Posts tagged: mania

Bipolar Disorders

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When I first started out as a psychologist 20 years ago, few people were diagnosed with manic depression. It was considered a fairly rare phenomenon, and the people who suffered with it considered gravely ill.   After working with developmentally disabled children and adults for a few years, I encountered my first manic patient at an inpatient psychiatric unit.  She was well dressed and apparently well-educated. I noticed her tremendous energy at two o’clock in the morning.  She was initially reasonable, calling attention to the bizarre admissions routine. After about 30 minutes in her room, she emerged completely naked, waving a piece of her clothing.  She was angry that I hadn’t told her when I would come to her room for a urine sample.  The patient was not aware of anything out of the ordinary. She believed her behavior to be normal and rational. At that point I knew this woman had nothing in common with the developmentally disabled with whom I had been working.

Since that time, I’ve experienced many flavors of manic behavior.  One of my patients talked so rapidly and for so long that he developed painful sores around his mouth.  Another patient constantly saw her father as the image of a devil.  Many of my patients with mania are unable to sleep for days. Their extraordinary energy can manifest in anger as well as euphoria.  Bipolar type I, as it is now known, is a horrendous illness that profoundly changes the course of one’s life.  The primary medication used to control its symptoms can be fatal, and causes flu-like illness when the level is too high in the body.  Often those with mania reject the use of medication, since like my naked patient, they have minimal awareness of their inappropriate behavior.  Bipolar type II is a newer and milder conceptualization of manic depression.  The mania is not so divorced from reality, and the depressive lows are typically not as bad.  What separates a Bipolar-type Mood Disorder from a Major Depression or Adjustment Disorder is the presence of one or more episodes of mania or hypomania.

Most viewers of this page are unlikely to be acutely manic, since the sustained attention to a computer would be impossible.  It is more common to suffer with hypomania, which often responds to psychotherapy.  Acute mania is not able to be treated with psychotherapy, other than some behavioral programming.  Much like a broken bone, if you have to ask, it’s unlikely you have the disorder.  The therapeutic treatment of hypomania is largely insight driven and psychodynamic, as I have not been exposed to behavioral treatment protocols for hypomania.  Mania is not known to be caused by medical illness, as are many instances of depression.  That is not to say mania is not a biological condition, rather it is not known to be secondary to a medical condition.  Mania appears to be a pure psychiatric symptom, not mimicked by other medical conditions.  Depression can be caused by many medical illnesses, and it even is a prodromal symptom  of neurological illness.  For example, the onset of primary Parkinson’s Disease is often presaged by a clinical depression.  There is no known analogous situation with a state of mania.

We can see that most consumers visiting this site, if they are Bipolar, are likely to be the type two variety.  Please keep in mind that the current nomenclature suggests the only difference between mania and hypomania is an impairment of social and/or occupational functioning.  The newer definition even suggests that hypomanics can suffer with delusions and hallucinations; as long as these patients are not impaired in their daily functioning.  I am unconvinced that someone who believes their food is poisoned, their husband works for the KGB, and they see visions of dead relatives or famous people can be normal in their everyday functioning.   There is no longer a neat discrimination between these conditions, which can be confusing to both patients and doctors.  I believe that the increasingly diffuse boundary between these important diagnoses is leading many people to take common emotional lability as a Bipolar Disorder.

So, is you is or is you ain’t Bipolar?  The quick answer is that it is unlikely if you are gainfully employed, intimately involved with another, and do not have legal difficulties hanging over your head.  If you have suffered with emotional swings since adolescence, have received negative comments about your expansive behavior, and you can’t seem to find steady employment or relationships, then you may want to take a closer look at the diagnosis of type two Bipolar Disorder.  Please leave your comments about this post in the space provided below.

Depression

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If you have been to informational websites on depression, then you have a sense of what psychologists consider to be depressive disorders.  The typical symptoms are well known, and discussed all the time.  Depression actually falls within the general category of  “Mood Disorders.”  Anyone who has suffered with a bout of moderate Major Depression does not have to be convinced of its impact on work and family life.  Many have no doubt run across the term “Bipolar Disorder” and its older antiquated name “Manic-depression.”  I consider this diagnosis  at greater length in another category on the blog titled “Bipolar.”

The major difference between Major Depression and Bipolar Disorder is a cycle of mania or hypomania.  This is not a trivial distinction, whatsoever.  Even its milder variant, hypomania, is alarming to others over prolonged periods, and negatively affects occupational and social functioning.  Mania is alarming to others over rather brief periods.  It is the polar opposite of Major Depression.  Often those afflicted are not aware of their expansive mood, or consider it to be a blessing.  Depressive people are aware of their symptoms, and sometimes dwell on them excessively.  Chronically irritated depressives are often not aware they are depressed, but they are aware of their anger.  Consider asking a confidant about your symptoms, since they may provide a fresh prospective.  We only know ourselves through the eyes of others.

Bipolar Disorders are less common than Major Depression.  Bipolar Disorders are often more debilitating, and with less effective long-term treatment.  Severe Major Depression is a nightmare, but add the disorganized frenzy of mania, and it sums to a complete breakdown in functioning.  People who suffer with a severe Major Depression have a willingness to commit suicide, and may even experience psychotic symptoms.  The type of delusions experienced by people with Major Depression and Bipolar Disorder are quite different, though either disorder may become self-destructive.

Most people using this site are more likely to have a mild form of  Major Depression than a Bipolar Disorder.  The Bipolar subcategory on this blog is more useful to significant others, than for those who suffer themselves.  This is not true for the hypomanic person, as they tend to maintain greater self-awareness than someone with mania.  It’s that the hypomanic tends to feel quite elated and energetic, such that a boring old computer blog is not their idea of entertainment.  Perhaps those suffering with acute mania are too frantic to web surf, and those with hypomania lack the awareness to consider their condition a problem.

Bipolar Disorder is often misdiagnosed.  Hypomania is mistaken for mania, and normal mood swings are taken for hypomania.  It is a very serious illness that has almost been reduced to a fad.  Twenty years ago, Borderline Personality Disorder was constantly diagnosed and questioned.  It is doubtful that Bipolar Disorder will be the last diagnostic fad in the fields of psychology and psychiatry.

Most people have had at least one bout of Major Depression in their lives.  Statistically, it’s almost deviant to avoid a Major Depressive Episode one’s whole life.  Whereas Bipolar Disorders are rarely aware of their problematic symptoms while manic, the chronic depressive knows they are depressed, but often under-appreciates the severity of their suffering.  The depression becomes a backdrop to their life, to the point good spirits seem strange and disconcerting.  Once the depression reaches the Moderate stage, it grabs one’s attention in a different way.  Physical symptoms rear their ugly heads.  Suddenly, you cannot sleep, or conversely, one can’t seem to rouse the whole day.  Your appetite is either nil or not capable of being appeased.  Chronic anxious rumination is not able to be suppressed.  It is not always easy to link all the cognitive symptoms of a depression together, in order for someone to realize they are depressed.  Most outpatients initially seek treatment in the moderate stage of a Major Depression, as the physical symptoms assert themselves.  It is likely that the moderate stage of depression inspires many web searches.

Generally, treatment is a combination of psychotherapy and medication.  The combined treatment is nearly four times as effective as either treatment used in isolation.  I believe this rule is most true for Moderate to Severe Major Depressions.  I recommend cognitive-behavioral or psychodynamic therapy for treatment of mild depression.  I am less concerned about attribution errors in more severe depressions than a milder depression.  For example, many of my patients are worried when antidepressant therapy is decreased or discontinued.  Often these patients had taken an antidepressant for years without positive results, or were placed on too low a dose of the antidepressant to be clinically effective.  Depressive patients often fail to give themselves credit for their hard work in psychotherapy.  This is an attribution error, and we all are prone to this sort of error.  Please share your comments regarding this post in the space provided below.

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