Bipolar disorder is a recurrent mood disorder featuring one or more episodes of mania or mixed episodes of mania and depression. Bipolar disorder is distinct from major depressive disorder in that the individual has a history of manic or hypomanic episodes (i.e., a milder form of mania that does not have any characteristics of psychosis). Other differences are related to the nature of depression in bipolar disorder. Its depressive episodes are typically associated with an earlier age at onset, more frequent episodes or recurrences, and a higher likelihood that the individual has family members with the same disorder.
Mania is derived from a French word that literally means "crazed" or "frenzied." The mood disturbance can range from pure euphoria or elation to irritability to a mixture of the mania with dysphoria (sadness). The content of the person's thoughts is usually grandiose (what many people would think of as "egotistical"), but also can be paranoid. Grandiosity usually takes the form both of overvalued ideas (e.g., “My book is the best one ever written”) and delusions (e.g., “I have radio transmitters implanted in my head and the Martians are monitoring my thoughts.”). Auditory and visual hallucinations (i.e., hearing or seeing things that others do not) complicate more severe episodes.
With mania, speed of thought increases, and ideas typically race through the manic person’s consciousness. Even so, their distractibility and poor concentration commonly interferes with their ability to execute their ideas. Judgment also can be severely compromised; spending sprees, offensive or over uninhibited behavior, and promiscuity or other objectively reckless behaviors are common. Subjective energy, libido, and activity typically increase, but a perceived reduced need for sleep can sap physical reserves. Sleep deprivation also can exacerbate cognitive difficulties and may lead to confused state known as "delirious mania." Because of this and other features of bipolar disorder, the manic patient is sometimes difficult to distinguish from a schizophrenic patient. Research has shown that mental health professional tend to most often misdiagnose mania as schizophrenia in African Americans. Most people with bipolar disorder have a history of remission and at least satisfactory functioning before onset of the index episode of illness.
Episodes of mania occur, on average, every 2 to 4 years, although accelerated mood cycles can occur each year or even more frequently. The most prevalent form of bipolar disorder is about equally common in men and women (unlike major depressive disorder, which is more common in women).
An excerpt from Mental Health: A Report of the Surgeon General, U.S. Department of Health & Human Services.
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