Mental Illness Fellowship Victoria. (n.d.). Factsheet – Understanding bipolar disorder.
Bipolar disorder is a mental illness that was previously referred to as manic depression. It affects the normal functioning of the brain so that the person experiences extreme moods – mania and depression.
People may also experience psychosis in the manic and/or depressed phase. A variety of types of bipolar disorder exists. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), the following are the distinct types:
- Bipolar 1 disorder – characterised by one or more major manic or mixed episodes, usually accompanied by major depressive episodes
- Bipolar 2 disorder – characterised by one or more major depressive episodes accompanied by at least one hypomanic episode
- Cyclothymic disorder – characterised by at least two years of numerous periods of hypomanic symptoms (that do not meet criteria for a manic episode) and numerous periods of depressive symptoms (that do not meet criteria for a major depressive episode)
- Bipolar disorder not otherwise specified – where bipolar features exist but do not meet any of the criteria for any of the specific diagnoses above. DSM (IV) further divides these distinct types into many subcategories.
1.6 percent of the population will develop bipolar disorder at some time in their lives.
The causes are not fully understood, but a genetic predisposition to the development of the illness has been clearly established.
While there is no cure for this illness it is highly treatable and manageable and 80–90 percent of people recover.
Community management of acute episodes of mania or depression depends on the degree of risk associated with the behaviours and mood. People will be hospitalised if their mania causes them to engage in life threatening, risk-taking behaviours and if their depression causes suicidal ideation or similar.
A biopsychosocial approach that includes attending to the biological need (chemical imbalance), as well as the psychological and social aspects of life is the most effective method in the treatment of, and recovery from, bipolar disorder.
Medication helps the brain to restore its usual chemical balance. Medications commonly used for bipolar include:
- Antipsychotic medication, used to control psychotic symptoms and severe agitation
- Mood stabilisers, which are the mainstay of maintenance therapy and improve symptoms during acute manic episodes
- Lithium is the most commonly used mood stabiliser
Verbal therapies are a very useful adjunct to medication for the management of bipolar disorder. The therapy of choice for bipolar is Cognitive Behavioural Therapy (CBT), but family therapy and other therapies can also be helpful. Improving coping mechanisms and identifying triggers to episodes can be achieved in this context. The development of and adherence to a Wellness Recovery Action Plan can be a very useful strategy for prevention of relapse for people experiencing bipolar disorder.
People with bipolar disorder have a great need to maintain a healthy and balanced lifestyle to reduce stresses that may trigger episodes. Social support and meaningful occupation all support the recovery process from bipolar disorder.
Recognising that someone is displaying symptoms of bipolar disorder is the first step to offering helpful interventions. Overleaf [below] are behaviours common to the experiences of depression and mania, with suggestions for helpful interventions.
Insight into the Experience of Depression | ||
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Symptom | Associated behaviour Remember, these behaviours are out of keeping with the person’s normal value system | Helpful interventions |
Depressed mood, loss of interest or pleasure in nearly all activities |
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Inability to concentrate |
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Suicidal ideation |
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Decreased energy, tiredness and fatigue |
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Sense of worthlessness or guilt |
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Changes in appetite |
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Changes in sleep patterns |
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Insight into the experience of mania | ||
Elevation in affect (mood) |
Note: It is important to remember that the person’s mood is very infectious. They can get everyone contributing. However, when others participate in the fun it can escalate the situation. Others can be presumed to be able to control their excitement. The person in this state cannot, and the situation can get out of hand, which may result in some combativeness and conflict. |
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Thoughts racing |
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Inflated self-esteem |
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Manic speech |
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Increased physical mobility and energy |
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Decreased need for sleep |
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Expansiveness and recklessness |
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Delusions and hallucinations, especially of a grandiose nature |
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Note
Risk taking behaviour is often related to manic episodes and can alert families and individuals to the onset of such an episode. Mania may begin as pleasurable so that people will be reluctant to give it up, and develop into a state that is out of control and frightening.
In addition to the specific interventions previously mentioned, there are many things friends and family can do to help.
- Always remember that bipolar disorder is a medical condition that requires medical treatment. Just as you cannot stop a person’s leg bleeding by talking to them, you cannot stop bipolar disorder without medical intervention. Treatment is effective.
- Find out as much about the illness as you can. Knowledge is power and gives you a much better chance of developing good coping strategies.
- Be patient. People experiencing bipolar disorder need to come to some insight regarding their illness. This is not always easy and takes time.
- Know what to expect of the mental health system and be prepared to be assertive in seeking appropriate care.
- Link in with community organisations that offer supports and services that complement the mental health system. They often provide educational programs, counselling and local support groups.
- Remember to stay healthy yourself. Do not underestimate the impact of the illness on you. Acute episodes of depression or mania often involve trauma and grief and have an impact on whole families. Be prepared to seek support to develop strategies that keep you well.
Ask an expert – receive answers to questions about schizophrenia from consultants and professionals: SFNSW
Mental Illness Fellowship Victoria
Mental Health Services Website (Vic)
National Alliance of the Mentally Ill (NAMI) (USA)