Bipolar disorder patients fluctuate between periods of mania in which they are overactive, euphoric or irritated. Phases of less pronounced mania (hypomania) or depression may happen in between. In addition to the depressive and manic episodes (extremes), 20 to 60% of patients experience so-called mixed conditions, in which both symptoms of depression and mania occur. Bipolar diseases can differ individually and can have quite different types and courses. That is why the clinical picture is not always clear to identify and establish.
Bipolar disorder is particularly severe when psychotic symptoms occur, i. the patient who has a distorted sense of reality, perceives the environment as distorted as well. These symptoms are more common during manic periods than during depression. Over two-thirds of all patients show individual psychotic symptoms, including boundless self-overestimation, persecutory delusions, hallucinations.
Bipolar disorder - Symptoms
- Euphoric, elevated (happy or energetic) mood irritability
- Emotional excitement
- Racing thoughts, talkativeness, accelerated motor skills and action
- Involvement in irresponsible activities that might have dangerous consequences, risky behavior, impulsiveness, reduction of social inhibitions, aggressiveness, carelessness
- An increased focus on reaching job or personal goals
- Increased creativity
- Ideations, concentration and attention disorders
- Decreased need for sleep
- Inflated self-esteem or unrealistic feelings of importance
- Inhibited emotions, feelings of numbness, fear, pessimism
- Slowed down thinking, language, motor skills and action
- Withdrawal behavior
- Loss of interest, joy and lack of motivation
- Lack of drive, diminished vitality, lack of energy, physical discomfort, loss of libido
- Sleep disorders or increased need for sleep, early awakening, nausea after sleep, morning droughts
- Self-doubt, feelings of guilt, insufficiency, despondency, life-weariness, suicidal thoughts
In some patients, instead of euphoria, irritability and mistrust can be observed during their manic phase.
If hypomania occurs – and it’s a less severe form of mania – the mood is usually up and patients have more energy than usual, but it’s not out of control. The person concerned is still able to grasp the reality and his personal situation. Hypomania may appear as a brief and temporary increase in normal mood, but it may also involve into mania. As a rule, it is necessary to intervene therapeutically as quickly as possible even in the case of hypomania, since it is often the beginning of a mania and mostly after it, manic depression follows again.
However, in most cases, the affected persons do not come to the doctor during the manic phase because they do not feel sick. Especially if someone has previously suffered from a depressive phase, the mania can understandably be taken as a liberation by him.
Bipolar disorder – types
Depending on the nature and severity of bipolar disorder, different forms are distinguished. Both the treatment strategy and the choice of a suitable drug depend on the type of bipolar disorder.
1. Bipolar I disorder
In bipolar I disorder, both manic and depressive episodes occur. The depressive phase lasts at least 14 days and the manic episode lasts at least 7 days, it is often severe and leads to negative consequences (debts, marital problems, etc). Both women and men are equally affected by this type of bipolar disorder.
2. Bipolar II Disorder
Bipolar II disorder is characterized by depressive episodes and one hypomanic phase lasting at least 4 days. With a presence of 2-4% in the population, the bipolar II disorder is quite common.
3. Rapid Cycling
"Rapid cycling" is when at least four or more episodes of mania, hypomania, or depression occur within twelve months, i.e. one year. It can also come to mixed episodes. Only 20% of patients show rapid cycling from the beginning, and the high frequency often develops later. Rapid cycling is often a complicated form of the disease, and some patients are also prone to emotional (mood) lability and adjustment problems in the episode-free intervals. Overall, 15 to 20% of patients with bipolar disease have rapid cycling. Women are more affected than men.
Specialist support: Prof. Md. Gregor Hasler, Bern (SGPP) and Prof. Md. Michael Bauer, Dresden (DGPPN), Dr Roger Pycha, Brunico (SIP)