Bipolar disorder, also known as a bipolar affective disorder, manic-depressive illness, or affective psychosis, is a mental illness characterized by periods of elevated mood and periods of depression.

The elevated mood is significant and is known as mania or hypomania depending on the severity. During mania, an individual feels or acts abnormally happy, energetic, or irritable.

They often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced.

During periods of depression there may be crying, poor eye contact with others, and a negative outlook on life.

The cause is not clearly understood, but both genetic and environmental factors play a role. Typically many genes are involved. Environmental factors include long term stress and a history of childhood abuse.

It is divided into bipolar I disorder if there is at least one manic episode and bipolar II disorder if there are at least one hypomanic episode and one major depressive episode.

Treatment commonly includes psychotherapy and medications such as mood stabilizers or antipsychotics.

Examples of mood stabilizers that are commonly used include lithium and anticonvulsants.

Treatment in a hospital against a person’s wishes may be required at times as people may be at risk to themselves or others yet refuse treatment. Severe behavioral problems may be managed with short term benzodiazepines or antipsychotics.

In periods of mania, it is recommended that antidepressants be stopped.

If antidepressants are used for periods of depression they should be used with a mood stabilizer.

Electroconvulsive therapy may be helpful in those who do not respond to other treatments. If treatments are stopped it is recommended that this be done slowly.

Most people have a social, financial or work-related problem due to the disorder.

These difficulties occur a quarter to a third of the time on average.

The risk of death from natural causes such as heart disease is twice that of the general population. This is due to poor lifestyle choices and the side effects of medications.

Mania is the defining feature of bipolar disorder and can occur with different levels of severity.

With milder levels of mania, known as hypomania, individuals appear energetic, excitable, and may be highly productive.

As mania worsens, individuals begin to exhibit erratic and impulsive behavior, often making poor decisions due to unrealistic ideas about the future, and sleep very little.

At the most severe level, manic individuals can experience very distorted beliefs about the world known as psychosis.

A depressive episode commonly follows an episode of mania.

The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode or vice versa remain poorly understood.

The diagnosis of bipolar disorder can be complicated by coexisting (comorbid) psychiatric conditions including the following: obsessive-compulsive disorder, substance abuse, eating disorders, attention deficit hyperactivity disorder, social phobia, premenstrual syndrome (including premenstrual dysphoric disorder), or panic disorder.

A careful longitudinal analysis of symptoms and episodes, enriched if possible by discussions with friends and family members, is crucial to establishing a treatment plan where these comorbidities exist.

The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear.

Bipolar disorder often goes unrecognized and is commonly diagnosed during adolescence or early adulthood.

The disorder can be difficult to distinguish from unipolar depression and the mean delay in diagnosis is 5–10 years after symptoms begin.

Diagnosis of bipolar disorder takes several factors into account and considers the self-reported experiences of the symptomatic individual, behavior abnormalities reported by family members, friends or co-workers, and observable signs of illness as assessed by a psychiatrist, nurse, social worker, clinical psychologist or other health professional.

Assessment is usually done on an outpatient basis. Admission to an inpatient facility is considered if there is a risk to oneself or others.

An initial assessment may include a physical exam by a physician. Although there are no biological tests that are diagnostic of bipolar disorder, tests may be carried out to exclude medical illnesses with clinical presentations similar to that of bipolar disorder such as hypothyroidism or hyperthyroidism, metabolic disturbance, a chronic disease, or an infection such as HIV or syphilis.

An EEG may be used to exclude a seizure disorder such as epilepsy, and a CT scan of the head may be used to exclude brain lesions.

Investigations are not generally repeated for relapse unless there is a specific medical indication.

Several rating scales for the screening and evaluation of bipolar disorder exist, such as the Bipolar spectrum diagnostic scale.

The use of evaluation scales can not substitute a full clinical interview but they serve to systematize the recollection of symptoms.

On the other hand, instruments for the screening of bipolar disorder have low sensitivity and limited diagnostic validity.

For many individuals with bipolar disorder, a good prognosis results from good treatment, which, in turn, results from an accurate diagnosis. Of the various forms of bipolar disorder.

Rapid cycling bipolar disorder is associated with the worst prognosis.

Because bipolar disorder can have a high rate of both under-diagnosis and misdiagnosis, it is often difficult for individuals with the condition to receive timely and competent treatment.

Bipolar disorder can be a severely disabling medical condition. However, many individuals with bipolar disorder can live full and satisfying lives.

Quite often, medication is needed to enable this. Persons with bipolar disorder may have periods of normal or near-normal functioning between episodes.

 

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