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Distinguishing Bipolar Disorders

Bipolar Disorders or the bipolar spectrum is vastly represented by mood variations with two “Poles”: major depressive episodes and manic episodes, with varying duration of both types of episodes. Bipolar disorders are distinguished from a unipolar depressive disorder, by the characteristic feature of the occurrence of mania. Although today, more commonly known as bipolar disorder, it is also referred to as manic-depression. 

Manic episodes in bipolar disorder have markedly elevated, energetic, and euphoric mood, with a high level of mental and physical energy. The range of manic episodes can be represented by hypomanic episodes and longer depressive episodes; to a hyper mania or pure mania state. Whereas the depressive episodes in bipolar disorder are distinguished from Persistent Depressive Disorder (PDD) by the duration and intensity of the depressive symptoms. In PDD, the duration of the depression has to be for at least 2 years with less than 2 months of remission. Unlike PDD, the bipolar depressive mood is more labile and the psychomotor retardation is heightened. (Faurholt-Jepsen, 2019)

There are several sub-types in the spectrum of bipolar disorders, of which the major three are explained, with their distinctive features as the following:

  • Cyclothymic Disorder: For a proper diagnosis, the patient needs to be experiencing hypomania for a period of at least 2 years. It is a lesser version of a full-blown manic episode of bipolar disorder, but the mood variations are far more severe compared to normal mood swings. 

In the hypomanic state, the person experiences a brief phase of creativity and productivity as he/she has a lot more mental and physical energy to utilise than in their depressive state. Unlike persistent depressive disorder, in the 2 years, the person should experience both hypomanic episodes and depressive episodes (1 year for adolescents). These episodes must be clinically distressing and hindering the important functionalities of the person. The individuals with cyclothymic disorder may likely develop full-blown any of the two bipolar disorders. 

  • Bipolar Disorder I: In both types of Bipolar, there have to be at least one manic episode in the individual’s lifetime. Bipolar I is represented by the presence of at least one manic episode and majorly depressive episodes compared to Bipolar II, but less than MDD. There has to be a mixed episode in which a full-blown manic and major depressive episode is extended until a week. 

It has been seen that those people who have their first manic episodes suffer long-term depressive episodes and are difficult to diagnose in the bipolar spectrum. When individuals only show manic episodes for more than a year, researchers argue that they may have been suffering from pure mania, in which a brief depressive state or no depression is seen, keeping in mind that full-blown mania is still considered as a bipolar disorder. (Butcher, 2020) 

  • Bipolar Disorder II: DSM-V (The Diagnostic and Statistical Manual of Mental Disorders-V), classifies another type of Bipolar disorder, as Bipolar II, which is more common than Bipolar I in about 2-3% of the US population (Kessler, 2018). Bipolar II is misdiagnosed as major depressive disorder or MDD in about 40% of individuals, as the hypomania is experienced less than in Bipolar I. In Bipolar II, there are no mixed episodes but they do experience clear hypomanic symptoms as well as major depressive episodes. 

The depressive episodes of Bipolar II are a lot more severe than in any other Bipolar Disorders but it has to be noted that the hypomanic episodes are experienced, and they have to be assessed properly so that the individual is not mistreated with MDD -Major Depressive Disorder or PDD- Persistent Depressive Disorder. 

The bipolar spectrum needs to be assessed with effective diagnostic tools and strategies, as the manic and depressive symptoms are overlapping in these disorders. The mood variations and the intensity of them are some of the essential distinctions used to identify each bipolar disorder. 

Orchestrate Health offers bespoke mental health services that people can access from the comfort of their own home or within their community, with rapid response times and even daily visits if needed. Orchestrate Health can provide help for those struggling with Bipolar Disorder, and remove the inconvenience of travelling to and from appointments.

 

References: 

  1. Faurholt-Jepsen, M., Frost, M., Busk, J., Christensen, E. M., Bardram, J. E., Vinberg, M., & Kessing, L. V. (2019). Differences in mood instability in patients with bipolar disorder type I and II: a smartphone-based study. International journal of bipolar disorders7(1), 5. https://doi.org/10.1186/s40345-019-0141-4
  2. Kessler, R. C., Karam, E. G., Lee, S., Bunting, B., & Nierenberg, A. A. (2018). Bipolar spectrum disorder. In K. M. Scott, P. de Jonge, D. J. Stein, & R. C. Kessler (Eds.), Mental disorders around the world: Facts and figures from the WHO World Mental Health Surveys (p. 57–78). Cambridge University Press. https://doi.org/10.1017/9781316336168.005

Butcher, J. N., Hooley, J. M. & Mineka, S. (2020). Abnormal Psychology, 17th edn. , Noida, India: Pearson India Education Pvt. Ltd.

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