Classic symptoms of bi-polar disorder
hippy
Join Date: Jul 2007
Location: UK
Posts: 492
DSM-IV Criteria ( This is from a UK site but is just as valid in US)
Introduction
This information has been developed to provide background information on the diagnostic categories, and must not be used for diagnostic purposes. Diagnosis should always be undertaken by an appropriately trained healthcare professional.
The purpose of diagnosis is to enable effective treatment; but it is worth noting that obtaining an appropriate diagnosis can be a complex and lengthy procedure. Diagnosis must be made on the basis of symptoms, family history and the course of the illness, as it cannot be identified, as yet, physiologically, through a blood test or a brain scan. It is a matter of ongoing debate whether or not separate categories are useful, or indeed, whether there should be more categories, (a number of researchers have suggested a 'bipolar spectrum' would be more useful than the current categorization).
The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) has proven to be an authoritative reference handbook for health professionals both in the United Kingdom and in the United States in categorizing and diagnosing mental health problems. The International Classification of Diseases (ICD) is also used in Europe as a means of diagnosing health problems.
DSM-IV - Diagnostic Categories for Manic Depression/ Bi-Polar Affective Disorder (BD)
There are only two sub-types of bipolar illness, which have been defined, clearly enough to be given their own DSM categories, Bipolar I and Bipolar II.
Bipolar I
This disorder is characterized by manic episodes; the 'high' of the manic-depressive cycle. Generally this manic period is followed by a period of depression, although some bipolar I individuals may not experience a major depressive episode. Mixed states, where both manic or hypomanic symptoms and depressive symptoms occur at the same time, also occur frequently with bipolar I patients (for example, depression with the racing thoughts of mania). Also, dysphoric mania is common, - this is mania characterized by anger and irritability.
Bipolar II
This disorder is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania. Hypomanic episodes can be a less disruptive form of mania and may be characterized by low-level, non-psychotic symptoms of mania, such as increased energy or a more elated mood than usual. It may not affect an individual's ability to function on a day to day basis. The criteria for hypomania differ from those for mania only by their shorter duration (at least 4 days instead of 1 week) and milder severity (no marked impairment of functioning, hospitalization or psychotic features).
If the depressive and manic symptoms last for two years and do not meet the criteria for a major depressive or a manic episode then the diagnosis is classified as a Cyclothymic disorder, which is a less severe form of bipolar affective disorder. Cyclothymic disorder is diagnosed over the course of two years and is characterized by frequent short periods of hypomania and depressive symptoms separated by periods of stability.
Rapid cycling occurs when an individual's mood fluctuates from depression to hypomania or mania in rapid succession with little or no periods of stability in between. One is said to experience rapid cycling when one has had four or more episodes, in a given year, that meet criteria for major depressive, manic, mixed or hypomanic episodes. Some people who rapid cycle can experience monthly, weekly or even daily shifts in polarity (sometimes called ultra rapid cycling)
When symptoms of mania, depression, mixed mood, or hypomania are caused directly by a medical disorder, such as thyroid disease or a stroke, the current diagnosis is Mood Disorder Due to a General Medical Condition.
If a manic mood is brought about through an antidepressant, ECT or through an individual using street drugs, the diagnosis is Substance-Induced Mood Disorder, with Manic Features.
Occasionally one comes across a diagnosis of Bipolar 111. This has been used to categorise manic episodes, which occur as a result of taking an antidepressant medication, rather than occurring spontaneously. Confusingly, it has also been used in instances where an individual experiences hypomania or cyclothymia (i.e. less severe mania) without major depression.
Definitions
Mania
Manic Depression is comprised of two distinct and opposite states of mood, whereby depression alternates with mania. The DSM IV gives a number of criteria that must be met before a disorder is classified as mania. The first one is that an individual's mood must be elevated, expansive or irritable. The mood must be a different one to the individual's usual affective state during a period of stability. There must be a marked change over a significant period of time. The person must become very elevated and have grandiose ideas. They may also become very irritated and may well appear to be 'arrogant' in manner.
The second main criterion for mania emphasizes that at least three of the following symptoms must have been present to a significant degree:
Inflated sense of self importance
Decreased need for sleep
Increased talkativeness
Flight of ideas or racing thoughts
Easily distracted
Increased goal-directed activity
Excessive involvement in activities that can bring pleasure but may have disastrous consequences (e.g. sexual affairs and spending excessively.)
The third criterion for mania in the DSM-IV emphasizes that the change in mood must be marked enough to affect an individual's job performance or ability to take part in regular social activities or relationships with others. This third criterion is used to emphasize the difference between mania and hypomania.
Depression
The DSM-IV states that there are a number of criteria by which major depression is clinically defined: The condition must have been evident for at least two weeks and must have five of the following symptoms:
A depressed mood for most of the day, almost every day
A loss of interest or pleasure in almost all activities, almost every day
Changes in weight and appetite
Sleep disturbance
A decrease in physical activity
Fatigue and loss of energy
Feelings of worthlessness or excessive feelings of guilt
Poor concentration levels
Suicidal thoughts.
Both the depressed mood and a loss of interest in everyday activities must be evident as two of the five symptoms, which characterize a major depression. It is difficult to distinguish the symptoms of an individual suffering from the depressed mood of manic depression than from someone suffering from a major depression. Dysthymia is a less severe depression than unipolar depression, but it can be more persistent.
Psychosis
Psychosis is characterized by disorders in basic perceptual, cognitive, affective, and judgmental processes. For example, one might experience delusions, hallucinations, disorganized speech, disorganized behaviour etc. A diagnosis of bipolar affective disorder does not mean that an individual will necessarily experience psychosis.
Hippy
Introduction
This information has been developed to provide background information on the diagnostic categories, and must not be used for diagnostic purposes. Diagnosis should always be undertaken by an appropriately trained healthcare professional.
The purpose of diagnosis is to enable effective treatment; but it is worth noting that obtaining an appropriate diagnosis can be a complex and lengthy procedure. Diagnosis must be made on the basis of symptoms, family history and the course of the illness, as it cannot be identified, as yet, physiologically, through a blood test or a brain scan. It is a matter of ongoing debate whether or not separate categories are useful, or indeed, whether there should be more categories, (a number of researchers have suggested a 'bipolar spectrum' would be more useful than the current categorization).
The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) has proven to be an authoritative reference handbook for health professionals both in the United Kingdom and in the United States in categorizing and diagnosing mental health problems. The International Classification of Diseases (ICD) is also used in Europe as a means of diagnosing health problems.
DSM-IV - Diagnostic Categories for Manic Depression/ Bi-Polar Affective Disorder (BD)
There are only two sub-types of bipolar illness, which have been defined, clearly enough to be given their own DSM categories, Bipolar I and Bipolar II.
Bipolar I
This disorder is characterized by manic episodes; the 'high' of the manic-depressive cycle. Generally this manic period is followed by a period of depression, although some bipolar I individuals may not experience a major depressive episode. Mixed states, where both manic or hypomanic symptoms and depressive symptoms occur at the same time, also occur frequently with bipolar I patients (for example, depression with the racing thoughts of mania). Also, dysphoric mania is common, - this is mania characterized by anger and irritability.
Bipolar II
This disorder is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania. Hypomanic episodes can be a less disruptive form of mania and may be characterized by low-level, non-psychotic symptoms of mania, such as increased energy or a more elated mood than usual. It may not affect an individual's ability to function on a day to day basis. The criteria for hypomania differ from those for mania only by their shorter duration (at least 4 days instead of 1 week) and milder severity (no marked impairment of functioning, hospitalization or psychotic features).
If the depressive and manic symptoms last for two years and do not meet the criteria for a major depressive or a manic episode then the diagnosis is classified as a Cyclothymic disorder, which is a less severe form of bipolar affective disorder. Cyclothymic disorder is diagnosed over the course of two years and is characterized by frequent short periods of hypomania and depressive symptoms separated by periods of stability.
Rapid cycling occurs when an individual's mood fluctuates from depression to hypomania or mania in rapid succession with little or no periods of stability in between. One is said to experience rapid cycling when one has had four or more episodes, in a given year, that meet criteria for major depressive, manic, mixed or hypomanic episodes. Some people who rapid cycle can experience monthly, weekly or even daily shifts in polarity (sometimes called ultra rapid cycling)
When symptoms of mania, depression, mixed mood, or hypomania are caused directly by a medical disorder, such as thyroid disease or a stroke, the current diagnosis is Mood Disorder Due to a General Medical Condition.
If a manic mood is brought about through an antidepressant, ECT or through an individual using street drugs, the diagnosis is Substance-Induced Mood Disorder, with Manic Features.
Occasionally one comes across a diagnosis of Bipolar 111. This has been used to categorise manic episodes, which occur as a result of taking an antidepressant medication, rather than occurring spontaneously. Confusingly, it has also been used in instances where an individual experiences hypomania or cyclothymia (i.e. less severe mania) without major depression.
Definitions
Mania
Manic Depression is comprised of two distinct and opposite states of mood, whereby depression alternates with mania. The DSM IV gives a number of criteria that must be met before a disorder is classified as mania. The first one is that an individual's mood must be elevated, expansive or irritable. The mood must be a different one to the individual's usual affective state during a period of stability. There must be a marked change over a significant period of time. The person must become very elevated and have grandiose ideas. They may also become very irritated and may well appear to be 'arrogant' in manner.
The second main criterion for mania emphasizes that at least three of the following symptoms must have been present to a significant degree:
Inflated sense of self importance
Decreased need for sleep
Increased talkativeness
Flight of ideas or racing thoughts
Easily distracted
Increased goal-directed activity
Excessive involvement in activities that can bring pleasure but may have disastrous consequences (e.g. sexual affairs and spending excessively.)
The third criterion for mania in the DSM-IV emphasizes that the change in mood must be marked enough to affect an individual's job performance or ability to take part in regular social activities or relationships with others. This third criterion is used to emphasize the difference between mania and hypomania.
Depression
The DSM-IV states that there are a number of criteria by which major depression is clinically defined: The condition must have been evident for at least two weeks and must have five of the following symptoms:
A depressed mood for most of the day, almost every day
A loss of interest or pleasure in almost all activities, almost every day
Changes in weight and appetite
Sleep disturbance
A decrease in physical activity
Fatigue and loss of energy
Feelings of worthlessness or excessive feelings of guilt
Poor concentration levels
Suicidal thoughts.
Both the depressed mood and a loss of interest in everyday activities must be evident as two of the five symptoms, which characterize a major depression. It is difficult to distinguish the symptoms of an individual suffering from the depressed mood of manic depression than from someone suffering from a major depression. Dysthymia is a less severe depression than unipolar depression, but it can be more persistent.
Psychosis
Psychosis is characterized by disorders in basic perceptual, cognitive, affective, and judgmental processes. For example, one might experience delusions, hallucinations, disorganized speech, disorganized behaviour etc. A diagnosis of bipolar affective disorder does not mean that an individual will necessarily experience psychosis.
Hippy
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