continuum rather than as discreet disorders.
Episodes of symptoms may last from weeks to
months. Many people experience periods of nor-
mal mood between the episodes of symptoms and
may experience extended time periods (some-
times years) without episodes of symptoms.
Some people experience a mix of depressive
and manic symptoms with each episode, which
often causes significant agitation and inability to
function. Severe episodes of either depression or
mania may include symptoms of psychosis
(detachment from reality) such as DELUSION, HALLU-
CINATION, and bizarre behavior.
The diagnostic path includes comprehensive
physical examination and NEUROLOGIC EXAMINATION,
psychologic evaluation, and often testing for ALCO-
HOLor substance abuse. The doctor may also eval-
uate THYROID GLANDfunction because some people
in whom manic episodes dominate have chronic
HYPOTHYROIDISM(low thyroid gland function). In
general, diagnostic criteria include the existence of
five or more symptoms during each episode of
symptoms that extend for two weeks or longer.
Shorter cycles or briefer episodes may indicate
similar though less severe disorders such as
CYCLOTHYMIC DISORDER. Psychiatrists further classify
bipolar disorder according to the pattern of symp-
toms:
- Bipolar I disorder is classic bipolar disorder,
with depressive and manic symptoms of equal
severity and length of episode. - Bipolar II disorder features mild, short manic
episodes though full depressive episodes. - Rapid-cycling bipolar disorder features short
though full-symptom cycles of episodes that
occur four times a year or more frequently.
Doctors commonly consider responsiveness to
treatment as affirmation of the diagnosis.
Treatment Options and OutlookNearly everyone who has bipolar disorder requires
long-term treatment with medication to moderate
symptoms. These medications include
- lithium carbonate or lithium citrate, a mood
stabilizing DRUGespecially effective for control-
ling manic symptoms- antiseizure medications such as valproic acid
(valproate), carbamazepine, gabapentin, and
topiramate - novel (atypical) ANTIPSYCHOTIC MEDICATIONSsuch
as clozapine, olanzapine, risperidone, quetia-
pine, and ziprasidone, which have mood stabi-
lizing effects - ELECTROCONVULSIVE THERAPY(ECT) when medica-
tions are not effective or symptoms are severe - forms of psychotherapy that help the person
develop behaviors and methods for managing
symptoms when they do occur - methods to reduce stress
- antiseizure medications such as valproic acid
People who have hypothyroidism also require
thyroid HORMONE supplementation; long-term
treatment with lithium can cause hypothyroidism
as well. Bipolar disorder is a lifelong condition that
requires ongoing, consistent treatment.Risk Factors and Preventive Measures
Family history is the most significant risk factor
for bipolar disorder. However, researchers do not
know what causes bipolar disorder, and there are
no measures to prevent it from developing. Early
diagnosis and consistent treatment are most effec-
tive for reducing the severity and disruptiveness of
symptoms and often can prevent the condition
from worsening.
See also STRESS AND STRESS MANAGEMENT.body dysmorphic disorder A condition of DELU-
SIONin which the person focuses obsessively on a
slight flaw or perceived imperfection of a particu-
lar body part to the extent of persistently seeking
medical care to “fix” the problem. The focus is so
intense that it interferes with the person’s social
and educational or professional interactions. The
person may stand in front of a mirror for hours
staring at the body part, engage in ritualistic
behavior such as manipulating the part into the
desired appearance, or refuse to go out in public
without covering the part to somehow mask it.
Some people avoid mirrors and reflective surfaces
to the extent of refusing to go to stores or office
buildings that have glass doors.
A person consumed with concern about his or
her ears, for example, might spend several hoursbody dysmorphic disorder 367