Bipolar I Disorder is a type of Bipolar Affective Disorder, which is a psychiatric illness of mood disorder. Once experienced it is something never to be forgotten. The poet Robert Lowell described his mania as "pathological enthusiasm" Bipolar I Disorder brings with it: 1. Changes in mood for a distinct period of time - feeling happy, optimistic, euphoric, irritable 2. Changes in thinking - thoughts speeding through one's brain, unrealistic self confidence, difficulty concentrating, grandiose plans, delusions, hallucinations 3. Changes in behavior - increased activity or socializing, immersion in plans or projects, talking very rapidly and excessively, excessive spending, impaired judgement, impulsive sexual involvement 4. Changes in physical condition - less need for sleep, increased energy, fewer health complaints Nine out of ten people with Bipolar I Disorder also experience depression including depressed mood, loss of interest in activities, feelings of worthlessness and hopelessness, lack of appetite, sleep difficulties, lack of energy and thoughts of suicide. For more about this read my past article Major Depression. If you suspect, or if others around you have mentioned that you are "higher" than usual, and you are concerned see the Goldberg Mania Inventory by Ivan Goldberg MD at http://mhnet.org/guide/mdquiz.htm. Use it to help determine if you need to see a mental health professional for diagnosis and treatment of mania or manic-depression or bipolar disorder. DIAGNOSIS A diagnosis of Bipolar I Disorder is officially based on the following DSM-IV Criteria One or more manic or mixed episodes.
Clinical Features Greater than 90% of patients who
have a mania single episode will have a recurrence.
Epidemiology The lifetime prevalence is approximately
0.5-1.5%
Classification Classification of involves describing
the current or most recent mood episode - Manic, Hypomanic, Mixed or Depressive.
(e.g. Most recent episode Mixed)
Without psychotic features
Rapid Cycling Diagnosis requires the presence of
at least 4 mood episodes within 1 year.
Manic Behavior you might Observe Generally an episode seems to begin overnight with a sudden and pleasant switch of mood to one of well-being, lightening, happiness and positive energy. At this stage (known as mild mania or hypomania) the individual is able to function quite well, and this mood may persist at this level for a long period of time without becoming more severe. In other cases it intensifies day by day into true mania. This is the state I will discuss here. Out of control of emotions and behavior….very distressed Normally amiable people may become increasingly angry, impulsive, emotional or irritable Intense euphoria that nothing can disturb, but if their plans are foiled they may become irritable or uncontrollably furious Some may become hostile A few manics may become paranoid or violent and assault others verbally or physically Very rapid speech, incessant and usually in a loud voice Answer questions at great length and continue talking when others speak Speech may be riddled with jokes, puns, or irrelevant witticisms Acting in theatrical roles and ways Offer money or advice to passing strangers Unable to sleep or sit still…often going for days with 2 or3 hrs sleep and not feeling tired Socially frenetic…throwing parties, going to bars Throw aside normal inhibitions and become sexually hyperactive or promiscuous Due to impaired judgement very poor decision making skills. Overspending, over commitment, quitting jobs, etc. In persons with extreme mania you may see some of the following: Thinking completely illogical Speech uncontrollable and sometimes incoherent Unable to distinguish between "real" and "not real" Delusions, paranoia, hallucinations Catatonia possible
TREATMENT Medication Mood stabilizing medications are the hallmark of treatment for individuals diagnosed with Bipolar Disorder. It wasn't until the late 1960's that the drug Lithium was serendipitously discovered to stabilize mood in North America. Lithium is still widely used. To read more about lithium go to Lithium questions and answers at http://www.bipolarworld.net/lith.html In the 70's and 80's two new drugs joined lithium as effective mood stabilizers. Carbamazepine (Tegretol) and Valproic Acid (Depakote, Depakene). An overview of the medications used for bipolar disorder can be found at http://www.bipolarworld.net/medn.html New medicines are coming to the forefront and are being researched and used for patients with bipolar disorder. Read about these medications…Gabapentin (Neurontin) at http://www.bipolarworld.net/depression_central_gabapentin.html Lamotrigine (Lamictal) at http://www.bipolarworld.net/depression_central_lamotrigine.html and Topirimate (Topamax) at http://www.bipolarworld.net/depression_central_topiramate.html Electroconvulsive Therapy (ECT): ECT usually is reserved for those so ill as to need the protections of an inpatient facility. Such cases include those with such severe suicidality that they require continuous protection, those in stupor or inanition, in manic delirious and excited catatonic states…read about Bipolar Disorder and ECT here http://www.schizophrenia.com/ami/meds/moreect.html ECT is recommended for treatment of severe mania in early pregnancy, when lithium and anticonvulsant medications should be avoided because of the risk of birth defects. It is said to be effective, although these reports are largely based on uncontrolled studies and anecdotal evidence. Transcranial magnetic stimulation This is a recent treatment development. To find out what it is please visit http://www.mhsource.com/bipolar/bp9802ask.html Psychotherapy Psychotherapy alone has not been proven to affect the long-term course of bipolar disorder. Behavioral, cognitive or dynamic psychotherapies have, however, proven effective in helping bipolars accept, understand and cope with the stresses of both the disorder and every day life. Through psychotherapy individuals can learn to restore self-esteem, adapt to a new range of emotions and work out ways to prevent relapses. Hospitalization Individuals with severe mania may require hospitalization to prevent harm to themselves or to others. Poor judgement can lead to personal danger. There are even rare cases where people with severe mania have died as a result of physical exhaustion. Maintenance Therapy How to Help Yourself When Getting Manic 1. Call your doctor before things get out of hand. 2. Be sure to take your medication regularly as prescribed. 3. Avoid spending money. Give your cheque-book and credit cards to someone you can trust. 4. Do not make any major decisions. Put them off until you are feeling calmer. 5. Reduce stress as much as possible. Stay away from stressful people. 6. Stay in non stimulating surroundings. Avoid dances and bars. 7. Talk to a support person. Let them know how you are feeling. 8. Avoid overstimulation. Restrict your activities to soothing, relaxing ones. 9. Make lists of things to do, or things you need to shop for and stick to them. 10. Learn and practice relaxation techniques. 11. Try to keep your thoughts focused, not rambling or obsessive. 12. Avoid sugar, caffeine and alcohol. 13. Eat nutritious well balanced meals. 14. Do not take on extra commitments until you are feeling better. 15. If you are not sleeping, call
your doctor right away. Lack of sleep exacerbates mania.
See http://www.bpso.org/nomania.htm for more tips on how to avoid a manic episode. Recovery from a Manic Episode Some easy steps to Help! Recovery from a Manic Episode 1. Take medications regularly and as prescribed by your doctor 2. Get emotional support from a supportive person. 3. Talk to a therapist or counselor 4. Tell yourself that you have been ill and that the things you said or did while ill were not the real "you" 5. Eat regular, nutritious meals. 6. Be kind to yourself. 7. Get plenty of rest. 8. Focus on living one day at a time 9. Use spirituality if desired 10. Reduce environmental stress Impact on Relationships Bipolar disorder, and mania, often strikes people who are charming, creative and charismatic. Initially it may be impossible for them and those close to them to admit anything is wrong. When their behaviour becomes outrageous...they have run up thousands of dollar in debts and put the family on the verge of, or into bankruptcy, when they have been involved with public brawls and the police, or when their sexual indiscretions become too obvious to ignore....the impact on relationships is enormous. Separation and divorce is common. Even the most understanding partner has problems understanding the illness and the symptoms are seen and felt as a personal attack. The anger displayed by the manic creates arguments and fights in the home. The partner finds it nearly impossible to defend himself against these attacks. Relationships are poor, and even after the mania has abated, it is difficult to pick up the pieces and go on with a relationship. Partners must realize that mania is an illness, and that it will get better. They must try not to take the symptoms of the disease as a personal affront, and to be supportive and protective until the episode is over. They may need to manage their manic partner....seeing that they take their medications, or getting them to professional help, including hospitalization when necessary. Conclusion Mania is a disorder that one cannot
manage on his own. Professional mental health care from a psychiatrist
is necessary. If you or someone you know is experiencing the symptoms
of mania get them to appropriate care as quickly as possible, then do all
you can to ensure they follow the long-term treatment program prescribed
by their doctor.
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