Bipolar disorder

Bipolar disorder, also known as manic-depression, is a mental illness which causes extreme mood swings between mania (excessive euphoria) and depression,negatively impacting an individual's ability to function normally. Typicallyappearing in early adolescence or young adulthood, it continues throughout life. It affects more than two million people in the United States and as manyas two-thirds of these individuals are undiagnosed, misdiagnosed, or receiving inappropriate treatment. Sufferers are at a 30-times greater risk of committing suicide than the general population, which makes accurate diagnosis andeffective treatment a priority. A combination of medication, psychotherapy, close observation by an informed individual, and support groups allow most people suffering from this disorder to lead healthy, productive lives.

One early warning sign of bipolar disorder, hypomania, usually does not dramatically affect daily functioning and thus often goes unrecognized. During this cycle, the individual has increased energy and activity, racing thoughts and rapid talk, excessive feelings of euphoria, unrealistic belief in their ability, increased sex drive, unrestrained buying sprees, aggressive behavior, decreased need for sleep, extreme irritability and distraction, abuse of drugs, alcohol, or sleeping medication, and denial that anything is amiss.This state must persist for at least four days to be diagnosed as a problem.For a diagnosis of full-blown mania, these tendencies must escalate tothe degree of severe interference with the ability to function, persist forat least one week, and be unrelated to drug, alcohol, or medication use.

A major depressive episode is defined by depression for at least two weeks. Symptoms include persistent anxiety; sadness; feelings of helplessness,hopelessness, worthlessness, pessimism, or guilt; restlessness; irritability; drastic loss of interest in pleasure or daily activities; reduced sex drive; fatigue or feeling 'slowed down;' difficulty concentrating, remembering, ormaking decisions; body aches not caused by physical illness; weight gain orloss; and suicidal tendencies.

There are several types of bipolar disorder with varying degrees of severity.Some individuals with Bipolar I disorder experience depression with few manic episodes while others experience mood swings which progress from severe, to moderate, to "the blues," to normal, moving into hypomania and mania.In Bipolar II disorder, some individuals experience extensive depression with infrequent episodes of mania while others experience the reverse. For a mixed episode diagnosis, criteria for both mania and major depressive episodes must apply.

Cycles of mania and depression vary greatly. Some individuals cycle only onceevery few years, rapid cyclers experience four or more episodes annually, ultra-rapid cyclers have episodes lasting less than a week, and ultradian cyclers experience dramatic mood shifts within 24 hours or less.

While there is no known single cause of bipolar disorder, there appears to besome genetic predisposition. Potential causes--such as increased stress or atraumatic emotional event--are many and varied, and experts believe a combination of factors may act as a trigger. The most effective treatment is a combination of appropriate drugs, skilled psychotherapy, and emotional support. Lithium is the most commonly used medication for mania; however, haloperidol or chlorpromazine are also used. Antidepressants may be necessary during severe depressive episodes but cautious observation is recommended as this treatment may push a patient into the manic state. In severe cases, hospitalizationmay be necessary and, as a last resort, Electroconvulsive Therapy (ECT). Because this disorder can be debilitating and deadly, recognition and accurate diagnosis is essential. Sufferers often 'need help to get help,' and observantfamily and friends can play an important role in this area.

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