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BIPOLAR DISORDERS

Bipolar disorders are mood episodes that affect a person’s ability to function.

Bipolar Disorders are where a person experiences an intrusive mood episode such as mania, hypomania, or depression. These changes in mood can appear as intense highs and lows and can last for days at a time or longer. They are generally well demarcated changes in mood that interrupt previous functioning, which is to be distinguished from volatile behavior that is better explained by poor characterological temperament or the psychological effects of substance abuse. 

Symptoms of mania and hypomania*:

  • having higher-than-normal energy levels

  • being restless or unable to sit still

  • having a decreased need for sleep

  • having increased self-esteem or confidence, or grandiosity

  • being extremely talkative

  • having a racing mind, or having lots of new ideas and plans

  • being easily distracted

  • having decreased inhibitions

  • engaging in risky behavior

 

* The main difference between mania and hypomania is the intensity of the symptoms. Symptoms of mania are much more intense than those of hypomania.

 

Bipolar I is when a person experiences a manic episode, they feel keyed up, seem to have a lot of energy, speak fast, and even seem irritable. For a diagnosis of Bipolar I, there needs to be one manic episode lasting one week (less days if interrupted by hospitalization). They may even participate in activities that are harmful or lead to painful consequences for themselves and their families. Although many people with Bipolar I experience a major depressive episode, it is not required to make the diagnosis. 

 

Bipolar II is considered a milder version of the disorder where a person experiences hypomania for a few days and a current or past major depressive episode. Hypomania is defined as an elevated and/or irritable mood. Other symptoms include decreased need for sleep, increased talking, racing thoughts, overactivity, and excessive involvement in risky behavior. The presence of psychotic symptoms, however, elevates the diagnosis to Bipolar I.

Cyclothymic Disorder is diagnosed when over the course of two years there have been many periods of hypomanic symptoms that fall short of a hypomanic episode as well as multiple symptoms of depression that also fall short of a major depressive episode. For children this syndrome must be at least one year. In order to meet this diagnosis, either the hypomanic or depressive episodes must be occurring for over half of the time. Additionally, there cannot be a time when either hypomanic or depressive symptoms are not present for more than a two months period. If a person meets the criteria for either a manic, hypomanic or major depressive episode, then Cyclothymic Disorder is no longer the diagnosis (APA, 2013).

Dr. Gary Sachs Interview

Dr. Gary Sachs is Clinical Vice President at Signant Health and the founder of Massachusetts General Hospital's Bipolar Clinic and Research Program. He is also an Associate Clinical Professor in Psychiatry at Harvard Medical School and was the Principal Investigator of the National Institute of Mental Health’s Systematic Treatment Enhancement Program for Bipolar disorder. Dr. Sachs is a Distinguished Fellow of the American Psychiatric Association. He chairs the Scientific Advisory Committee of the Depression and Bipolar Support Alliance (DBSA) also serves on DBSA board of directors. In March of 2020, he became president elect of the International Society for CNS Clinical Trial Methodology (ISCTM)  Dr. Sachs has authored over 200 peer reviewed articles and is a contributor to the seminal book Managing Bipolar Disorder: A Cognitive Behavior Treatment Program Therapist Guide (Treatments That Work) which addresses the management of bipolar disorder.

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