[Jon]

here's a start, more to follow. Keep in mind that someone with Bi-Polar who is also an alcoholic/addcit is termed "Dual Diagnosis".

Bipolar Disorder
WHAT IS BIPOLAR DISORDER?
Bipolar disorder, or manic-depression, is characterized by moods that swing between two opposite poles:
Periods of mania (mood elevation, including exaggerated euphoria, irritability, or both). For a diagnosis of bipolar disorder, only one episode of mood elevation needs to be reported.


Episodes of depression.
[ For details, see Box Symptoms of Bipolar Disorder.]
Bipolar Disorder Categories
Bipolar disorder is classified according to symptom severity as bipolar disorder I, bipolar disorder II, and cyclothymic disorder.

Bipolar Disorder Type I. Bipolar disorder type I is characterized by at least one manic episode, with or without major depression. With mania, either euphoria or irritability may mark the phase, and there are significant negative effects (such as sexual recklessness, excessive impulse shopping, sudden traveling) on a patients' social life, work, or both. Untreated mania lasts at least a week or results in hospitalization. Typically, depressive episodes tend to last six to 12 months if untreated. However, untreated manic episodes last three to six months.

Hypomania and Bipolar Disorder Type II. Bipolar disorder type II is characterized by at least one episode of hypomania and at least one episode of major depression. With hypomania the symptoms of mania (euphoria or irritability) appear in milder forms and are of shorter duration. They do not affect social or work life as dramatically, and hospitalization is not generally required.

Cyclothymic Disorder. Cyclothymic disorder is not as severe as either bipolar disorder II or I, but the condition is more chronic. The disorder lasts at least two years, with single episodes persisting for more than two months. Cyclothymic disorder may be a precursor to full-blown bipolar disorder in some people or it may continue as a low-grade chronic condition.
Course of the Illness
Bipolar disorder can be severe and long-term, or it can be mild with infrequent episodes. The usual pattern of bipolar disorder is one of increasing intensity and duration of symptoms that progresses slowly over many years. (Patients with the disease, however, may experience symptoms in very different ways.) A bipolar disorder patient averages 8 to 10 manic or depressive episodes over a lifetime, but some people experience more and some fewer episodes.

Typical Bipolar Cycles. In most cases of bipolar disorder, the depressive phases far outnumber manic phases, and the cycles of mania and depression are neither regular nor predictable. Many patients, in fact, experience mixed mania, or a mixed state, in which both mania and depression occur.

Rapid Cycling. About 15% of patients have a temporary, complicated phase known as rapid cycling, in which the manic and depressive episodes alternate at least four times a year and, in severe cases, can even progress to several cycles a day. (Some experts suggest that rapid cycling may first occur in bipolar disorder patients who are on antidepressants, which trigger a switch to mania and set up a cyclical pattern.)

SYMPTOMS OF BIPOLAR DISORDER
Symptoms of the Depression Phase
The symptoms of depression experienced in bipolar disorder are almost identical to those of major depression, the primary form of unipolar depressive disorder. They include the following:
Sad mood.


Fatigue or loss of energy.


Sleep problems (insomnia, excessive sleeping, or shallow sleep with frequent awakenings).


Weight changes (either gain or loss).


Diminished ability to concentrate or make decisions.


Agitation or markedly sedentary behavior.


Feelings of guilt, pessimism, helplessness, and low self-esteem.


Loss of interest or pleasure in life.


Thoughts of, or attempts at, suicide.
Depressive episodes associated with bipolar disorder often differ from those of unipolar depressive disorder in the following ways:
People with unipolar depression can still experience a variety of moods, but the moods are neither elevated nor pathological and the affected person does not meet the criteria for mania. [ See Well-Connected Report #8, Depression.]


Episodes of depression in bipolar disorder are less likely to have a specific trigger than are those with major depression disorder.


Bipolar depression does not typically last as long as major depression (although left untreated some bipolar disorder episodes can still last six to 12 months).


Bipolar depressive episodes develop more gradually than those caused by major depression.


Depressive symptoms in bipolar disorder patients also tend to be atypical, i.e., one sees an increase in sleep and appetite, a feeling of heaviness and slowness in the body, a tendency to feel rejected, and a preservation of volatile mood.


One interesting study reported that many bipolar disorder patients experienced dreams of death at the low point of their depression, and those dreams were soon followed by an upward mood change.
Symptoms of the Acute Manic Phase
The acute manic phase is always characterized by mood elevation, either presented as exaggerated euphoria, irritability, or both. The episode lasts for at least a week or for any duration if it was severe enough to cause hospitalization.

In addition, certain other symptoms are present to assist in making a diagnosis. Some mental health professionals use the mnemonic device DIGFAST to identify them.

In general, for a diagnosis of mania, patient must have experienced either euphoria with three DIGFAST symptoms or irritability with four of these symptoms:
D. Distractibility. This is the most common symptom and is usually characterized by the inability to pay attention to any activity for very long.


I. Insomnia in mania typically means having high energy and requiring less sleep. (This differs from insomnia in depression, in which the patient has low energy plus an inability to sleep.)


G. Grandiosity. Patients with this symptom have an inflated sense of themselves, which, in severe cases, can be delusional. Close to 60% of all manic patients experience feelings of omnipotence. Sometimes they feel that they are godlike or have celebrity status.


F. Flight of ideas. Thoughts literally race.


A. Activity. An increase in intensity in goal-directed activities occurs, which is related to social behavior, sexual activity, work, school, or combinations.


S. Speech. Excessive talking. Is present


T. Thoughtlessness. Excessive involvement in high-risk activities is present (e.g., unrestrained shopping, promiscuity). Mood disturbance may be severe enough to damage one's job or social functioning or relationships with others, or which require hospitalization to prevent harm to others or to the self.
Hypomania. With hypomania the symptoms of mania are milder and of shorter duration (but they last at least four days). They do not affect social or work life as dramatically.

Mixed or Pure Mania. Manic episodes themselves can be characterized as mixed mania or pure mania:
In pure mania, either euphoria or irritability is present along with other symptoms of mania and there are no indications of depression.


In mixed mania (also called a mixed state), depressed mood and manic symptoms occur for at least a week. Depression is present most of the day and nearly every day. Symptoms of mania are also present to a significant degree