Bipolar mood disorder is the second type of mood disorder that we should try to understand. As the name suggests, most frequently, there are two extremes of the mood; the high and the low which may be considered as the signature feature of this terribly devastating illness.
Why I consider this as terrible and devastating? Simple. The one afflicted with the illness does not realise that he or she is ill. The one who observes such a person may be under the impression that this person is a very industrious, self sacrificing, ever-so-ready-to help kind of a person. Therefore to convince someone that they have a problem that needs addressing or to convince a relative, employer or friend that the person needs help can prove to be extremely challenging. Until and unless it reaches a time of critical mass or certain unforeseen circumstances where damage happens, rarely does the person receive appropriate help.
Case 1:
A 40 year old successful business man, Mr A, with six outlets of on-going business presents to the vast majority as a successful and enterprising person. Common public opinion including most of his family members indicates that he is a relentless hardworking individual with keen business acumen and a caring person.
What is NOT known to them is that Mr A is heavily in debt. His debts are about 1 million Ringgit. His interest payout to loan sharks is about RM70,000 every month. He doesn’t sleep at night most of the time. He has resorted to taking alcohol to calm himself down and catch a few hours of rest most nights. He also had an Indonesian mistress who siphons about RM10,000 every month. He also used to bet on football games and his average losses were about RM300 a day. Amidst all these, he is still keen in looking for new business ventures although his financial balances are not on a positive take.
Following treatment for a period of 3 months, he realised that his debts are not making any sense due to the large amount he is paying out every month as interest. He has decided to consolidate his business and settle his debts. Following this move, his interest payout had reduced to about RM8,000. He now has a positive bank balance. He has given up his mistress and has saved himself another RM10,000 and spends more quality time with his family. In therapy he acknowledged for the first time that he realised that his wife had stood by him all these years.
This is just one of those Bipolar patients with a happy ending. For every Bipolar patient detected there are probably a hundred others who are yet to be identified and probably only 10% of these individuals would consider themselves for any kind of help or treatment.
Prevalence and Incidence of Bipolar Disorder
Bipolar Mood disorder was previously known as Manic Depression. It is a condition where there are extremes of moods, such as depression for a period of time followed by a period of euphoria (mania).
Needless to say this type of mood disorder may affect emotions (mood), thoughts, actions and perceptions. The incidence rate may vary from 0.3 to 1.5% in the general population. This type of disorder can be of serious concern as 25-50% of those affected may at some point attempt suicide. Of this group, it is considered that about 11% may actually succeed in the suicide attempt.
Bipolar mood disorder normally may present in individuals as early as 15 – 25 years of age. However, it is not uncommon for it to start at an earlier age and in some cases there has been consideration of childhood ADHD, which may be the first signs of Bipolar Disorder in later life.
Presentation of Bipolar Disorder
Bipolar Disorder: The person involved usually does not recognise the symptoms. There is a sharp boost in their physical and mental activity. This mood disorder is beyond the normal ‘ups’ and ‘down’ that most people go through in their life. The boosted activity may consist of excessive spending, promiscuity and unusual physical activity such as very little need for rest and sleep. They become easily irritable and their libido becomes very high. On the contrasting side for being depressive, they may sleep excessive hours, lack of interest in daily chores/activities and a prevailing type of sadness that cannot be explained.
Different Types of Bipolar
Bipolar I – This is the most common type of Bipolar disorder. There are repeated, alternated episodes of mania and depression. In this type of mania, there is almost a loss of touch in reality during the manic phase. This is the extreme form of mania where even psychosis like presentation may occur in the extreme cases.
Bipolar II – There is a milder version of the mania (known as hypomania) alternating with depression. Hypomania can be easily missed for hyperactive or over generously excitable person. There is no loss of touch with reality.
Cyclothymia – there is a cyclical version of hypomania and less severe type of depression
Rapid cycling Bipolar disorder – Mania and depression alternating episode more than 4 times in a year.
Some Key Symptoms:
Mania: Expansive and or unrealistic ideas. Whilst we always encourage ambitiousness in people, being unrealistic is altogether another factor. Quite often it is this factor that gets them into problem spots.
Thought: There can be racing thoughts and speech, some may not even be related. There can be pressure of speech and long winded explanations instead of simple answers (Mania)
There is high-risk taking behaviour. This is due to them being unrealistically and highly positive of their expectations. There is very little need for sleep and they are rarely tired. A few hours of sleep are sufficient for them. Sexual libido is high and often this results in a very high sexual drive. Some have the risk of promiscuous sexual behaviour or highly sexually provocative.
Depression
Lasting sadness: There can be a sense of unexplained prevailing sadness
Hopelessness or guilt: A prevailing self blame leading to hopelessness and guilt feelings such being responsible for all the negative outcomes real or imaginary.
Loss of pleasure: Normal activities do not bring them pleasure anymore.
Decreased energy: a sense of lethargy and lack of motivation.
Lack of concentration: inability to focus on even simple tasks at hand.
Sleep problems: either excessive sleep or inability to sleep.
Some may even see changes in their food pattern in the form of increased or decreased appetite. It is not uncommon for individuals to have alcohol or drug related problems as a result of this illness.
One does not necessarily need to have all the symptoms as listed under mania and depression to validate this diagnosis. It is considered sufficient to make this diagnosis, if one had three out of the symptoms for mania and five out of the symptoms for depression.
Bipolar illness is common in the intelligent group of people and this makes it difficult to enforce treatment. Most of the time they get away from anything and are capable of talking their way out of problems. Many famous personalities are said to have suffered from this illness such as Beethoven, Napoleon Bonaparte and even actress Catherine Zeta Jones.
Case 2:
A 45 year old housewife with a history of credit card spending spree. Usually buys things needed for the household and therefore the husband does not criticise. However things may be given away due to expiry risk or not being happy with the purchase for one reason or other. Although children were taken care of, the risks were not considered seriously. She would take her 5 year old child into late night shopping claiming that she was busy (she was unemployed) or she may leave the child in the neighbour’s house and forget to pick the child even after several hours.
There was always a reason for her lack of attention. Eventually she started using alcohol and developed a gambling habit to keep up with her spending habits. By the time her husband decided to seek help the situation had become fairly serious. Her debts had increased and she had attempted suicide.
Following treatment for a period of 6 months she recovered partially and was able to see some of her faults. After a year in therapy, she showed sufficient improvement.
Bipolar mood disorder is best addressed early. Support, help and treatment brings about a better prognosis. Long term medication is indicated from the illness worsening and leading to sometime catastrophic outcomes.
Dr. Selva
MBBS, MDCH (UK), DCP (UK), Dip PsychSexual Med (UK), PhD (UK)
