Characteristics of Bipolar i Disorder

Not only is Bipolar I a medical complexity, but a personal experience. The following information is transcribed in a straight forward manner in which to promote education, but also to describe some intrinsic experience. Though this may appear dryly written, the point is to give BP I the respect it deserves in hopes that health care, employers and people without this experience will incorporate understanding.

In the psychiatric field, theoretical diagnosis differentiates between Bipolar I and Bipolar II. Persons with Bipolar I,  just like Bipolar II, experience mixed episodes, hypo-mania, and depression. However, the distinct difference between Bipolar I and Bipolar II is that in BP I, there is the state of true mania, which can result in hospitalization. The important fact to note is that the mania in Bipolar I does not occur, or rarely occurs, in Bipolar II (APA. DSM-IV-TR. 2000. NY, NY)

Contrary to pop culture belief, these disorders are not due to a “split personality”. People with BP are not friendly one minute and then biting another person’s head off the next. It is unimportant for the world to be politically correct, but understanding can stamp out biased opinion and replace it with fact.

When diagnosed with either BP disorder, it is important to iterate the differences between the two (mainly) clinically defined illnesses.  Separating the two gives the patient a chance to understand his/her’s biological diagnosis and allows clinicians to prescribe appropriate medications for each sub-type.

Many medications, such as Lithium Carbonate and Lamictal (Lamotrigine) are specific to Bipolar I to help stabilize moods with true mania, although these drugs have been tried for both BP types. These medications target areas of the brain prone to excitability during manic phases and attempt bring the individual to middle ground. Topamax has recently started to be prescribed for Bipolar II (American Psychological Association, 2000.  DSM-IV-TR).

Antidepressants, used in combination with a mood stabilizer, are the ideal treatments for Bipolar II since depression is the most prominent of mood disturbances. However, many mood stabilizers can be personally experimented with and if the current drug is not aiding in producing improvement, then there are many old and new medications to try until the right fit comes along.

Bipolar Disorder I is characterized by typical mood disruption lasting for two weeks or more. Some individuals experience a deep clinical depression marked with lethargy and suicidal thoughts, for a period of time, then experience stability, only to be jolted awake in a manic state a few weeks or months later. Endless combinations between these states occur throughout a lifetime, which is the explanation for the change in term from “Manic-Depression” to “Bipolar Disorder” (American Psychological Association, 2000.  DSM-IV-TR. NY, NY).

Bipolar is a new description that promotes knowledge to explain that people diagnosed are not restricted to one combination of mood events. Picture a globe or a vertical pole. The top and bottom of a pole is not the only point in which the pole can be touched or seen. Therefore, the desire in the medical community was to correct the idea that lacked the entire story. There are not only two moods, but a myriad of states.

Phases of this illness can range from clinical depression, a remission period, hypomanic states (hypo, Greek, meaning “under”), and true mania. Episodes are less frequent, but severe in that depression is often debilitating due to psychomotoretardation and mania is accompanied with such fervent energy that the individual remains awake for days upon end leading to psychosis. In some cases, manic phases can be spaced as far apart as 10 years. When manic, many individuals are hospitalized. [1]

Hypomania, is characterized by an extra surge of energy, sociability, creativity, and task oriented activities. Sometimes, hypo-mania is quite enjoyable and productive for persons experiencing it.  This is when these individuals feel on top of the world and come across as quite charming to themselves and others.

When hypomanic, many times sales positions are performed to excellence due to the ability to be social with clients, have a quicker memory time, and use the fast pace of thoughts to help the customer make a decision on what to purchase.  [2]

In the hypo-manic phase, individuals may dress a little bit more provocatively and engage in regrettable activities such as going on spending sprees for thousands of dollars or become argumentative with those closest. Impulse control is lessened and an awareness of consequences is diminished.

Chemically, these changes in mood are due to an imbalance of dopamine, seratonin, epinepherine, and norepinepherine. During hypo-mania and mania, estrogen, progesterone, and testosterone levels elevate as well. (Martini & Bartholemew, 2000.  The Essentials of Anatomy and Physiology.  Prentice Hall, NJ).

Mania can be exacerbated through stresses on the body, a lack of sleep, and sometimes nutritional deficiencies. True mania is highly recognizable. During depression, the same person that wanted nothing more than to sleep or rest while avoiding others reclusively in nature, begins in hypo-mania and escalates from there (Gruen, E. 2004).

The manic person is sociable, but can be obviously impaired, especially to loved ones and friends. Individuals may speak with broken sentences that are too hard to keep up with for both the listener and episodic manic person attempting to explain. This often is due to a racing flight of thoughts burning through his/her mind. Energy becomes excessive sometimes turning into obsession, where a person may attempt to satiate through hours of exercise, large projects, and risk taking behavior. [3]

During mania, the experience may include hallucinations, both auditory and visually, which are sometimes accompanied by paranoia. Grandiosity and aggression can become violent in nature towards others as well as the self. Some individuals black out eventually, where memory of this time period is lost. This is referred to as “Black Mania” by some with this illness. This mimics the effects of cocaine or amphetamine use, which explains the reason drugs are inquired about initially. [4]

Mixed manic states are the most dangerous states for a person to experience. At this time, mania is present as well as symptoms of depression bleeding through. Combined impulse control, racing thoughts, and suicidal ideology usually leads to violent or hurtful behavior towards the self mostly and sometimes others. Once a person with BP says they will hurt themselves or others, they are hospitalized and treated appropriately. [5]

While this article is personally motivated in posting, the hope is to spread the word about these disorders. They are hereditary based, just as Diabetes is. Perhaps thinking about this differently will lead to speaking about it differently.

[Footnotes 1-5: Citations from American Psychological Association, DSM-IV-TR, 2000.  Washington, D.C]