The ups and downs of bipolar disorder

Published 5:04 pm Monday, September 5, 2011

The following article will discuss the signs and symptoms of bipolar disorder, more specifically with some of the behaviors that are associated with this mental illness. We will also discuss the current treatment options for patients who suffer with this illness. And finally I will give some pointers if you think you or a loved one has this illness.

Bipolar disorder is both a fascinating and yet one of the most frustrating illnesses to treat. One of the challenges is establishing the diagnosis. Too many times patients are labeled as being bipolar by family and health care professionals. It can take up to 10 years for the diagnosis to be recognized. One of the main reasons is that bipolar patients do not present in a manic state. The majority of them are depressed (up to 90 percent) which clouds the diagnosis. Of course, the key diagnostic feature for bipolar disorder is experiencing a manic episode.

A manic episode is defined as a distinct period where a patient has extreme amounts of energy that does not abate and experiences an elevated mood. This episode has to last at least one week. This euphoria is not caused by drugs. When a patient is acutely manic it is hard to get a word in when talking to them. This is because their mind is racing a hundred miles an hour. In fact when interviewing a manic patient sometimes you have to interrupt them because their thoughts can get sidetracked to a different subject. These patients have no need for sleep. Sometimes they can be up for 10 days and not feel fatigued. Even though manic patients may at times feel this enormous energy serves them.  Unfortunately their ability to function in all realms of their life is significantly impaired. Bipolar patients can be extremely happy or extremely angry while they are manic. Since an acutely manic patient is unpredictable, so is their behavior. A lot of signs and symptoms overlap with other mental illness, thus adding further diagnostic challenges for the psychiatrist.

More common behaviors associated with mania are excessive spending to the point that it puts them in financial ruin. For example, a young man may spend his whole monthly paycheck on a watch before fulfilling any financial obligations. Some patients can have sexual indiscretions that are out of character for the patient and most importantly potentially endangers them. These patients can be extremely impulsive and less commonly can be violent. These behaviors are usually present when the patient is in a manic state. Patients can be psychotic and their ability to be in touch with reality is compromised. When a patient is acutely manic it is imperative that they receive treatment. If not, the patient could end up in jail, in the hospital or die. Suicide is very common with this illness.

One mainstay of treatment for this disorder is medication specifically mood stabilizers like lithium, anticonvulsants, and antipsychotic drugs. Psychotherapy can be helpful, especially to help the patient recognize when they are starting to have a manic episode. However, medications are crucial because the probability of the patient having another manic episode is 90 percent, and with every manic episode the risk increases. An advantage of using lithium is that it has been shown to decrease suicide for these patients. Also, it is still considered the gold standard treatment for this illness.

One professor explained it this way. If you had three divorces, three different jobs, and three different treatment regimens in a three year span you could be bipolar. Another challenging aspect is that some patients like the extreme high while manic. Even though a bipolar patient may feel they are at their most creative and productive while manic. Research reveals patients who are treated are far more productive and most importantly they are able to function.

So what can you do if you feel you or a loved one may be afflicted with this disease? First, recognize that a manic patient requires psychiatric treatment that includes medication intervention. An acute manic patient cannot be talked out of a manic state. Some patients even require involuntary commitment. If a patient has an untreated manic episode, it can last up to three months. One painful decision a loved one has to consider is involuntary commitment. Sometimes this is necessary to keep the patient from hurting themselves or others as a result of the manic episode. If a patient is not in an acute manic state they can seek treatment at a mental health clinic. Here at Beaufort Hospital, we have Tideland Psychiatric Services, Pamlico Psychiatric Services, and Ray Silverthorne Crisis Center. For more information go to and type “bipolar” in the search section of the website.

Dr. Paul Garcia is a psychiatrist and medical director of the Ray G. Silverthorne Crisis Center, Tideland Mental Health Services, Pamlico Psychiatric Service and the Beaufort Hospital Inpatient Psychiatric Center.