Bipolar Contributed by: Dr Kyla Brown. Speciality Registrar Child and Adolescent Psychiatrist

What is Bipolar?

Bipolar disorder is a condition in which a person has extreme changes of mood with episodes of feeling very sad and depressed and at least one episode of feeling intensely happy (mania). A less severe form of mania called hypomania can also occur, which may not last as long or lead to as much disruption of normal life as mania does.

Bipolar disorder is a lifelong diagnosis. The majority of people fully recover from their initial episode on medication however relapse at some point is more common than not. For a minority, full recovery is difficult and their bipolar disorder is something they learn to live with and manage.

Fast Facts!

1 in 100 young people will have Bipolar Affective Disorder.

Stress can trigger episodes of Bipolar.

There is thought to be a genetic link to the illness.

Males and Females have the same rates of Bipolar.

 

What causes it?

Bipolar runs in families, and it is thought that there is a genetic cause or link with the illness.

 

It is well known that some situations can trigger a bipolar episode – particularly stress, alcohol or drugs and physical illness.

 

There is a link with the chemicals in the brain being raised that is thought to be a physical cause for the symptoms of Bipolar. There is lots of research currently going on in this area.

What are the symptoms?

People with Bipolar can experience periods of both mania and depression.

Manic Periods – Feeling unusually happy and excited. Often young people feel irritable and can have explosive outbursts of rage. They are restless and try to do lots of things, some of which may be risky things.  They might be more sociable, flirty and interested in sex than normal, be very confident, talk very quickly and experience racing thoughts. This can make concentration difficult and being distracted from things more likely.

Sleep and appetite can be poor with manic people feeling they need less sleep and food than normal. They can also have poor self care, and struggle to look after themselves physically.

Occasionally people can hear voices or have strange false beliefs, like Lisa in the case study above thinking she could fly. These are psychotic symptoms and they indicate a severe illness.

Depressed Periods – Feeling sad or irritable almost all the time. Finding it difficult to enjoy things like their favourite TV programme or seeing friends. They have no energy, confidence or self-esteem. It’s difficult to get motivated and often people withdraw from friends, family and school.

Sleep can be affected by wanting to sleep more, some sleep less. Appetite can be affected in the same way.

Lots of young people with depression have thoughts of harming themselves or killing themselves. Occasionally in severe cases people have psychotic symptoms, for example thinking you smell really bad or can hear people saying horrible things about you.

Sometimes people can have symptoms of both a manic and a depressive episode at the same time – this is called a mixed episode. For example a young person could be very active, have disorganised thinking and behaviour, irritability, poor sleep, low mood with suicidal thoughts. Moods can also cycle, or change rapidly from one extreme to the other.

How is it diagnosed?

There is no medical test to diagnose bipolar disorder. The diagnosis is made by a psychiatrist on the basis of the information given by the young person (and their family and friends) as well as an observation of their behaviour. Sometimes a young person may also be offered a brain scan in order to rule out other causes of their change in behaviour. Young people will have routine blood tests for the same reason and also prior to starting medication.

How is it treated?

There is no medical test to diagnose bipolar disorder. The diagnosis is made by a psychiatrist on the basis of the information given by the young person (and their family and friends) as well as an observation of their behaviour. Sometimes a young person may also be offered a brain scan in order to rule out other causes of their change in behaviour. Young people will have routine blood tests for the same reason and also prior to starting medication.

Treatment is based on whether you are depressed and how severe the episode is. In some circumstances it may not be safe for you to be treated at home, in which case admission to hospital will be considered. Medication is usually used to help reduce the symptoms and the particular choice will depend on the individual person and their current episode. Your psychiatrist will discuss the options with you and your family so you can choose the right medication.  To read more about medication download our handy PDF.

Other important treatments include psychoeducation – and learning what triggers your bipolar disorder, how to notice if it is recurring and take measures to counteract this (relapse prevention). They will think about whether you and your family need extra support at home.

Maintaining good sleeping habits, having daytime regular exercise, avoiding substance misuse, limiting stress and having support within the family will all help maintain your recovery.

Talking therapy may also be offered to treat bipolar disorder. This might be Cognitive Behavioural Therapy (CBT) where the young person (with the support of their family) learns to understand their thoughts and feelings (cognitive part) and how they link to their behaviour in order to improve symptoms and stop unhelpful patterns of thinking and behaviour from making things worse.

 

Case Study

Lisa has been depressed in the past and attended a Child and Adolescent Mental Health Service for talking therapy. She is 16 and studying for important exams at school. Three weeks ago she started to feel less need for sleep and full of energy. She was excited about everything, spoke quickly, laughed a lot and shouted out in class, which was unlike her.

Four days ago Lisa stopped eating properly and began staying up all night to write poems and songs. Her friends noticed that she was very flirty with a local shop assistant. She told her friends that she had never felt this good or this confident. In fact, she was a better singer than Adele and should try to get on the X Factor by taking the train to London. Lisa spent a large amount of money on a train ticket to London. She talked of perhaps not needing the train and being able to fly like a bird instead. Lisa’s friends were worried and told her parents, who were very concerned. When they asked her about it she swore at them and was frustrated that they weren’t taking her singing seriously. They took Lisa to see her GP, who arranged for a psychiatrist to review her that day.

She was admitted to hospital and treated with medicine for bipolar disorder. Lisa now takes her medicine every day and is back at school. She continues to see a psychiatrist and a community psychiatric nurse who help her to monitor her mood, identify triggers and look for early signs that she may be becoming unwell again in order to get extra help quickly and minimise any disruption to her life.

Want to know more?

www.bipolaruk.org.uk is a national charity that supports people with a diagnosis of bipolar disorder and their families.

f you are worried about yourself or a friend/family member, then you should encourage them to go and see their GP.