Bipolar disorder is when one experiences both a significantly low mood (depression) and significantly high moods (mania), which cannot be explained by one’s surroundings.

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The brains of people with bipolar disorder resemble the brains of those with schizophrenia, to an extent.

A recent meta-analysis involving over 4,000 people in 42 studies, compared the brains of healthy people, those with bipolar disorder, and schizophrenics. They concluded that both illnesses involve less gray matter in the paralimbic part of the brain; however, more extensive deficits, and also reductions in the neocortical and limbic brain regions, characterized people with schiozophrenia.

Nevertheless, effective pharmaceutical treatments between bipolar disorder and schizophrenia oftentimes overlap (antipsychotic medication).

About one in two people originally thought to have unipolar depression (depression without any mania), are now thought to suffer from bipolar depression. Documenting a patient’s family history and the impressions of a close friend or family member, can help to properly diagnose.

There are symptoms that present themselves more often in bipolar depression, than in unipolar depression. These are oversleeping, overeating, and marked suicidality.

Originally, it was believed that about…

  • 86% of mood disorders were those with major depressive disorder
  • 2% bipolar I
  • 2% bipolar II
  • and 10% unspecified

The recent view holds that…

  • Approximately 50% of those with significant disturbance in mood have major depressive disorder
  • 2% have bipolar I
  • 5% suffer from bipolar II
  • and the last 33% have some illness in the bipolar spectrum.

A mixed mood state is when depression and mania occur at the same time.

Hypomania is a less severe form of mania.

Unfortunately, a systematic review has produced chilling data for the suicidality of people afflicted with bipolar disorder…

  • The risk of suicide is 60 times higher than in the general population
  • Up to 20% end up killing themselves, but not you!
  • Their “success” rate is over 30 times that of the national average.
  1. Bipolar I
    1. One has a manic (not hypomania) or mixed episode (full mania and full depression).  Rapid cycling is when one shifts between mania and depression at a very fast rate. Rapid cycling mania is suffering from at least four episodes of mania in 12 months. Rapid cycling switches is when one has four mood episodes in a year. Bipolar I patients usually experience at least one episode of major depression.
  2. Bipolar II includes at least one episode of hypomania, and at least one episode of major depression.
    1. One is said to be cyclothymic if they have manic and depressive mood swings that aren’t as severe as full-blown mania and depression. These are hypomania, and dysthymia, respectively.
  3. There is a mood disorder that isn’t quite bipolar, but which symptoms are some of those seen in people suffering from bipolar disorder.
    1. These people tend to respond quickly to antidepressants, but they tend to stop working.
    2. Adding a mood stabilizer helps this population.
    3. The disease is referred to as Bipolar 0.25.
  4. Bipolar 0.5, also called schizobipolar disorder or schizoaffective disorder, includes a mix of significant mood and psychotic symptoms.
  5. Bipolar 1.5 includes those with just hypomania.
    1. Odds are that in the future, they will suffer from a major depressive episode, and be categorized as bipolar II.
  6. Bipolar 2.5 is when people are cyclothymic, and then develop a major depressive episode.
    1. Caution is urged with these patients, as treatment with an antidepressant could trigger mania.
  7. Those who develop hypomania or mania after being treated with an antidepressant are termed bipolar 3.0.
    1. Officially, this diagnosis would be substance-induced mood disorder.
    2. When the antidepressant is removed, these patients are more appropriately diagnosed as having bipolar I or bipolar II.
  8. A variant of bipolar 3.0, bipolar 3.5, includes a significant aspect of drug abuse (self-medication, usually to treat depressive episode).
  9. People who have bipolar 4.0 are for years at a time optimistic, hard-working, and usually successful, then suffer an extreme major depressive episode.
  10. Bipolar 5.0 includes those with episodes of major depression who experience hypomania at the same time.
    1. The symptoms do not quite fulfill the requirements for official mania.
  11. The last recognized form of bipolar disorder, bipolar 6.0, is when one also has dementia.

One theory, the continuum disease model, holds that schizophrenia and bipolar disorder are each on the far end of a spectrum that includes all of the illnesses with psychotic and/or mood symptoms.

Another idea, the dichotomous disease model, states that schizophrenia includes psychotic symptoms that make it very hard to live one’s life comfortable; bipolar consists of moods symptoms that become relatively easy to live with; and finally, that schizoaffective disorder is  a third, distinct illness.

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Sources: Stahl’s Essential Psychopharmacology, https://calculatingmind.wordpress.com/2017/02/28/the-bipolar-spectrum-beyond-depression-type-i-type-ii/, https://slideplayer.com/slide/5199998/