What Is Bipolar Disorder: Diagnosis by the DSM-5

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a person with bipolar disorder experiences clinically significant episodes of depression and mania. To diagnose someone as bipolar, he or she must have specific symptoms for a designated period of time. Those symptoms, or mood episodes, include the following:

• Major depressive episodes
• Manic episodes
• Mixed episodes
• Hypomanic episodes

Two Poles of Bipolar Disorder

1. The Lows (Depression)
2. The Highs (Mania and hypomania)

Definition of Bipolar Disorders

• Bipolar Disorder I: When a person has had a full manic episode, which means they had mania for at least seven days, and a two-week depressive episode.
• Bipolar Disorder II: When a person has at least one major depressive and one hypomanic episode
• Rapid cycling – When a person with bipolar disorder repeatedly swings from a high to low phase quickly without having a “normal” period in between
• Mixed state – When a person with bipolar disorder experiences symptoms of depression and mania together; for example, over activity with a depressed mood
• Cyclothymia – If your mood swings last a long time but aren’t severe enough to be classed as bipolar disorder, you may be diagnosed with (a mild form of bipolar disorder).

Major Depressive Episode

According to DSM-5 major depressive episode begins with constant depression or a complete lack of interest or pleasure in normal daily activities, almost every day for a two-week period. In addition to one of these two scenarios, at least five or more of the following symptoms must be present every day over the same period to categorize an episode as major depressive:

• A significant change in weight or appetite (A change of more than 5% of body weight in a month)
• Thoughts of death or suicide or an attempt
• Slowed speech, thinking or movement, or heightened activity (pacing, problems sitting still, etc.)
• Feeling worthless or intensely guilty (Inappropriate guilt)
• Inability to sleep or inability to stay awake (Sleep Disturbance)
• Difficulty concentrating or making decisions, indecisiveness
• Fatigue throughout the day

Manic Episode

When someone experiences a manic episode, he or she is unnaturally euphoric or persistently irritable for a period of at least one week. This person may also go from one feeling to the other, but to be considered a manic episode, it must include three to three (four if mood is irritable) of the following symptoms:

• Exaggerated self-esteem or confidence or grandiosity
• Increased goal directed activity
• Inability to focus on one thing, even if it is important or distractibility
• Diminished need for sleep(e.g feels rested after only 3 hours of sleep)
• Excessive pursuance of a goal or trouble sitting still or psychomotor agitation
• Flights of ideas or subjective experience that thoughts racing
• More talkative than usual or pressure to keep talking

Hypomanic Episode

A person is having a hypomanic episode if they are experiencing the symptoms of a less extreme manic one. These indicators only need to be present for four days in this type of episode, but have to be noticeable by others as a change from the norm and evident that they affect normal functioning.

What Causes Bipolar Disorder?

There are multiple causes of bipolar disorder. Several factors may contribute to heightened risk and the development of the disorder. Studies have shown any combination of the following factors may cause the problem:

• Biochemical Brain Function: A chemical imbalance related to norepinephrine, dopamine and serotonin levels
• Genetics: The presence of particular genes that make it more probable you will experience the disorder
• Family History: Someone else in your family is or was bipolar
• Age: You are between 15 and 30 years old
• Alterations of Hormonal Regulation: Lasting alterations in neuroendocrine and behavioral responses can result from severe early stress.
• Substance use :Alcohol, cannabis etc.
• Alterations of Sleep Neurophysiology
• Life Events and Environmental Stress: A long-standing clinical observation is that stressful life events more often precede first, rather than subsequent, episodes of mood disorders. This association has been reported for both patients with major depressive disorder and patients with bipolar I disorder. A stressful circumstance or situation often triggers the symptoms of bipolar disorder. Examples of stressful triggers include – A stressful circumstance or situation often triggers the symptoms of bipolar disorder. Examples of stressful triggers include –
• the breakdown of a relationship
• physical, sexual or emotional abuse
• the death of a close family member or loved one
• physical illness

sleep disturbances

How Is Bipolar Disorder Treated?

Once diagnosed, bipolar disorder can be treated using a combination of methods, including medication, psychotherapy and electro conclusive therapy (ECT). Treatment should be continuous and consistent for maximum results, as bipolar disorder is a lifelong condition.

Medication

Most bipolar patients will take some form of medication to treat the symptoms, and often a combination of drugs. The most commonly used medications are antidepressants, mood stabilizers and atypical antipsychotics.

Psychotherapy

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change and overcome problems in desired ways. Psychotherapy aims to improve an individual’s well-being and mental health, to resolve or mitigate troublesome behaviours, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills.

1. Cognitive Behavioural Therapy (CBT):, CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (e.g. thoughts, beliefs, and attitudes), behaviours, and emotional regulation.
2. Family-Focused Therapy
3. Interpersonal and Social Rhythm Therapy (IPSRT)

Electroconvulsive Therapy (ECT)

It can be effective in nearly 75% of patients. In electroconvulsive therapy, an electric current is passed through the scalp to cause a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in people who suffer from mania or severe depression. It is recommended electroconvulsive treatment is administered three times a week until symptoms start to improve, then reduced to maintenance treatments based on the individual person.