Bipolar Disorder

Bipolar disorder is a major mood disorder including moderate or severe depression that alternates with very high levels of happiness, physical activity most of the time. There are two major types of bipolar disorder. Bipolar I and Bipolar II.

In Bipolar, the symptom of mania is present and it is severe enough to compromise functioning.

Mania is a state of over arousal with difficulties concentrating, very little need for sleep, inflated self-esteem (grandiocity- delusions of grandure), and sometimes hallucinations. 90% of patients have periods of depression. Attacks are often separated by months of years, but some people may cycle between depression and mania over days or weeks. Pure Mania (unipolar mania) is rare but may occur.

Bipolar II occurs when a patient has a Major Depression but also experiences a hypomanic episode (usually around the time of the depression) but never develops a full manic episode.

5 to 10% of first degree relatives with bipolar disorder develop the illness. Bipolar Disorder is considered a genetic disorder (by some) due to 70% concordance for identical twins. There is some evidence to suggest an abnormality on chromosome 11 but this is not clear at this time.

The first manic episode usually occurs before age 30. It usually occurs quickly and resolves in 2 to 4 months. One or more periods of depression have usually already occurred. Suicide is a major risk during depressive episodes. Legal difficulties or substance abuse are major risks during manic episodes.

Theoretical approaches used with this disorder are psychoeducation, and cognitive-behavioral therapy. The treatment of bipolar deals with the acute manic and acute depression as well as the prevention of manic and depressive recurrence. It seems that discussing the diagnosis and including the patient in his or her own treatment is effective. The patient should keep a chart of sleeping patterns and mood patterns.


If mania is present than the patient may need to be hospitalized to ensure personal safety. A referral to a physician is a good idea to rule out any possible general medical condition that may pre-exist. A referral to a physician will be necessary also to obtain an antidepressant medication evaluation. Neuroleptic medication in small doses may help hypomanic episodes. Larger doses may be needed to treat mania.