Thursday, December 11, 2008

p37. Deleted Comment

In a comment left on p32., a person named Dr. Michael, said…

“Bipolar disorder is not a single disorder, but a category of mood disorders characterized by the presence of one or more episodes of abnormally elevated mood, clinically referred to as mania. Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present.”

Dr. Michael went on to put a link to an unrelated drug site, which is not appropriate nor acceptable on this blog. Because of this I have deleted his comment.

I thought his clinical assessment warranted a bit more human speak, so I visited NAMI because some of what he mentions are episodes used for identifying the course of bipolar, not the types/classifications.

The 4 types of Bipolar disorder are classified from the DSM-IV—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition published by the American Psychiatric Association, research by the National Institute of Mental Health, these articles also use interviews with leading bipolar experts.

I will put the excerpts of these articles in italics. My added comments will just be in plain type.

The following are 2 of the 10 Myths (you can find the full articles on NAMI's website):

“Top 10 Myths about Bipolar Disorder”: by John McManamy

2. Bipolar disorder is a mood disorder.

Half true. Bipolar disorder certainly affects mood, but it also affects cognition and the ability to perform mental tasks. Some days we can out-think Stephen Hawking. Other days we make Forrest Gump look like an intellectual.

3. Yes, but bipolar disorder is still a mood disorder.

Granted, but for most of us it is also part of a package deal that may include anxiety, substance and alcohol abuse and sleep disorders. Also, researchers are finding smoking guns linking the illness to heart disease, migraines and other physical ailments.

Bipolar disorder certainly affects mood, but it also affects cognition and the ability to perform mental tasks. Some days we can out-think Stephen Hawking. Other days we make Forrest Gump look like an intellectual.
The above information was mainly accredited to:

HealthCentral's Bipolar Connection at

I thought one of the articles at NAMI, covered the classifications of Bipolar, in an understandable fashion. If you have been following this blog about raising Da, you know, she without question–has Bipolar 1.

I have edited some text that refers to another section of the article not mentioned here and have added to some paragraphs to keep the content from two articles flowing.

"The many faces & facets of BP"

By Michelle Roberts
From "bp Magazine", Summer 200

Bipolar I

This is the most severe type of bipolar disorder and the classic type. A diagnosis of Bipolar I requires at least one full-blown manic episode some time during a person's life that doctors cannot attribute to another cause, such as a medication or substance abuse. The manic episode must last at least one week, or be serious enough to require hospitalization or cause functional impairment in some aspect of a person's life (marriage, career, finances, etc.). Interestingly, a major depressive episode is not required to be diagnosed with this form of bipolar disorder, but it is almost always present and usually even much more common than the manic episodes.

Note: most of us, (well I did), think of depression as a form of sadness and suicide – I always thought people who were depressed were experiencing the end of the world–without hope. It was certainly understandable when I first learned, that it also includes:

• restlessness and irritability

• inability to concentrate or make decisions

• either an elated, happy mood or an irritable, angry, unpleasant mood

are all considered depressive episodes.

Excuse my language, but when thinking of a woman - how many of us thought, this was just a blond bitch?

Bipolar II

Most experts agree that there are versions of bipolar disorder that don't produce full mania, yet respond very well to mood-stabilizing medications. People whose symptoms fit this category are often diagnosed with Bipolar II, sometimes called "soft" bipolar. According to Dr. Ghaemi, the primary difference between Bipolar I and Bipolar II is that the manic symptoms of the latter are not severe enough to cause functional impairment.

Cyclothymic Disorder

Sometimes called "bipolar lite," this diagnosis requires multiple depressive and hypomanic episodes not extreme enough to warrant a diagnosis of Bipolar I or II. In some cases, depression and mania occur simultaneously, resulting in a state of chronic irritability. A person's symptoms must last for at least two years with no more than two months of stable mood during that time.

Bipolar NOS (Not Otherwise Specified)

This form of bipolar requires manic or depressive episodes that doctors can't categorize as unipolar depression. The episodes also can't fit into any of the other bipolar categories. The Bipolar NOS label often applies in the following circumstances:

• Rapid mood fluctuations intense enough to qualify as manic, hypomanic, or depressive, but that don't meet the duration requirements for a Bipolar I, Bipolar II, or Cyclothymic disorder diagnosis
• Hypomania without depression
• Mania or Cyclothymic disorder that occurs simultaneously with schizophrenia, psychotic disorder NOS, or delusional disorder (a disorder characterized by psychoses, hallucinations, and delusional thinking)
• Chronic depression or dysthymia (long-term, low-level depression) accompanied by hypomanic episodes.

Dr. Ghaemi suggests that this category also be used for persons with recurrent severe depression (but no clear hypomania) who also experience manic or hypomanic periods only with antidepressant use, or who have family members diagnosed with bipolar disorder.

Dr. Michael (who left the comment on this Blog), seems to refer to a "mixed" MANIC episodes, here is the definition from the article…

A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation.

Diagnosis of mixed states is most likely to be made after a patient fails to respond to outpatient treatment, or becomes worse on antidepressant medications and is subsequently admitted to the hospital for closer observation. This state is found in BP I, II, and is not considered a classification of BP.

There are also episodes known as rapid cycling... that are also, not considered a separate type of BP; it is a descriptor of the course of bp.

Sometimes individuals may experience an increased frequency of episodes. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women.

I hope some of you found this technical information to help you understand this complex illness.

Some people, in all families, tend to stick their heads in the sand and not learn about what it means to be Bipolar. They rather look for snake oils or herbs from far away places to fix it. As I have always heard "you have to know how to drive a car, before you can park it!", maybe they didn't receive this wisdom in their past.

I think after living with Da for 23 years, and watching her grow into young adulthood, the quote from John McManamy has become a good summation of–well at least a part of her illness:

“…it also affects cognition and the ability to perform mental tasks. Some days we can out-think Stephen Hawking. Other days we make Forrest Gump look like an intellectual.”

Admittedly, I am not an Einstein either.


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