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Bipolar Disorder FAQ v 1.1 (1 of 4)

( Part1 - Part2 - Part3 - Part4 )
[ Usenet FAQs | Web FAQs | Documents | RFC Index | Forum archive ]
----------------------------------------------------------------------
| |
| Bipolar Disorder Frequently Asked Questions (FAQ) File |
| ------------------------------------------------------ |
| |
| |
| Version: 1.1 |
| |
| Release Date: 25 September1996 |
| |
| Usenet Newsgroups: alt.support.depression.manic (ASDM) |
| soc.support.depression.manic (SSDM) |
| |
| Maintainers: Barry Campbell (barry@webveranda.com) |
| http://webveranda.com/barry/ |
| |
| Marco Anglesio (anglesio@cspo.queensu.ca) |
| http://cspo.queensu.ca/~anglesio |
| |
| Archived at: http://www.moodswing.org/faq.html |
| http://cspo.queensu.ca/~anglesio/faq |
| |
----------------------------------------------------------------------

See reader questions & answers on this topic! - Help others by sharing your knowledge
******************************************************************************

                       DISCLAIMER AND COPYRIGHT NOTICE 
                          (IMPORTANT - PLEASE READ)

The information presented in this FAQ is derived from published and unpublished
sources, and from the experiences and contributions of readers of the Usenet
newsgroups alt.support.depression.manic and soc.support.depression.manic.  

Some of it is fact.  Some of it is opinion.  Some of it might well be 
controversial in some circles.  NONE of it should be relied upon as expert
opinion.  This FAQ is provided as-is, without any express or implied
warranties. 

While we have made every effort to make it as accurate, responsible, and
helpful as possible, this FAQ is NOT the place to go if you're seeking expert
medical, psychological, or legal advice.  The authors, maintainers, and
contributors responsible for the content of this FAQ assume no responsibility
for errors or omissions, or for damages resulting from the use of the
information contained herein.

If you have questions or concerns, contact a psychiatrist, psychologist,
licensed clinical social worker, pharmacist, nurse, other qualified and
licensed therapist or practitioner, or attorney, as the case may be.

This FAQ may contain short, excerpted material from texts or
electronic media. Where materials are directly quoted, complete references
have been cited. The Bipolar Disorders FAQ has been assembled for educational
and informational purposes only, and with no intent to profit; it is 
distributed free of charge. No violation of U.S. copyright law is intended; all
quotations are made under the "Fair Use" doctrine.  All authors of quoted
material retain full copyright protection.

The definitions of disorders used throughout this FAQ are those found in 
"Diagnostic and Statistical Manual of Mental Disorders," Fourth Edition
(American Psychiatric Association, 1994).  To obtain your own copy of this
and other American Psychiatric Association publications in book or digital
form, contact:

                 American Psychiatric Association
                 1400 K Street, NW; Suite 1101
                 Washington, DC 20005-2403
                
                 Phone: 1-800-368-5777 (M-F, 9 a.m.-5 p.m., EST)
                 Fax: 1-202-789-2648
                 http://www.appi.org

This FAQ may be posted to any USENET newsgroup, on-line service, or BBS,
or pointed to or included on any WWW page, as long as it is posted in its
entirety and includes this copyright statement.  

This FAQ may not be distributed for financial gain.

This FAQ may not be included in commercial collections or compilations
without express permission from the author(s).

ALL MATERIAL HEREIN NOT EXPRESSLY COVERED BY OTHER COPYRIGHT NOTICES IS
COPYRIGHT 1996, ALL RIGHTS RESERVED, UNDER UNITED STATES LAW AND THE BERNE
CONVENTION BY THE PRIMARY MAINTAINER, BARRY CAMPBELL (btc@concentric.net). THE
AUTHOR OF ALL UNATTRIBUTED MATERIAL FOR PURPOSES OF THE BERNE CONVENTION IS
BARRY CAMPBELL.  THIS FAQ MAY NOT BE USED OR REPRODUCED IN CD-ROM COLLECTIONS,
PRINTED REPRODUCTIONS, OR ANY OTHER MEDIA FORMAT WITHOUT EXPRESS WRITTEN
PERMISSION.

******************************************************************************



                         -----------------
                         TABLE OF CONTENTS
                         -----------------
      
      
1.0  Introduction and Acknowledgments to Contributors


2.0  Revision history and archive locations


3.0  Definitions (DSM-IV and "Extended")

3.1   What is Bipolar Disorder?
3.2   What is Depression?
3.3   What is Mania?
3.4   What is Hypomania?
3.5   What is the difference between euphoria and dysphoria?
3.6   What is a Mixed State?
3.7   What is Rapid Cycling?
3.8   What are delusions and hallucinations?
3.9   How do you tell unipolar depression and bipolar
      disorder apart?
3.10  What is Cyclothymia?
3.11  What is Dysthymic Disorder?
3.12  What is Schizoaffective Disorder?
3.13  What is Seasonal Affective Disorder?
3.14  How do I distinguish between and among all of 
      these disorders?


4.0  How can I best take care of myself?

4.1  How can I assess my own mental status?
     (Includes: The Goldberg Depression and Mania
     Self-Rating Scales)
4.2  What treatment options are available?
4.3  How do I find a good health care provider?
4.4  What medications are commonly used in treatment?
4.5  What "alternative" therapies exist, and are they 
     any good?
4.6  How do I pay for all this? (Insurance-related
     issues.)
4.7  What are my rights as a patient?
4.8  What are my rights as a person with Bipolar Affective
     Disorder?
4.9  How can I tell my (friends, family, coworkers)?  Should I?
4.10 Resource organizations


5.0  How do I help a friend or loved one?

5.1  What to do (and what not to do) when someone you care
     about is diagnosed
5.2  What to do (and what not to do) if you suspect that
     someone you care about needs help, but resists
     seeking it for themselves.


6.0  Resources for education and support

6.1  Internet Resources
6.2  Books 
6.3  Magazine and Journal Articles


7.0  Controversial Issues - making sense of them

7.1  To drug, or not to drug?
7.2  Should I participate in a study or other 
     research program?
7.3  How do I evaluate "alternative" therapies?
7.4  The Psychiatric Survivors' Movement
7.5  Critics of Psychiatry and Psychology


8.0  Is there life (and hope) after diagnosis?

8.1  Coping hints from readers and participants
8.2  Research trends and directions



      
-----------------------------------------------------------------------------
1.0  Introduction and Acknowledgments to Contributors
-----------------------------------------------------------------------------

The Bipolar Disorder FAQ is based largely on the FAQ from the Usenet newsgroup
alt.support.depression.manic.  The alt.support.depression.manic FAQ was
originated and maintained until recently by PsyberNut/Bipolar Bear/Scott
(lsm@crl.com), and this FAQ document contains much of his original work,
essentially unmodified; in particular, the "more complete list of symptoms"
sections are his writing.  We gratefully acknowledge our enormous debt to
Scott, and wish him the very best.

Many readers of alt.support.depression.manic (ASDM) and
soc.support.depression.manic (SSDM) have contributed directly and indirectly to
the development of this FAQ; many more have read it and offered comments and
criticism.  So have readers and contributors to the PENDULUM mailing list.

A few contributors, in particular, must be singled out for their extraordinary
contributions.  Thanks to:

Joy Ikelman (parrot@frii.com), who allowed us to ransack her "Media File," an
excellent resource for finding mood disorder information and references in
print.  Joy also completely rewrote and updated the "definitions" section of
the FAQ, based on DSM-IV, and read early drafts, giving many helpful editorial
criticisms along the way.

Millie Niss (millie@gauss.math.brown.edu), for her well-researched
contributions to the Drug Therapy section of the FAQ.

Dr. Ivan K. Goldberg, M.D (psydoc@netcom.com) for his permission to reproduce
the Goldberg Depression and Mania Scales.


-----------------------------------------------------------------------------
2.0  Revision history and archive locations
-----------------------------------------------------------------------------

This is Version 1.1 of the Bipolar Disorder FAQ, released 25 September 1996.

This FAQ is posted periodically to the Usenet newsgroups
alt.support.depression.manic and soc.support.depression.manic.

The current version of the Bipolar Disorder FAQ may always be found on
the World Wide Web at:

http://www.moodswing.org/faq.html       (in the US) and
http://cspo.queensu.ca/~anglesio/faq    (in Canada)

We're always looking for folks who are willing to locate the FAQ for
us in their own countries.  The Web IS international by definition,
but it's always nicer to hit a nearby server if you can. :-)

It is also available via anonymous FTP from

ftp://members.aol.com/bipolarfaq/public/


-----------------------------------------------------------------------------
3.0  Definitions (DSM-IV and "Extended")
-----------------------------------------------------------------------------

There are many different mood disorders, and discussing them all thoroughly is
beyond the scope of this FAQ.

This FAQ focuses on the mood disorders which tend to be characterized by "mood
swings": alternating cycles of abnormally depressed and elevated (manic)
moods.  You're up, you're down, you're up, you're down, you're up... and some
(or most) of the time, you're in the middle, trying to figure out what happened.

While reading these definitions, it may be useful to think of Bipolar Disorder
and related disorders as existing along a continuum of "affects," or moods.
 

------------------------------
3.1  What is Bipolar Disorder?
------------------------------

Bipolar Disorder is the medical name for Manic Depression; at various times, it
has also been known as Bipolar Affective Disorder and Manic-Depressive Illness.
It is a mood disorder that affects approximately 1% of the adult population of
the United States--and roughly the same percentage in other countries, as far
as we know. :-)  

It's in the same family of illnesses (called "affective disorders") as clinical
depression.  However, unlike clinical depression, which seems to affect far more
women than men, Bipolar Disorder seems to affect men and women in approximately
equal numbers.

It's characterized by mood swings.  Though there is no known cure, most forms
of bipolar disorder are eminently treatable with medication and supportive
psychotherapy.

The textbook definition of Bipolar Disorder is: one or more Manic or Hypomanic
Episodes, accompanied by one or more Major Depressive Episodes.  These episodes
typically happen in cycles.

All of these terms will be defined at greater length below...but in plain
English, a person who has Bipolar Disorder will be severely up some of the
time, severely down some of the time, and in the middle some or most of the
time.

There are two main types of Bipolar Disorder:

-- Bipolar I is the "classic" form of Bipolar Disorder.  It most often involves
widely spaced, long-lasting bouts of mania followed by long-lasting bouts of
depression and vice-versa.  However, the essential definition is depression
plus mania, or "mixed states."

-- Bipolar II involves at least one Hypomanic Episode and one Major Depressive
Episode, but never either a full-blown Manic Episode or Cyclothymia.  The
essential definition is depression plus hypomania.

Although the shifts from one state to another are usually gradual, they can be
quite sudden.  The "rapid-cycling" form of the disorder involves four or more
complete mood cycles within a year's time, and some rapid-cyclers can complete
a mood cycle in a matter of days--or, more rarely, in hours.

It is also possible for someone who has Bipolar Disorder to be in a "mixed
state."  This means that they're in a mood state which has some characteristics
of depression and some of mania or hypomania.

There are a few rare documented cases of mania without depression, but DSM-IV
does not currently include a category for just "mania".  (This diagnosis was
present in DSM-III, but is unaccountably absent in DSM-IV!)

Using DSM-IV, a person exhibiting the symptoms of mania will almost always be
diagnosed as bipolar.  The general feeling in the mental health community seems
to be that what or whom goes up, must eventually come down.

The DSM-IV and "extended" definitions of depression and mania are presented in
the sections that follow.  It is very important to remember the following:

-- These definitions are not a guide for self-diagnosis!  

-- One does not need to exhibit *all*  of the symptoms of depression to be
depressed, nor does one need to display *all* of the symptoms of mania to be
manic.  


------------------------
3.2  What is Depression?
------------------------


******************************************************************************

Criteria for Major Depressive Episode (DSM-IV, p. 327)

A. Five (or more) of the following symptoms have been present during the same
2-week period and represent a change from previous functioning; at least one
of the symptoms is either (1) depressed mood or (2) loss of interest or
pleasure.

Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others
(e.g. appears tearful). Note: In children and adolescents, can be irritable
mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities
most of the day, nearly every day (as indicated by either subjective account
or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of
more than 5% of body weight in a month), or decrease or increase in appetite
nearly every day. Note: In children, consider failure to make expected weight
gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may
be delusional) nearly every day (not merely self-reproach or guilt about being
sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly
every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal
ideation without a specific plan, or a suicide attempt or a specific plan for
committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the
loss of a loved one, the symptoms persist for longer than 2 months or are
characterized by marked functional impairment, morbid preoccupation with
worthlessness, suicidal ideation, psychotic symptoms, or psychomotor
retardation.

******************************************************************************

Well, the APA gives us a good starting point, but it all sounds sort of
clinical.  Here's a more complete list of symptoms of depression that our
readers and participants have identified:

      * Reduced interest in activities (like writing FAQs)
      
      * Indecisiveness (maybe)
      
      * Feeling sad, unhappy, or blue (pervasive attitude that
      life sucks)
      
      * Irritability, dammit.
      
      * Getting too much (hypersomnia) or too little (insomnia)
      sleep.
      
      * Loss of, um, what were we talking about?  Oh yeah,
      concentration.
      
      * Increased or decreased appetite  (my ex-mother-in-law's
      cooking  notwithstanding)
      
      * Loss of self-esteem, such as my understanding that I suck.
      
      * Decreased sexual desire.
      
      * Problems with, whaddya call it?  Oh yeah, memory.
      
      * Despair and hopelessness
      
      * Suicidal thoughts.
      
      * Reduced pleasurable feelings.
      
      * Guilt feelings, which are all my fault anyway.
      
      * Crying uncontrollably and/or for no apparent reason.
      
      * Feeling helpless, which I can't do anything about.
      
      * Restlessness, especially when I can't hold still.
      
      * Feeling disorganized (hell, look at my desk).
      
      * Difficulty doing things (again, like finishing this FAQ)
      
      * Lack of energy and feeling tired.
      
      * Self-critical thoughts
      
      * Moving and thinking slooooooowwwwwwwly.
      
      * Feeling that one is in a stupor, or that one's head is in
      a fog.
      
      * Speeeeeeeakiiinnnnng slooooooowwwwwwwly.
      
      * Emotional and/or physical pain.
      
      * Hypochondriacal worries; fears or illnesses which prove to
      be psychosomatic.
      
      * Feeling dead or detached.
      
      * Delusions of guilt or of financial poverty.
      
      * Hallucinating.



-------------------
3.3  What is Mania?
-------------------


******************************************************************************

Criteria for Manic Episode (DSM-IV, p. 332)

A. A distinct period of abnormally and persistently elevated, expansive, or
irritable mood, lasting at least 1 week (or any duration if hospitalization is
necessary).

B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have been
present to a significant degree:

(1) inflated self-esteem or grandiosity

(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

(3) more talkative than usual or pressure to keep talking

(4) flight of ideas or subjective experience that thoughts are racing

(5) distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)

(6) increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation

(7) excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with
others, or to necessitate hospitalization to prevent harm to self or others,
or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication, or other treatments) or a general
medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy) should
not count toward a diagnosis of Bipolar I Disorder.

******************************************************************************

Again, the APA gives us a good starting point for studying mania, but the
language is awfully clinical.  Here's a plain-English version, with some
extensions:

      * Decreased need for sleep.
      
      * Restlessness.
      
      * Feeling full of energy.
      
      * Distractibility (what was that?)
      
      * Increased talkativeness (or increased typeativeness)
      
      * Creative thinking.
      
      * Increase in activities.
      
      * Feelings of elation.
      
      * Laughing inappropriately
      
      * Inappropriate humor.
      
      * Speeded up thinking.
      
      * Rapid, pressured speech, that you can teach, eating a
      peach, while on  a beach.
      
      * Impaired judgment
      
      * Increased religious thinking or beliefs.
      
      * Feelings of exhilaration.
      
      * Racing thoughts, which can't be taught, and can't be
      bought, although they ought, you might get caught.
      
      * Irritability (dammit, there it is again!)
      
      * Excitability.
      
      * Inappropriate behaviors.
      
      * Impulsive behaviors.
      
      * Increased sexuality (also known as "platoon-of-Marines-on-
        shore-leave syndrome")... or

      * "clang associations" (the association of words based on
          their sound, a possible reason so many poets are
          bipolar, also why we have pun fun)

     * _decreased_ interest in sex, or any other interpersonal
          relationships, due to obsessive interest in some other
          subject or activity
      
      * Inflated self-esteem (so prove I'm NOT the world's leading
      authority!)
      
      * Financial extravagance.
      
      * Grandiose thinking.
      
      * Heightened perceptions.
      
      * Bizarre hallucinations.
      
      * Disorientation.
      
      * Disjointed thinking.
      
      * Incoherent speech.
      
      * Paranoia, delusions of being persecuted.
      
      * Violent behavior, hostility
      
      * Severe insomnia
      
      * Profound weight loss
      
      * Exhaustion 
      
 

-----------------------
3.4  What is Hypomania?
-----------------------

Hypomania means, literally, "mild mania."

It's sometimes difficult to draw a distinct line between "manic" and
"hypomanic," as "marked impairment" is a necessarily subjective evaluation.

Also, one of the reasons that bipolar disorder often has a delayed
diagnosis may be that hypomanic episodes are often overlooked amid
the "Sturm und Drang" of adolescense and early adulthood.

The associated features of mania are present in Hypomanic Episodes, except that
delusions are never present and all other symptoms are *generally* less severe
than they would be in Manic Episodes.


******************************************************************************

Criteria for Hypomanic Episode (DSM-IV, p. 338)

A. A distinct period of persistently elevated, expansive, or irritable mood,
lasting throughout at least 4 days, that is clearly different from the usual
nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have been
present to a significant degree:

(1) inflated self-esteem or grandiosity

(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

(3) more talkative than usual or pressure to keep talking

(4) flight of ideas or subjective experience that thoughts are racing

(5) distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)

(6) increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation

(7) excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is
uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by
others.

E. The episode is not severe enough to cause marked impairment in social or
occupational functioning, or to necessitate hospitalization, and there are no
psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication, or other treatment) or a general medical
condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic
antidepressant treatment (e.g., medication, electroconvulsive therapy, light
therapy) should not count toward a diagnosis of Bipolar II Disorder.

******************************************************************************


------------------------------------------------------------
3.5   What is the difference between euphoria and dysphoria?
------------------------------------------------------------

There are two basic types of mania (or hypomania): euphoric and dysphoric.

A person can experience both types when they have bipolar disorder.

In euphoria, a person is high, in love with the world, one with the world,
feeling boundless energy, talking a mile a minute, mind is racing, deluded
with grandiose thoughts, etc.  This kind of mania is generally the kind
described in the popular literature. 

Dysphoria is another type of mania. In dysphoria one is "high" but in a
different sense: agitated, destructive, full of rage, talking a mile a minute,
mind racing, deluded with grandiose thoughts, paranoid, full of anxiety,
panic-stricken.

In addition, dysphoria can also come into the depressive side. These are often
referred to as "mixed episodes." Mixed episodes are quite dangerous; suicidal
ideation often accompanies this state.

What's the difference between agitated depression and dysphoric (hypo)mania?

Dr. Ivan Goldberg (psydoc@netcom.com) explains: "While folks in an agitated
depression show increased motor activity, they never show increased
sociability, increased creative thinking, joking and punning that may be seen
in someone experiencing a dysphoric (hypo)manic state."
 

---------------------------
3.6  What is a Mixed State?
---------------------------


******************************************************************************

Criteria for Mixed Episode (DSM-IV, p. 335)

A. The criteria are met both for a Manic Episode and for a Major Depressive
Episode (except for duration) nearly every day during at least a 1-week
period.

B. The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with
others, or to necessitate hospitalization to prevent harm to self or others,
or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication, or other treatment) or a general medical
condition (e.g., hyperthyroidism).

******************************************************************************

Comment: This may be an instance in which the DSM-IV definition is a 
bit too narrow.  Many readers and participants in ASDM and SSDM report
experiencing mixed states with hypomanic, but not fully manic, features.


---------------------------
3.7  What is Rapid Cycling?
---------------------------

The "rapid-cycling" form of Bipolar Disorder involves four or more complete
mood cycles within a year's time, and some rapid-cyclers can complete a mood
cycle in a matter of days--or, more rarely, in hours.  Studies show that women
are more likely than men to be diagnosed as rapid-cyclers.


--------------------------------------------
3.8   What are delusions and hallucinations?
--------------------------------------------


-- What are delusions? 

Delusions are, in general, "false beliefs." The DSM-IV (p. 763) defines a
delusion as:

     A false belief based on incorrect inference about external
     reality that is firmly sustained despite what almost
     everyone else believes and despite what constitutes
     incontrovertible and obvious proof or evidence to the
     contrary.

People who are in a manic or depressed episode may have delusions. Some of
these might include delusions of reference, where the individual feels like
events, objects, or other persons have a particular and unusual significance.
The individual may also have grandiose delusions or delusions of persecution
(such as paranoia).

It's important to note that delusions must be diagnosed in terms of 
cultural, social, and religious norms.  A belief that one is in direct
communication with God, for example, might be either a delusion or an
expression of certain kinds of religious faith. :-)


-- Can people with bipolar disorder have hallucinations?

Most certainly. The DSM-IV (p. 766) defines a hallucination as:

     A sensory perception that has the compelling sense of
     reality of a true perception but that occurs without
     external stimulation of the relevant sensory organ.
     Hallucinations should be distinguished from illusions, in
     which an actual external stimulus is misperceived or
     misinterpreted.

Some people know that they are having hallucinations, and others do not. Most
people who have bipolar disorder realize that the hallucinations are not actual
perceptions of reality. However, this realization does not keep them from
occurring.


-- What kind of hallucinations are there?

Hallucinations may occur in any of the senses: auditory (for example, hearing
voices or music), gustatory (for example, unpleasant tastes), olfactory (for
example, unpleasant smells), somatic (for example, a feeling of "electricity"),
tactile (for example, a sensation of being touched, or "skin crawling"
sensations), visual (for example, flashes of light, colors, images on the
periphery).


----------------------------------------------------
3.9  How do you tell unipolar depression and bipolar
     disorder apart?
----------------------------------------------------

If the person in question is known to have had even a single Manic or Hypomanic
Episode, then there is virtually no question; the diagnosis is a form of bipolar
disorder (or, in the case of hypomania, possibly cyclothymia.)  

If the person in question is currently depressed, and his or her history is not
known, or is incomplete, the following guidelines by Dr. Ivan Goldberg may prove
to be useful:

      The things that make me suspect bipolarity in a patient
      diagnosed as unipolar are:
      
      - oversleeping when depressed

      - overeating when depressed

      - a history of bipolarity in the family 

      - a patient who when depressed can still joke and laugh 

      - anyone with a history of frequent depressive episodes
        (rapidly cycling unipolar disorder) 

      - success as a salesperson, politician, or actor  (in school
        or real world) 

      - extreme rejection sensitivity 

      - a history of having ever been diagnosed as bipolar or given
        lithium (except to potentiate antidepressants)

Of course, a unipolar patient can still sleep too much, unipolar depression or
bipolar disorder can surface earlier or later in life, and so on.  These are
guidelines, not hard-and-fast rules. 


CONTINUED IN PART 2.

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