Bipolar disorder, once called manic depression, is characterized by mood swings from one extreme to the other. People with bipolar disorder may experience periods of heightened energy followed by periods of deep depression. Until recently, the Diagnostic and Statistical Manual (DSM) described only one form of bipolar disorder, but the fourth edition now includes a second form of bipolar disorder which has slightly different diagnostic criteria.

Symptoms

According to the DSM-IV, both bipolar disorder I and II include recurring and alternating episodes of exultant or irritable mood and debilitating depression, each of several days duration. At least three of the following must be present: rushing thoughts, distractibility, an increase in risk-taking behaviors, feelings of grandeur, talking jags, going for long periods without feeling the need for sleep, agitation, or an increase in activity directed toward a goal of some kind. In bipolar disorder I, these manic states often cause an inability to work or play normally, while in bipolar disorder II, the mania is subdued and sometimes functionality is increased.

Diagnosis

The manic episodes for bipolar disorder I are extreme. Often they include a psychotic component, periods of irrationality or delusion. Bipolar disorder II, however, does not contain this element of psychosis, and sometimes has the effect of increasing the functionality of the person experiencing this hypomania. A person in a hypomanic state can work harder, longer, and faster than when in a non-manic state. This may discourage some people with bipolar disorder II from seeking treatment, but the danger is in the depressive episodes that almost inevitably follow. In this state, the person may not be able to or want to function at all. In addition to recognizing the characteristics of bipolar disorder II, the clinician must rule out other psychological or physiological disorders that may explain the symptoms better. Some of these disorders include: schizophrenia, schizoaffective disorder, delusional disorders, schizophreniform disorder, or an unclassified psychotic disorder.

Treatment

Once bipolar disorder II has been diagnosed by an experienced and credentialed clinician, it is treated in the same way as bipolar disorder I, with mood-stabilizing drugs such as lithium and valproate, as well as antipsychotic drugs. According to the National Institutes of Health, some studies have suggested that antidepressants may have a positive effect on treating the depressive episodes of bipolar disorder II, but other research suggests that the use of antidepressants may increase the intensity of hypomanic episodes.

Source:

National Institutes of Health

PsychNet-UK