I or II later in life. Unspecified bipolar and related disorders are mood states that do not meet the full criteria for any specific disorder in the bipolar and related disorders class.

Conditions similar to bipolar disorder

In order to be diagnosed with bipolar disorder, the fluctuations in mood can not be related to any other cause. Unfortunately, there are many medical conditions, medications, and substances that can cause symptoms of depression and mania.
Abuse and use of certain drugs such as hallucinogens, alcohol, marijuana, and withdrawals from substances such as alcohol, opioids, or benzodiazepines can cause manic episodes.
Brain tumors, strokes, infections, electrolyte abnormalities, and hormonal conditions such as Addison’s disease, Cushing disease, or hyper/hypothyroidism can cause manic episodes.

Additionally, medications such as antidepressants, steroids, certain decongestants, and herbal products can also cause manic episodes.

Abuse and use of certain drugs such as hallucinogens, alcohol, marijuana, and withdrawals from substances such as alcohol, opioids, or benzodiazepines can cause manic episodes.

There is also a similar psychiatric disorder that shares many similarities to bipolar disorder, Schizoaffective disorder. This disorder, in short, is a mix between schizophrenia and bipolar disorder and is likely the reason why the two conditions are often confused.

Those with schizoaffective disorder experience mood episodes similar to those with bipolar, but they will also experience psychosis or dissociation from reality between episodes.

Due to the vast number of factors that can influence mood, diagnosing bipolar disorder can be difficult. However, we hope that with today’s article, you can better understand the disorder.

Stay on the lookout for our next article where we will be covering the impacts, treatments, and other aspects of living with bipolar.


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