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What is bipolar disorder and how is it diagnosed?

Bipolar disorders are a group of disorders characterised by episodes of mania or hypomania and depression. In between episodes, mild symptoms of mania and/or depression may, or may not, be present. Bipolar disorders characterised in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, version 5) include bipolar 1 disorder, bipolar 2 disorder, and cyclothymic disorder.

A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including one of the first two): intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes in appetite; loss of energy; difficulty concentrating, remembering or making decisions; and/or thoughts of death or suicide.

A manic episode is a period of at least one week when a person is high spirited or irritable in an extreme way most of the day for most days. A manic episode involves changes in normal behaviour such as showing exaggerated self-esteem or grandiosity, less need for sleep, talking more than usual, talking more loudly and quickly, being easily distracted, doing many activities at once, scheduling more events in a day than can be accomplished, embarking on risky behaviour, uncontrollable racing thoughts, and/or quickly changing ideas or topics. These changes in behaviour are significant and clear to friends and family and are severe enough to cause major dysfunction.

A hypomanic episode is similar to a manic episode but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes, and the person is still able to function.

The difference between bipolar 1 disorder and bipolar 2 disorder is determined by the existence of mania in bipolar 1 disorder or hypomania in bipolar 2 disorder.

Cyclothymic disorder is a milder form of bipolar disorder involving many mood swings, with hypomania and depressive symptoms that occur often and fairly constantly. People with cyclothymia experience emotional ups and downs, but with less severe extremes than in bipolar I or 2 disorder. Cyclothymic symptoms include at least two years of many periods of hypomanic and depressive symptoms that have lasted for at least half the time and have never stopped for more than two months.

April 2019

Last updated at: 10:36 pm, 9th April 2019

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