The Phenomenon of Bipolar Affective Disorder

The phenomenon of Bipolar Affective Disorder has been a mystery since the 16th

and 17th century. The Dutch painter Vincent Van Gogh was thought to of suffered from

bipolar disorder. It appears that there are an abundance of people with the disorder yet,

no true causes or cures for the disorder. Clearly the Bipolar disorder severely undermines

their ability to obtain and sustain social and occupational success. However, the journey

for the causes and cures for the Bipolar disorder must continue.

Affective disorders are primarily characterized by depressed mood, elevated

mood or (mania), or alternations of depressed and elevated moods. The classical term is

manic-depressive illness, a newer term is Bipolar disorder. The two are interchangeable.

Milder forms of a depressive syndrome are called dysthymic disorder, mild forms of

mania are hypomania and the milder expressions of Bipolar disorder are called

cyclothymic disorders. The use of the term primary affective disorder refers to the

individuals who had no previous psychiatric disorders or else only episodes of mania or

depression. Secondary affective disorder refers to patients with preexisting psychiatric

illness other than depression or mania (Goodwin, Guze. 1989, p.7 ).

Bipolar affective disorder affects approximately one percent or three million

persons in the United States, afflicting both males and females. Bipolar disorder involves

episodes of mania and depression. The manic episodes are characterized by elevated or

irritable mood, increased energy, decreased need for sleep, poor judgment and insight,

and often reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). These episodes

may alternate with profound depressions characterized by a pervasive sadness, almost

inability to move, hopelessness, and disturbances in appetite, sleep, in concentrations and

driving.

Bipolar disorder is diagnosed if an episode of mania occurs whether depression

has been diagnosed or not (Goodwin, Guze, 1989, p 11). Most commonly, individuals

with manic episodes experience a period of depression. Mood is either elated, expansive,

or irritable, hyperactivity, pressure of speech, flight of ideas, inflated self esteem,

decreased need for sleep, distractibility, and excessive involvement in activities with high

potential for painful consequences. Rarest symptoms were periods of loss of all interest

and retardation or agitation (Weisman, 1991).

As the National Depressive and Manic Depressive Association (MDMDA) has

demonstrated, bipolar disorder can create substantial developmental delays, marital and

family disruptions, occupational setbacks, and financial disasters. This devastating

disease causes disruptions of families, loss of jobs and millions of dollars in cost to

society. Many times bipolar patients report that the depressions are longer and increase

in frequency as the individual ages. Many times bipolar in a psychotic state are

misdiagnosed as schizophrenic. Speech patterns help distinguish between the two

disorders (Lish, 1994).

The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years

of age, with a second peak in the mid-forties for women. A typical bipolar patient may

experience eight to ten episodes in their lifetime. However, those who have rapid cycling

may experience more episodes of mania and depression that succeed each other without a

period of remission (DSM III-R).

The three stages of mania begins with hypomania, which patients report that they

are energetic, extroverted and assertive. The hypomania state has let observers to feel

that bipolar patients are "addicted" to their mania. Hypomania progresses into mania as

the transition is marked by loss of judgment. Often, euphoric grandiose characters are

recognized as well as a paranoid or irritable character begins to manifest. The third stage

of mania is evident when the patient experiences delusions with often paranoid themes.

Speech is generally rapid and behavior manifests with hyperactivity and sometimes

assaultiveness.

When both manic and depressive symptoms occur at the same time it is called a

mixed episode. These people are a special risk because of the combination of

hopelessness, agitation and anxiety make them feel like they "could jump out of their

skin"(Hirschfeld, 1995). Up to 50% of all patients with mania have a mixture of

depressed moods. Patients report feeling very dysphoric, depressed and unhappy yet

exhibit the energy associated with mania. Rapid cycling mania is yet another

presentation of bipolar disorder. Mania may be present with four or more distinct

episodes within a 12 month period. There is now evidence to suggest that sometimes