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RECOGNITION OF BIPOLAR SYMPTOMS
Bipolar disorder involves cycles of mania and depression.
Signs and symptoms of mania include discrete periods of:
- Increased energy, activity, restlessness, racing thoughts, and rapid
talking
- Excessive "high" or euphoric feelings
- Extreme irritability and distractibility
- Decreased need for sleep
- Unrealistic beliefs in one's abilities and powers
- Uncharacteristically poor judgment
- A sustained period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
Signs and symptoms of depression include discrete periods of:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in ordinary activities, including sex
- Decreased energy, a feeling of fatigue or of being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleep disturbances
- Loss of appetite and weight, or weight gain
- Chronic pain or other persistent bodily symptoms that are not caused by
physical disease
- Thoughts of death or suicide; suicide attempts
It may be helpful to think of the various mood states in manic-depressive
illness as a spectrum or continuous range. At one end is severe depression,
which shades into moderate depression; then come mild and brief mood
disturbances that many people call "the blues," then normal mood,
then hypomania (a mild form of mania), and then mania.
Some people with untreated bipolar disorder have repeated depressions and
only an occasional episode of hypomania (bipolar II). In the other extreme,
mania may be the main problem and depression may occur only infrequently. In
fact, symptoms of mania and depression may be mixed together in a single
"mixed" bipolar state.
Descriptions provided by patients themselves offer valuable insights into
the various mood states associated with bipolar disorder:
Depression:
I doubt completely my ability to do anything well. It seems as though my
mind has slowed down and burned out to the point of being virtually
useless....[I am] haunt[ed]...with the total, the desperate hopelessness of it
all... Others say, "It's only temporary, it will pass, you will get over
it," but of course they haven't any idea of how I feel, although they are
certain they do. If I can't feel, move, think, or care, then what on earth is
the point?
Hypomania:
At first when I'm high, it's tremendous...ideas are fast...like shooting
stars you follow until brighter ones appear...all shyness disappears, the right
words and gestures are suddenly there...uninteresting people, things, become
intensely interesting. Sensuality is pervasive, the desire to seduce and be
seduced is irresistible. Your marrow is infused with unbelievable feelings of
ease, power, well-being, omnipotence, euphoria...you can do anything...but,
somewhere this changes.
Mania:
The fast ideas become too fast and there are far too many...overwhelming
confusion replaces clarity...you stop keeping up with it--memory goes.
Infectious humor ceases to amuse. Your friends become frightened...everything
is now against the grain...you are irritable, angry, frightened,
uncontrollable, and trapped. Recognition of the various mood states is
essential so that the person who has manic-depressive illness can obtain
effective treatment and avoid the harmful consequences of the disease, which
include destruction of personal relationships, loss of employment, and suicide.
Manic-depressive illness is often not recognized by the patient,
relatives, friends, or even physicians.
- An early sign of manic-depressive illness may be hypomania--a state in
which the person shows a high level of energy, excessive moodiness or
irritability, and impulsive or reckless behavior.
- Hypomania may feel good to the person who experiences it. Thus, even when
family and friends learn to recognize the mood swings, the individual often
will deny that anything is wrong.
- In its early stages, bipolar disorder may masquerade as a problem other
than mental illness. For example, it may first appear as alcohol or drug abuse,
or poor school or work performance.
- If left untreated, bipolar disorder tends to worsen, and the person
experiences episodes of full-fledged mania and clinical depression.
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