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122-623: Hypomania is a sustained state of elevated or irritable mood that is less severe than mania yet may still significantly affect the quality of life and result in permanent consequences including reckless spending, damaged relationships and poor judgment. Unlike mania, hypomania cannot include psychosis . The hypomanic episodes associated with BP-II must last for at least four days. Commonly, depressive episodes are more frequent and more intense than hypomanic episodes. Additionally, when compared to BP-I, type II presents more frequent depressive episodes and shorter intervals of well-being. The course of BP-II

244-458: A genetic association (often just "association" in context). By definition, an association indicates that the collection of signs and symptoms occurs in combination more frequently than would be likely by chance alone . Syndromes are often named after the physician or group of physicians that discovered them or initially described the full clinical picture. Such eponymous syndrome names are examples of medical eponyms . Recently, there has been

366-436: A " psychosis ", and described "the three major psychoses" as schizophrenia, epilepsy, and manic-depressive illness . In the field of medical genetics, the term "syndrome" is traditionally only used when the underlying genetic cause is known. Thus, trisomy 21 is commonly known as Down syndrome. Until 2005, CHARGE syndrome was most frequently referred to as "CHARGE association". When the major causative gene ( CHD7 ) for

488-574: A "well-being plan" serves several purposes: it informs the patients, protects them from future episodes, teaches them to add value to their life, and works toward building a strong sense of self to fend off depression and reduce the desire to succumb to the seductive hypomanic highs. The plan has to aim high. Otherwise, patients will relapse into depression. A large part of this plan involves the patient being very aware of warning signs and stress triggers so that they take an active role in their recovery and prevention of relapse. Several studies have shown that

610-417: A chronic relapsing nature. It has been suggested that BP-II patients have a higher degree of relapse than BP-I patients. Generally, within four years of an episode, around 60% of patients will relapse into another episode. Some patients are symptomatic half the time, either with full on episodes or symptoms that fall just below the threshold of an episode. Because of the nature of the illness, long-term therapy

732-565: A class, the first generation antipsychotics are associated with movement disorders , along with anticholinergic side effects compared with second generation antipsychotics. There is evidence to support the use of SSRI and SNRI antidepressants in BP-II, but the use of these treatments is controversial. Potential risks of antidepressant pharmacotherapy in patients with bipolar disorder include increased mood cycling, development of rapid cycling, dysphoria , and switch to hypomania. In addition,

854-799: A comprehensive history, medication review, and laboratory work are key to diagnosing BP-II and differentiating it from other conditions. The differential diagnosis of BP-II is as follows: unipolar major depression , borderline personality disorder , posttraumatic stress disorder , substance use disorders , and attention deficit hyperactivity disorder . Major differences between BP-I and BP-II have been identified in their clinical features, comorbidity rates and family histories. During depressive episodes, BP-II patients tend to show higher rates of psychomotor agitation , guilt, shame, suicidal ideation , and suicide attempts. BP-II patients have shown higher lifetime comorbidity rates of phobias , anxiety disorders , substance use, and eating disorders . In addition, there

976-475: A decrease in brain excitation due to blockage of low-voltage sodium-gated channels, decrease in glutamate and excitatory amino acids, and potentiation of levels of GABA . There is evidence that lamotrigine decreases the risk of relapse in rapid-cycling BP-II. It is more effective in BP-II than BP-I, suggesting that lamotrigine is more effective for the treatment of depressive rather than manic episodes. Doses ranging from 100 to 200 mg have been reported to have

1098-402: A depressive episode. It is during depressive episodes that BP-II patients often seek help. Symptoms may be syndromal or subsyndromal . Depressive episodes in BP-II can present similarly to those experienced in unipolar depressive disorders . Patients characteristically experience a depressed mood and may describe themselves as feeling sad, gloomy, down in the dumps, or hopeless, for most of

1220-498: A depressive period, or simply to better organize one's life by setting boundaries for one's perceptions and behaviors. There is evidence to suggest that BP-II has a more chronic course of illness than BP-I. This constant and pervasive course of the illness leads to an increased risk in suicide and more hypomanic and major depressive episodes with shorter periods between episodes than BP-I patients experience. The natural course of BP-II, when left untreated, leads to patients spending

1342-551: A direct and persisting impact on psychosocial functioning. An abnormal semantic memory organization can manipulate thoughts and lead to the formation of delusions and possibly affect speech and communication problems, which can lead to interpersonal issues. BP-II patients have also been shown to present worse cognitive functioning than those patients with BP-I, though they demonstrate about the same disability when it comes to occupational functioning, interpersonal relationships, and autonomy . This disruption in cognitive functioning takes

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1464-463: A greater risk of substance use, anxiety disorders, and suicidality. In addition, they are associated with increased treatment resistance compared to non-mixed episodes. Bipolar disorder is often a lifelong condition, and patients should be followed up regularly for relapse prevention. Although BP-II is thought to be less severe than BP-I in regard to symptom intensity, BP-II is associated with higher frequencies of rapid cycling and depressive episodes. In

1586-582: A high potential for painful consequences (engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments.) Hypomania is distinct from mania . During a typical hypomanic episode, patients may present as upbeat, may show signs of poor judgment or display signs of increased energy despite lack of sleep, but do not meet the full criteria for an acute manic episode. Patients may display elevated confidence, but do not express delusional thoughts as in mania. They can experience increase in goal-directed activity and creativity , but do not reach

1708-417: A level far beyond that which they would be capable of during euthymia . A very simple indicator of a manic state would be if a heretofore clinically depressed patient suddenly becomes inordinately energetic, enthusiastic, cheerful, aggressive, or "over-happy". Other, often less obvious, elements of mania include delusions (generally of either grandeur or persecution , according to whether the predominant mood

1830-502: A liability. English actor Stephen Fry , who has bipolar disorder , recounts manic behaviour during his adolescence: "When I was about 17 ... going around London on two stolen credit cards, it was a sort of fantastic reinvention of myself, an attempt to. I bought ridiculous suits with stiff collars and silk ties from the 1920s, and would go to the Savoy and Ritz and drink cocktails." While he has experienced suicidal thoughts , he says

1952-438: A major cause of psychosocial disability. There is evidence that shows the mild depressive symptoms, or even sub-syndromal symptoms, are responsible for the non-recovery of social functioning, which furthers the idea that residual depressive symptoms are detrimental for functional recovery in patients being treated for BP-II. It has been suggested that symptom interference in relation to social and interpersonal relationships in BP-II

2074-401: A major depressive episode, the best chance for recovery is to have therapeutic interventions that focus on the residual depressive symptoms and to aim for improvement in psychosocial and cognitive functioning. Even with treatment, a certain amount of responsibility is placed in the patient's hands; they have to be able to assume responsibility for their illness by accepting their diagnosis, taking

2196-436: A manic episode as one where mood is higher than the person's situation warrants and may vary from relaxed high spirits to barely controllable exuberance, is accompanied by hyperactivity, a compulsion to speak, a reduced sleep requirement, difficulty sustaining attention, and/or often increased distractibility. Frequently, confidence and self-esteem are excessively enlarged, and grand, extravagant ideas are expressed. Behavior that

2318-454: A manic episode of bipolar disorder involves the utilization of either a mood stabilizer (e.g., carbamazepine , valproate , lithium , or lamotrigine ) or an atypical antipsychotic (e.g., olanzapine , quetiapine , risperidone , aripiprazole , or cariprazine ). More recently, substances such as iloperidone have been approved for the acute treatment of manic episodes related to bipolar I disorder . The use of antipsychotic agents in

2440-428: A non-mental medical illness (e.g., hyperthyroidism ), and: (a) is causing obvious difficulties at work or in social relationships and activities, or (b) requires admission to hospital to protect the person or others, or (c) the person has psychosis . To be classified as a manic episode, while the disturbed mood and an increase in goal-directed activity or energy is present, at least three (or four, if only irritability

2562-459: A particular disease or disorder. The word derives from the Greek σύνδρομον, meaning "concurrence". When a syndrome is paired with a definite cause this becomes a disease. In some instances, a syndrome is so closely linked with a pathogenesis or cause that the words syndrome , disease , and disorder end up being used interchangeably for them. This substitution of terminology often confuses

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2684-580: A patient with depression with mixed features may have a depressed mood, but has simultaneous symptoms of rapid speech, increased energy, and flight of ideas. Conversely, a patient with hypomania with mixed features will present with the full criteria for a hypomanic episode, but with concurrent symptoms of decreased appetite, loss of interest, and low energy. Episodes with mixed features can last up to several months. They occur more frequently in patients with an earlier onset of bipolar disorder, are associated with higher frequency of episodes, and are associated with

2806-452: A patient's prognosis, long-term therapy is most favorably recommended for controlling symptoms, maintaining remission and preventing relapses. With treatment, patients have been shown to present a decreased risk of suicide (especially when treated with lithium ) and a reduction of frequency and severity of their episodes, which in turn moves them toward a stable life and reduces the time they spend ill. To maintain their state of balance, therapy

2928-432: A person could make them more engaging and outgoing, and cause them to have a positive outlook in life. When exaggerated in hypomania, however, such a person can display excessive optimism , grandiosity , and poor decision-making, often with little regard to the consequences. A single manic episode, in the absence of secondary causes, (i.e., substance use disorders , certain medications , or general medical conditions )

3050-514: A person's life can trigger a relapse in patients with BP-II. These include stressful life events, criticism from peers or relatives, and a disrupted circadian rhythm. In addition, the addition of antidepressant medications can trigger a hypomanic episode. Comorbid conditions are extremely common in individuals with BP-II. In fact, individuals are twice as likely to present a comorbid disorder than not. These include anxiety , eating , personality (cluster B) , and substance use disorders . For BP-II,

3172-453: A result of the high suicide risk for this group, reducing the risk and preventing attempts remains a main part of the treatment; a combination of self-monitoring, close supervision by a therapist, and faithful adherence to their medication regimen will help to reduce the risk and prevent the likelihood of suicide. Suicide is a common endpoint for many patients with severe psychiatric illness. The mood disorders (depression and bipolar) are by far

3294-454: A review and meta-analysis exploring this relationship found that this assumption may be too general and empirical research evidence is lacking. In hypomania, there is less need for sleep and both goal-motivated behaviour and metabolism increase. Some studies exploring brain metabolism in subjects with hypomania, however, did not find any conclusive link; while there are studies that reported abnormalities, some failed to detect differences. Though

3416-529: A role of dopamine in mania. Decreased cerebrospinal fluid levels of the serotonin metabolite 5-HIAA have been found in manic patients too, which may be explained by a failure of serotonergic regulation and dopaminergic hyperactivity. Limited evidence suggests that mania is associated with behavioral reward hypersensitivity, as well as with neural reward hypersensitivity. Electrophysiological evidence supporting this comes from studies associating left frontal EEG activity with mania. As left frontal EEG activity

3538-535: A shift towards naming conditions descriptively (by symptoms or underlying cause) rather than eponymously, but the eponymous syndrome names often persist in common usage. The defining of syndromes has sometimes been termed syndromology, but it is usually not a separate discipline from nosology and differential diagnosis generally, which inherently involve pattern recognition (both sentient and automated ) and differentiation among overlapping sets of signs and symptoms. Teratology (dysmorphology) by its nature involves

3660-603: A subset of all medical syndromes. Early texts by physicians noted the symptoms of various maladies and introduced diagnoses based upon those symptoms. For example, Avicenna 's The Canon of Medicine (1025) describes diagnosing pleurisy by its symptoms, including chronic fever, cough, shooting pains, and labored breathing. The 17th century doctor Thomas Sydenham likewise approached diagnoses based upon collections of symptoms. Psychiatric syndromes often called psychopathological syndromes ( psychopathology refers both to psychic dysfunctions occurring in mental disorders , and

3782-433: A toll on their ability to function in the workplace, which leads to high rates of work loss in BP-II patient populations. After treatment and while in remission, BP-II patients tend to report a good psychosocial functioning but they still score less than patients without the disorder. These lasting impacts further suggest that a prolonged period of untreated BP-II can lead to permanent adverse effects on functioning. BP-II has

Bipolar II disorder - Misplaced Pages Continue

3904-960: Is antidepressant therapy. Studies show that the risk of switching while on an antidepressant is between 6-69 percent. Dopaminergic drugs such as reuptake inhibitors and dopamine agonists may also increase risk of switch. Other medications possibly include glutaminergic agents and drugs that alter the HPA axis . Lifestyle triggers include irregular sleep-wake schedules and sleep deprivation , as well as extremely emotional or stressful stimuli . Various genes that have been implicated in genetic studies of bipolar have been manipulated in preclinical animal models to produce syndromes reflecting different aspects of mania. CLOCK and DBP polymorphisms have been linked to bipolar in population studies, and behavioral changes induced by knockout are reversed by lithium treatment. Metabotropic glutamate receptor 6 has been genetically linked to bipolar, and found to be under-expressed in

4026-407: Is a psychiatric behavioral syndrome defined as a state of abnormally elevated arousal , affect , and energy level. During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli . Although mania is often conceived of as a "mirror image" to depression , the heightened mood can be dysphoric as well as euphoric . As

4148-523: Is a higher correlation between BP-II patients and family history of psychiatric illness, including major depression and substance-related disorders compared to BP-I. The occurrence rate of psychiatric illness in first degree relatives of BP-II patients was 26.5%, versus 15.4% in BP-I patients. Although BP-II is a prevalent condition associated with morbidity and mortality, there has been an absence of robust clinical trials and systematic reviews that investigate

4270-487: Is a syndrome with multiple causes. Although the vast majority of cases occur in the context of bipolar disorder , it is a key component of other psychiatric disorders (such as schizoaffective disorder , bipolar type) and may also occur secondary to various general medical conditions, such as multiple sclerosis ; certain medications may perpetuate a manic state, for example prednisone ; or substances prone to abuse, especially stimulants, such as amphetamine and cocaine . In

4392-497: Is defined in the American Psychiatric Association 's diagnostic manual (DSM) as a "distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration, if hospitalization is necessary)," where the mood is not caused by drugs/medication or

4514-527: Is directly tied to poor psychosocial functioning, a common side-effect in patients with BP-II. The impact on a patient's psychosocial functioning stems from the depressive symptoms (more common in BP-II than BP-I). An increase in these symptoms' severity seems to correlate with a significant increase in psychosocial disability. Psychosocial disability can present itself in poor semantic memory , which in turn affects other cognitive domains like verbal memory and (as mentioned earlier) executive functioning leading to

4636-531: Is euphoric or irritable), hypersensitivity, hypervigilance , hypersexuality, hyper-religiosity, hyperactivity and impulsivity, a compulsion to over explain (typically accompanied by pressure of speech), grandiose schemes and ideas, and a decreased need for sleep (for example, feeling rested after only 3 or 4 hours of sleep). In the case of the latter, the eyes of such patients may both look and seem abnormally "wide open", rarely blinking, and may contribute to some clinicians' erroneous belief that these patients are under

4758-546: Is generally thought to be a reflection of behavioral activation system activity, this is thought to support a role for reward hypersensitivity in mania. Tentative evidence also comes from one study that reported an association between manic traits and feedback negativity during receipt of monetary reward or loss. Neuroimaging evidence during acute mania is sparse, but one study reported elevated orbitofrontal cortex activity to monetary reward, and another study reported elevated striatal activity to reward omission. The latter finding

4880-504: Is important to manage symptoms of mania and depression, studies show relying on medications alone is not the most effective method of treatment. Medication is most effective when used in combination with other bipolar disorder treatments, including psychotherapy , self-help coping strategies, and healthy lifestyle choices. Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. A systematic review found that long term lithium treatment substantially reduces

5002-504: Is more chronic and consists of more frequent cycling than the course of BP-I. Finally, BP-II is associated with a greater risk of suicidal thoughts and behaviors than BP-I or unipolar depression . BP-II is no less severe than BP-I, and types I and II present equally severe burdens. BP-II is notoriously difficult to diagnose. Patients usually seek help when they are in a depressed state, or when their hypomanic symptoms manifest themselves in unwanted effects, such as high levels of anxiety , or

Bipolar II disorder - Misplaced Pages Continue

5124-420: Is more common than BP-I, while BP-II and major depressive disorder have about the same rate of diagnosis. Of all individuals initially diagnosed with major depressive disorder , between 40% and 50% will later be diagnosed with either BP-I or BP-II. Substance use disorders (which have high co-morbidity with BP-II) and periods of mixed depression may also make it more difficult to accurately identify BP-II. Despite

5246-425: Is not always the case that the clearly manic/hypomanic bipolar patient needs or wants medical help; such persons often either retain sufficient self-control to function normally or are unaware that they have "gone manic" severely enough to be committed or to commit themselves . Manic persons often can be mistaken for being under the influence of drugs . In a mixed affective state , the individual, though meeting

5368-693: Is often continued indefinitely, as around 50% of the patients who discontinue it relapse quickly and experience either full-blown episodes or sub-syndromal symptoms that bring significant functional impairments. The deficits in functioning associated with BP-II stem mostly from the recurrent depression that BP-II patients experience. Depressive symptoms are much more disabling than hypomanic symptoms and are potentially as, or more disabling than mania symptoms. Functional impairment has been shown to be directly linked with increasing percentages of depressive symptoms, and because sub-syndromal symptoms are more common—and frequent—in BP-II, they have been implicated heavily as

5490-475: Is often sufficient to diagnose bipolar I disorder . Hypomania may be indicative of bipolar II disorder . Manic episodes are often complicated by delusions and/or hallucinations ; and if the psychotic features persist for a duration significantly longer than the episode of typical mania (two weeks or more), a diagnosis of schizoaffective disorder is more appropriate. Certain obsessive–compulsive spectrum disorders as well as impulse-control disorders share

5612-429: Is out-of-character and risky, foolish or inappropriate may result from a loss of normal social restraint. Some people also have physical symptoms, such as sweating , pacing, and weight loss . In full-blown mania, often the manic person will feel as though their goal(s) are of paramount importance, that there are no consequences, or that negative consequences would be minimal, and that they need not exercise restraint in

5734-414: Is present) of the following must have been consistently present: Though the activities one participates in while in a manic state are not always negative, those with the potential to have negative outcomes are far more likely. If the person is concurrently depressed, they are said to be having a mixed episode . The World Health Organization 's International Classification of Diseases (ICD) defines

5856-405: Is strongly associated with atypical depression . A mixed episode is defined by the presence of a hypomanic or depressive episode that is accompanied by symptoms of the opposite polarity. This is commonly referred to as a mood episode with mixed features (e.g. depression with mixed features or hypomania with mixed features), but can also be referred to as mixed episodes or mixed states. For example,

5978-402: Is that the mood episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (from the depressive symptoms or the unpredictability of cycling between periods of depression and hypomania). A hypomanic episode is established if a patient's symptoms last for most of the day each day for at least four days. Furthermore, three or more of

6100-460: Is the best option and aims to not only control the symptoms but to maintain sustained remission and prevent relapses from occurring. Even with treatment, patients do not always regain full functioning, especially in the social realm. There is a very clear gap between symptomatic recovery and full functional recovery for both BP-I and BP-II patients. As such, and because those with BP-II spend more time with depressive symptoms that do not quite qualify as

6222-501: Is the only mood stabilizer to demonstrate a decrease in suicide and self-harm in patients with mood disorders. Due to lithium's narrow therapeutic index , lithium levels must be monitored regularly for prevention of lithium toxicity . There is also evidence that the anticonvulsants valproate, lamotrigine, carbamazepine, and topiramate are effective in the reduction of symptoms of hypomanic and depressive episodes of bipolar disorder. Potential mechanisms contributing to these effects include

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6344-564: Is the standard of care for treatment of both BP-I and BP-II, additional non-pharmaceutical therapies can also help those with the illness. Benefits include prevention of relapse and improved maintenance medication adherence. These include psychotherapy (e.g. cognitive behavioral therapy , psychodynamic therapy , psychoanalysis , interpersonal therapy , behavioral therapy , cognitive therapy , and family-focused therapy ), social rhythm therapy , art therapy , music therapy , psychoeducation , mindfulness , and light therapy . Meta-analyses in

6466-610: Is used to promptly alleviate symptoms of agitation, aggression , and psychosis . Antidepressant monotherapy is not recommended for the treatment of depression in patients with bipolar disorders I or II, and no benefit has been demonstrated by combining antidepressants with mood stabilizers in these patients. Some atypical antidepressants , however, such as mirtazapine and trazodone , have been occasionally used after other options have failed. In Electroboy: A Memoir of Mania by Andy Behrman, he describes his experience of mania as "the most perfect prescription glasses with which to see

6588-491: Is useful from a descriptive and differential diagnostic point of view. Mania varies in intensity, from mild mania ( hypomania ) to delirious mania, marked by such symptoms as disorientation, acute psychosis , incoherence, and catatonia . Standardized tools such as Altman Self-Rating Mania Scale and Young Mania Rating Scale can be used to measure severity of manic episodes. Because mania and hypomania have also long been associated with creativity and artistic talent, it

6710-461: Is usually a manifestation of severe psychiatric distress that is often associated with a diagnosable and treatable form of depression or other mental illness. In a clinical setting, an assessment of suicidal risk must precede any attempt to treat psychiatric illness. The global estimated lifetime prevalence of bipolar disorder among adults range from 1 to 3 percent. The annual incidence is estimated to vary from 0.3 to 1.2 percent worldwide. According to

6832-491: Is very recurrent and results in severe disabilities, interpersonal relationship problems, barriers to academic, financial, and vocational goals, and a loss of social standing in their community, all of which increase the likelihood of suicide. Mixed symptoms and rapid-cycling, both very common in BP-II, are also associated with an increased risk of suicide. The tendency for BP-II to be misdiagnosed and treated ineffectively, or not at all in some cases, leads to an increased risk. As

6954-446: Is worse than symptom interference in other chronic medical illnesses such as cancer. This social impairment can last for years, even after treatment that has resulted in a resolution of mood symptoms. The factors related to this persistent social impairment are residual depressive symptoms, limited illness insight (a very common occurrence in patients with BP-II), and impaired executive functioning. Impaired ability in executive functions

7076-505: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) . In addition, alternative diagnostic criteria is established in the World Health Organization's International Classification of Diseases-11th Revision (ICD-11)]. The diagnostic criteria are established from self-reported experiences from patients or their family members, the psychiatric assessment , and

7198-671: The ICD-10 , there are several disorders with the manic syndrome: organic manic disorder ( F06.30 ), mania without psychotic symptoms ( F30.1 ), mania with psychotic symptoms ( F30.2 ), other manic episodes ( F30.8 ), unspecified manic episode ( F30.9 ), manic type of schizoaffective disorder ( F25.0 ), bipolar disorder , current episode manic without psychotic symptoms ( F31.1 ), bipolar affective disorder, current episode manic with psychotic symptoms ( F31.2 ). Before beginning treatment for mania, careful differential diagnosis must be performed to rule out secondary causes. The acute treatment of

7320-647: The ICD-11 , a BP-II patient will have experienced episodic experiences of one or more hypomaniac episodes and one or more major depressive episodes , and no history of a manic episode or mixed episode. These symptoms cannot be explained by other diagnoses such as: The specifiers are the same as the DSM-5 with the exception of catatonic features and if symptoms have occurred with or without psychosis about 6 weeks after childbirth . The signs and symptoms of BP-II may overlap significantly with those of other conditions. Thus,

7442-1373: The amygdala and other subcortical structures such as the ventral striatum tend to be increased, although results are inconsistent and likely dependent upon task characteristics such as valence. Reduced functional connectivity between the ventral prefrontal cortex and amygdala along with variable findings supports a hypothesis of general dysregulation of subcortical structures by the prefrontal cortex. A bias towards positively valenced stimuli , and increased responsiveness in reward circuitry may predispose towards mania. Mania tends to be associated with right hemisphere lesions, while depression tends to be associated with left hemisphere lesions. Post-mortem examinations of bipolar disorder demonstrate increased expression of Protein Kinase C (PKC). While limited, some studies demonstrate manipulation of PKC in animals produces behavioral changes mirroring mania, and treatment with PKC inhibitor tamoxifen (also an anti-estrogen drug) demonstrates antimanic effects. Traditional antimanic drugs also demonstrate PKC inhibiting properties, among other effects such as GSK3 inhibition. Manic episodes may be triggered by dopamine receptor agonists , and this combined with tentative reports of increased VMAT2 activity, measured via PET scans of radioligand binding , suggests

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7564-424: The glutamatergic system , and hormonal regulation play a role in the pathophysiology of the disease. The cause of Bipolar disorder can be attributed to misfiring neurotransmitters that overstimulate the amygdala, which in turn causes the prefrontal cortex to stop working properly. The bipolar patient becomes overwhelmed with emotional stimulation with no way of understanding it, which can trigger mania and exacerbate

7686-663: The mental status examination . In addition, Screening instruments like the Mood Disorders Questionnaire are helpful tools in determining a patient's status on the bipolar spectrum. In addition, certain features have been shown to increase the chances that depressed patients have a bipolar disorder, including atypical symptoms of depression like hypersomnia and hyperphagia , a family history of bipolar disorder, medication-induced hypomania, recurrent or psychotic depression , antidepressant refractory depression , and early or postpartum depression . According to

7808-648: The subthalamic nucleus in Parkinson's disease has been associated with mania, especially with electrodes placed in the ventromedial STN . A proposed mechanism involves increased excitatory input from the STN to dopaminergic nuclei. There are certain psychoactive substances that can induce a state of manic psychosis, including: amphetamine , cathinone , cocaine , MDMA , methamphetamine , methylphenidate , oxycodone , phencyclidine , designer drugs , etc. Mania can also be caused by physical trauma or illness . When

7930-429: The syndrome nomenclature. In other instances, a syndrome is not specific to only one disease. For example, toxic shock syndrome can be caused by various toxins; another medical syndrome named as premotor syndrome can be caused by various brain lesions; and premenstrual syndrome is not a disease but simply a set of symptoms. If an underlying genetic cause is suspected but not known, a condition may be referred to as

8052-431: The DSM-5, a patient diagnosed with BP-II will have experienced at least one hypomanic episode , at least one major depressive episodes , and no manic episode . Furthermore, the occurrence of the mood episodes are not better explained by schizoaffective disorder , schizophrenia , delusional disorder , or other specified or unspecified schizophrenia spectrum and other psychotic disorder. The final criteria that must be met

8174-748: The World Mental Health Survey Initiative, the lifetime prevalence of BP-II was found to be 0.4%, with a 12-month prevalence of 0.3%. Other meta-analyses have found lifetime prevalence of BP-II up to 1.57%. In the United States, the estimated lifetime prevalence of BP-II was found to be 1.1%, with a 12-month prevalence of 0.8%. The mean age of onset for BP-II was 20 years. Thus far, there have been no studies that have conclusively demonstrated that an unequal distribution of bipolar disorders across sex and ethnicity exists. Mania Mania , also known as manic syndrome ,

8296-670: The ability to think clearly. Racing thoughts and misperceptions lead to frustration and decreased ability to communicate with others. Mania may also, as earlier mentioned, be divided into three "stages". Stage I corresponds with hypomania and may feature typical hypomanic characteristics, such as gregariousness and euphoria . In stages II and III mania, however, the patient may be extraordinarily irritable, psychotic or even delirious . These latter two stages are referred to as acute and delirious (or Bell's), respectively. Various triggers have been associated with switching from euthymic or depressed states into mania. One common trigger of mania

8418-494: The case of a relapse, patients may experience new onset sleep disturbance, racing thoughts and/or speech, anxiety, irritability , and increase in emotional intensity. Family and/or friends may notice that patients are arguing more frequently with them, spending more money than usual, are increasing their binging on food, drugs, or alcohol, and may suddenly start taking on many projects at once. These symptoms often occur and are considered early warning signs. Psychosocial factors in

8540-752: The causes are physical, it is called secondary mania . In some individuals, manic symptoms are also correlated with the season of spring. The mechanism underlying mania is unknown, but the neurocognitive profile of mania is highly consistent with dysfunction in the right prefrontal cortex , a common finding in neuroimaging studies. Various lines of evidence from post-mortem studies and the putative mechanisms of anti-manic agents point to abnormalities in GSK-3 , dopamine , Protein kinase C , and Inositol monophosphatase . Meta analysis of neuroimaging studies demonstrate increased thalamic activity, and bilaterally reduced inferior frontal gyrus activation. Activity in

8662-489: The condition was discovered, the name was changed. The consensus underlying cause of VACTERL association has not been determined, and thus it is not commonly referred to as a "syndrome". In biology, "syndrome" is used in a more general sense to describe characteristic sets of features in various contexts. Examples include behavioral syndromes , as well as pollination syndromes and seed dispersal syndromes . In orbital mechanics and astronomy, Kessler syndrome refers to

8784-419: The cortex. Pituitary adenylate cyclase-activating peptide has been associated with bipolar in gene linkage studies, and knockout in mice produces mania like-behavior. Targets of various treatments such as GSK-3 , and ERK1 have also demonstrated mania like behavior in preclinical models. Mania may be associated with strokes, especially cerebral lesions in the right hemisphere. Deep brain stimulation of

8906-400: The current DSM-5 , hypomanic episodes are separated from the more severe full manic episodes, which, in turn, are characterized as either mild, moderate, or severe, with certain diagnostic criteria (e.g., catatonia , psychosis ). Mania is divided into three stages: hypomania, or stage I; acute mania, or stage II; and delirious mania ( delirium ), or stage III. This "staging" of a manic episode

9028-515: The day, nearly every day. In children, this can present with an irritable mood. Most patients report significant fatigue , loss of energy, or tiredness. Patients or their family members may note diminished interest in usual activities such as sex, hobbies, or daily routines. Many patients report a change in appetite along with associated weight change. Sleep disturbances may be present, and can manifest as problems falling or staying asleep, frequent awakenings, excessive sleep, or difficulties getting up in

9150-413: The defining of congenital syndromes that may include birth defects (pathoanatomy), dysmetabolism (pathophysiology), and neurodevelopmental disorders . When there are a number of symptoms suggesting a particular disease or condition but does not meet the defined criteria used to make a diagnosis of that disease or condition. This can be a bit subjective because it is ultimately up to the clinician to make

9272-406: The diagnosis. This could be because it has not advanced to the level or passed a threshold or just similar symptoms cause by other issues. Subclinical is synonymous since one of its definitions is "where some criteria are met but not enough to achieve clinical status"; but subclinical is not always interchangeable since it can also mean "not detectable or producing effects that are not detectable by

9394-562: The difficulties, it is important that BP-II individuals be correctly assessed so that they can receive the proper treatment. Antidepressant use, in the absence of mood stabilizers, is correlated with worsening BP-II symptoms. Multiple factors contribute to the development of bipolar spectrum disorders, although there have been very few studies conducted to examine the possible causes of BP-II specifically. While no identifiable single dysfunctions in specific neurotransmitters have been found, preliminary data has shown that calcium signal transmission,

9516-428: The effect where the density of objects in low Earth orbit (LEO) is high enough that collisions between objects could cause a cascade in which each collision generates space debris that increases the likelihood of further collisions. In quantum error correction theory syndromes correspond to errors in code words which are determined with syndrome measurements, which only collapse the state on an error state, so that

9638-728: The effects of depression. Bipolar disorder is characterized by marked swings in mood, activity, and behavior. BP-II is characterized by periods of hypomania, which may occur before, after, or independently of a depressive episode . Hypomania is the signature characteristic of BP-II, defined by an experience of elevated mood. A patient's mood is typically cheerful, enthusiastic, euphoric, or irritable. In addition, they can present with symptoms of inflated self-esteem or grandiosity, decreased need for sleep, talkativeness or pressured speech, flight of ideas or rapid cycling of thoughts, distractibility, increased goal-directed activity, psychomotor agitation, and/or excessive involvement in activities that have

9760-437: The efficacy of pharmacologic treatments for the hypomanic and depressive phases of BP-II. Thus, the current treatment guidelines for the symptoms of BP-II are derived and extrapolated from the treatment guidelines in BP-I, along with limited randomized controlled trials published in the literature. The treatment of BP-II consists of the following: treatment of hypomania, treatment of major depression, and maintenance therapy for

9882-406: The elevated mood and energy level typical of hypomania could be seen as a benefit, true mania itself generally has many undesirable consequences, including suicidal tendencies , and hypomania can, if the prominent mood is irritable as opposed to euphoric , be a rather unpleasant experience. In addition, the exaggerated case of hypomania can lead to problems. For instance, trait-based positivity for

10004-407: The error can be corrected without affecting the quantum information stored in the code words. There is no set common convention for the naming of newly identified syndromes. In the past, syndromes were often named after the physician or scientist who identified and described the condition in an initial publication. These are referred to as "eponymous syndromes". In some cases, diseases are named after

10126-434: The evidence for their efficacy in bipolar depression is mixed. Thus, in most cases, antidepressant monotherapy in patients with BP-II is not recommended. However, antidepressants may provide benefit to some patients when used in addition to mood stabilizers and antipsychotics, as these drugs reduce the risk of manic/hypomanic switching. However, the risk still exists, and should be used with caution. Although medication therapy

10248-466: The field have attempted to find reliable differences between BP-I depressive episodes and episodes of major depressive disorder, but the data is inconsistent. However, some clinicians report that patients who came in with a depressive episode, but were later diagnosed as having bipolar disorder often presented with hypersomnia , increased appetite, psychomotor retardation , and a history of antidepressant -induced hypomania. Evidence also suggests that BP-II

10370-426: The flow of thoughts. Racing thoughts also interfere with the ability to fall asleep. Manic states are always relative to the normal state of intensity of the affected individual; thus, already irritable patients may find themselves losing their tempers even more quickly, and an academically gifted person may, during the hypomanic stage, adopt seemingly "genius" characteristics and an ability to perform and articulate at

10492-412: The following symptoms must be present: Inflated sense of self-esteem or grandiose thoughts, feeling well rested despite getting low amounts of sleep (3 hours), talkativeness, racing thoughts, distractibility, and increase in goal-directed activity or psychomotor agitation, or excessive involvement in activities with high risk of painful consequences. Per DSM-5 criteria, a major depressive episode consists of

10614-403: The frequency and severity of depressive episodes. Lithium prevents mood relapse and works especially well in BP-II patients who experience rapid-cycling. Almost all BP-II patients who take lithium have a decrease in the amount of time they spend ill and a decrease in mood episodes. Along with medication, other forms of therapy have been shown to be beneficial for BP-II patients. A treatment called

10736-405: The general criteria for a hypomanic (discussed below) or manic episode, experiences three or more concurrent depressive symptoms. This has caused some speculation, among clinicians , that mania and depression, rather than constituting "true" polar opposites, are, rather, two independent axes in a unipolar—bipolar spectrum. A mixed affective state, especially with prominent manic symptoms, places

10858-440: The individual's lack of judgment and insight regarding periods of exacerbation of characteristic states. Manic patients are frequently grandiose, obsessive, impulsive, irritable, belligerent, and frequently deny anything is wrong with them. Because mania frequently encourages high energy and decreased perception of need or ability to sleep, within a few days of a manic cycle, sleep-deprived psychosis may appear, further complicating

10980-686: The influence of a stimulant drug, when the patient, in fact, is either not on any mind-altering substances or is actually on a depressant drug. Individuals may also engage in out-of-character behavior during the episode, such as questionable business transactions, wasteful expenditures of money (e.g., spending sprees), risky sexual activity, abuse of recreational substances, excessive gambling, reckless behavior (such as extreme speeding or other daredevil activity), abnormal social interaction (e.g., over-familiarity and conversing with strangers), or highly vocal arguments. These behaviours may increase stress in personal relationships, lead to problems at work, and increase

11102-420: The literature has shown that psychotherapy plus pharmacotherapy was associated with a lower relapse rate compared with patients treated with pharmacotherapy alone. However, relapse can still occur, despite continued medication and therapy. People with bipolar disorder may develop dissociation to match each mood they experience. For some, this is done intentionally, as a means by which to escape trauma or pain from

11224-419: The majority of their lives with some symptoms, primarily stemming from depression . Their recurrent depression results in personal distress and disability. This disability can present itself in the form of psychosocial impairment, which has been suggested to be worse in BP-II patients than in BP-I patients. Another facet of this illness that is associated with a poorer prognosis is rapid cycling , which denotes

11346-652: The mania intensifies, irritability can be more pronounced and result in anxiety or anger . The symptoms of mania include elevated mood (either euphoric or irritable), flight of ideas , pressure of speech , increased energy, decreased "need" and desire for sleep, and hyperactivity . They are most plainly evident in fully developed hypomanic states, however, in full-blown mania, these symptoms become progressively exacerbated . In severe manic episodes, these symptoms may even be obscured by other signs and symptoms characteristic of psychosis , such as delusions, hallucinations, fragmentation of behavior, and catatonia . Mania

11468-515: The manic side of his condition has had positive contributions on his life. The nosology of the various stages of a manic episode has changed over the decades. The word derives from the Ancient Greek μανία ( manía ), "madness, frenzy" and the verb μαίνομαι ( maínomai ), "to be mad, to rage, to be furious." Syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with

11590-465: The mild disorders, consists of five syndromes: emotional, paranoid, hysterical , delirious , and impulsive. The second, intermediate, group includes two syndromes: schizophrenic syndrome and speech-hallucinatory syndrome . The third includes the most severe disorders, and consists of three syndromes: epileptic , oligophrenic and dementia . In Kraepelin's era, epilepsy was viewed as a mental illness; Karl Jaspers also considered "genuine epilepsy"

11712-591: The morning. Around half of depressed patients develop changes in psychomotor activity, described as slowness in thinking, speaking, or movement. Conversely, they may also present with agitation, with inability to sit still or wringing their hands. Changes in posture, speech, facial expression, and grooming can be observed. Other signs and symptoms include changes in posture and facial expression, slowed speech, poor hygiene, unkempt appearance, feelings of guilt, shame, or helplessness, diminished ability to concentrate, nihilistic thoughts, and suicidal ideation . Many experts in

11834-430: The most common psychiatric conditions associated with suicide. At least 25% to 50% of patients with bipolar disorder also attempt suicide at least once. Aside from lithium—which is the most demonstrably effective treatment against suicide—little is known about contributions of specific mood-altering treatments to minimizing mortality rates in persons with either major mood disorders or bipolar depression specifically. Suicide

11956-400: The most conservative estimate of lifetime prevalence of alcohol or other substance use disorders is 20%. In patients with comorbid substance use disorder and BP-II, episodes have a longer duration and treatment compliance decreases. Preliminary studies suggest that comorbid substance use is also linked to increased risk of suicidality. BP-II is diagnosed according to the criteria established in

12078-399: The most efficacy, while experimental doses of 400 mg have rendered little response. A large, multicenter trial comparing carbamazepine and lithium over two and a half years found that carbamazepine was superior in terms of preventing future episodes of BP-II, although lithium was superior in individuals with BP-I. There is also some evidence for the use of valproate and topiramate, although

12200-481: The non-possessive form, while European references often use the possessive. A 2009 study demonstrated a trend away from the possessive form in Europe in medical literature from 1970 through 2008. Even in syndromes with no known etiology , the presence of the associated symptoms with a statistically improbable correlation normally leads the researchers to hypothesize that there exists an unknown underlying cause for all

12322-399: The occurrence of four or more major Depressive, Hypomanic, and/or mixed episodes in a 12-month period. Rapid cycling is quite common in those with BP-II, much more so in women than in men (70% vs. 40%), and without treatment leads to added sources of disability and an increased risk of suicide. Women are more prone to rapid cycling between hypomanic episodes and depressive episodes. To improve

12444-442: The patient at a greater risk for suicide . Depression on its own is a risk factor but, when coupled with an increase in energy and goal-directed activity, the patient is far more likely to act with violence on suicidal impulses. Hypomania , which means "less than mania", is a lowered state of mania that does little to impair function or decrease quality of life. Although creativity and hypomania have been historically linked,

12566-448: The patient who initially presents with symptoms, or their home town ( Stockholm syndrome ). There have been isolated cases of patients being eager to have their syndromes named after them, while their physicians are hesitant. When a syndrome is named after a person, there is some difference of opinion as to whether it should take the possessive form or not (e.g. Down syndrome vs. Down's syndrome). North American usage has tended to favor

12688-471: The presence of a depressed mood or loss of interest/pleasure in activities ( anhedonia ). In addition to the former symptoms, five out of the nine following symptoms must occur for more than two weeks (to the extent in which it impairs functioning): weight loss/gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness/inappropriate guilt, decreased concentration, or thoughts of death/suicide. Specifiers: According to

12810-471: The prevention of relapse of hypomania or depression. As BP-II is a chronic condition, the goal of treatment is to achieve remission of symptoms and prevention of self-harm in patients. Treatment modalities of BP-II include medication-based pharmacotherapy, along with various forms of psychotherapy. The most common pharmacologic agents utilized in the treatment of BP-II includes mood stabilizers , antipsychotics , and antidepressants . Mood stabilizers used in

12932-432: The pursuit of what they are after. Hypomania is different, as it may cause little or no impairment in function. The hypomanic person's connection with the external world, and its standards of interaction, remain intact, although intensity of moods is heightened. But those with prolonged unresolved hypomania do run the risk of developing full mania, and may cross that "line" without even realizing they have done so. One of

13054-471: The reality and meaning of medical diagnoses. This is especially true of inherited syndromes. About one third of all phenotypes that are listed in OMIM are described as dysmorphic, which usually refers to the facial gestalt. For example, Down syndrome , Wolf–Hirschhorn syndrome , and Andersen–Tawil syndrome are disorders with known pathogeneses, so each is more than just a set of signs and symptoms, despite

13176-410: The required medication, and seeking help when needed to do well in the future. Treatment often lasts after remission is achieved, and the treatment that worked is continued during the continuation phase (lasting anywhere from 6–12 months) and maintenance can last 1–2 years or, in some cases, indefinitely. One of the treatments of choice is Lithium , which has been shown to be very beneficial in reducing

13298-670: The results for the use of gabapentin have been disappointing. Antipsychotics are utilized as a second line option for hypomanic episodes, typically indicated patients who do not respond to mood stabilizers. However, quetiapine is the only antipsychotic that has demonstrated efficacy in multiple meta-analyses of Randomized controlled trials for treating acute BP-II depression, and is a first-line option for patients with BP-II depression. Other antipsychotics that are used to treat BP-II include lurasidone , olanzapine , cariprazine , aripiprazole , asenapine , paliperidone , risperidone , ziprasidone , haloperidol , and chlorpromazine . As

13420-564: The risk of suicide is slightly higher in patients who have BP-II than those with BP-I. In results of a summary of several lifetime study experiments, it was found that 32.4% of BP-I patients experienced suicidal ideation or suicide attempts compared to 36% in BP-II patients. Bipolar disorders, in general, are the third leading cause of death in 15- to 24-year-olds. BP-II patients were also found to employ more lethal means and have more complete suicides overall. BP-II patients have several risk factors that increase their risk of suicide. The illness

13542-495: The risk of altercations with law enforcement. There is a high risk of impulsively taking part in activities potentially harmful to the self and others. Although "severely elevated mood" sounds somewhat desirable and enjoyable, the experience of mania is ultimately often quite unpleasant and sometimes disturbing, if not frightening, for the person involved and for those close to them, and it may lead to impulsive behaviour that may later be regretted. It can also often be complicated by

13664-468: The risk of bipolar manic relapse, by 42%. Anticonvulsants such as valproate , oxcarbazepine , and carbamazepine are also used for prophylaxis . More recent drug solutions include lamotrigine and topiramate , both anticonvulsants as well. In some cases, long-acting benzodiazepines , particularly clonazepam , are used after other options are exhausted. In more urgent circumstances, such as in emergency rooms, lorazepam , combined with haloperidol ,

13786-521: The seeming inability to focus on tasks. Because many of the symptoms of hypomania are often mistaken for high-functioning behavior or simply attributed to personality, patients are typically not aware of their hypomanic symptoms. In addition, many people with BP-II have periods of normal affect . As a result, when patients seek help, they are very often unable to provide their doctor with all the information needed for an accurate assessment; these individuals are often misdiagnosed with unipolar depression. BP-II

13908-535: The severity of aimlessness and disorganization. Speech may be rapid, but interruptible. Patients with hypomania never present with psychotic symptoms and do not reach the severity to require psychiatric hospitalization. For these reasons, hypomania commonly goes unnoticed. Individuals often will only seek treatment during a depressive episode, and their history of hypomania may go undiagnosed. Although hypomania may increase functioning, episodes require treatment as they may indicate increasing instability and can precipitate

14030-417: The signature symptoms of mania (and to a lesser extent, hypomania ) is what many have described as racing thoughts . These are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli. This experience creates an absent-mindedness where the manic individual's thoughts totally preoccupy them, making them unable to keep track of time, or be aware of anything besides

14152-1676: The study of the origin, diagnosis, development, and treatment of mental disorders). In Russia those psychopathological syndromes are used in modern clinical practice and described in psychiatric literature in the details: asthenic syndrome , obsessive syndrome , emotional syndromes (for example, manic syndrome , depressive syndrome), Cotard's syndrome , catatonic syndrome , hebephrenic syndrome, delusional and hallucinatory syndromes (for example, paranoid syndrome, paranoid-hallucinatory syndrome, Kandinsky - Clérambault's syndrome also known as syndrome of psychic automatism, hallucinosis), paraphrenic syndrome , psychopathic syndromes (includes all personality disorders), clouding of consciousness syndromes (for example, twilight clouding of consciousness, amential syndrome also known as amentia, delirious syndrome , stunned consciousness syndrome, oneiroid syndrome ), hysteric syndrome, neurotic syndrome , Korsakoff's syndrome , hypochondriacal syndrome , paranoiac syndrome, senestopathic syndrome, encephalopathic syndrome . Some examples of psychopathological syndromes used in modern Germany are psychoorganic syndrome , depressive syndrome, paranoid-hallucinatory syndrome, obsessive-compulsive syndrome , autonomic syndrome, hostility syndrome, manic syndrome , apathy syndrome . Münchausen syndrome , Ganser syndrome , neuroleptic-induced deficit syndrome , olfactory reference syndrome are also well-known. The most important psychopathological syndromes were classified into three groups ranked in order of severity by German psychiatrist Emil Kraepelin (1856—1926). The first group, which includes

14274-653: The suffix "-mania," namely, kleptomania , pyromania , and trichotillomania . Despite the unfortunate association implied by the name, however, no connection exists between mania or bipolar disorder and these disorders. Furthermore, evidence indicates a vitamin B 12 deficiency can also cause symptoms characteristic of mania and psychosis. Hyperthyroidism can produce similar symptoms to those of mania, such as agitation, elevated mood, increased energy, hyperactivity, sleep disturbances and sometimes, especially in severe cases, psychosis. Postpartum psychosis can also cause manic episodes ( unipolar mania ). A manic episode

14396-451: The treatment of acute mania was reviewed by Tohen and Vieta in 2009. When the manic behaviours have gone, long-term treatment then focuses on prophylactic treatment to try to stabilize the patient's mood, typically through a combination of pharmacotherapy and psychotherapy . The likelihood of having a relapse is very high for those who have experienced two or more episodes of mania or depression. While medication for bipolar disorder

14518-404: The treatment of hypomanic and depressive episodes of BP-II include lithium , and the anticonvulsant medications valproate , carbamazepine , lamotrigine , and topiramate . There is strong evidence that lithium is effective in treating both the depressive and hypomanic symptoms in BP-II, along with the reduction of hypomanic switch in patients treated with antidepressants. Furthermore, lithium

14640-427: The usual clinical tests"; i.e., asymptomatic. In medicine, a broad definition of syndrome is used, which describes a collection of symptoms and findings without necessarily tying them to a single identifiable pathogenesis. Examples of infectious syndromes include encephalitis and hepatitis , which can both have several different infectious causes. The more specific definition employed in medical genetics describes

14762-486: The world... life appears in front of you like an oversized movie screen." Behrman indicates early in his memoir that he sees himself not as a person with an uncontrollable disabling illness, but as a director of the movie that is his vivid and emotionally alive life. There is some evidence that people in the creative industries have bipolar disorder more often than those in other occupations. Winston Churchill had periods of manic symptoms that may have been both an asset and

14884-452: Was interpreted in the context of either elevated baseline activity (resulting in a null finding of reward hypersensitivity), or reduced ability to discriminate between reward and punishment, still supporting reward hyperactivity in mania. Punishment hyposensitivity , as reflected in a number of neuroimaging studies as reduced lateral orbitofrontal response to punishment, has been proposed as a mechanism of reward hypersensitivity in mania. In

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