A common diagnosis in psychiatry is bipolar disorder. Though
Dr. Hagop S. Akiskal may have propounded a 7 type classification of bipolar
disorder which is very famous but it is an equally well-known fact that the most
common classification practiced is of Bipolar 1 and Bipolar 2.
Now what it is being Bipolar?
Bipolarity in its common meaning means exhibiting 2
different poles in same person and that is exactly what happens. A person diagnosed as bipolar disorder certainly falls into depression for months and
then lifts into mania or hypomania. Many people exhibit swings of mood from
being into sad state to joyous. Are they always bipolar?
A simple answer is no. There is a specific set of symptoms which
should be exhibited for certain duration of time to be called bipolar.
Now let us discuss both commonly used of bipolar disorder types.
BIPOLAR 1
Bipolar 1 is diagnosed when a patient shows a clear picture
of separate episodes of mania and depression separated invariably by a period
of normalcy which should be ideally for 2 months.
A typical maniac episode characterizes by-
1. A persistent irritable or euphoric mood. Plus 3 for euphoric and 4 for irritable of following symptoms
2. Decreased need for sleep
3. Grandiosity- characterized by delusion of power, wealth or position.
4. Increased activity
5. Hyper sexuality
6. Pressure of speech-Speech which is fast than normal to the extent of being incomprehensible.
7. Decreased appetite
8. Planning
9.Overfamiliarity
10. Recklessness, overconfidence and dis tractability.
1. A persistent irritable or euphoric mood. Plus 3 for euphoric and 4 for irritable of following symptoms
2. Decreased need for sleep
3. Grandiosity- characterized by delusion of power, wealth or position.
4. Increased activity
5. Hyper sexuality
6. Pressure of speech-Speech which is fast than normal to the extent of being incomprehensible.
7. Decreased appetite
8. Planning
9.Overfamiliarity
10. Recklessness, overconfidence and dis tractability.
Symptoms should be present for more than 7 days.
A typical depressive
episode characterizes by-
Major symptoms
1.
Persistent sad mood
2.
Decrease in energy levels
3.
Loss of interest in once pleasurable activities.
Minor Symptoms
1.
Decreased or increased sleep
2.
Decreased or increased appetite
3.
Decreased level of concentration
4.
Decreased level of confidence
5.
Loss of libido
6.
Guilt
7.
Weight loss
8.
Social withdrawal
9.
Suicidal tendencies
A milder form is diagnosed when 2 major plus 2 minor
symptoms are present and a severe form when at-least 3 major plus 4 minor
symptoms are present.
Duration of at-least 15 days is required except in case of
rapid very severe type with major socio- occupational disruption.
Both mania and depression can have secondary psychotic
symptoms.
BIPOLAR 2
Bipolar 2 is diagnosed when a patient shows a clear picture
of separate episodes of hypomania and depression separated invariably by a
period of normalcy which should be ideally for 2 months.
A typical hypo-maniac episode characterizes by-
1.
A persistent irritable or euphoric mood.
Plus
3 for euphoric and 4 for irritable of following symptoms
2.
Decreased need for sleep
3.
Grandiosity- Grandiosity is not at delusional
level.
4.
Increased activity
5.
Hyper sexuality
6.
Push of speech instead of pressure is present
7.
Decreased appetite
8.
Planning
9.
Overfamiliarity
10.
Recklessness, overconfidence and distractibility.
Symptoms should be present for not more than 4 days or not so
severe to be disruptive socio- occupationally non psychotic or require hospitalization.
A typical depressive episode characterizes by-
Major symptoms
1.
Persistent sad mood
2.
Decrease in energy levels
3.
Loss of interest in once pleasurable activities.
Minor Symptoms
1.
Decreased or increased sleep
2.
Decreased or increased appetite
3.
Decreased level of concentration
4.
Decreased level of confidence
5.
Loss of libido
6.
Guilt
7.
Weight loss
8.
Social withdrawal
9.
Suicidal tendencies
A milder form is diagnosed when 2 major plus 2 minor
symptoms are present and a severe form when at-least 3 major plus 4 minor
symptoms are present.
Duration of at-least 15 days is required except in case of
rapid very severe type with major socio-occupational disruption.
Depression can have secondary psychotic symptoms.
Apart from the above mentioned differences there are several
other differences
1.
Bipolar 1 usually starts with maniac episode and
bipolar 2 with depressive.
2.
There are more chances of suicide in bipolar 2
than 1.
3.
Lamotrigine is more effective in bipolar 2.
Apart from these types there is a mixed type too, rapid
cyclers and ultra-rapid cyclers but these are present in very less amount of
cases.
With best wishes for healthy and long life
Dr Hitesh Sharma
Dr Hitesh Sharma
MBBS, MD (Psychiatry)
