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Bipolar disorder, formerly known as manic- depressive disorder, has intrigued scholars dating back to ancient Greece, yet it remains enigmatic in man ways. Hypomania, with its euphoria, energy, and productivity has been described as powerful elixir, and there is no other psychiatric condition in which people report craving the return of symptoms. Literature, art, and history, have been shaped by the remarkable creativity of individuals with bipolar disorder, including Vincent van Gogh, Martin Luther, Robert Schumann, Pyotr Illich Tchaikovsky, and the Pulitzer Prize winners John Berryman, Amy Lowell, and Anne Sexton. In popular imagery, mania remains an alluring, powerful, and mysterious condition. Indeed, mania has been chosen as the name for a perfume. It is unlikely that an other psychiatric condition will ever be used in that way. Despite mesmerizing stereotypes, however, bipolar disorder is one of the most sever of psychiatric disorders.
Diagnostic errors are common with this disorders. The most common misdiagnosis I unipolar depression: Approximately 40% of persons with bipolar disorder are misdiagnosed with unipolar disorder (Ghaemi, Boiman, & Goodwin, 2000). Even though approximately 10% of people with major depression have a history of mania, three quarters of practitioners fail to screen for mania rout for mania routinely among individuals reporting depression. When treated with antidepressants without mood-stabilizing medication, as many as one-foruth of individuals with bipolar disorder experience iatrogenic manic symptoms. In one managed care organization, failure to consistently note a history of mania was associated with a doubled risk of hospitalization. Hence, differential diagnosis of bipolar disorder remains an important challenge in health care systems today.
Even though the lay public tends to think of mania as involving euphoria, it is important to note that the cardinal mood symptoms can include either euphoria and expansiveness or anger and irritability. In addition to a distinct change in mood, the diagnostic criteria for mania include at least three or seven symptoms (four, if irritability is the major mood state). The symptoms of mania include inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal-directed activity, and increased involvement in pleasurable activities with a high potential for negative consequences. Symptoms must be present for 1 week or require hospitalization. In addition to symptoms, marked functional impairment must be present. A mixed episode includes symptoms of depression and mania. That is, symptoms meet severity criteria for a manic episode and a depressed episode for at least 1 week, and market functional impairment is present.
Bipolar II disorder is diagnosed on the basis of a single lifetime episode of hypomania (in the absence of mania) and at least one lifetime episode of major depression. Hypomanic episodes require the presence of at least three of the symptoms of mania described above (again, four if irritability is the major mood state). Unlike the definition of mania, hypomanic episodes do not include sever impairment and only need to present for 4 days. Notably, lifetime episodes of hypomonia in the absence of depressive episodes do not meet criteria for any diagnosis. Few individuals are expected to seek treatment for brief periods of increased mood, activity, energy, and confidence that fail to cause sever impairment and are not associated with depression. Some people believe that period s of hypomania may underlie the increased productivity and artistic endeavors seen within bipolar disorder.
DSM-IV-TR also includes a range of bipolar spectrum conditions, including cyclothymia (milder but frequent symptoms of hypomania and depression) and substance-induced mood disorders (e.g., manic episodes triggered by antidepressants or other substances). In addition, DSM-IV-TR includes a diagnosis of bipolar disorder not otherwise specified. This diagnostic category may be useful for individuals who report atypical manic symptoms, manic symptoms lasting less than 4 days, or hypomanic symptoms in the abse4nce of depressive episodes.
Psychotic symptoms can co-occur with either manic or depressive episodes. In studies of relatively sever samples, psychotic symptoms have been reported by approximately one-third to one-half of those with bipolar I disorder (Judd et al., 2002). However, these symptoms tend to be brief- they tend to present for only one or two weeks per year – and they are much more likely to accompany mania than depression. Psychotic symptoms that occur for 2 weeks or more outside the context of a mood episode are an indicator of schizoaffective disorder. Because schizoaffective disorder ma represent the expression of underlying genetic vulnerabilities for both psychosis and mood disorders (Cardno, Rijskijk, Sham, Murray & McGuffin, 2002), more intensive and specialized treatment is likely to be required in theses cases.