In popular psychology, or “street” psychology, bipolar disorder has been defined as a psychology in which people have frequent and uncontrolled mood swings. First they are sad, then happy, then angry, then suddenly calm. But this is not entirely true – bipolar disorder needs to be defined more accurately and in more detail.
There are two forms of bipolar disorder: type I and type II. Type I is characterized by manic or euphoric states, while type II is characterized by hypomanic and major depressive states.
manic and hypomanic states
What is a manic state?
According to the DSM-5, manic episodes are characterized by an excessive or irritable mood that is abnormal and consistently elevated in activation or energy.
For a period of at least one week (or for any period if hospitalizations are very acute), the person spends most of each day in this state with at least 3 additional symptoms (decreased sleep, increased self-esteem or grandiosity, excessive participation in risky activities, etc.). )
The mood of a person in a manic episode is often described as feeling euphoric, overly happy, high, or “on top of the world”. For example, they may spontaneously start a conversation with strangers and their thoughts often flow faster than they can verbalize.
The mood of a person in a manic episode is often described as feeling euphoric, overly happy, high, or “on top of the world”.
Exuberant moods, excessive optimism, grandiosity, lack of judgment can lead to some risky behaviors. These; overspending, giving away one’s possessions, reckless driving, foolish investments, and unusual sex. These behaviors usually result in nothing but economic and social losses for the person.
It can be serious enough to cause significant impairment in social and occupational functions, require hospitalization, or cause psychotic symptoms (delusions, hallucinations, etc.).
What is a hypomanic state?
According to the DSM-5, a hypomanic state is a period of abnormal and persistently elevated, euphoric or irritable mood and an abnormal or sustained increase in activation or energy that lasts for at least four consecutive days.
Compared to a manic episode, a hypomanic episode is not serious enough to cause a serious change in social or occupational functioning, require hospitalization, or cause psychotic symptoms.
Compared to the manic state, the hypomanic state is not serious enough to be hospitalized.
Major depression status
Depression is well known to the public. People use this word colloquially as sadness, melancholy, exhaustion, insomnia, lethargy etc. They use it to express all of their feelings. As we do in manic and hypomanic states, we will now see what criteria are required to be able to diagnose major depression.
The DSM-5 states that at least five of the following symptoms must be present nearly every day and most of the day for at least 2 weeks. In addition, the person must also be experiencing a depressed state or loss of interest or pleasure.
At least 90% of people with depression appear sad or unhappy. It’s important to ask what the best and worst moments of the day are and if there is anything that can help them feel better because these factors are related to those feelings.
Anhedonia (Inability to enjoy)
This means loss of pleasure in daily activities. Nothing makes them feel good, whether it’s going out, visiting family, or watching TV.
Change in appetite and/or weight
Although sometimes this symptom can be difficult to assess, the criteria used to measure it are to see a 5% increase or decrease from our normal weight in a 1-month period.
Insomnia is always considered a symptom of depression, but there is more suspicion about hypersomnia that becomes atypical. There are three different types of insomnia to examine: transient, acute, and chronic. In addition, the patient’s fatigue during the day, whether the sleep state is correctable, how much time spent in bed, etc. It is important that you analyze.
A common criterion for transient insomnia is lasting less than a week. Acute insomnia refers to the time when the patient has not been able to sleep well for less than a month. Chronic insomnia lasts more than a month. There is no set criteria for hypersomnia.
This indicates psychomotor delays and agitation. To be diagnosed, certain behaviors must be clearly visible to others.
Lack or loss of energy
Sometimes patients report a lack of energy, but it’s actually more like a lack of interest.
Excessive self-criticism, feeling guilty, lack of self-worth
It is important to ask the patient to describe themselves and to see this person describe their friends and family.
Difficulty concentrating, thinking, and making decisions
Typically, he will ask the patient if he is able to follow conversations and TV shows and focus on his work.
Recurrent thoughts of suicide or death
Between 60% and 80% of suicides are committed by people diagnosed with depression. Suffering from depression increases the risk of suicide by 30% compared to the general population.
When someone experiences 5 or more of these symptoms, they do not automatically mean they will be diagnosed with major depressive disorder. They must also have a significant degree of psychosocial impairment, and their condition must not be related to a substance or medical condition (such as dementia) or normal reactions to a law.
To diagnose major depression, the person must exhibit a depressed mood or loss of interest or pleasure.
Characteristics of type I bipolar disorder
As we mentioned above, type I bipolar disorder is characterized by the presence of a manic state. There may be hypomanic or major depressive episodes before or after.
During manic episodes, people do not tend to realize that they are sick or need treatment, so they fiercely resist them. They tend to change their clothes, makeup or personal appearance to be more interesting.
Some patients are aggressive and become a purely physical threat. If they are hallucinating, they may physically attack other people or commit suicide. Due to impaired judgment, lack of awareness, and hyperactivity, manic episodes can cause serious disasters.
A person’s mood can quickly turn into anger or depression. During manic episodes, depressive symptoms can occur and last for moments, hours, or more rarely days.
Type I bipolar disorder is characterized by the presence of manic episodes.
Suicide risk in type I bipolar disorder
The DSM-5 estimates that the risk of suicide for patients with type I bipolar disorder is 15 times greater than that of the general population. This explains a quarter of all suicides.
Characteristics of type II bipolar disorder
Type II bipolar disorder is characterized by the presence of a hypomanic episode and a major depressive episode. Manic episodes are specific to type I. People with type II usually go to the doctor during a major depressive episode and rarely complain of symptoms of hypomania. Hypomanic episodes usually do not spontaneously lead to dysfunction.
Type II-related dysfunction is the result of major depressive episodes, a persistent pattern of unpredictable and fluctuating changes in mood and a pattern of unreliable interpersonal or professional relationships. People with bipolar II don’t find their hypomanic episodes to be pathological or negative, but their erratic behavior can bother other people.
A common feature of this disorder is impulsiveness, which can contribute to suicide attempts and substance abuse.
Type II bipolar disorder is characterized by the presence of a hypomanic episode and a major depressive state.
Suicide risk in type II bipolar disorder
The DSM-5 reports that people with type II bipolar disorder have a higher risk of suicide. About one-third of patients with type II bipolar disorder have a history of suicide attempts. Interventions were more lethal for type II patients than for type I.