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12-25-2009, 01:44 PM
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Bipolar disorder
:emTE10:
is a psychiatric diagnosis (http://en.wikipedia.org/wiki/Classification_of_mental_disorders) that describes a category of mood disorders (http://en.wikipedia.org/wiki/Mood_disorders) defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania (http://en.wikipedia.org/wiki/Mania) or, if milder, hypomania (http://en.wikipedia.org/wiki/Hypomania). Individuals who experience manic episodes also commonly experience depressive (http://en.wikipedia.org/wiki/Major_depressive_episode) episodes or symptoms, or mixed episodes (http://en.wikipedia.org/wiki/Mixed_episodes)in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of "normal" mood (http://en.wikipedia.org/wiki/Mood_%28psychology%29), but in some individuals, depression and mania may rapidly alternate, known as rapid cycling (http://en.wikipedia.org/wiki/Bipolar_disorder#Rapid_cycling)
. <o:p></o:p>
Signs and symptoms<o:p></o:p>
Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and abnormally depressed states for a period of time in a way that interferes with functioning. Bipolar disorder has been estimated to afflict more than 5 million<o:p></o:p>
Americans—about 1 out of every 45 adults.<sup>] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-3#cite_note-3)</sup>It is equally prevalent in men and women, and is found across all cultures and ethnic groups.<sup>[5] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-4#cite_note-4)</sup>Not everyone's symptoms are the same, and there is no blood test to confirm the disorder. Scientists<sup>]</sup>believe that bipolar disorder may be caused by chemical imbalances in the brain. Bipolar disorder can appear to be unipolar depression. Diagnosing bipolar disorder is difficult, even for mental health professionals. What distinguishes bipolar disorder from unipolar depression is that the affected person jumps between states of mania and depression. Often bipolar is inconsistent among patients because some people feel depressed more often than not and experience little mania whereas others may predominantly experience manic symptoms.<o:p></o:p>
<o:p> </o:p>
Depressive episode<o:p></o:p>
Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference;depersonalization (http://en.wikipedia.org/wiki/Depersonalization); loss of interest in sexual activity; shyness orsocial anxiety (http://en.wikipedia.org/wiki/Social_anxiety); irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation.<sup>[6] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Mayo-dsection2-5#cite_note-Mayo-dsection2-5)</sup>In severe cases, the individual may becomepsychotic (http://en.wikipedia.org/wiki/Psychotic), a condition also known as severe bipolar depression with psychotic features.<o:p></o:p>
<o:p> </o:p>
Manic episode<o:p></o:p>
Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person's speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen," are "on a special mission," or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis (http://en.wikipedia.org/wiki/Psychosis), or a break with reality, where thinking is affected along with mood. Many people in a manic state experience severe anxiety (http://en.wikipedia.org/wiki/Anxiety) and are very irritable (to the point of rage), while others areeuphoric (http://en.wikipedia.org/wiki/Euphoria_%28emotion%29) and grandiose.<o:p></o:p>
In order to be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM) a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required. According to the National Institute of Mental Health, "A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be <o:p></o:p>
Hypomanic episode<o:p></o:p>
Hypomania is generally a mild to moderate level of mania, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Some people have increased creativity while others demonstrate poor judgment and irritability. Others experience hypersexuality (http://en.wikipedia.org/wiki/Hypersexuality). These persons generally have increased energy and tend to become more active than usual. They do not, however, have delusions (http://en.wikipedia.org/wiki/Delusions) or hallucinations. Hypomania can be difficult to diagnose because it may masquerade as mere happiness, though it carries the same risks as mania.<o:p></o:p>
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
. <o:p></o:p>
Mixed affective episode<o:p></o:p>
In the context of bipolar disorder, a mixed state is a condition during which symptoms ofmania (http://en.wikipedia.org/wiki/Mania)andclinical depression (http://en.wikipedia.org/wiki/Clinical_depression)occur simultaneously (for example,agitation (http://en.wikipedia.org/wiki/Agitation_%28emotion%29),anxiety (http://en.wikipedia.org/wiki/Anxiety), aggressiveness or belligerence, confusion,fatigue (http://en.wikipedia.org/wiki/Fatigue_%28physical%29), impulsiveness,insomnia (http://en.wikipedia.org/wiki/Insomnia), irritability, morbid and/orsuicidal ideation (http://en.wikipedia.org/wiki/Suicidal_ideation),panic (http://en.wikipedia.org/wiki/Panic),paranoia (http://en.wikipedia.org/wiki/Paranoia), persecutory delusions, pressured speech, <o:p></o:p>
racing thoughts (http://en.wikipedia.org/wiki/Racing_thoughts), restlessness, andrage (http://en.wikipedia.org/wiki/Rage_%28emotion%29)).<sup><o:p></o:p></sup>
Causes<o:p></o:p>
Genetic<o:p></o:p>
Childhood precursors<o:p></o:p>
Life events and experiences<o:p></o:p>
Neural processes<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
Diagnosis<o:p></o:p>
Diagnosis is based on the self-reported experiences of an individual as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a psychiatrist (http://en.wikipedia.org/wiki/Psychiatrist), nurse (http://en.wikipedia.org/wiki/Nurse), social worker (http://en.wikipedia.org/wiki/Social_worker), clinical psychologist (http://en.wikipedia.org/wiki/Clinical_psychologist) or other clinician in a clinical assessment. There are lists of criteria for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disord ers), the current version being DSM-IV-TR, and the World Health Organization's (http://en.wikipedia.org/wiki/World_Health_Organization) International Statistical Classification of Diseases and Related Health Problems (http://en.wikipedia.org/wiki/ICD), currently the ICD-10. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions, as well as prevailing in research studies.<o:p></o:p>
An initial assessment may include a physical exam by a physician. Although there are no biological tests which confirm bipolar disorder, tests may be carried out to exclude medical illnesses such as hypo- (http://en.wikipedia.org/wiki/Hypothyroidism) or hyperthyroidism (http://en.wikipedia.org/wiki/Hyperthyroidism), metabolic disturbance, a systemic infection or chronic disease, and syphilis (http://en.wikipedia.org/wiki/Syphilis) or HIV (http://en.wikipedia.org/wiki/HIV) infection. An EEG (http://en.wikipedia.org/wiki/Electroencephalography) may be used to exclude epilepsy (http://en.wikipedia.org/wiki/Epilepsy), and a CT scan (http://en.wikipedia.org/wiki/Computed_tomography) of the head to exclude brain lesions. Investigations are not generally repeated for relapse unless there is a specific [I]medical indication.<o:p></o:p>
There are several other mental disorders which may involve similar symptoms to bipolar disorder. These include schizophrenia (http://en.wikipedia.org/wiki/Schizophrenia),<sup>[60] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-59#cite_note-59)</sup>schizoaffective disorder (http://en.wikipedia.org/wiki/Schizoaffective_disorder), drug intoxication, brief drug-induced psychosis, schizophreniform disorder (http://en.wikipedia.org/wiki/Schizophreniform_disorder) and borderline personality disorder (http://en.wikipedia.org/wiki/Borderline_personality_disorder). Both borderline personality and bipolar disorder can involve what are referred to as "mood swings". In bipolar disorder, the term refers to the cyclic episodes of elevated and depressed mood which generally last weeks or months. The term in borderline personality refers to the marked lability (http://en.wikipedia.org/wiki/Affective_lability)and reactivity of mood, known as emotional dysregulation (http://en.wikipedia.org/wiki/Emotional_dysregulation), due to response to external psychosocial and intrapsychic stressors; these may arise or subside suddenly and dramatically and last for seconds, minutes, hours or days. A bipolar depression is generally more pervasive with sleep, appetite disturbance and nonreactive mood, whereas the mood in dysthymia of borderline personality remains markedly reactive and sleep disturbance not acute. Some hold that borderline personality disorder represents a subthreshold form of mood disorder, while others maintain the distinctness, though noting they often coexist
. <o:p></o:p>
Criteria and subtypes<o:p></o:p>
There is no clear consensus as to how many types of bipolar disorder exist.<sup>[68] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-67#cite_note-67)</sup> In DSM-IV-TR (http://en.wikipedia.org/wiki/DSM-IV-TR) and ICD-10 (http://en.wikipedia.org/wiki/ICD-10), bipolar disorder is conceptualized as a spectrum (http://en.wikipedia.org/wiki/Bipolar_spectrum) of disorders occurring on a continuum. The DSM-IV-TR lists four types of mood disorders which fit into the bipolar categories:Bipolar I (http://en.wikipedia.org/wiki/Bipolar_I), Bipolar II (http://en.wikipedia.org/wiki/Bipolar_II), Cyclothymia (http://en.wikipedia.org/wiki/Cyclothymia), and Bipolar Disorder NOS (http://en.wikipedia.org/wiki/Bipolar_Disorder_NOS) (Not Otherwise Specified).<o:p></o:p>
Bipolar I<o:p></o:p>
In Bipolar I disorder (http://en.wikipedia.org/wiki/Bipolar_I_disorder), an individual has experienced one or more manic episodes (http://en.wikipedia.org/wiki/Manic_episodes) with or without major depressive episodes. For a diagnosis of Bipolar I disorder according to the DSM-IV-TR (http://en.wikipedia.org/wiki/DSM-IV-TR), one or more manic or mixed episodes are required. A depressive episode is not required for the diagnosis of Bipolar I but it frequently occurs.<o:p></o:p>
Bipolar II<o:p></o:p>
Bipolar II disorder (http://en.wikipedia.org/wiki/Bipolar_II_disorder) is characterized by hypomanic (http://en.wikipedia.org/wiki/Hypomanic) episodes rather than actual manic episodes (http://en.wikipedia.org/wiki/Manic_episodes), as well as at least one major depressive episode (http://en.wikipedia.org/wiki/Major_depressive_episode). Patients with a Bipolar II diagnosis under the DSM IV criteria cannot, by definition, ever have had a manic episode prior to their diagnosis. However, a Bipolar II diagnosis is not a guarantee that they will not eventually suffer from such an episode in the future
Hypomanic episodes do not go to the full extremes of mania (i.e. do not usually cause severe social or occupational impairment, and withoutpsychosis (http://en.wikipedia.org/wiki/Psychosis)), and this can make Bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression. For both Bipolar I and II, there are a number of specifiers that indicate the presentation and course of the disorder, including "chronic", "rapid cycling", "catatonic" and "melancholic".<o:p></o:p>
Management<o:p></o:p>
here are a number of pharmacological (http://en.wikipedia.org/wiki/Pharmacological) and psychotherapeutic (http://en.wikipedia.org/wiki/Psychotherapeutic) techniques used for Bipolar Disorder. Individuals may use self-help (http://en.wikipedia.org/wiki/Self-help_groups_for_mental_health) and pursue a personal recovery (http://en.wikipedia.org/wiki/Recovery_model) journey.<o:p></o:p>
Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment (http://en.wikipedia.org/wiki/Involuntary_commitment)). Long-term inpatient stays are now less common due to deinstitutionalization (http://en.wikipedia.org/wiki/Deinstitutionalization), although can still occur Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment (http://en.wikipedia.org/wiki/Assertive_Community_Treatment) team, supported employment and patient-led support groups. <o:p></o:p>
Prognosis<o:p></o:p>
For many individuals with bipolar disorder a good prognosis (http://en.wikipedia.org/wiki/Prognosis) results from good treatment, which, in turn, results from an accurate diagnosis (http://en.wikipedia.org/wiki/Medical_diagnosis). Because bipolar disorder can have a high rate of both under-diagnosis and misdiagnosis (http://en.wikipedia.org/wiki/Misdiagnosis)<sup>]</sup>, it is often difficult for individuals with the condition to receive timely and competent treatment.<o:p></o:p>
<o:p> </o:p>
Bipolar disorder
:emTE10:
is a psychiatric diagnosis (http://en.wikipedia.org/wiki/Classification_of_mental_disorders) that describes a category of mood disorders (http://en.wikipedia.org/wiki/Mood_disorders) defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania (http://en.wikipedia.org/wiki/Mania) or, if milder, hypomania (http://en.wikipedia.org/wiki/Hypomania). Individuals who experience manic episodes also commonly experience depressive (http://en.wikipedia.org/wiki/Major_depressive_episode) episodes or symptoms, or mixed episodes (http://en.wikipedia.org/wiki/Mixed_episodes)in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of "normal" mood (http://en.wikipedia.org/wiki/Mood_%28psychology%29), but in some individuals, depression and mania may rapidly alternate, known as rapid cycling (http://en.wikipedia.org/wiki/Bipolar_disorder#Rapid_cycling)
. <o:p></o:p>
Signs and symptoms<o:p></o:p>
Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and abnormally depressed states for a period of time in a way that interferes with functioning. Bipolar disorder has been estimated to afflict more than 5 million<o:p></o:p>
Americans—about 1 out of every 45 adults.<sup>] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-3#cite_note-3)</sup>It is equally prevalent in men and women, and is found across all cultures and ethnic groups.<sup>[5] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-4#cite_note-4)</sup>Not everyone's symptoms are the same, and there is no blood test to confirm the disorder. Scientists<sup>]</sup>believe that bipolar disorder may be caused by chemical imbalances in the brain. Bipolar disorder can appear to be unipolar depression. Diagnosing bipolar disorder is difficult, even for mental health professionals. What distinguishes bipolar disorder from unipolar depression is that the affected person jumps between states of mania and depression. Often bipolar is inconsistent among patients because some people feel depressed more often than not and experience little mania whereas others may predominantly experience manic symptoms.<o:p></o:p>
<o:p> </o:p>
Depressive episode<o:p></o:p>
Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference;depersonalization (http://en.wikipedia.org/wiki/Depersonalization); loss of interest in sexual activity; shyness orsocial anxiety (http://en.wikipedia.org/wiki/Social_anxiety); irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation.<sup>[6] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Mayo-dsection2-5#cite_note-Mayo-dsection2-5)</sup>In severe cases, the individual may becomepsychotic (http://en.wikipedia.org/wiki/Psychotic), a condition also known as severe bipolar depression with psychotic features.<o:p></o:p>
<o:p> </o:p>
Manic episode<o:p></o:p>
Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person's speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen," are "on a special mission," or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis (http://en.wikipedia.org/wiki/Psychosis), or a break with reality, where thinking is affected along with mood. Many people in a manic state experience severe anxiety (http://en.wikipedia.org/wiki/Anxiety) and are very irritable (to the point of rage), while others areeuphoric (http://en.wikipedia.org/wiki/Euphoria_%28emotion%29) and grandiose.<o:p></o:p>
In order to be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM) a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalization is required. According to the National Institute of Mental Health, "A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be <o:p></o:p>
Hypomanic episode<o:p></o:p>
Hypomania is generally a mild to moderate level of mania, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Some people have increased creativity while others demonstrate poor judgment and irritability. Others experience hypersexuality (http://en.wikipedia.org/wiki/Hypersexuality). These persons generally have increased energy and tend to become more active than usual. They do not, however, have delusions (http://en.wikipedia.org/wiki/Delusions) or hallucinations. Hypomania can be difficult to diagnose because it may masquerade as mere happiness, though it carries the same risks as mania.<o:p></o:p>
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
. <o:p></o:p>
Mixed affective episode<o:p></o:p>
In the context of bipolar disorder, a mixed state is a condition during which symptoms ofmania (http://en.wikipedia.org/wiki/Mania)andclinical depression (http://en.wikipedia.org/wiki/Clinical_depression)occur simultaneously (for example,agitation (http://en.wikipedia.org/wiki/Agitation_%28emotion%29),anxiety (http://en.wikipedia.org/wiki/Anxiety), aggressiveness or belligerence, confusion,fatigue (http://en.wikipedia.org/wiki/Fatigue_%28physical%29), impulsiveness,insomnia (http://en.wikipedia.org/wiki/Insomnia), irritability, morbid and/orsuicidal ideation (http://en.wikipedia.org/wiki/Suicidal_ideation),panic (http://en.wikipedia.org/wiki/Panic),paranoia (http://en.wikipedia.org/wiki/Paranoia), persecutory delusions, pressured speech, <o:p></o:p>
racing thoughts (http://en.wikipedia.org/wiki/Racing_thoughts), restlessness, andrage (http://en.wikipedia.org/wiki/Rage_%28emotion%29)).<sup><o:p></o:p></sup>
Causes<o:p></o:p>
Genetic<o:p></o:p>
Childhood precursors<o:p></o:p>
Life events and experiences<o:p></o:p>
Neural processes<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
Diagnosis<o:p></o:p>
Diagnosis is based on the self-reported experiences of an individual as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a psychiatrist (http://en.wikipedia.org/wiki/Psychiatrist), nurse (http://en.wikipedia.org/wiki/Nurse), social worker (http://en.wikipedia.org/wiki/Social_worker), clinical psychologist (http://en.wikipedia.org/wiki/Clinical_psychologist) or other clinician in a clinical assessment. There are lists of criteria for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disord ers), the current version being DSM-IV-TR, and the World Health Organization's (http://en.wikipedia.org/wiki/World_Health_Organization) International Statistical Classification of Diseases and Related Health Problems (http://en.wikipedia.org/wiki/ICD), currently the ICD-10. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions, as well as prevailing in research studies.<o:p></o:p>
An initial assessment may include a physical exam by a physician. Although there are no biological tests which confirm bipolar disorder, tests may be carried out to exclude medical illnesses such as hypo- (http://en.wikipedia.org/wiki/Hypothyroidism) or hyperthyroidism (http://en.wikipedia.org/wiki/Hyperthyroidism), metabolic disturbance, a systemic infection or chronic disease, and syphilis (http://en.wikipedia.org/wiki/Syphilis) or HIV (http://en.wikipedia.org/wiki/HIV) infection. An EEG (http://en.wikipedia.org/wiki/Electroencephalography) may be used to exclude epilepsy (http://en.wikipedia.org/wiki/Epilepsy), and a CT scan (http://en.wikipedia.org/wiki/Computed_tomography) of the head to exclude brain lesions. Investigations are not generally repeated for relapse unless there is a specific [I]medical indication.<o:p></o:p>
There are several other mental disorders which may involve similar symptoms to bipolar disorder. These include schizophrenia (http://en.wikipedia.org/wiki/Schizophrenia),<sup>[60] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-59#cite_note-59)</sup>schizoaffective disorder (http://en.wikipedia.org/wiki/Schizoaffective_disorder), drug intoxication, brief drug-induced psychosis, schizophreniform disorder (http://en.wikipedia.org/wiki/Schizophreniform_disorder) and borderline personality disorder (http://en.wikipedia.org/wiki/Borderline_personality_disorder). Both borderline personality and bipolar disorder can involve what are referred to as "mood swings". In bipolar disorder, the term refers to the cyclic episodes of elevated and depressed mood which generally last weeks or months. The term in borderline personality refers to the marked lability (http://en.wikipedia.org/wiki/Affective_lability)and reactivity of mood, known as emotional dysregulation (http://en.wikipedia.org/wiki/Emotional_dysregulation), due to response to external psychosocial and intrapsychic stressors; these may arise or subside suddenly and dramatically and last for seconds, minutes, hours or days. A bipolar depression is generally more pervasive with sleep, appetite disturbance and nonreactive mood, whereas the mood in dysthymia of borderline personality remains markedly reactive and sleep disturbance not acute. Some hold that borderline personality disorder represents a subthreshold form of mood disorder, while others maintain the distinctness, though noting they often coexist
. <o:p></o:p>
Criteria and subtypes<o:p></o:p>
There is no clear consensus as to how many types of bipolar disorder exist.<sup>[68] (http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-67#cite_note-67)</sup> In DSM-IV-TR (http://en.wikipedia.org/wiki/DSM-IV-TR) and ICD-10 (http://en.wikipedia.org/wiki/ICD-10), bipolar disorder is conceptualized as a spectrum (http://en.wikipedia.org/wiki/Bipolar_spectrum) of disorders occurring on a continuum. The DSM-IV-TR lists four types of mood disorders which fit into the bipolar categories:Bipolar I (http://en.wikipedia.org/wiki/Bipolar_I), Bipolar II (http://en.wikipedia.org/wiki/Bipolar_II), Cyclothymia (http://en.wikipedia.org/wiki/Cyclothymia), and Bipolar Disorder NOS (http://en.wikipedia.org/wiki/Bipolar_Disorder_NOS) (Not Otherwise Specified).<o:p></o:p>
Bipolar I<o:p></o:p>
In Bipolar I disorder (http://en.wikipedia.org/wiki/Bipolar_I_disorder), an individual has experienced one or more manic episodes (http://en.wikipedia.org/wiki/Manic_episodes) with or without major depressive episodes. For a diagnosis of Bipolar I disorder according to the DSM-IV-TR (http://en.wikipedia.org/wiki/DSM-IV-TR), one or more manic or mixed episodes are required. A depressive episode is not required for the diagnosis of Bipolar I but it frequently occurs.<o:p></o:p>
Bipolar II<o:p></o:p>
Bipolar II disorder (http://en.wikipedia.org/wiki/Bipolar_II_disorder) is characterized by hypomanic (http://en.wikipedia.org/wiki/Hypomanic) episodes rather than actual manic episodes (http://en.wikipedia.org/wiki/Manic_episodes), as well as at least one major depressive episode (http://en.wikipedia.org/wiki/Major_depressive_episode). Patients with a Bipolar II diagnosis under the DSM IV criteria cannot, by definition, ever have had a manic episode prior to their diagnosis. However, a Bipolar II diagnosis is not a guarantee that they will not eventually suffer from such an episode in the future
Hypomanic episodes do not go to the full extremes of mania (i.e. do not usually cause severe social or occupational impairment, and withoutpsychosis (http://en.wikipedia.org/wiki/Psychosis)), and this can make Bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression. For both Bipolar I and II, there are a number of specifiers that indicate the presentation and course of the disorder, including "chronic", "rapid cycling", "catatonic" and "melancholic".<o:p></o:p>
Management<o:p></o:p>
here are a number of pharmacological (http://en.wikipedia.org/wiki/Pharmacological) and psychotherapeutic (http://en.wikipedia.org/wiki/Psychotherapeutic) techniques used for Bipolar Disorder. Individuals may use self-help (http://en.wikipedia.org/wiki/Self-help_groups_for_mental_health) and pursue a personal recovery (http://en.wikipedia.org/wiki/Recovery_model) journey.<o:p></o:p>
Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment (http://en.wikipedia.org/wiki/Involuntary_commitment)). Long-term inpatient stays are now less common due to deinstitutionalization (http://en.wikipedia.org/wiki/Deinstitutionalization), although can still occur Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment (http://en.wikipedia.org/wiki/Assertive_Community_Treatment) team, supported employment and patient-led support groups. <o:p></o:p>
Prognosis<o:p></o:p>
For many individuals with bipolar disorder a good prognosis (http://en.wikipedia.org/wiki/Prognosis) results from good treatment, which, in turn, results from an accurate diagnosis (http://en.wikipedia.org/wiki/Medical_diagnosis). Because bipolar disorder can have a high rate of both under-diagnosis and misdiagnosis (http://en.wikipedia.org/wiki/Misdiagnosis)<sup>]</sup>, it is often difficult for individuals with the condition to receive timely and competent treatment.<o:p></o:p>
<o:p> </o:p>