Current Conceptualizations in Bipolar Disorder

Bipolar disorder, the foremost extreme style of that was antecedently called emotional disturbance, could be a important disturbance of mood characterised by 'mood swings', euphoria, high levels of energy and productivity. it's presumably the sole condition wherever sufferers really crave the come back of a number of the symptoms and it remains one among the foremost intriguing and disabling medical specialty disorders. people with the disorder have incontestable exceptional levels of ability in fields like literature, visual arts, music and history.

The disorder was delineate as early as 1921 by Kraepelin United Nations agency noted the vary of symptoms, pattern of episodes and impairments in functioning. The disorder will have a period prevalence of up to twenty (depending on the sort of criteria being used) with several affected by continual multiple and disabling episodes despite the employment of mood-stabilizing medications. though manic depressive illness will (rarely) start in childhood, onset is someone within the teens or early 20s. One medicine study has advised a rate of one hundred and twenty fifth amongst adolescents (Lewinsohn, Klein and Seeley, 1995).

The disorder is related to high mortality and morbidity rates. period risk for suicide for folks with manic depressive illness is V-day. Around one quarter of individuals with manic depressive illness can build a suicide try (usually associated with the depressive component) someday in their lives. once vessel events, suicide is that the presumably reason behind death for people with manic depressive illness (Angst et al., 2002).

According to the planet Health Organisation, manic depressive illness is that the sixth leading reason behind incapacity world wide (when measured in DALYs - incapacity adjusted life years). The burden of living with manic depressive illness is large in terms of lost productivity and social relationships, not solely to the individual, however conjointly to families and communities generally (for example, in one study alone, manic depressive illness was thought to account for forty fifth of patient care costs; Johnson et al., 2003). Up to at least one third of individuals diagnosed with manic depressive illness stay jobless a year once hospitalization for mania (Harrow et al., 1990).

Current conceptualizations of manic depressive illness

There has been goodly dialogue on whether or not unipolar and bipolar disorders square measure categorical or dimensional constructs. each the ICD-10 and DSM-IV assert a categorical approach to unipolar and manic depressive illness. However, some studies have argued for continuity between continual depressive episodes and manic depressive illness.

There is conjointly dialogue regarding the classification of the various forms of manic depressive illness. progressively but, there has been a move to the event of classes or subtypes of manic depressive illness like Bipolar I and Bipolar II. The principal forms of manic depressive illness, that's Bipolar I and Bipolar II, could also be separate sub-types or disagree simply dimensionally (e.g. by severity or duration), with the term 'Bipolar Spectrum' assumptive dimensional variations.

The Bipolar Spectrum

I - emotional disturbance
II - Depression + Hypomania
III - Hypomania in association with antidepressant drug medication (starting up, withdrawing). this can be cited as 'switching'.
IV - Depression superimposed on 'hyperthymic temperaments'
V and VI - different additional 'temperament' ideas

From Akiskal (2005), Journal of affectional Disorders, 84, 107-115.

Bipolar I and Bipolar II could also be distinguished by variety of key characteristics. folks with Bipolar I square measure additional doubtless to expertise additional 'severe' and longer highs or wild episodes (which could embody psychotic features) and need treatment in hospital than those with Bipolar II. In distinction, Bipolar II is a smaller amount severe with no psychotic experiences, and with episodes tending to last solely hours to a couple of days. Symptoms of Bipolar II might not be as obvious as those for Bipolar I. whereas the highs in Bipolar II, usually cited as hypomania, can even be distressing to sufferers, they're usually characterised by periods of intense productivity.

Occasionally, folks will expertise a mix of each highs and lows at identical time, or switch throughout the day, giving a mixed image. In rare cases (up to 5%), folks with manic depressive illness solely expertise the highs and not the lows. The pattern of the disorder is quite distinct with some folks experiencing daily mood swings et al. having only 1 episode of mania per decade. folks with manic depressive illness will expertise traditional moods between their swings.

The popular read holds that Bipolar II could be a abundant milder version of manic depressive illness. However, recent proof (e.g. Hadjipavlou et al, 2004) has indicated that Bipolar lI is related to additional chronic and frequent depressive episodes, larger periods of your time with sub-syndromal symptoms and better rates of tried and completed suicide. Bipolar I and Bipolar II sufferers have equivalent levels of impairments in psychosocial functioning and in use of mental state services. though the 'highs' in Bipolar II could also be less severe than those related to Bipolar l, the depressive episodes square measure equally distressing and draining.

The distinction between Bipolar I and Bipolar II has vital implications for treatment. In Bipolar I, the mood stabilisers (especially the gold normal, lithium) square measure thought of to be the mainstay of treatment. The role of the mood stabilisers in Bipolar II Disorder is a smaller amount clear and up for dialogue, particularly as new antidepressants and atypical antipsychotics have return on the market. there's associate degree increasing interest during this space and additional trials square measure presently afoot which is able to hopefully clarify whether or not every condition ought to be equally treated.

In addition, Bipolar I Disorder (but not Bipolar II Disorder) is additionally characterised by variety of psychotic symptoms like delusions and hallucinations. These generally occur throughout associate degree acute wild episode however can even occur throughout a severe episode of melancholic depression. In Bipolar I Disorder, delusions square measure rather more common than hallucinations.

The prevalence of Bipolar II tends to be higher in females and ladies with manic depressive illness square measure at the next risk (around 60%) of getting a depressive or wild episode throughout or (and additional commonly) within the 1st few weeks once delivery. whereas most can suffer from depression, a big proportion can have highs, and up to 100 percent can have mixed highs and lows.