Bipolar and Related Disorders

Bipolar disorder, also known in some parts of the world by its older name “manic depression,” is a mental disorder that is characterized by serious and significant mood swings. A person with bipolar disorder experiences alternating “highs” (mania) and “lows” (depression). Both the manic and depressive periods can be brief, from just a few hours to a few days. Or the cycles can be much longer, lasting up to several weeks or even months. The periods of mania and depression vary from person to person — many people may only experience very brief periods of these intense moods, and may not even be aware that they have bipolar disorder.

An important feature to be aware about is Bipolar cycling, which can either be rapid, or more slowly over time. Those who experience rapid cycling can go between depression and mania as often as a few times a week (some even cycle within the same day). Most people with bipolar disorder are of the slow cycling type — they experience long periods of being up (“high” or manic phase) and of being down (“low” or depressive phase). Researchers do not yet understand why some people cycle more quickly than others.

The DSM-5 criteria for Bipolar disorder are:

Bipolar I Disorder

A) Essential feature of Bipolar I is that the person experiences one full manic episode (though the manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes).

B) The occurrence of the manic and major depressive episode(s) is not explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorders.

C) Symptoms of manic and major depressive episodes must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Symptoms must not be the result of substance use or abuse (e.g., alcohol, drugs, or medications) or caused by a general medical condition.

Bipolar II Disorder

A) Occurrence (or history) of at least one Hypomanic Episode and at least one Major Depressive Episode

B) There must never have been a full Manic Episode.

C) The occurrence of the Hypomanic and major depressive episode(s) are not explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorders.

D) The Symptoms of hypomanic and major depressive episodes must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Symptoms must not be the result of substance use or abuse (e.g., alcohol, drugs, or medications) or caused by a general medical condition.

In both Bipolar I and II disorders, a person can have a mood episode (i.e., primarily manic or depressed) with mixed features. A manic/hypomanic episode may have significant depressive symptoms, and a depressive episode may some manic/hypomanic symptoms.

Additionally, both bipolar and regular depression (i.e., major depressive disorder) can occur with anxious distress, seasonal pattern, with psychotic features, with peri-partum onset, with melancholia, and with atypical features.

 

Cyclothymic Disorder

People with cyclothymic disorder have, for at least 2 years (1 year in children and adolescents), the presence of numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Cyclothymic disorder usually begins in adolescence or early adult life and is sometimes considered to reflect a temperamental predisposition to other bipolar-and-related disorders.

During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms above for more than 2 months at a time.

No Major Depressive EpisodeManic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.

Note:  After the initial 2 years (1 year in children and  adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder  may be diagnosed).

*Note: in accordance with DSM-5 changes that acknowledge high levels of anxiety within this population, “with anxious distress” can be added to a cyclothymic disorder diagnosis as an optional clinical specifier.

The disturbance is not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. The symptoms can not be due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). Furthermore, the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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