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     Volume 4 Issue 31 | January 28, 2005 |

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The Blues...

Everyone feels "blue" at one time or another, or "good" at other times. People who suffer from bipolar disorder, however, have pathological mood swings from mania to depression, with a pattern of exacerbation and remission that are sometimes cyclic.

The manic phase is characterised by elevated mood, hyperactivity, over-involvement in activities, inflated self-esteem, a tendency to be easily distracted, and little need for sleep. The manic episodes may last from several days to months.

In the depressive phase, there is loss of self-esteem, withdrawal and sadness, and a risk of suicide. While in either phase, patients may abuse alcohol or other substances which worsen the symptoms.

The disorder appears between the ages of 15 and 25, and it affects men and women equally. The exact cause is unknown, but it is a disturbance of areas of the brain which regulate mood. There is a strong genetic component. The incidence is higher in relatives of people with bipolar disorder.

*Alternating episodes of mania and depression.
In the manic phase the following symptoms can be seen:
*Increase in goal-directed activities.
*Increased energy
*Flight of ideas or subjective experience that thoughts are racing
*Inflated self-esteem or grandiosity
*Increased involvement in activities that may be pleasurable, but may have dire consequences.
*Decreased need for sleep.
*Patient may be more talkative than usual or may feel pressured to speak
*Easily agitated or irritated
*Lack of self-control

In hypomanic episodes, symptoms are similar, but fewer and/or less intense. Delusions, (false beliefs based on incorrect information about external reality) if present, may be congruent with mood, such as delusions of grandeur, or a sense of special powers and abilities.

In the depressive phase patients may experience:
*Persistent sadness and depressed mood
*Feelings of hopelessness, worthlessness, pessimism, and "emptiness"
*Loss of interest or pleasure in activities that were once enjoyed, including sex
*Sleep disturbances
*Feelings of guilt and worthlessness
*Overwhelming sluggishness
*Difficulty concentrating, remembering, or making decisions
*Loss of appetite and/or weight loss, or overeating and weight gain
*Thoughts of death or suicide

If delusions are present, they may be congruent with mood such as delusions of worthlessness or accusing voices. In "atypical depression", patients sleep more than usual and have increased appetite.

Signs and tests
A psychiatric history of mood swings, and observation of current behaviour and mood are important in the diagnosis of this disorder. A family history of manic-depressive illness may be present. A physical examination may be performed to rule out physical causes for the symptoms or potentially drug-induced symptoms.

*Noncompliance with treatment, leading to a recurrence of the illness.
*Bipolar disorder may be complicated by alcohol and drug abuse, often used as a strategy to "self-medicate" mood.



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