Symptoms
People with Bipolar Affective disorders alternate between episodes of very high, elated mood (mania or hypomania) and very low mood (depression).
- Both states may cause disordered thinking and impaired judgement.
- Typically these episodes recur throughout life.
- Mood may be normal between episodes, or continuing symptoms of elevated mood or depression of varying degree may persist.
Symptoms of mania include:
- feeling euphoric with increased energy and an acceleration of mental and physical activity.
- The person’s mind races, and becomes full of ideas leading to incoherent and disjointed thinking. This soon leads to confusion, inattention, poor concentration and difficulty with remembering things.
- The person is easily distracted from the activity in hand and becomes irritable, fearful or angry. This can lead to hostile and aggressive behaviour towards family and friends.
People may develop grandiose ideas with an exaggerated view of their own personal identity or the activities in which they engage. They may become very arrogant believing that they are famous or that they have a special relationship with someone who is famous.
The acceleration of mental activity is accompanied by an increase in physical activity and restlessness, and people no longer sleep. They may go on shopping sprees, or talk for hours on the telephone with no consideration of the financial consequences. Behaviour may be dis-inhibited – shouting obscenities, removing their clothes and singing loudly. Strange combinations of brightly coloured clothes may be worn, or the person may be dishevelled and untidy. In addition inappropriate sexual behaviour may occur. In this state people fail to eat and drink; physical exhaustion and dehydration can ensue. Personal hygiene and household cleanliness may also be ignored.
In an acute episode of mania the person may become increasingly deluded believing that others are persecuting them or that thoughts are being put in their heads. Auditory and, less commonly, visual hallucinations may occur. The person may hear voices telling them that they have special powers. Hallucinations may have a religious content.
During an acute episode the person’s insight is usually impaired. They do not appreciate that their behaviour is abnormal and may have adverse consequences for themselves or others. Admission to hospital is usually necessary for their personal safety and to institute treatment with medication.
Less severe forms of mania are known as hypomania. The intensity of the feeling of the euphoria may vary from day to day or during the day. The person with hypomania may be very busy and active, bursting with ideas and full of confidence. However concentration may be impaired and tasks are not completed. The person may be talkative, even vociferous, but quickly become irritable or hostile, especially if challenged by others e.g. family or work colleagues. They will show poor judgement and may make clearly unsuitable or reckless judgements. Hypomania may develop into full-blown mania.
Following a period of mania the person is likely to experience a period of depression. The symptoms of depression are usually severe and include feelings of profound misery, emptiness and worthlessness. The person will be pessimistic, negative, has no pleasure in life and be lethargic and apathetic. Sleep will be disturbed (either an inability to sleep or sometimes excessive sleep), appetite is reduced leading to significant weight loss and constipation may develop. Concentration is markedly reduced and memory impaired. Some people may become agitated and restless, despite fatigue and lack of energy.
The person may also experience delusions about bodily functions; for example they may believe that their illness is a punishment for previous sins.
The person may become preoccupied with thoughts of death and suicide. There is an increased risk of suicide. Suicide attempts may occur around the time when the depression is treated with medication. The person becomes less apathetic and lethargic, and as improvement occurs they embark on a course of action to bring their life to an end.
During a major episode of depression a person may neglect themselves, failing to eat, drink and attend to personal hygiene as a result of apathy and impaired concentration. Insight may be impaired to varying degrees and the person may not acknowledge the illness, the severity of it or the need to have treatment.
Bipolar disorders may co-exist with other mental health disorders such as substance misuse and alcohol dependence.
