by Jengy Pie

Created on: December 12, 2008

Bipolar affective disorder affects about 1% of the population. Its name is derived from its clincial presentation, which is commonly, but not exclusively, chararcterized by unpredictable swings from hypomania (bipolar II disorder) or mania (bipolar I disorder) to clinical depression. The clinical phenotype is variable and depends on whether the patient is experiencing hypomania, mania or depression. Likewise the treatment of bipolar disorder varies with its clinical pattern and current activity. The symptoms and treatment of bipolar disorder is discussed thoroughly below.

Patients may present with a manic episode, the most distinguishing feature of bipolar affective disorder. Mania usually builds up over weeks, but may be days, and lasts for 6 - 9 months if left untreated. To fit the DSM-IV-TR (2000) criteria for a manic episode, a person must experience a marked alteration from previous functioning over the course of a week in which their mood is elevated or irritable, and certain characteristics need to be present to a significant degree. These features are:
- Inflated self-esteem or gradiosity
- Reduced need for sleep
- More talkative than usual
- Racing thoughts and ideas
- Distractibility
- Increase in activities, which may be sexual, shopping sprees, social events, so on, or agitation.
- Overinvolvement in activities that carry a high risk of personal cosequences, such as having an affair or gambling excessively.

In its most severe form, mania is accompanied by hallucinations and delusions, which may be voices telling the patient how great he or she is or confer a sense of invincibility and 'special powers'.

Patients may also present in a milder form, termed hypomania. Hypomania caries many of the features listed above, however it does not impact on their life as much.

Depression can also occur during the course of bipolar affective disorder or be its first presenting syndrome. Depression is charaterised by a few weeks of lowered mood, reduced interest in daily acitivites, impairment of thinking, feelings of worthlessness and sometimes suicidal thoughts. Sufferers may also experience bodily symptoms, such as sleep disturbance, weight or appetite changes and excessive fatigue. Bipolar depression may last up to 15 months if left untreated. It differs clincially from unipolar depression in that patients are more likely to be psychotic, higher suicide rate and patients reactivity of mood is often preserved.

Treatment of bipolar depression consists of a combination of

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