by Dr. Manura Nanayakkara

Created on: September 24, 2010

Bipolar disorder is a mental disorder, characterized by extreme mood swings which are beyond what most people experience. These extremes may include lows (depression) and highs (elation/mania) and it affects person’s daily activities in a bad way. If the fluctuation of the mood does not cause any problems in his/her daily activities, it is called cyclothymia and it is not an illness. But sometimes cyclothymia can go into full blown bipolar disorder.

Features of bipolar disorder may change from one person to another or one episode to the next within the same patient. Classically patients present with prolonged depression alternating with mania (extreme elation).

What are the features in manic (elated) phase of the illness?

Elevated mood: - These patients have elevated mood that is out of keeping with the circumstances. They may be jovial and happy.

Increased energy: - Patients with mania usually gets up early in the morning and they say that they can do more work than usual. Their activity level is higher than the normal individuals. But the quality of work they do is less. Additionally, they have increased pressure of speech. They talk more including irrelevant things. They skip from one topic to another in rapid succession and it is called flight of ideas.

Increased self-esteem:- They have overoptimistic ideas. Because of that they tend to overspend money. They may also start new risky business ventures. In addition, some patients can have grandiose ideas. e.g. they are the god and they have god like powers.

Most of the patients can have social disinhibition. Due to that, they can become sexually promiscuous. In addition some patients may sing songs in inappropriate places. Other than that certain patients can become overfamiliar. They may say, that they know people, they have never seen before.

Some patients with the severe form of disorder may hear or see hallucinations. Examples would be hearing “you are the god” or “you are the president of USA”

What are the symptoms of the depressive (low) phase?

Most people with bipolar disorder get more depressive episodes than manic ones. They have features that are opposite to the mania. Low mood is the most characteristic feature. In addition patients can have lack of energy, lack of drive, reduced speech, suicidal ideas and reduced sleep. They may even have multiple unrelated medically unexplainable symptoms such as pain and pins and needles in neurological incompatible places.

Some patients can have various hallucinations and delusions. Examples of depressive hallucination would be “you are damned, you are a bad person”.

Finally it is interesting to note that many famous people have bipolar disorder including Tim burton, Van Damme, Larry Flynt and Ben Stiller.

Sources

Oxford handbook of Psychiatry

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