Bipolar Disorders

Two primary sets of disorders characterized by changes in mood that are significantly beyond the typical everyday variations of emotions.

Diagnosis:
- An individual must experience an intense and disruptive period known as a manic episode lasting for at least 1 week.
- Characterized by unusually high levels of euphoria, which is described as feeling more cheerful, elated, or even ecstatic than average.
- Hypomanic episode: Similar symptoms to a manic episode but lasts for up to 4 days instead of 1 week.

Duration:
- Distinct period of elevated, expansive, or irritable mood and increased activity or energy lasting at least 1 week (or shorter if hospitalization is necessary).
Symptoms Required:
- Presence of at least 3 of the following symptoms to a significant degree (4 if mood is primarily irritable):
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (feeling rested after about 3 hours).
- Talkative mood or pressure to keep talking.
- Flight of ideas or experience of racing thoughts.
- Distractibility (easy attention drawn to unimportant stimuli).
- Increased goal-directed activity (either socially, at work or school, sexually, or psychomotor agitation).
- Excessive engagement in risky activities (e.g., buying sprees, sexual indiscretions, foolish investments).
Behavioral Change:
- There must be a notable observable change in functioning or the episode must be severe enough to warrant hospitalization.

Bipolar I Disorder:
- Involves one or more manic episodes; major depressive episodes are not required for diagnosis but may occur.
Bipolar II Disorder:
- Characterized by one or more major depressive episodes and at least one hypomanic episode without severe impairment requiring hospitalization.

Important considerations:
- Symptoms must not be better attributed to schizoaffective disorder or any schizophrenia spectrum disorders.
Severity Rating:
- The severity of manic episodes differs from major depressive episodes, with a manic episode being inherently more severe (there is no such thing as a "mild" manic episode).
- Severity is rated based on the number of symptoms present, the level of activity increase or judgment impairment, and the degree of supervision needed to prevent harm.

American actress, screenwriter, novelist, lecturer, best known as Princess Leia in Star Wars.
Authored four books, including Wishful Drinking, which discusses her life with bipolar disorder and addictions.

Born in Beverly Hills, daughter of actress Debbie Reynolds and singer Eddie Fisher.
Developed a career in acting from age 12 and dropped out of high school for performances.
Gained fame with her role in the film Shampoo (1975) and as Princess Leia in 1977.
Struggled with substance abuse from a young age, using drugs to self-medicate her mood episodes.

Diagnosed with manic depression at age 24 but did not pursue treatment initially.
Married musician Paul Simon in the early 1980s, divorced shortly thereafter.
Gained insight later into how her mental health contributed to substance abuse.

Hospitalized in the mid-1980s due to substance abuse; inspired her novel Postcards from the Edge.
Experienced a psychotic break in 1997 linked to treatment for depression.
Underwent electroconvulsive therapy (ECT), which she describes with mixed emotions.
- Noted its effectiveness against her severe depressive episodes.
- Mentioned fears surrounding the treatment due to its portrayal in media.

Post-acceptance of her diagnosis, Fisher focused on reducing the stigma of mental illness.
Advocated for public funding of mental health treatment.
- Described the switching between mania and depression using personifications ("Roy" for mania and "Pam" for depression).

In the US:
- Lifetime prevalence rate: 1%.
- 12-month prevalence: 0.6%.
Globally:
- Lifetime prevalence: 0.6%.
- 12-month prevalence: 0.4%.
- Sources include Merikangas et al. (2011).

Individuals with bipolar disorder face:
- Higher rates of chronic health issues (heart disease, diabetes, elevated cholesterol levels).
- Associated with lower life expectancy due to various health causes.
- Kessing et al. (2015) document higher mortality rates from illnesses, suicide, and violent deaths that can be 20-30 times greater than that of the general population.

Importance of medication adherence varies based on:
- Age, recency of diagnosis, number of psychiatric hospitalizations.
- Younger individuals and those with multiple hospitalizations are generally less adherent.
- Psychoeducation and early treatment monitoring may improve outcomes (Lintunen et al., 2023).

Individuals are diagnosed with bipolar disorder, rapid cycling, when having four or more episodes meeting the criteria for manic, hypomanic, or major depressive disorder within a year.
Individuals with rapid cycling face higher suicide risks and often have a longer duration of the disorder (Gigante et al., 2016).