Comprehensive Medical/Psychiatric Evaluation

Medication Management of Depression and Treatment Resistant Depression

Bipolar Disorders and Psychotic Disorders

Anxiety Disorder, Panic Disorder, PTSD, Obsessive-compulsive Disorder, ADD, ADHD

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a chronic brain disorder that causes unusual, extreme and impairing shifts in mood, energy, thinking,  and behavior. Symptoms of bipolar disorder are often severe. They are different from the normal ups and downs that everyone occasionally experiences. Bipolar disorder symptoms can result in damaged relationships, loss of jobs, poor school performance, and even suicide. However, bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Causes of Bipolar Disorder

Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.

We do know that bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person’s chance of developing the illness.

Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, the majority of children with a family history of bipolar disorder will not develop the illness.

The researchers also identified certain traits that appeared to run in families, including:

• History of psychiatric hospitalization
• Co-occurring obsessive-compulsive disorder (OCD)
• Age at first manic episode
• Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.
But studies have determined that genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar disorder does not always develop the disorder. This is important because identical twins share all of the same genes.

The study results suggest there are other factors besides genes may also contribute to the disorder and when it manifests as an illness. It’s likely that many different genes and a person’s environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Symptoms of Bipolar Disorder

Bipolar disorder is not easy to recognize when it starts. The symptoms may seem like separate problems, and they are often not identified as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated.

People with bipolar disorder experience intense emotional states that occur in distinct periods called “mood episodes.” An over-the-top feeling of bliss or an overexcited state is called a manic episode, and an extremely sad, helpless or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.

A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.

Bipolar disorder often develops in a person’s teenage years or early adulthood. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life. Symptoms may include:

• A long period of feeling “high,” or an overly happy or outgoing mood
• Extremely irritable mood, agitation, feeling “jumpy” or “wired.”
• Talking very fast, jumping from one idea to another, having racing thoughts
• Being easily distracted
• Increasing goal-directed activities, such as taking on new projects
• Being restless
• Sleeping little
• Having an unrealistic belief in one’s abilities
• Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments
• A long period of feeling worried or empty
• Loss of interest in activities once enjoyed, including sex
• Feeling tired or “slowed down”
• Having problems concentrating, remembering, and making decisions
• Being restless or irritable
• Changing eating, sleeping, or other habits
• Thinking of death or suicide, or attempting suicide. In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.

Some people with bipolar disorder also experience hypomania. During a hypomanic episode, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person’s extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.

Treatment of Bipolar Disorder

Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. However, even with proper treatment, mood changes can occur.

Treatment may be more effective when the person works closely with a doctor and talks openly about his or her concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help the doctor assess a person’s response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.

Proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms. This is also true for people with the most severe forms of the illness.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.