The phenomenon of Bipolar Affective Disorder has been a mystery since the 16th
and 17th century. The Dutch painter Vincent Van Gogh was thought to of suffered from
bipolar disorder. It appears that there are an abundance of people with the disorder yet,
no true causes or cures for the disorder. Clearly the Bipolar disorder severely undermines
their ability to obtain and sustain social and occupational success. However, the journey
for the causes and cures for the Bipolar disorder must continue.
Affective disorders are primarily characterized by depressed mood, elevated
mood or (mania), or alternations of depressed and elevated moods. The classical term is
manic-depressive illness, a newer term is Bipolar disorder. The two are interchangeable.
Milder forms of a depressive syndrome are called dysthymic disorder, mild forms of
mania are hypomania and the milder expressions of Bipolar disorder are called
cyclothymic disorders. The use of the term primary affective disorder refers to the
individuals who had no previous psychiatric disorders or else only episodes of mania or
depression. Secondary affective disorder refers to patients with preexisting psychiatric
illness other than depression or mania (Goodwin, Guze. 1989, p.7 ).
Bipolar affective disorder affects approximately one percent or three million
persons in the United States, afflicting both males and females. Bipolar disorder involves
episodes of mania and depression. The manic episodes are characterized by elevated or
irritable mood, increased energy, decreased need for sleep, poor judgment and insight,
and often reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). These episodes
may alternate with profound depressions characterized by a pervasive sadness, almost
inability to move, hopelessness, and disturbances in appetite, sleep, in concentrations and
Bipolar disorder is diagnosed if an episode of mania occurs whether depression
has been diagnosed or not (Goodwin, Guze, 1989, p 11). Most commonly, individuals
with manic episodes experience a period of depression. Mood is either elated, expansive,
or irritable, hyperactivity, pressure of speech, flight of ideas, inflated self esteem,
decreased need for sleep, distractibility, and excessive involvement in activities with high
potential for painful consequences. Rarest symptoms were periods of loss of all interest
and retardation or agitation (Weisman, 1991).
As the National Depressive and Manic Depressive Association (MDMDA) has
demonstrated, bipolar disorder can create substantial developmental delays, marital and
family disruptions, occupational setbacks, and financial disasters. This devastating
disease causes disruptions of families, loss of jobs and millions of dollars in cost to
society. Many times bipolar patients report that the depressions are longer and increase
in frequency as the individual ages. Many times bipolar in a psychotic state are
misdiagnosed as schizophrenic. Speech patterns help distinguish between the two
disorders (Lish, 1994).
The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years
of age, with a second peak in the mid-forties for women. A typical bipolar patient may
experience eight to ten episodes in their lifetime. However, those who have rapid cycling
may experience more episodes of mania and depression that succeed each other without a
period of remission (DSM III-R).
The three stages of mania begins with hypomania, which patients report that they
are energetic, extroverted and assertive. The hypomania state has let observers to feel
that bipolar patients are "addicted" to their mania. Hypomania progresses into mania as
the transition is marked by loss of judgment. Often, euphoric grandiose characters are
recognized as well as a paranoid or irritable character begins to manifest. The third stage
of mania is evident when the patient experiences delusions with often paranoid themes.
Speech is generally rapid and behavior manifests with hyperactivity and sometimes
When both manic and depressive symptoms occur at the same time it is called a
mixed episode. These people are a special risk because of the combination of
hopelessness, agitation and anxiety make them feel like they "could jump out of their
skin"(Hirschfeld, 1995). Up to 50% of all patients with mania have a mixture of
depressed moods. Patients report feeling very dysphoric, depressed and unhappy yet
exhibit the energy associated with mania. Rapid cycling mania is yet another
presentation of bipolar disorder. Mania may be present with four or more distinct
episodes within a 12 month period. There is now evidence to suggest that sometimes
rapid cycling may be a transient manifestation of the bipolar disorder. This form of the
disease experiences more episodes of mania and depression than bipolar.
Lithium has been the primary treatment of bipolar disorder since its introduction
in the 1960's. It is main function is to stabilize the cycling characteristic of bipolar
disorder. In four controlled studies by F. K. Goodwin