akiskal bipolar spectrum
Bipolar disorder, the most extreme form of which was formerly known as manic depression, is a significant disturbance in mood characterized by "mood swings, euphoria, high energy levels and productivity. It's possibly the only, where the sick really crave the return of some symptoms and remains one of the most intriguing and disabling psychiatric disorders. People with the disease have shown significant levels of creativity in fields such as literature, visual arts, music and history.
The disorder was first described by Kraepelin early 1921 that noted the range of symptoms, the pattern of episodes and deficiencies in the operation. The disorder may have a prevalence of up to 2% (depending on the type of criteria used), with many suffering from multiple episodes recurrent and disabling despite the use of drugs mood stabilizers. Although bipolar disorder may (rarely) begin in childhood onset is more frequent in adolescence or 20 years. An epidemiological study has suggested a rate of 1% of adolescents (Lewinsohn, Klein and Seeley, 1995).
The disorder is associated with high mortality and morbidity. Lifetime risk for suicide in people with bipolar disorder is 15%. About a quarter of people with bipolar disorder will a suicide attempt (usually related to the depressive component) at some point in their lives. After cardiovascular events, suicide is the most probable death for people with bipolar disorder (Angst et al., 2002).
According to the World Health Organization, bipolar disorder is the sixth leading cause Main disability world wide (as measured in DALYs – Years of Disability Adjusted Life). The burden of living with bipolar disorder is huge in terms of loss productivity and social relations, not only for individuals but also families and communities in general (for example, one study alone, bipolar disorder is thought to represent 45% of the costs of hospital care, Johnson et al., 2003). Up to one third of people diagnosed with bipolar disorder remain unemployed one year after hospitalization for mania (Harrow et al., 1990).
Current conceptualizations of bipolar disorder
There has been considerable debate over whether unipolar and bipolar disorders are categorical or dimensional constructs. Both the ICD-10 and DSM-IV categorical approach to affirm a unipolar and bipolar disorder. However, some studies have argued for continuity between recurrent depressive episodes and bipolar disorder.
There is also debate about the classification of different types of bipolar disorder. Increasingly, however, has been a movement for the development of categories or subtypes of bipolar disorder, such as disorder bipolar I and bipolar II. The main types of bipolar disorder is bipolar I and bipolar II, may be separate or different sub-types only dimensions (eg, by gravity or duration), differing the term "dimension of the bipolar spectrum" assuming.
The bipolar spectrum
I – Manic Depression
II – Depression + hypomania
III – The hypomania in association with antidepressant medications (starting up, withdrawal). This is known as the 'change'.
IV – Depression superimposed on 'temperaments hyperthymic'
Concepts V and VI – Other more "temperament"
Of Akiskal (2005), Journal of Affective Disorders, 84, 107-115.
Bipolar I and Bipolar II is distinguished by a number of key characteristics. People with bipolar I disorder have more likely to experience more "serious" and more highs or manic episodes (which may include psychotic symptoms) and require treatment in the hospital than those with bipolar II disorder. In contrast, bipolar II is less severe, without psychotic experiences, and episodes tend to last only a few hours to a few days. The symptoms of bipolar II disorder may not be as obvious as those of bipolar I While the maximum bipolar II disorder, often referred to as hypomania, may also be distressing to patients, often characterized by periods of intense productivity.
Occasionally, people may experience a mixture of both high and low, at the same time, or change during the day, giving a mixed picture. In rare cases (up to 5%), people with bipolar disorder experience only the high and not low. The disease pattern can be very different with some people experience mood changes daily, and others who have only one episode of mania per decade. People with bipolar disorder may experience normal moods between the swings.
The popular view holds that the bipolar II is a much milder version of bipolar disorder. However, recent evidence (eg Hadjipavlou et al, 2004) has indicated that bipolar ll is associated with more chronic and frequent depressive episodes, more periods of time with sub-syndromal symptoms and higher rates of attempted and completed suicide. Bipolar I and bipolar II patients have equivalent levels of deficiencies in psychosocial functioning and the use of mental health services. Although the "high" in bipolar II disorder may be less severe than those associated with bipolar l, depressive episodes are also disturbing and debilitating.
The distinction between bipolar I and bipolar II has important implications for treatment. In Bipolar I Disorder, mood stabilizers (especially the gold standard, lithium) are considered the mainstay of treatment. The role of mood stabilizers in bipolar II disorder is less clear and up for debate, especially the new antidepressants and atypical antipsychotics have come on the market. There is growing interest in this area and more trials are currently underway that we hope to clarify whether each state should be equal – treaties.
Furthermore, bipolar disorder I (but not bipolar II disorder) is characterized by a series of psychotic symptoms such as delusions and hallucinations. Sometimes occur during an episode of acute mania, but can also occur during a severe episode of melancholic depression. In bipolar I disorder, delusions are more common than hallucinations.
The prevalence of bipolar II disorder tends to be higher in women and women with bipolar disorder have a higher risk (about 60%) of having a manic episode or depressed during or (and more commonly) in the first weeks after birth. While most depression sufferers, a significant proportion will have highs and up to 10% have mixed the highs and lows.
A/Professor Vijaya Manicavasagar PhD, is the Director of Psychological Services at the Black Dog Institute, a not-for profit, educational, research, clinical and community-oriented facility dedicated to improving the understanding, diagnosis and treatment of depression and bipolar disorder. For more information or to find out your personality style visit http://www.blackdoginstitute.org.au
