Bipolar disorder Classification and external resources
ICD-10	F31.
ICD-9	296.80
OMIM	125480 309200
DiseasesDB	7812
MedlinePlus	001528
eMedicine	med/229
MeSH	D001714

Bipolar disorder is not a single disorder, but a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood, clinically referred to as mania. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The 2007 version of the ICD is available online at http//wwwwho The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A mood disorder is the term given for a group of diagnoses in the DSM IV TR classification system where a disturbance in the person's emotional mood is hypothesised Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression This article is an expansion of a section entitled '''Mixed state''' from the main article Bipolar disorder In the context of Mental These episodes are normally separated by periods of normal mood, but in some patients, depression and mania may rapidly alternate, known as rapid cycling. Extreme manic episodes can sometimes lead to psychotic symptoms such as delusions and hallucinations. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic A delusion is commonly defined as a fixed False Belief and is used in everyday language to describe a belief that is either false fanciful or derived from Deception A hallucination, in the broadest sense is a Perception in the absence of a stimulus. The disorder has been subdivided into bipolar I, bipolar II, Bipolar NOS, and cyclothymia based on the type and severity of mood episodes experienced. Bipolar II Disorder is a Bipolar spectrum disorder that is characterized by at least one Hypomanic episode and at least one Major depressive episode; with Cyclothymia (pronounced /ˌsaɪkləˈθaɪmiə ˌsɪklə-/ is a Mood disorder.

Also called bipolar affective mood disorder until recently, the current name is of fairly recent origin and refers to the cycling between high and low episodes; it has replaced the older term manic-depressive illness coined by Emil Kraepelin (1856–1926) in the late nineteenth century. Emil Kraepelin ( February 15, 1856 – October 7, 1926) was a German Psychiatrist. ^[1] The new term is designed to be neutral, to avoid the stigma in the non-mental health community that comes from conflating "manic" and "depression. "

Onset of symptoms generally occurs in young adulthood. Diagnosis is based on the person's self-reported experiences, as well as observed behavior. Episodes of illness are associated with distress and disruption, and a relatively high risk of suicide. ^[2] Studies suggest that genetics, early environment, neurobiology, and psychological and social processes are important contributory factors. Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is Neurobiology is the study of cells of the Nervous system and the organization of these cells into functional circuits that process information and mediate behavior Psychiatric research is focused on the role of neurobiology, but a clear organic cause has not been found. Bipolar disorder is usually treated with medications and/or counseling. The mainstay of medication are a number of drugs termed 'mood stabilizers', in particular lithium and sodium valproate; these are a group of unrelated medications used to prevent relapses of further episodes. This article refers to the medication For other uses see Stabilizer. Lithium in pharmacology refers to use of the Lithium Ion, Li+ as a drug See also Valproic acid Sodium valproate ( INN) or valproate sodium ( USAN) is the sodium salt of Valproic acid and is an Antipsychotic medications, sometimes called neuroleptics, in particular olanzapine, are used in the treatment of manic episodes and in maintenance. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Olanzapine ( Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, or in combination with Fluoxetine Symbyax) is The benefits of using antidepressants in depressive episodes is unclear. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression Depending on the jurisdiction, in serious cases where there is risk to self or others involuntary commitment may be used; these cases generally involve severe manic episodes with dangerous behaviour or depressive episodes with suicidal ideation. Involuntary commitment is the practice of using legal means or forms as part of a Mental health law to commit a person to a Mental hospital, Insane asylum Hospital stays are less frequent and for shorter periods than they were in previous years.

Some studies have suggested a significant correlation between creativity and bipolar disorder. Creativity is a mental process involving the generation of new Ideas or Concepts, or new associations of the creative mind between existing ideas or concepts Though studies consistently show a positive correlation between the two, the exact nature of the relationship between the disorder and creativity is still relatively unclear. ^[3][4][5] One study indicated increased striving for and attainment of goals and achievements was correlated with onset of manic symptoms. ^[6] While the disorder affects people differently, individuals with bipolar disorder tend to be much more outgoing and daring than individuals without bipolar disorder. The disorder is also found in a large number of people involved in the arts. The arts is a broad subdivision of Culture, composed of many expressive disciplines. It is an ongoing study as to why many creative geniuses had bipolar disorder. A genius is a person of great Intelligence or remarkable abilities in a specific subject who shows an exceptional natural capacity of intellect and/or ability especially

Contents 1 Course 1.1 Major depressive episode 1.2 Manic episode 1.3 Hypomanic episode 1.4 Mixed affective episode 2 Diagnosis 2.1 Diagnostic criteria and classification 2.1.1 Bipolar I 2.1.2 Bipolar II 2.1.3 Cyclothymia 2.1.4 Bipolar-NOS 2.2 Delay in diagnosis 2.3 Children 2.4 Other theoretical models 3 Associated features 3.1 Cognitive impairment 3.2 Creativity 4 Epidemiology 4.1 Controversy 5 Causes 5.1 Heritability or inheritance 5.2 Genetic research 6 Treatment 6.1 Medication 7 Research 7.1 Medical imaging 7.2 New treatments 8 Prognosis 8.1 Recurrence 8.2 Mortality 9 History 10 Sociological and cultural aspects 10.1 Cultural references 11 References 11.1 Cited texts 12 Further reading 13 External links

Course

Bipolar disorder is often a cyclic illness where people periodically exhibit elevated (manic) and depressive episodes. Most people will experience a number of episodes, averaging 0. 4 to 0. 7 a year with each lasting three to six months, although some will experience only a single mood episode. ^[7][8] Late adolescence and early adulthood are peak years for the onset of the illness. ^[9][10] These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.

Rapid cycling, defined as having four or more episodes per year, is found in a significant fraction of patients with bipolar disorder. It has been associated with greater disability or a worse prognosis, due to the confusing changeability and difficulty in establishing a stable state. Rapid cycling can be induced or made worse by antidepressants, unless there is adjunctive treatment with a mood stabilizer. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression ^[11][12]

The definition of rapid cycling most frequently cited in the literature is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period. ^[13] There are references that describe very rapid (ultra-rapid) or extremely rapid^[14] (ultra-ultra or ultradian) cycling. Ultradian rhythms are recurrent periods or cycles repeated throughout a 24-hour circadian day One definition of ultra-ultra rapid cycling is defining distinct shifts in mood within a 24–48-hour period.

Major depressive episode

Main article: Major depressive episode

Signs and symptoms of the depressive phase of bipolar disorder include: persistent feelings of sadness, anxiety, guilt, anger, isolation and/or hopelessness, disturbances in sleep and appetite, fatigue and loss of interest in usually enjoyed activities, problems concentrating, loneliness, self-loathing, apathy or indifference, depersonalization, loss of interest in sexual activity, shyness or social anxiety, irritability, chronic pain (with or without a known cause), lack of motivation, and morbid/suicidal ideation. Major depressive episode is a key symptom of Major depressive disorder. Sadness is an Emotion characterized by Feelings of disadvantage loss and helplessness Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components ---- Guilt is the Fact, state or Verdict (by a Court or other Tribunal) of an Offence, Crime, Violation Anger is an emotional state that may range from minor irritation to intense rage Sleep is a Natural state of bodily rest observed throughout the animal kingdom Loneliness is an Emotional state in which a Person experiences a powerful feeling of Emptiness and isolation. Depersonalization (or depersonalisation) is an 'alteration' in the perception or experience of the self so that one feels 'detached' from and as if one is an 'outside' observer In Humans shyness (also called diffidence) is a Social psychology term used to describe the Feeling of apprehension lack of confidence Social Phobia Social anxiety is a term used to describe an experience of Anxiety ( Emotional discomfort Fear, apprehension or Worry Irritability is an excessive response to stimuli. Irritability takes many forms from the Contraction of a Unicellular organism when touched to complex Chronic pain is defined as Pain that persists longer than the temporal course of natural healing associated with a particular type of injury or disease process Suicidal ideation is a common medical term for thoughts about Suicide, which may be as detailed as a formulated plan without the suicidal act itself ^[15] In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic

Manic episode

Main article: Manic episode

Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition 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 or intrusive. 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, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic ^[16] Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose. Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Euphoria is a medically recognized emotional state related to Pleasure and Happiness.

In order to be diagnosed with mania according to DSM-IV a person must experience this state of elevated or irritable mood, as well as other symptoms, for at least one week, less if hospitalisation 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 present. "^[17]

Hypomanic episode

Main article: Hypomanic episode

Hypomania is generally a less extreme state than mania, and people in the hypomanic phase generally experience fewer symptoms of mania than those in a full-blown manic episode. This article is an expansion of a section entitled '''Hypomania''' from within the main article Bipolar disorder. During an episode, one might feel an uncontrollable impulse to laugh at things he or she does not normally find funny. The duration is usually also shorter than in mania. This is often a very "artistic" state of the disorder, where there is a flight of ideas, extremely clever thinking, and an increase in energy. Although hypomania does not last as long as a manic episode, and most cases do not involve all manic symptoms, this doesn't mean such episodes are completely less severe.

Mixed affective episode

Main article: Mixed state (psychiatry)

In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage). This article is an expansion of a section entitled '''Mixed state''' from the main article Bipolar disorder In the context of Mental Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity Suicidal ideation is a common medical term for thoughts about Suicide, which may be as detailed as a formulated plan without the suicidal act itself For psychological condition see Panic attack Panic is a sudden Fear which dominates or replaces thinking and often affects groups of Paranoia is a disturbed thought process characterized by excessive Anxiety or Fear, often to the point of Irrationality and Delusion. Racing thoughts refers to thought confusion which occurs in manic episodes hypomanic or mixed episodes and sometimes depression Rage, in Psychiatry, is a mental state that is one extreme of the intensity spectrum of Anger. ^[18]

Diagnosis

Diagnosis is based on the self-reported experiences of the patient as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a psychiatrist, nurse, social worker, clinical psychologist or other clinician in a clinical assessment. A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders A nurse is responsible—along with other Health care Professionals —for the treatment safety and recovery of acutely or chronically Social work is a discipline involving the application of Social theory and research methods to study and improve the lives of people groups and societies Clinical psychology includes the scientific study and application of Psychology for the purpose of understanding preventing There is a list of criteria that must be met for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms.

An initial assessment includes a comprehensive history and physical examination by a physician. Although there are no biological tests which confirm bipolar disorder, tests are carried out to exclude medical illnesses which may rarely present with psychiatric symptoms. These include blood tests measuring TSH to exclude hypo- or hyperthyroidism, basic electrolytes and serum calcium to rule out a metabolic disturbance, full blood count including ESR to rule out a systemic infection or chronic disease, and serology to exclude syphilis or HIV infection; two commonly ordered investigations are EEG to exclude epilepsy, and a CT scan of the head to exclude brain lesions. Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a Peptide hormone synthesized and secreted by Thyrotrope cells in the Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is The erythrocyte sedimentation rate (ESR also called a sedimentation rate, sed rate, or Biernacki Reaction, is the rate at which Red blood cells Serology is the scientific study of blood serum. In practice the term usually refers to the Diagnostic identification of antibodies in the serum Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. Computed tomography (CT is a Medical imaging method employing Tomography.

There are several psychiatric illnesses which may present with similar symptoms; these include schizophrenia,^[19], schizoaffective disorder, drug intoxication, brief drug-induced psychosis, schizophreniform disorder and borderline personality disorder. Schizophrenia ( from the Greek roots schizein (σχίζειν "to split" and phrēn Schizoaffective disorder is a Psychiatric Diagnosis of neurobiological illness. Schizophreniform disorder is characterized by the presence of criterion A symptoms of Schizophrenia. Borderline personality disorder ( BPD) is a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV Personality Alternately, patients currently in a hypomanic or mixed affective episode may display symptoms resembling borderline personality disorder.

The last is important as both diagnoses involve symptoms commonly known as "mood swings". In bipolar disorder, the term refers to the cyclic episodes of elevated and depressed mood which generally last weeks or months (notwithstanding Rapid Cycling variant of greater than four episodes a year). The term in borderline personality refers to the marked lability and reactivity of mood, known as 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. Labile affect or pseudobulbar affect refers to the pathological expression of Laughter, Crying or smiling. Emotional dysregulation, in contrast to Emotional self-regulation, is a term used in the Mental health community 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. ^[20]

The relationship between bipolar disorder and borderline personality disorder has been debated; some hold that the latter represents a subthreshold form of affective disorder,^[21][22] while others maintain the distinctness, though noting they often coexist. ^[23][24]

Investigations are not generally repeated for relapse unless there is a specific medical indication. These may include serum BSL if olanzapine has previously been prescribed, lithium or valproate level to check compliance or toxicity with those medications, renal or thyroid function if lithium has been previously prescribed and taken regularly. Olanzapine ( Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, or in combination with Fluoxetine Symbyax) is Assessment and treatment are usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self 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, the current version being DSM-IV-TR, and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, currently the ICD-10. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The latter criteria are typically used in European countries while the DSM criteria are used in the USA or the rest of the world, as well as prevailing in research studies.

Recent studies by Dr. John Kelsoe have linked bipolar disorder to genetic defects. “…[M]utations in the G protein receptorhinase (GRK3) gene—which regulates sensitivity to brain neurotransmitters such as dopamine…”^[25] Dr. John Kelsoe is currently with the University of California in San Diego in the Department of Psychiatry^[26] Kelsoe’s genetic discovery seeks to provide alternative treatments for those with bipolar disease. In 1997 a genome survey was completed and Dr. Kelsoe, along with his colleges reported that, “results support the presence of a susceptibility locus for bipolar disorder on chromosome 22…These molecular data raise the possibility that common susceptibility genes may be involved. ”^[27] In February 2008, Dr. Kelsoe released an at-home bipolar test. The tests are sold over the internet to consumers for $399 through his company, La Jolla, Calif. -based Psynomics. This new form of diagnostics seeks to move away from diagnosing people based solely on their behavior. Bipolar disorder is derived from a combination of genetic factors and life experiences^[28] Although Dr. Kelsoe is well-respected in his field of study, the test has become controversial and concerning to medical experts. To avoid misdiagnosis, the DNA results from the tests are sent only to the consumers’ doctors from Psynomics.

Diagnostic criteria and classification

Main article: Current diagnostic criteria for bipolar disorder

There is no clear consensus as to how many types of bipolar disorder exist. This article is an expansion of a section entitled '''Diagnosis''' from within the main article Bipolar disorder The current ^[29] In DSM-IV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The Bipolar spectrum refers to a category of Mood disorders that feature abnormally elevated mood The DSM-IV-TR lists four types of mood disorders which fit into the bipolar categories: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified). Cyclothymia (pronounced /ˌsaɪkləˈθaɪmiə ˌsɪklə-/ is a Mood disorder.

Bipolar I

In Bipolar I disorder, an individual has experienced one or more manic episodes with or without major depressive episodes. Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition For a diagnosis of Bipolar I disorder according to the DSM-IV-TR, there requires one or more manic or mixed episodes. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs.

Bipolar II

Bipolar II disorder is characterized by hypomanic episodes as well as at least one major depressive episode. Bipolar II Disorder is a Bipolar spectrum disorder that is characterized by at least one Hypomanic episode and at least one Major depressive episode; with This article is an expansion of a section entitled '''Hypomania''' from within the main article Bipolar disorder. Major depressive episode is a key symptom of Major depressive disorder. Hypomanic episodes usually do not go to the full extremes of mania (i. e. do not cause severe social or occupational impairment, and without 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 depression. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic For both disorders, there are a number of specifiers that indicate the presentation and course of the disorder, including "chronic", "rapid cycling", "catatonic" and "melancholic".

Cyclothymia

Cyclothymia involves a presence or history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. Cyclothymia (pronounced /ˌsaɪkləˈθaɪmiə ˌsɪklə-/ is a Mood disorder. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. Cyclothymia (pronounced /ˌsaɪkləˈθaɪmiə ˌsɪklə-/ is a Mood disorder. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning.

Bipolar-NOS

Bipolar Disorder Not Otherwise Specified is a catch-all diagnosis that is used to indicate bipolar illness that does not fit into the other diagnostic categories. If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified).

Although a patient will most likely be depressed when they first seek help, it is important to find out from the patient or the patient's family or friends if a manic or hypomanic episode has ever occurred. This will prevent misdiagnosis of Depressive Disorder and avoids the use of an antidepressant which may trigger a "switch" to hypomania or mania or induce rapid cycling. Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32) have been developed to assist the quite often difficult detection of Bipolar II disorders.

Delay in diagnosis

The behavioral manifestations of bipolar disorder are often not understood by patients nor recognized by mental health professionals, so diagnosis may sometimes be delayed for 10 years or more. ^[30] That treatment lag is apparently not decreasing, even though there is now increased public awareness of this mental health condition in popular magazines and health websites. Recent TV specials, for example the BBC's The Secret Life of the Manic Depressive,^[31] MTV's True Life: I'm Bipolar, talk shows, and public radio shows, and the greater willingness of public figures to discuss their own bipolar disorder, have focused on psychiatric conditions thereby further raising public awareness. A television special is a Television program, typically a Short film or Television movie, which interrupts or temporarily replaces programming normally True Life is a documentary series running on MTV since 1998 Each episode follows a particular topic such as heroin addiction in the first episode "Fatal Dose" Despite this increased focus, individuals are still commonly misdiagnosed. ^[32]

Children

Main article: Bipolar disorder in children

Children with bipolar disorder do not often meet the strict DSM-IV definition, tending to have rapid-cycling or mixed-cycling pattern. This article is an expansion of a section entitled '''Children''' from within the main article Bipolar disorder Childhood ^[33] The incidence in this age group has been traditionally held to be very rare. In September 2007, experts (from New York, Maryland and Madrid) found that the number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, and it was increasing ever since. New York ( is a state in the Mid-Atlantic and Northeastern regions of the United States and is the nation's third most populous Madrid (pronounced in English in Spanish and colloquially in Spain) is the Capital and largest city of Spain. The United States of America —commonly referred to as the CHILD syndrome (or congenital hemidysplasia with ichthyosiform erythroderma and limb defects) is a genetic disorder The Adolescents are a Hardcore punk band formed in 1980 in Fullerton, California. They concluded that doctors had been more aggressively applying the diagnosis to children, and not that the incidence of the disorder had increased. A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health Diagnosis is the identification by Process of elimination, of the nature of anything The study calculated the number of visits which increased, from 20,000 in 1994 to 800,000 in 2003, or 1% of the population under age 20. In Biology a population is the collection of inter-breeding organisms of a particular Species; in Sociology ^[34][35]

Often other psychiatric conditions are diagnosed in bipolar children. These other diagnoses may be concurrent problems, or they may be misdiagnosed as bipolar disorder. Depression, ADHD, ODD, schizophrenia, and Tourette syndrome are common comorbid conditions. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Attention-Deficit Hyperactivity Disorder (ADHD is a neurobehavioral developmental disorder affecting about 3-5% of the world's population Oppositional defiant disorder is a psychiatric category listed in the Diagnostic and Statistical Manual of Mental Disorders where it is described as an ongoing pattern of Schizophrenia ( from the Greek roots schizein (σχίζειν "to split" and phrēn Tourette syndrome (also called Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS or more commonly simply Tourette's In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to Furthermore some children with histories of abuse or neglect may have Bipolar I Disorder.

Other theoretical models

Flux is the fundamental nature of bipolar disorder. ^[36] Individuals with the illness have continual changes in energy, mood, thought, sleep, and activity. The diagnostic subtypes of bipolar disorder are thus static descriptions — snapshots, perhaps — of an illness in continual flux, with a great diversity of symptoms and varying degrees of severity. Diagnosis is the identification by Process of elimination, of the nature of anything In Computer science, a subtype is a Datatype that is generally related to another datatype (the supertype) by some notion of Substitutability Individuals may stay in one subtype, or change into another, over the course of their illness (Goodwin & Jamison, 1990). The DSM V, to be published in 2012, will likely include further and more accurate sub-typing (Akiskal and Ghaemi, 2006).

Associated features

Associated features are clinical phenomenon that often accompany the disorder, but are not part of the diagnostic criteria for the disorder.

Cognitive impairment

Recent studies have found that bipolar disorder involves certain cognitive deficits or impairments, even in states of remission. Cognitive deficit is an inclusive term to describe any characteristic that acts as a barrier to cognitive performance Remission is the state of absence of Disease activity in patients with known Chronic illness. ^{[37][38][39][40][41]}

It is not known whether specific cognitive deficits are mood state dependent or disorder-specific features of bipolar disorder. Few studies have examined impairments throughout all the different mood states, and many studies show conflicting data compared to other studies on account of methodological differences. Furthermore, the presence of mixed mood states complicates the identification of accurate cognitive models for this condition. Some use theories that conform to the cognitive models for unipolar depression and others on theories that focus solely on physiological or biological aspects of mania. However, Deborah Yurgelun-Todd of McLean Hospital in Belmont, Massachusetts has argued that some deficits should be included as a core feature of bipolar disorder. McLean Hospital (pronounced 'Mc-Lane' is a Psychiatric hospital in Belmont, Massachusetts. Belmont is a town in Middlesex County, Massachusetts, a Suburb of Boston. The Commonwealth of Massachusetts ( is a state located in the New England region of the northeastern United States. According to McIntyre et al. (2006),

Study results now press the point that neurocognitive deficits are a primary feature of BD; they are highly prevalent and persist in the absence of overt symptomatology. Although disparate neurocognitive abnormalities have been reported, disturbances in attention, visual memory, and executive function are most consistently reported. Visual memory is a part of Memory preserving some characteristics of our Senses pertaining to visual experience. ^[42]

However, in the April–June 2007 issue of the Journal of Psychiatric Research (41, 3–4, 265–272) Spanish researchers (Selva et al. ) reported that people with bipolar I who have a history of psychotic symptoms do not necessarily experience an increase in cognitive impairment. Some individuals diagnosed with bipolar I may experience only mood-congruent psychotic symptoms which may suggest a less severe prognosis, but this is by no means conclusive.

Creativity

Main article: Creativity and mental illness

A number of recent studies have observed a correlation between creativity and bipolar disorder,^[3][4][5] although it is unclear in which direction the cause lies, or whether both conditions are caused by a third unknown factor. Mental illness and Creativity are popularly considered to be related particularly in the case of Bipolar disorder. Temperament has been hypothesized to be one such factor.

Epidemiology

Clinical depression and bipolar disorder are classified as separate illnesses. Some researchers increasingly view them as part of an overlapping spectrum that also includes anxiety and psychosis.

According to Hagop Akiskal, M.D., at the one end of the spectrum is bipolar type schizoaffective disorder, and at the other end is unipolar depression (recurrent or not recurrent), with the anxiety disorders present across the spectrum. Doctor of Medicine ( MD or MD, from the Latin Medicinæ Doctor meaning "Teacher of Medicine" is a doctoral Schizoaffective disorder is a Psychiatric Diagnosis of neurobiological illness. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Also included in this view is premenstrual dysphoric disorder, postpartum depression, and postpartum psychosis. Premenstrual dysphoric disorder (PMDD is a severe form of Premenstrual syndrome, afflicting 3% to 8% of women This view helps to explain why many people who have the illness do not have first-degree relatives with clear-cut "bipolar disorder", but who have family members with a history of these other disorders.

In a 2003 study, Hagop Akiskal M. D. and Lew Judd M. D. re-examined data from the landmark Epidemiologic Catchment Area study from two decades before. Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the A catchment is any device or structure that captures Water. ^[43] The original study found that 0. 8 percent of the population surveyed had experienced a manic episode at least once (the diagnostic threshold for bipolar I) and 0. Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition 5 a hypomanic episode (the diagnostic threshold for bipolar II). This article is an expansion of a section entitled '''Hypomania''' from within the main article Bipolar disorder.

By tabulating survey responses to include sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, the authors arrived at an additional 5. 1 percent of the population, adding up to a total of 6. 4 percent of the entire population who can be thought of as having a bipolar spectrum disorder. This and similar recent studies have been interpreted by some prominent bipolar disorders researchers as evidence for a much higher prevalence of bipolar conditions in the general population than previously thought. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given

However these re-analyses should be interpreted cautiously because of substantive as well as methodological study limitations. Indeed, prevalence studies of bipolar disorder are carried out by lay interviewers (that is, not by expert clinicians/psychiatrists who are more costly to employ) who follow fully structured/fixed interview schemes; responses to single items from such interviews may suffer limited validity.

Furthermore, a well-known statistical problem arises when ascertaining disorders and conditions with a relatively low population prevalence or base-rate, such as bipolar disorder: even assuming that lay interviews diagnoses are highly accurate in terms of sensitivity and specificity and their corresponding area under the ROC curve (that is, AUC, or area under the receiver operating characteristic curve), a condition with a relatively low prevalence or base-rate is bound to yield high false positive rates, which exceed false negative rates; in such a circumstance a limited positive predictive value, PPV, yields high false positive rates even in presence of a specificity which is very close to 100%. In Signal detection theory, a receiver operating characteristic ( ROC) or simply ROC curve, is a graphical plot of the sensitivity In Signal detection theory, a receiver operating characteristic ( ROC) or simply ROC curve, is a graphical plot of the sensitivity In Statistics, the terms Type I error (also α error, or false positive) and type II error ( β error, or a false negative In Statistics, the terms Type I error (also α error, or false positive) and type II error ( β error, or a false negative The positive predictive value, or precision rate, or post-test probability of disease, is the proportion of patients with positive test results who are correctly diagnosed In Statistics, the terms Type I error (also α error, or false positive) and type II error ( β error, or a false negative ^[44] To simplify, it can be said that a very small error applied over a very large number of individuals (that is, those who are *not affected* by the condition in the general population during their lifetime; for example, over 95%) produces a relevant, non-negligible number of subjects who are incorrectly classified as having the condition or any other condition which is the object of a survey study: these subjects are the so-called false positives; such reasoning applies to the 'false positive' but not the 'false negative' problem where we have an error applied over a relatively very small number of individuals to begin with (that is, those who are *affected* by the condition in the general population; for example, less than 5%). Hence, a very high percentage of subjects who seem to have a history of bipolar disorder at the interview are false positives for such a medical condition and apparently never suffered a fully clinical syndrome (that is, bipolar disorder type I): the population prevalence of bipolar disorder type I, which includes at least a lifetime manic episode, continues to be estimated at 1%. In Medicine and Psychology, the term syndrome refers to the association of several clinically recognizable features signs (observed by a physician ^[45] "Mild-to-severe versions of bipolar disorder afflict nearly 4 percent of adults at some time in their lives. "^[46]

A different but related problem in evaluating the public health significance of psychiatric conditions has been highlighted by Robert Spitzer of Columbia University: fulfillment of diagnostic criteria and the resulting diagnosis do not necessarily imply need for treatment. Dr Robert L Spitzer is a Professor of Psychiatry at Columbia University in New York City, United States and is on the research faculty of the Columbia University is a private University in the United States and a member of the Ivy League. Diagnosis is the identification by Process of elimination, of the nature of anything Diagnosis is the identification by Process of elimination, of the nature of anything ^[47] As a consequence, subjects who experience bipolar symptoms but not a full-blown, impairing bipolar syndrome should not be automatically considered as patients in need of treatment.

Recent studies have indicated that at least 50% of adult sufferers report manifestation of symptoms before the age of 17. Moreover, there is a growing consensus that bipolar disorder originates in childhood. In young children the illness is now referred to as pediatric bipolar disorder. Pediatrics (also spelled paediatrics) is the branch of Medicine that deals with the medical care of Infants Children and Adolescents Today about 0. 5% of children under 18 are believed to have the condition. For children, the main concern is that bipolar disorder needs to be diagnosed correctly and treated properly because it can look like unipolar depression, ADHD, or conduct disorder. Attention-Deficit Hyperactivity Disorder (ADHD is a neurobehavioral developmental disorder affecting about 3-5% of the world's population Conduct disorder is a psychiatric category to describe a pattern of repetitive behavior where the rights of others or the current Social norms are violated Young children, adolescents and adults each express the condition differently according to child and adolescent bipolar disorders expert Demitri Papolos M.D. and the Child and Adolescent Bipolar Foundation. For the 2008 British film by Noel Clarke see Adulthood (film. There is, however, controversy about this last point. ^[48]

Bipolar disorder manifests in late life as well. Some individuals with "hyperthymic" temperament (or "hypomanic" personality style) who experience depression in later life appear to have a form of bipolar disorder. Personality style has been defined as "an individual's relatively consistent inclinations and preferences across contexts Much more needs to be elucidated about late-life bipolar disorder.

Controversy

A debate rages in the medical community on the prevalence of bipolar disorders. ^[49] Concerns have arisen about the potential for overdiagnosis of BD. ^[50] One controversy has been the validity of the construct of a mental disorder across different cultural perspectives (Lopez & Guarnaccia 2000, Sher & Trull 1996). ^[51] Culture-bound syndromes represent recurrent patterns of maladaptive behaviors and/or troubling experiences specifically associated with different cultures or localities (APA, 1994b). ^[52] It can be difficult to distinguish between age-appropriate restlessness, the fidgeting of children with ADHD, and the purposeful busy activity of mania (Harrington & Myatt, 2003). Attention-Deficit Hyperactivity Disorder (ADHD is a neurobehavioral developmental disorder affecting about 3-5% of the world's population ^[53] Further complicating the diagnosis: Abused or traumatized children can seem to have bipolar disorder when they are actually reacting to horrors in their lives. ^[54] Assumptions regarding behavior, particularly in regard to diagnosing bipolar disorder, ADHD, and mania in children and adolescents, have raised considerable questions regarding unnecessary treatment. Antipsychotic drugs prescribed for the treatment of BD may increase risk to health including heart problems, diabetes, liver failure, and death. ^[55] "Consequences of overdiagnosis … include exposure to a greater medication burden (in some cases requiring additional monitoring) as well as lesser likelihood of clinical improvement. "^[56] When checking for a misdiagnosis of Bipolar disorder or confirming a diagnosis of Bipolar disorder, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. ^[57]

Causes

According to the U. S. government's National Institute of Mental Health (NIMH), "There is no single cause for bipolar disorder — rather, many factors act together to produce the illness. The National Institute of Mental Health ( NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in " "Because bipolar disorder tends to run in families, researchers have been searching for specific genes passed down through generations that may increase a person's chance of developing the illness. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance " "In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene. ". ^[58]

It is well established that bipolar disorder is a genetically influenced condition which can respond very well to medication (Johnson & Leahy, 2004; Miklowitz & Goldstein, 1997; Frank, 2005). (See treatment of bipolar disorder for a more detailed discussion of treatment. This article is an expansion of a section entitled '''Treatment''' from within the main article Bipolar disorder The emphasis )

Psychological factors also play a strong role in both the psychopathology of the disorder and the psychotherapeutic factors aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing prodromal symptoms before full-blown recurrence, and, practising the factors that lead to maintenance of remission (Lam et al, 1999; Johnson & Leahy, 2004; Basco & Rush, 2005; Miklowitz & Goldstein, 1997; Frank, 2005). Psychopathology is a term which refers to either the study of Mental illness or mental distress or the manifestation of behaviours and experiences which may be indicative Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living In Medicine, a prodrome is an early non-specific Symptom (or set of symptoms indicating the start of a Disease before specific symptoms occur Remission is the state of absence of Disease activity in patients with known Chronic illness. Modern evidence based psychotherapies designed specifically for bipolar disorder when used in combination with standard medication treatment increase the time the individual stays well significantly longer than medications alone (Frank, 2005). Evidence-based medicine (EBM aims to apply Evidence gained from the Scientific method to certain parts of medical practice These psychotherapies are interpersonal and social rhythm therapy for bipolar disorder, family focused therapy for bipolar disorder, psychoeducation, cognitive therapy for bipolar disorder, and prodrome detection. Interpersonal and Social Rhythm Therapy (IPSRT developed by Dr Cognitive Therapy (CT is a type of Psychotherapy developed by American Psychiatrist Aaron T In Medicine, a prodrome is an early non-specific Symptom (or set of symptoms indicating the start of a Disease before specific symptoms occur All except psychoeducation and prodrome detection are available as books.

Abnormalities in brain function have been related to feelings of anxiety and lower stress resilience. Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components When faced with a very stressful, negative major life event, such as a failure in an important area, an individual may have his first major depression. Conversely, when an individual accomplishes a major achievement he may experience his first hypomanic or manic episode. This article is an expansion of a section entitled '''Hypomania''' from within the main article Bipolar disorder. Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition Individuals with bipolar disorder tend to experience episode triggers involving either interpersonal or achievement-related life events. An interpersonal relationship is a relatively long-term association between two or more people An example of interpersonal-life events include falling in love or, conversely, the death of a close friend. "Falling in love" is a mainly Western term used to describe the process of moving from a feeling of neutrality towards someone to one of Love. Achievement-related life events include acceptance into an elite graduate school or by contrast, being fired from work (Miklowitz & Goldstein, 1997). A graduate school or ("grad school" is a school that awards advanced degrees such as doctoral degrees with the general requirement that students must have earned Childbirth can also trigger a postpartum psychosis for bipolar women, which can lead in the worst cases to infanticide. Childbirth (also called labour, birth, partus or parturition) is the culmination of a Human Pregnancy or Infanticide is the practice of someone intentionally causing the death of an Infant.

The "kindling" theory asserts that people who are genetically predisposed toward bipolar disorder can experience a series of stressful events,^[59] each of which lowers the threshold at which mood changes occur. Eventually, a mood episode can start (and become recurrent) by itself. There is evidence of hypothalamic-pituitary-adrenal axis (HPA axis) abnormalities in bipolar disorder due to stress. The hypothalamic-pituitary-adrenal axis ( HPA or HTPA axis) also known as the Limbic -hypothalamic-pituitary-adrenal axis (LHPA axis is a complex set of direct influences ^[60] Some individuals experience subsequent mood episodes in the absence of positive or negative life events, however, which can be especially debilitating.

Individuals with late-adolescent/early adult onset of the disorder will very likely have experienced childhood anxiety and depression. For the 2008 British film by Noel Clarke see Adulthood (film. Child article read through the various talk pages for the debate -- it's been put on and removed twice Some argue that childhood-onset bipolar disorder should be treated when it occurs to prevent the full development of the disorder.

A family history of bipolar spectrum disorders can impart a genetic predisposition towards developing a bipolar spectrum disorder. In Medicine, a family history consists of information about disorders that a patient's direct blood relatives have suffered from The Bipolar spectrum refers to a category of Mood disorders that feature abnormally elevated mood ^[61] Since bipolar disorders are polygenic (involving many genes), there are apt to be many unipolar and bipolar disordered individuals in the same family pedigree. Inheritance of quantitative traits or polygenic inheritance refers to the inheritance of a phenotypic characteristic that varies in degree and can be attributed to This is very often the case (Barondes, 1998). Anxiety disorders, clinical depression, eating disorders, premenstrual dysphoric disorder, postpartum depression, postpartum psychosis schizoaffective disorder and/or schizophrenia may be part of the patient's family history and reflects a term called "genetic loading". Anxiety disorder is a blanket term covering several different forms of abnormal pathological anxieties Fears and Phobias In clinical usage "fear" An eating disorder is a compulsion to eat or avoid eating that negatively affects both one's physical and mental health Premenstrual dysphoric disorder (PMDD is a severe form of Premenstrual syndrome, afflicting 3% to 8% of women Schizoaffective disorder is a Psychiatric Diagnosis of neurobiological illness. Schizophrenia ( from the Greek roots schizein (σχίζειν "to split" and phrēn

Bipolar disorder is not either environmental or physiological, it is multifactorial; that is, many genes and environmental factors conspire to create the disorder (Johnson & Leahy, 2004). In Epidemiology, environmental factors are those determinants of disease that are not transmitted genetically.

Since bipolar disorder is so heterogeneous, it is likely that people experience different pathways towards the illness (Miklowitz & Goldstein, 1997). Heterogeneous is an adjective used to describe an object or system consisting of multiple items having a large number of structural variations

For example, recent research done in Japan hypothesizes that dysfunctional mitochondria in the brain may play a role (Stork & Renshaw, 2005). In Cell biology, a mitochondrion (plural mitochondria) is a membrane-enclosed Organelle found in most eukaryotic cells.

Heritability or inheritance

The disorder runs in families. ^[62] More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression.

Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. Scientists are continuing their search for these genes, using advanced genetic analytic methods and large samples of families affected by the illness. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process.

Genetic research

There is increasing evidence for a genetic component in the causation of bipolar disorder, provided by a number of twin studies and gene linkage studies. Twin studies are one of a family of designs in Behavior genetics which aid the study of individual differences by highlighting the role of environmental and genetic Genetic linkage occurs when particular genetic loci or Alleles for genes are inherited jointly

The monozygotic concordance rate for the disorder is 70%. Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. For other uses see Concordance. Concordance as used in Genetics usually means the presence of the same trait in both This means that if a person has the disorder, an identical twin has a 70% likelihood of having the disorder as well. Dizygotic twins have a 23% concordance rate. Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. These concordance rates are not universally replicated in the literature; recent studies have shown rates of around 40% for monozygotic and less than 10% for dizygotic twins (see Kieseppa, 2004 and Cardno, 1999). ^[63][64]

In 2003, a group of American and Canadian researchers published a paper that used gene linkage techniques to identify a mutation in the GRK3 gene as a possible cause of up to 10% of cases of bipolar disorder. Genetic linkage occurs when particular genetic loci or Alleles for genes are inherited jointly In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism Adrenergic beta receptor kinase 2, also known as ADRBK2, is a human Gene. This gene is associated with a kinase enzyme called G protein receptor kinase 3, which appears to be involved in dopamine metabolism, and may provide a possible target for new drugs for bipolar disorder. In Chemistry and Biochemistry, a kinase, alternatively known as a phosphotransferase, is a type of Enzyme that transfers Phosphate Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. ^[65]

A 2007 gene-linkage study by an international team coordinated by the NIMH has identified a number of genes as likely to be involved in the etiology of bipolar disorder, suggesting that bipolar disorder may be a polygenic disease. Inheritance of quantitative traits or polygenic inheritance refers to the inheritance of a phenotypic characteristic that varies in degree and can be attributed to The researchers at NIMH have found a correlation between DGKH (diacylglycerol kinase eta) and bipolar disorder. The portion of the genome that encodes DGKH, a key protein in the lithium-sensitive phosphatidyl inositol pathway. ^[66]

Treatment

Main article: Treatment of bipolar disorder

Bipolar disorder cannot be cured; instead, the emphasis of treatment is on effective management of acute episodes and prevention of further episodes by use of pharmacological and psychotherapeutic techniques. This article is an expansion of a section entitled '''Treatment''' from within the main article Bipolar disorder The emphasis Pharmacology (from Greek grc φάρμακον pharmakon, "drug" and grc -λογία -logia) is the study of how Drugs Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living

Hospitalization may occur, especially with manic episodes. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Involuntary commitment is the practice of using legal means or forms as part of a Mental health law to commit a person to a Mental hospital, Insane asylum Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur. Deinstitutionalisation (from de-institution-alisation is the process of replacing long-stay mental institutions with less isolated Community mental health services ^[67] 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 team, supported employment and patient-led support groups. Assertive community treatment, or ACT, is a highly intensive and integrated approach for community mental health service delivery ^[68]

Medication

The mainstay of treatment is a mood stabilizer medication; these comprise several unrelated compounds which have been shown to be effective in preventing relapses of manic, or in the one case, depressive episodes. The first known and "gold standard" mood stabilizer is lithium,^[69] while almost as widely used is sodium valproate,^[70] originally used as an anticonvulsant. Lithium in pharmacology refers to use of the Lithium Ion, Li+ as a drug See also Valproic acid Sodium valproate ( INN) or valproate sodium ( USAN) is the sodium salt of Valproic acid and is an The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic Other anticonvulsants used in bipolar disorder include carbamazepine, reportedly more effective in rapid cycling bipolar disorder, and lamotrigine, which is the first anticonvulsant shown to be of benefit in bipolar depression. Carbamazepine ("CBZ" is an Anticonvulsant and mood stabilizing drug used primarily in the treatment of Epilepsy and Bipolar disorder Lamotrigine (marketed as Lamictal (ləˈmɪktəl by GlaxoSmithKline, called Lamictin in South Africa, he למוג'ין ( Lamogine ^[71]

Treatment of the agitation in acute manic episodes has often required the use of antipsychotic medications, such as Quetiapine, Olanzapine and Chlorpromazine. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Quetiapine ( kwe-TYE-a-peen marketed by AstraZeneca as Seroquel and by Orion Pharma as Ketipinor, is an Atypical antipsychotic Olanzapine ( Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, or in combination with Fluoxetine Symbyax) is Chlorpromazine (as chlorpromazine Hydrochloride, abbreviated CPZ, marketed in the US as Thorazine) is a Phenothiazine Antipsychotic More recently, Olanzapine and Quetiapine have been approved as effective monotherapy for the maintenance of bipolar disorder. ^[72] A head-to-head randomized control trial in 2005 has also shown olanzapine monotherapy to be as effective and safe as lithium in prophylaxis. Prophylaxis ( Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or Public health procedure whose purpose ^[73]

The use of antidepressants in bipolar disorder has been debated, with some studies reporting a worse outcome with their use triggering manic, hypomanic or mixed episodes, especially if no mood stabiliser is used. However, most mood stabilizers are of limited effectiveness in depressive episodes.

Research

Main article: Bipolar disorders research

The following studies are ongoing, and are recruiting volunteers:

The Maudsley Bipolar Twin Study, based at the Institute of Psychiatry in London is conducting research about the genetic basis of bipolar disorder using twin methodology. Bipolar disorder research Heritability or inheritance of the illness More than two-thirds of people with bipolar disorder have at least one close relative with the disorder The Institute of Psychiatry (IOP is a research institution dedicated to discovering what causes Mental illness and diseases of the Brain. London ( ˈlʌndən is the capital and largest urban area in the United Kingdom. Currently recruiting volunteers: identical and non-identical twins pairs, where either one or both twins has a diagnosis of bipolar I or II.

The Maudsley Bipolar eMonitoring Project, another research study based at the Institute of Psychiatry in London, is conducting novel research on electronic monitoring methodologies (electronic mood diaries and actigraphy) for tracking bipolar symptom fluctuations in Bipolar individuals who are interested in self-managing their condition. The Institute of Psychiatry (IOP is a research institution dedicated to discovering what causes Mental illness and diseases of the Brain. London ( ˈlʌndən is the capital and largest urban area in the United Kingdom. Actigraphy is a relatively Non-invasive method of monitoring human rest/activity cycles The study is currently recruiting volunteers from all over the world (see Remote eMonitoring)

Medical imaging

Researchers are using advanced brain imaging techniques to examine brain function and structure in people with bipolar disorder, particularly using the functional MRI and positron emission tomography. Functional MRI or functional Magnetic Resonance Imaging (fMRI is a type of specialized MRI scan Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the An important area of neuroimaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/ Pharmacology of the Brain Neurons (ˈnjuːɹɒn also known as neurones and nerve cells) are responsive cells in the Nervous system that process and transmit information The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders, and studies have found anatomical differences in areas such as the amygdala,^[74] prefrontal cortex^[75] and hippocampus. Anatomy (from the Greek anatomia, from ana separate apart from and temnein, to cut up cut open is a branch of Biology that is the consideration The la amygdalae ( Latin, also la corpus amygdaloideum, singular la amygdala, from Greek el αμυγδαλή grc-Latn amygdalē, 'almond' The hippocampus is a part of the Forebrain, located in the medial Temporal lobe.

Better understanding of the neural circuits involved in regulating mood states, and genetic factors such as the cadherin gene FAT linked to bipolar disorder,^[76] may influence the development of new and better treatments, and may ultimately aid in early diagnosis and even a cure. In Neuroscience, a neural network describes a population of physically interconnected Neurons or a group of disparate neurons whose inputs or signalling targets define Cadherins are a class of type-1 Transmembrane proteins They play important roles in Cell adhesion, ensuring that cells within tissues are bound together

New treatments

In late 2003, researchers at McLean Hospital found tentative evidence of improvements in mood during echo-planar magnetic resonance spectroscopic imaging (EP-MRSI), and attempts are being made to develop this into a form which can be evaluated as a possible treatment. McLean Hospital (pronounced 'Mc-Lane' is a Psychiatric hospital in Belmont, Massachusetts. ^[77][78]

NIMH has initiated a large-scale study at 20 sites across the United States to determine the most effective treatment strategies for people with bipolar disorder. The United States of America —commonly referred to as the This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5–8 years. For more information, visit the Clinical Trials page of the NIMH Web site. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices ^[79]

Transcranial magnetic stimulation is another fairly new technique being studied. Transcranial magnetic stimulation ( TMS) is a noninvasive method to excite neurons in the Brain: weak Electric currents are induced in the tissue by rapidly

Pharmaceutical research in the United States is extensive and ongoing, as seen at clinicaltrials.gov.

Prognosis

A good prognosis results from good treatment, which, in turn, results from an accurate diagnosis. Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the Diagnosis is the identification by Process of elimination, of the nature of anything Because bipolar disorder continues to have a high rate of both under-diagnosis and misdiagnosis, it is often difficult for individuals with the condition to receive timely and competent treatment. Medical Error is an inaccurate or incomplete diagnosis and/or Treatment of a Disease; Injury; Syndrome;

Bipolar disorder can be a severely disabling medical condition. However, with appropriate treatment, many individuals with bipolar disorder can live full and satisfying lives. Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes.

Ultimately one's prognosis depends on many factors, which are, in fact, under the individual's control: the right medicines; the right dose of each; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive and warm therapist; a supportive family or significant other; and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times.

There are obviously other factors that lead to a good prognosis as well, such as being very aware of small changes in one's energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one's doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can assist them in predicting changes. ^[80]

Recurrence

Even when on medication, some people may still experience weaker episodes, or have a complete manic or depressive episode. In fact, a recent study found bipolar disorder to be "characterized by a low rate of recovery, a high rate of recurrence, and poor interepisodic functioning. " Worse, the study confirmed the seriousness of the disorder as "the standardized all-cause mortality ratio among patients with BD is increased approximately 2-fold. " Bipolar disorder is currently regarded "as possibly the most costly category of mental disorders in the United States. "^[81]

The following behaviors can lead to depressive or manic recurrence:

• Discontinuing or lowering one's dose of medication, without consulting one's physician. Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease
• Being under- or over-medicated. Generally, taking a lower dosage of a mood stabilizer can lead to relapse into mania. This article refers to the medication For other uses see Stabilizer. Taking a lower dosage of an antidepressant, may cause the patient to relapse into depression, while higher doses can cause destabilization into mixed-states or mania. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression
• An inconsistent sleep schedule can destabilize the illness. Sleep is a Natural state of bodily rest observed throughout the animal kingdom Too much sleep (possibly caused by medication) can lead to depression, while too little sleep can lead to mixed states or mania.
• Caffeine can cause destabilization of mood toward irritability, dysphoria, and mania. Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic Dysphoria (from Greek δύσφορος (dysphoros from δυσ- difficult and φέρω to bear is generally characterized as an unpleasant or uncomfortable mood such as sadness Anecdotal evidence seems to suggest that lower dosages of caffeine can have effects ranging from anti-depressant to mania-inducing. Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition
• Inadequate stress management and poor lifestyle choices. Stress management encompasses techniques intended to equip a person with effective coping mechanisms for dealing with psychological stress, with stress defined as a person's If unmedicated, excessive stress can cause the individual to relapse. Medication raises the stress threshold somewhat, but too much stress still causes relapse.
• Often bipolar individuals are subject to self-medication, the most common drugs being alcohol, and marijuana. Self-medication is the use of drugs, sometimes illicit to treat a perceived or real malady often of a psychological nature In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon Cannabis, also known as marijuana or marihuana, or ganja (from Hindi / Sanskrit: गांजा gānjā hemp) is a Sometimes they may also turn to hard drugs, which can cause the condition to worsen. Hard and soft drugs are loose categories of non-prescription Psychoactive drugs This distinction is used in both official and casual discourse Studies show that tobacco smoking induces a calming effect on most bipolar people, and a very high percentage suffering from the disorder smoke. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. ^[82]

Recurrence can be managed by the sufferer with the help of a close friend, based on the occurrence of idiosyncratic prodromal events. ^[83] This theorizes that a close friend could notice which moods, activities, behaviours, thinking processes, or thoughts typically occur at the outset of bipolar episodes. They can then take planned steps to slow or reverse the onset of illness, or take action to prevent the episode from being damaging. ^[84] These sensitivity triggers show some similarity to traits of a highly sensitive person. A highly sensitive person (HSP is a person having the innate trait of high sensitivity (or innate sensitiveness as Carl Gustav Jung originally coined it

Mortality

"Mortality studies have documented an increase in all-cause mortality in patients with BD. A newly established and rapidly growing database indicates that mortality due to chronic medical disorders (eg, cardiovascular disease) is the single largest cause of premature and excess deaths in BD. The standardized mortality ratio from suicide in BD is estimated to be approximately 18 to 25, further emphasizing the lethality of the disorder. The standardized mortality ratio or SMR in Epidemiology is the ratio of observed deaths to expected deaths according to a specific Health outcome in a "^[85]

Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate in males and females with diagnosed bipolar disorder (0. 4%) is 10 to more than 20 times that in the general population. ^[86]

Individuals with bipolar disorder may become suicidal, especially during mixed states such as dysphoric mania and agitated depression. A suicide crisis, suicidal crisis, or potential suicide, is a situation in which a person is attempting to kill him or herself or is seriously contemplating This article is an expansion of a section entitled '''Mixed state''' from the main article Bipolar disorder In the context of Mental Dysphoria (from Greek δύσφορος (dysphoros from δυσ- difficult and φέρω to bear is generally characterized as an unpleasant or uncomfortable mood such as sadness Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition This article is an expansion of a section entitled '''Mixed state''' from the main article Bipolar disorder In the context of Mental ^[87] Persons suffering from Bipolar II have high rates of suicide compared to persons suffering from other mental health conditions, including Major Depression. Major Depressive episodes are part of the Bipolar II experience, and there is evidence that sufferers of this disorder spend proportionally much more of their life in the depressive phase of the illness than their counterparts with Bipolar I Disorder (Akiskal & Kessler, 2007).

History

Main article: History of bipolar disorder

Varying moods and energy levels have been a part of the human experience since time immemorial. This article is an expansion of a section entitled '''History of bipolar disorder''' from within the main article Bipolar disorder The words "melancholia" (an old word for depression) and "mania" have their etymologies in Ancient Greek. In the fields of Psychology and Psychiatry, the terms depression or depressed refer to both expected and pathologically chronic or severe Etymology is the study of the History of Words &mdash when they entered a language from what source and how their form and meaning have changed over time The Ancient Greek language is the historical stage in the development of the Hellenic language family spanning the Archaic (c The word melancholia is derived from melas/μελας, meaning "black", and chole/χολη, meaning "bile" or "gall",^[88] indicative of the term’s origins in pre-Hippocratic humoral theories. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca The Humoral Immune Response (HIR is the aspect of immunity that is mediated by secreted Antibodies (as opposed to Cell-mediated immunity which involves Within the humoral theories, mania was viewed as arising from an excess of yellow bile, or a mixture of black and yellow bile. Erich Adickes, Eduard Spränger, Ernst Kretschmer, and Erich Fromm all theorized on the four temperaments (with different names and greatly The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the Roman physician Caelius Aurelianus, including the Greek word ‘ania’, meaning to produce great mental anguish, and ‘manos’, meaning relaxed or loose, which would contextually approximate to an excessive relaxing of the mind or soul (Angst and Marneros 2001). Ancient Rome was a Civilization that grew out of a small agricultural community founded on the Italian Peninsula as early as the 10th century BC Caelius Aurelianus ( fl 5th century CE was a Roman Physician and writer on medical topics of Sicca in Numidia There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic poetry and mythologies (Angst and Marneros 2001). The word mythology (from the Greek grc μυθολογία mythología, meaning "a story-telling a legendary lore"

The idea of a relationship between mania and melancholia can be traced back to at least the 2nd century AD. Soranus of Ephesus (98–177 AD) described mania and melancholia as distinct diseases with separate etiologies;^[89] however, he acknowledged that “many others consider melancholia a form of the disease of mania” (Cited in Mondimore 2005 p. Soranus, Greek Physician, born at Ephesus, lived during the reigns of Trajan and Hadrian (AD 98-138 Etiology (alternatively aetiology, aitiology) is the study of causation. 49).

A clear understanding of bipolar disorder as a mental illness was recognized by early Chinese authors. The encyclopedist Gao Lian (c. 1583) describes the malady in his Eight Treatises on the Nurturing of Life (Ts'un-sheng pa-chien). ^[90]

The earliest written descriptions of a relationship between mania and melancholia are attributed to Aretaeus of Cappadocia. Aretaeus ( is one of the most celebrated of the ancient Greek Physicians of whose life however few particulars are known Aretaeus was an eclectic medical philosopher who lived in Alexandria somewhere between 30 and 150 AD (Roccatagliata 1986; Akiskal 1996). Eclectic medicine was a branch of American medicine which made use of botanical remedies along with other substances and physical therapy practices popular in the latter half Alexandria ( Egyptian Arabic: اسكندريه Eskendereyya; Standard Arabic: ar الإسكندرية Al-Iskandariyya; Ἀλεξάνδρεια Aretaeus is recognized as having authored most of the surviving texts referring to a unified concept of manic-depressive illness, viewing both melancholia and mania as having a common origin in ‘black bile’ (Akiskal 1996; Marneros 2001).

Avicenna, a Persian physician and psychological thinker who wrote The Canon of Medicine in 1025, identified bipolar disorder as a manic depressive psychosis, which he clearly distinguished from other forms of madness (Junun) such as as mania, rabies, and schizophrenia (Junun Mufrit or severe madness). TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born The Canon of Medicine ( Arabic: القانون في الطب Al-Qanun fi al-Tibb " The Law of Medicine " Persian Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition Rabies (from rabies “madness rage fury” Also known as “ hydrophobia ” is a viral Zoonotic neuroinvasive disease that Schizophrenia ( from the Greek roots schizein (σχίζειν "to split" and phrēn ^[91]

The basis of the current conceptualisation of manic-depressive illness can be traced back to the 1850s; on January 31, 1854, Jules Baillarger described to the French Imperial Academy of Medicine a biphasic mental illness causing recurrent oscillations between mania and depression, which he termed folie à double forme (‘dual-form insanity’). Events 1504 - France cedes Naples to Aragon. 1606 - Gunpowder Plot: Guy Fawkes Year 1854 ( MDCCCLIV) was a Common year starting on Sunday (link will display the full calendar of the Gregorian Calendar (or a Common year Jules Baillarger, full name Jules Gabriel François Baillarger ( March 26, 1809 - December 31, 1890) was a French Neurologist Académie Nationale de Médecine, or National Academy of Medicine was created in 1820 by king Louis XVIII at the urging of baron Antoine Portal. Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as Two weeks later, on February 14, 1854, Jean-Pierre Falret presented a description to the Academy on what was essentially the same disorder, and designated folie circulaire (‘circular insanity’) by him. Events 842 - Charles the Bald and Louis the German swear the Oaths of Strasbourg in the French and German Year 1854 ( MDCCCLIV) was a Common year starting on Sunday (link will display the full calendar of the Gregorian Calendar (or a Common year Jean-Pierre Falret ( April 26, 1794 - October 28, 1870) was a French Psychiatrist who was born in Marseille. Traditionally insanity or madness is the behaviour whereby a person flouts societal norms and may become a danger to himself and others (Sedler 1983) The two bitterly disputed as to who had been the first to conceptualise the condition.

These concepts were developed by the German psychiatrist Emil Kraepelin (1856–1926), who categorized and studied the natural course of untreated bipolar patients. A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders Emil Kraepelin ( February 15, 1856 – October 7, 1926) was a German Psychiatrist. He coined the term manic depressive psychosis, after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally. Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic ^[92]

After World War II, Dr. World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including John Cade, an Australian psychiatrist, was investigating the effects of various compounds on veteran patients with manic depressive psychosis. This article is about the Australian psychiatrist For the leader of the Kent Rebellion see Jack Cade. A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders In 1949, Cade discovered that lithium carbonate could be used as a successful treatment of manic depressive psychosis. Lithium carbonate is a Chemical compound with the formula Li2CO3 ^[93] Because there was a fear that table salt substitutes could lead to toxicity or death, Cade's findings did not immediately lead to treatments. In the 1950s, U. S. hospitals began experimenting with lithium on their patients. By the mid-'60s, reports started appearing in the medical literature regarding lithium's effectiveness. The U. S. Food and Drug Administration did not approve of lithium's use until 1970. ^[94]

The term "manic-depressive reaction" appeared in the first American Psychiatric Association Diagnostic Manual in 1952, influenced by the legacy of Adolf Meyer who had introduced the paradigm illness as a reaction of biogenetic factors to psychological and social influences. The American Psychiatric Association (APA is the main Professional organization of Psychiatrists and trainee psychiatrists in the United States, and the Adolf Meyer, MD LLD ( September 13 1866 in Niederwenigen, near Zurich Switzerland - March 17 1950) was a Swiss ^[95] Subclassification of bipolar disorder was first proposed by German psychiatrist Karl Leonhard in 1957; he was also the first to introduce the terms bipolar (for those with mania) and unipolar (for those with depressive episodes only). Karl Leonhard (born March 21, 1904 in Edelsfeld, Bavaria, Germany; died April 23, 1988 in East Berlin ^[96]

In 1968, both the newly revised classification systems ICD-8 and DSM-II termed the condition "manic-depressive illness" as biological thinking came to the fore. ^[97]

The current nosology, bipolar disorder, became popular only recently, and some individuals prefer the older term because it provides a better description of a continually changing multi-dimensional illness. Nosology (from the Greek νόσος, nosos, "disease" + λόγος " Logos " is a branch of Medicine

Sociological and cultural aspects

Cultural references

See also: List of people affected by bipolar disorder

Kay Redfield Jamison is a clinical psychologist and Professor of Psychiatry at the Johns Hopkins University School of Medicine, who profiled her own bipolar disorder in her 1995 memoir An Unquiet Mind and argued for a connection between bipolar disorder and artistic creativity in her 1993 book, Touched with Fire. This is a list of people accompanied by verifiable source citations associating them Kay Redfield Jamison (born June 22, 1946) is an American clinical psychologist and writer who is one of the foremost experts on Bipolar disorder Year 1995 ( MCMXCV) was a Common year starting on Sunday. Events of 1995 Kay Redfield Jamison (born June 22, 1946) is an American clinical psychologist and writer who is one of the foremost experts on Bipolar disorder Year 1993 ( MCMXCIII) was a Common year starting on Friday (link will display full 1993 Gregorian calendar) Touched with Fire Manic-Depressive Illness and the Artistic Temperament is a Book by the American Psychologist Kay Redfield Jamison that examines

Several films have portrayed characters with traits strongly suggestive of the diagnosis which have been the subject of discussion by psychiatrists and film experts alike. The 1993 film Mr. Jones is a notable example, with Richard Gere playing a person who swings from a manic episode into a depressive phase and back again, spending time in a psychiatric hospital and displaying many of the features of the syndrome. Mr Jones is a 1993 romantic Drama film starring Richard Gere, Lena Olin, Delroy Lindo and Anne Bancroft Richard Tiffany Gere (born August 31, 1949) is a Golden Globe - and Screen Actors Guild Award -winning American Actor. ^[98] Allie Fox, the character played by Harrison Ford in the 1992 movie The Mosquito Coast, displays some features including recklessness, grandiosity, increased goal-directed activity and mood lability, as well as some paranoia. Harrison Ford (born July 13, 1942) is an Academy Award - and BAFTA -nominated as well as Golden Globe -winning American The article is about the novel and film For the Central American area see Mosquito Coast. ^[99]

References

Cited texts

• Goodwin FK, Jamison KR (1990). Manic-Depressive Illness. New York: Oxford University Press. ISBN 0-19-503934-3.  

Further reading

Contemporary first-person accounts on this subject include

• Jamison, Kay Redfield. 1995. An Unquiet Mind: A Memoir of Moods and Madness. New York: Knopf. ISBN 0-330-34651-2.
• Simon, Lizzie. 2002. Detour: My Bipolar Road Trip in 4-D. New York: Simon and Schuster. ISBN 0-7434-4659-3.
• Behrman, Andy. 2002. Electroboy: A Memoir of Mania. New York: Random House, 2002. ISBN 0-375-50358-7.

For a practical guide to living with bipolar disorder from the perspective of the sufferer, see

• Kelly, Madeleine Bipolar and the Art of Roller-coaster Riding. Strathbogie: Two Trees Media 2005 ISBN 0-646-44939-7

For a critique of genetic explanations of bipolar disorder, see

• Joseph, J. 2006. The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes. New York: Algora.

For readings regarding bipolar disorder in children, see:

• Raeburn, Paul. 2004. Acquainted with the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children.
• Earley, Pete. Crazy. 2006. New York: G. P. Putnam's Sons. ISBN 0-399-15313-6. A father's account of his son's bipolar disorder.
• About Pediatric Bipolar Disorder: www. bpkids. org/site/PageServer?pagename=lrn_about
• The Child and Adolescent Bipolar Foundation: www. bpkids. org
• Time Magazine checklist for childhood/adolescent bipolarity: www. time. com/time/covers/1101020819/worksheet/
• A Model IEP for a bipolar child's medication that works correctly: http://www.bipolarchild.com/iep.html

Classic works on this subject include

• Kraepelin, Emil. Emil Kraepelin ( February 15, 1856 – October 7, 1926) was a German Psychiatrist. 1921. Manic-depressive Insanity and Paranoia ISBN 0-405-07441-7 (English translation of the original German from the earlier eighth edition of Kraepelin's textbook — now outdated, but a work of major historical importance).
• Touched With Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (The Free Press: Macmillian, Inc. , New York, 1993) 1996 reprint: ISBN 0-684-83183-X
• Mind Over Mood: Cognitive Treatment Therapy Manual for Clients by Christine Padesky, Dennis Greenberger. ISBN 0-89862-128-3

External links

• Bipolar Disorder at the Open Directory Project

The Open Directory Project ( ODP) also known as dmoz (from directory

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