Bipolar II: Similar to Bipolar I Disorder, there are periods of highs as described above and often followed by periods of depression. Bipolar II Disorder, however is different in that the highs are hypo manic, rather than manic (APA, 2000). In other words, they have similar symptoms but they are not severe enough to cause marked impairment in social or occupational functioning and typically do not require hospitalization in order to assure the safety of the person.
A person's family history and genetics (diathesis) often play an important role in the greater likelihood of someone having bipolar disorder in their lifetime (Mental Help Net, 2004). Increased stress and inadequate coping mechanisms to deal with that stress may also contribute to the disorder's manifestation. Bipolar disorder is most often experienced as a swing between a manic and a depressed mood, which may often be related to increased stress or other event in a person's normal life (Mental Help Net, 2004). Nearly anything can trigger a person to shift in mood, and sometimes there is no obvious trigger at all. Often, the first manic episode is triggered because of some external stressor the person has experienced. However, the hallmark of Bipolar disorder is that the person's extreme moods often seem to come on of their own accord (Mental Help Net, 2004). Once the person's mood begins to cycle, there is often not an external reason the person can find for feeling the way that he/she does.
As a clinician, I would look for the following symptoms of mania (or a manic episode), which include:
* Increased energy, activity, and restlessness
* Excessively "high," overly good, euphoric mood
* Extreme irritability
* Racing thoughts and talking very fast, jumping from one idea to another
* Distractibility, can't concentrate well
* Little needed
* Unrealistic beliefs in one's abilities and powers
* Poor judgment Spending sprees
* A lasting period of behavior that is different from usual
* Increased sexual drive
* Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
* Provocative, intrusive, or aggressive behavior
* Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present (APA, 2000).
Signs and symptoms of (or a depressive episode) that I would look for include:
* Lasting sad, anxious, or empty mood
* Feelings of hopelessness or pessimism
* Feelings of guilt, worthlessness, or helplessness
* Loss of interest or pleasure in activities once enjoyed, including sex
* Decreased energy, a feeling of fatigue or of being "slowed down"
* Difficulty concentrating, remembering, making decisions Restlessness or irritability
* Sleeping too much, or can't Change in appetite and/or unintended weight loss or gain
* or other persistent bodily symptoms that are not caused by physical illness or injury
* Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer (APA, 2000).
Treatment of clients with bipolar disorder involves initial and ongoing patient education (Soreff, 2004). The educational efforts must be directed not only toward the patient but also toward their family and support system, who are also greatly affected by the disorder. The treatment of bipolar disorder is directly related to the phase of the episode, e.g, depression or mania, and the severity of that phase (Soreff, 2004). For example, a person who is extremely depressed and exhibits suicidal behavior requires inpatient treatment. In contrast, an individual with a moderate depression who still can work would be treated as an outpatient.
Inpatient hospital treatment: The indications for hospitalization in a person with bipolar disorder include the following (Soreff, 2004):
* Danger to self: A patient, especially one in a depressive episode, may present with a significant risk for suicide. Serious suicide attempts and specific ideation with plans constitute clear evidence of the need for constant observation and preventive protection; however, in other situations, the danger to the person may come from other aspects of the disease. For example, a person who is depressed enough to not eat might be at risk of death. Alternately, a person in extreme mania, who foregoes rest, sleep, or food, may be in a state of serious exhaustion.
* Danger to others: Patients with bipolar disorder can become a threat to others. For example, a patient experiencing a severe depression believed the world was so bleak that she planned to kill her children to spare them from the world's misery. In the other extreme, a delusional patient having a manic episode believed everyone was against him; he searched for a rifle in order to defend himself and to get them before they got him.
* Total inability to function: Occasionally, depression is so profound that the person cannot function at all. Leaving such a person alone would be dangerous and not therapeutic.
* Totally out of control: This is true especially during a manic episode. In this situation, a person's behavior is so beyond limits, they are destroying their career and can be harmful to those around them.
* Medical conditions that warrant medication monitoring: For example, patients with certain cardiac conditions should be in a medical environment where the effects of the psychotropic medications can be monitored and observed closely.
* Partial hospitalization or a day-treatment program
In general, these patients have severe symptoms but have a level of control and a stable living environment. For example, a patient with severe depression who has thoughts of suicide but no plans to act upon them and who has a high degree of motivation can get well when given a great deal of interpersonal support, especially during the day, and with the help of a very involved and supportive family (Soreff, 2004). The family needs to be home every night and should be very concerned with the patient's care. Partial hospitalization also offers a bridge to return to work (Soreff, 2004). Returning directly to work often is difficult for patients with severe symptoms, and partial hospitalization provides support and interpersonal relationships.
Other ways the family is affected and ways the family can help an individual with a bipolar disorder (Soreff, 2004):
First, look at areas of stress and find ways to handle them. The stresses can stem from family or work, but if they accumulate, they propel the person into mania or depression. This is a form of psychotherapy.
Second, monitor and support the medication. Medications make an incredible difference. The key is to get the benefits and avoid adverse effects. Patients are ambivalent about their medications. They recognize that the drugs help and prevent hospitalizations, yet they also resent that they need them. The job is to address their feelings and allow them to continue with the medications.
The third aspect involves the clinician and family and the subject of education. The clinician must help educate both the patient and the family about bipolar illness. They need to be aware of the dangers of substance abuse, the situations that would lead to relapse, and the essential role of medications. Support groups for patients and families are of tremendous importance.
References:
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.
Mental Help Net. (2004). Bipolar Disorder. Retrieved February 5, 2004, from
Soreff, S. (2004). Bipolar Affective Disorder. eMedicine Journal. Retrieved February 5, 2004, from
