Bipolar disorder is an illness classically characterised by an individual's mood being repeatedly very high (manic) or very low (depressed), or a combination of the two. A person must have suffered at least two episodes of mania, or a similar but less severe episode called hypomania, in order to be diagnosed with bipolar disorder; this will be the case even if they have never been depressed. Additionally, a person who has had episodes of depression for many years but then has one episode of mania or hypomania should be subsequently diagnosed as suffering from bipolar disorder.
Bipolar disorder is one of the most heritable mental disorders; individuals who suffer with bipolar disorder are more likely to have had family members suffering with a mood disorder (either bipolar disorder or depression).
Some fluctuations in mood from day to day is entirely normal, as is a personality which is generally on the cheerful side or the gloomy side.
Some people also have personalities which tend to change rapidly, especially at times of stress. In this context, it can be seen how the diagnosis of bipolar disorder can be difficult to make; this illness is estimated to affect around 2 in 100 people over the age of 16 in England at any one time, yet one study showed that the average time between the start of symptoms of bipolar illness and someone getting appropriate treatment was nearly six years. 6 out of 10 of people are not receiving appropriate medication or psychological therapy.
A hypomanic episode is diagnosed when an individual's mood is elevated or irritable to a degree that is definitely abnormal for them for at least four consecutive days. They must display three typical symptoms, such as physical restlessness, increased talkativeness or decreased need for sleep, which are interfering with (but not totally disrupting) their everyday life.
A manic episode is a more severe episode of elevated or irritable abnormal mood which has been present for at least one week; again, three typical symptoms are required to make the diagnosis, but, in this case, an individual's personal functioning is severely affected or completed disrupted.
Treatment for bipolar disorder involves treating the episode of abnormal mood currently affecting an individual, but also looking at preventative treatments to stop the occurrence of future episodes. The treatment for a depressive episode is described in the section on depression. The treatment for a manic or hypomanic episode will include medication to try and restore mood to a normal state, as well as other medication which may be used in the short term to relieve any associated irritability. In the longer term, medication to maintain mood at a normal level and prevent extreme fluctuations can be used successfully; regular review and monitoring is required.
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