Frequently Asked Questions (FAQs) about Bipolar
Affective Disorder

Edited by Kay McCrary, Ed.D.,
Director, Patient & Family Education
G. Werber Bryan Psychiatric Hospital, Columbia, South Carolina
copyright 1998

What exactly is "Bipolar Affective Disorder"?
Once called "manic depression", bipolar affective disorder is a mental illness, a brain disease, that involves abnormalities in both the brain's anatomy (physical structure, particularly the hippocampus) and brain's physiology (its balance of "messenger chemicals"). People who have this illness experience moodswings that go outside the normal range of moods --"too low" moods (depression), "too high" moods (mania) or both. When moods are seriously imbalanced, judgment can become impaired and the individual is unable to function within normal limits or demands.

Are there different types of Bipolar Affective Disorder? Yes. To name the most common, there's Bipolar I Disorder in which the sufferer has one or more of either Manic Episodes (moods too high) or Mixed Episodes (with rapidly alternating symptoms of both mania and depression), plus usually also has one or more Major Depressive Episodes. In Bipolar II Disorder the ill person has one or more Major Depressive Episodes plus at least one Hypomanic Episodes (the mood is high but may not be high to the point it causes impaired functioning and problems).

How is a diagnosis of Bipolar Affective Disorder made? A physician makes this diagnosis based on the patient's symptoms. Other conditions that might also cause these symptoms will be considered and ruled out. The patient's medical history, including whether there have been previous episodes of mental illness, will be evaluated. Family medical history, particularly of mood disorders, is important information. Blood tests are not routine at present but are being researched as a future aid in diagnosing.

What causes Bipolar Affective Disorder?
There are several different pathways into the set of symptoms given the diagnosis "Bipolar Affective Disorder". Among the explanations indicated by research and generally accepted are the following:

• Genetic abnormalities. Bipolar affective disorder has clearly been shown to run in families. (Genetic abnormalities on chromosomes 18 and 21 are suspected.)

• Chemical imbalance in the brain, particularly related to leaking membranes in the pathways used for delivering messages within the brain.

• A seizure disorder in the brain's frontal cortex. No convulsions occur with frontal cortex seizures because there are no psycho-motor centers located in the frontal cortex. Seizures occurring in this area affect mood and judgment.

Is Bipolar Affective Disorder a rare condition? In the general population, approximately 3 people out of every 200 people have Bipolar Affective Disorder. Bipolar II Disorder occurs less frequently than Bipolar I. Between one and two million Americans suffer from Bipolar Affective Disorder.

WHAT ARE THE SYMPTOMS OF BIPOLAR AFFECTIVE DISORDER?
DEPRESSIVE SYMPTOMS

• Sad mood.
• Loss of energy, fatigue.
• Sleep problems --may sleep too much; may have shallow sleep with frequent awakenings; or may not be able to get much sleep.
• Weight loss or gain without trying.
• Difficulty concentrating, making decisions.
• Physically either very slowed down or anxious and restless.
• Feelings of being helpless, hopeless, guilty, and worthless. Low self-esteem.
• Loss of interest and pleasure in life. No longer enjoys hobbies or usual pleasures.
• Thoughts about suicide or suicide attempts.

MANIC SYMPTOMS

• Grandiose ideas --unrealistic big plans; inflated self-esteem, feeling no limits on spending or what can be accomplished. May feel godlike or act like a celebrity.
• Decreased need for sleep --for example, feels rested after only three hours of sleep.
• Rapid speech. More talkative than usual or is pressured to keep talking.
• Racing thoughts --thoughts runs faster than can be kept up with.
• Easily distracted. Can't stay focused on topic. Jumps from topic to topic.
• Hallucinations --hears voices and/or sees visions that others don't. (These may occur in depression as well.)
• Increase in goal-directed activity (social, sexual, work or school). Starts many new projects, which don't get completed.
• Excessively involved in pleasures that are likely to have painful consequences --for example, buying sprees, sexual fIings, foolish business investments.

Who is more likely to receive this diagnosis? No differences of Bipolar Affective Disorder based on race or ethnicity have been reported by research. Bipolar I Disorder affects men and women equally. Women are three times more likely to experience rapid cycling (manic and depressive stages alternate at least four times a year). Bipolar II Disorder may be more common in women than in men.

How is Bipolar Affective Disorder treated? Ongoing medical treatment is necessary in the vast majority of cases. Regular appointments with a psychiatrist and prescribed medication are usual. Lifestyle adjustments to minimize reoccurrence are necessary. These include

• monitoring moods and symptoms, including becoming aware of cycles and the possible effect of seasons.

• practicing good stress management.

• pacing oneself to avoid over-stimulation and under-stimulation.

• having supportive relationships with family members and friends.

• using hobbies for enrichment and stress relief.

• maintaining a positive outlook and positive "self-talk".

• avoiding alcohol, drugs, caffeine, and stimulants.

Can it be cured? Currently, no; but research offers much hope and is rapidly adding to the necessary body of knowledge about the mechanisms of this disease which will then lead to development of more effective treatments. For a large percentage of people diagnosed to have Bipolar Affective Disorder, the good news is that it can, for the most part, be controlled with medication and lifestyle adjustments.

WHAT RESOURCES ARE AVAILABLE IN THE COMMUNITY TO PEOPLE DEALING WITH BIPOLAR AFFECTIVE DISORDER?

• A network of community mental health centers, providing a full range of psychiatric outpatient services on a sliding fee scale based on ability to pay.
• The National Depressive and Manic-Depressive Association (NDMDA) is specifically for people who have manic depression and their relatives. The NDMDA has 35,000 members and 250 chapters. Its address is 730 North Franklin St., Suite 501, Chicago, IL 606610, phone 1-800-82-NDMDA. One local chapter, "Ups & Downs" (ph. 803-772-0859), meets twice per month in Columbia.
• S.C. SHARE (Self-Help Association Regarding Emotions) is a statewide organization of mental health consumers open to anyone who is currently experiencing, or has formerly experienced, mental illness or emotional problems. Call 1-800-832-8032 for more information.
• The National Alliance for the Mentally Ill of S.C. (NAMI-SC) offers support, education, and advocacy for people who have a mental illness and for their families. Call 1-800-788-5131 for more information.
• The Mental Health Association of S.C. has many local chapters and services. Call 1-800-375-9894 for more information.
• Protection & Advocacy for Individuals with Mental Illness (1-800-922-5225) is an advocacy resource that addresses discrimination in employment and/or housing that occurs as a result of having a mental illness.