Bipolar Disorder Types

Bipolar I disorder Individuals have had at least one full manic or mixed mood episode, and may or may not suffer from episodes of depression. Bipolar II disorder Individuals have at least one depressive episode and at least one hypo manic episode, but never experience a full manic or mixed mood episode. Bipolar II can go unrecognized because the hypo manic symptoms may not appear that unusual. Cyclothymic disorder Individuals have suffered numerous hypo manic and depressive symptoms over at least 2 years that are not severe enough or not long enough in duration to meet the criteria for a mood episode. Subtypes of bipolar Rapid cycling. Individuals who experience more frequent mood episodes ( 4 or more per year) arecalled rapid cyclers. Ultra-Rapid Cycling. This is the same as rapid cycling, only the cycles are more frequent. (4 or more perweek, and can cycle as rapidly as 4 or more per day) Seasonal pattern. Some individuals have predictable seasonal patterns to the onset of their mood episodes. Post-partum onset. When the mood disturbance occurs within 4 weeks of childbirth.

The most important distinctions between bipolar I and II are: A person with bipolar I has manic episodes, while someone with bipolar II has hypomanic episodes The main difference between mania and hypomania is a matter of severity. In the hypomania of bipolar 2, a person has a sustained mood that is elevated (heightened), expansive (grand, superior) or irritable. This mood has to be noticeably different from his or her normal mood when not depressed. In mania, that mood is abnormally different, and is also combined with increased activity or energy that is also abnormal. For example, Hank, when he has hypomanic episodes, is exceptionally cheerful,

needs only three hours sleep instead of his usual seven, spends more money than he safely should and speaks far more rapidly than usual, along with other symptoms of hypomania. This behavior is noticeably different from his own stable mood, yet there are cheerful people who need little sleep, spend a lot and talk fast who don't have bipolar disorder, so it's not considered abnormal. On the other hand, Hank's friend Robert, who has manic episodes, is out-of-control happy, even during serious events (he burst out laughing disruptively during a funeral). He ran around outside at midnight shouting how much he loved all his neighbors (along with other symptoms of mania). This is abnormal behavior for anyone. Other differences between bipolar I mania and bipolar II hypomania One or more of the following conditions has to exist in mania but can't be present in hypomania: 1. Mania may include psychotic symptoms - delusions or hallucinations. Hypomania does not have psychotic symptoms. Robert firmly believes he is the mayor of his town and introduces himself to people as such, telling them about grandiose and sometimes bizarre plans he has for making improvements to services and infrastructure. If Hank had a similar delusion, his diagnosis would be bipolar I rather than bipolar II. The presence of psychosis automatically rules out hypomania. 2. While hypomania may interfere to a degree with daily functioning, in mania day-today life is significantly impaired. Robert missed an important business meeting because of a spur-of-the-moment decision to take flying lessons. Hank may be longing to take flying lessons while hypomanic, but if he does, he takes them at a reasonable time when he has no other obligations. 3. The manic person has to be put in the hospital because of the severity of symptoms. During an irritable manic episode, Robert began throwing crockery, silverware, pots and pans at his wife because he wasn't satisfied with that night's dinner. He was subsequently hospitalized because he had become a danger to others. Hank's hypomania does not escalate to such an extreme extent. A. MANIA Bipolar mania - or a manic episode as part of a bipolar illness - is a condition most commonly characterized by having an abnormally elevated mood, along with such other symptoms as an excess of energy, extravagant behavior, rapid speech, reckless spending and hallucinations. A person who is experiencing mania is having a manic episode, as opposed to a hypomanic or depressive episode. The following three conditions are specific to mania or a manic episode (as opposed to hypomania or a hypomanic episode): 1. Mania symptoms must last for at least one week or require hospitalization. 2. There must be a "sustained and abnormally elevated, expansive or irritable mood" through the episode [emphasis mine]. In addition, there must be an abnormal increase in energy or activity. Both of these conditions have to be there most of the day, almost every day.

3. Symptoms of psychosis (see below) may be present. Everyone has times when they are exhilarated, especially talkative, generous or outgoing, or irritable (imagine a woman excitedly getting ready for her wedding). These moods can last quite some time. In mania, such a mood is exaggerated beyond what most people would experience and more than likely has no relationship to anything going on in the person's life. This is why the word "abnormally" is part of the definition of a manic episode. Additional Diagnostic Symptoms of Mania In addition to having abnormal mood as given above for at least a week (if hospitalization was necessary, how long doesn't matter), at least three additional symptoms from the list below have to be present as well, or four if the abnormal mood is only irritable: Inflated self-esteem or grandiose thinking - for example, believing you are better than anyone else at doing something or that you can accomplish a difficult task in hours instead of the more reasonable time frame of days or weeks. Not needing much sleep, without feeling fatigued - for example, a person who normally sleeps eight hours now sleeps only four hours and feels fine. Being more talkative than usual, or pressure to keep talking (pressured speech). This could show up as talking so fast it is difficult for other people to understand. The disconnected speech pattern called flight of ideas or racing thoughts, where thoughts move at a rapid speed that may be uncomfortable. Being too easily distracted, such as being unable to focus on a task, even when there is a deadline for finishing it, because unimportant or irrelevant things easily take your attention away. Psychomotor agitation, a severe form of physical restlessness, and/or an increase in what's called goal-directed activity. Examples might be suddenly throwing parties every night; taking on an unusual number of home projects; volunteering to do extra jobs at work or school; or wanting more sexual activity with a partner than usual (a symptom of hypersexuality). Indulging excessively in high-risk behaviors. These can include compulsive gambling, risky investing, or spending without regard for one's true financial state (like buying a car when you can't possibly make the payments). Hypersexual behaviors can also be high-risk, like making inappropriate sexual advances; spending a great deal of money on phone sex, internet pornography, or prostitutes; or having affairs.

B. HYPOMANIA Hypomania is a state of mind, mood and behavior that may express itself as unusual gaiety, excitement, flamboyance or irritability. In addition, hypomania is accompanied by such behaviors as restlessness, talking nonstop, feeling fresh on only a few hours of sleep, furious focus on a single activity or being much too easily distracted, and/or a variety of other symptoms. The diagnostic criteria for a hypomanic episode are quite specific, but the way the symptoms appear can vary

widely from one person to another. Diagnosing Hypomania For a person to be diagnosed as hypomanic, the first requirement is that there must be a sustained, elevated, expansive or irritable mood, plus unusually and persistently increased activity for most of the day over at least four days. The mood and the activity must be observable by others and clearly different from the way you are when you are not depressed. That means there isn't just a big contrast to a depressive state, but there's also a marked contrast to your everyday state when you're not having any bipolar symptoms. Before you can be diagnosed as having a hypomanic episode, you'll also have to be experiencing at least three of the following symptoms - or four if your unusually sustained mood is only irritable: 1. You don't need much sleep. 2. You're more talkative than usual or feel pressure to keep talking. 3. You are experiencing a flight of ideas or feel that your thoughts are racing. 4. You are easily distracted. 5. You are driven toward accomplishing specific goals (either socially - at work or school - or sexually) or you are experiencing psychomotor agitation. 6. You have grandiose thinking. For example, you believe you are better than anyone else at doing something or that you can accomplish a difficult task in hours instead of days. For more, see "What Is Grandiosity?" 7. You've become excessively involved with pleasurable activities that have a high potential for painful consequences, such as unrestrained buying sprees, sexual indiscretions or foolish business investments. There are also three factors that can't be present in hypomania. These are possible characteristics of a "manic" episode: Symptoms of psychosis. In hypomania, a person doesn't have hallucinations or delusions such as paranoia. The symptoms of hypomania aren't so severe as to require hospitalization. While hypomania may interfere with daily life to a degree, the impairment in functioning is not marked. A simple example is that while a hypomanic person might talk a great deal more than usual at a company meeting, a manic person might jump on the conference table and break into loud singing.

What Is An Episode? Wherever you see something written about bipolar disorder, you will encounter mentions of bipolar disorder episodes. Manic episodes, depressive episodes, mixed episodes - all are bipolar disorder episodes. But just what is an episode in the context of bipolar disorder? Answer: Dictionary definitions of episode abound, but the nearest lay definition that fits a bipolar disorder episode is "an incident or event that is part of a larger sequence." The larger sequence, of course, is the ongoing flow between the highs and lows of manic depression.

The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSMIV) has strict durations for each type of episode that may occur in bipolar disorder: 1. A manic episode must last at least one week unless hospitalization is necessary then the episode may be shorter and still be classed as manic. 2. A hypomanic episode must last at least four days. 3. A major depressive episode must last at least two weeks. 4. A mixed episode must last at least one week with symptoms present "nearly every day." Within each of these time periods, a given number of certain diagnostic symptoms must appear. For example: In a manic episode, there must be a sustained and abnormally elevated, expansive or irritable mood throughout the period. In a hypomanic episode, there must be a sustained and elevated, expansive or irritable mood throughout the period - but the word "abnormally" is omitted from the description. In a major depressive episode, at least one of the symptoms must be depressed mood or loss of pleasure or interest. In a mixed episode, the criteria for both a major depressive episode and a manic episode must be met.