What is bipolar disorder?

Bipolar disorder is a mental illness that was previously referred to as manic depression. It affects the normal functioning of the brain so that the person experiences extreme moods – mania and depression.

People may also experience psychosis in the manic and/or depressed phase. A variety of types of bipolar disorder exists. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), the following are the distinct types:

Bipolar 1 disorder – characterised by one or more major manic or mixed episodes, usually accompanied by major depressive episodes

• Bipolar 2 disorder – characterised by one or more major depressive episodes accompanied by at least one hypomanic episode
• Cyclothymic disorder – characterised by at least two years of numerous periods of hypomanic symptoms (that do not meet criteria for a manic episode) and numerous periods of depressive symptoms (that do not meet criteria for a major depressive episode)
• Bipolar disorder not otherwise specified – where bipolar features exist but do not meet any of the criteria for any of the specific diagnoses above. DSM (IV) further divides these distinct types into many subcategories.

What causes bipolar disorder?

The causes are not fully understood, but a genetic predisposition to the development of the illness has been clearly established.

Treatment and recovery from bipolar disorder

While there is no cure for this illness it is highly treatable and manageable and 80–90 percent of people recover.

Acute episodes

Community management of acute episodes of mania or depression depends on the degree of risk associated with the behaviours and mood. People will be hospitalised if their mania causes them to engage in life threatening, risk-taking
behaviours and if their depression causes suicidal ideation or similar. A biopsychosocial approach that includes attending to the biological need (chemical imbalance), as well as the psychological and social aspects of life is the most effective method in the treatment of, and recovery from, bipolar disorder.

Medication

Medication helps the brain to restore its usual chemical balance. Medications commonly used for bipolar include:

• Antipsychotic medication, used to control psychotic symptoms and severe agitation
• Mood stabilisers, which are the mainstay of maintenance therapy and improve symptoms during acute manic episodes
• Lithium is the most commonly used mood stabiliser.

Therapy

Verbal therapies are a very useful adjunct to medication for the management of bipolar disorder. The therapy of choice for bipolar is Cognitive Behavioural Therapy (CBT), but family therapy and other therapies can also be helpful. Improving coping mechanisms and identifying triggers to episodes can be achieved in this context.

The development of and adherence to a Wellness Recovery Action Plan can be a very useful strategy for prevention
of relapse for people experiencing bipolar disorder.

Social

People with bipolar disorder have a great need to maintain a healthy and balanced lifestyle to reduce stresses that may trigger episodes. Social support and meaningful occupation all support the recovery process from bipolar disorder.

Helpful interventions

Recognising that someone is displaying symptoms of bipolar disorder is the first step to offering helpful interventions.

Overleaf are behaviours common to the experiences of depression and mania, with suggestions for helpful interventions.

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