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Bipolar Disorder

Symptoms of bipolar dipolar disorder include both mania and depression. And, unlike those experiencing unipolar depression, those in a state of mania typically experience dramatic rises in mood, feeling elation, increased energy, and a decreased need for sleep. Some in the midst of a mania will go days without sleep, working through the night on projects or other endeavors. Their behavior is extremely active, with racing thoughts and rapid and often loud speech. They often exhibit poor judgment and planning, and it is difficult for others to slow them down. This, combined with impulsivity, often creates major problems for the person in the manic state. For example, they may leave their jobs or ruin their business, go on expensive shopping sprees, or make wild investments. They may engage in dangerous substance-related behaviors, or promiscuous sexuality.

Finally, in many cases of mania, the person may become grandiose, with a heightened sense of self-esteem. As the mania (and often sleeplessness) continues, the person may lose touch with reality and exhibit psychotic symptoms, such as hallucinations (false sensory experiences) or delusions (false beliefs). At this point, most will need to go into a hospital for containment and treatment.

Following the mania, a depression usually ensues. The length and depth of each episode greatly varies from person to person.

The Importance And Difficulty Of Early Diagnosis

Bipolar disorder is a complex mood disorder. Patients suffering from the disorder experience episodes of mania, hypomania, major depression and/or mixed moods. Once considered an adult disorder, more recent research and anecdotal reports suggest that the onset of the disease for many may begin in childhood, adolescence, or early adulthood. Unfortunately, evidence is also emerging that the diagnosis of bipolar disorder may be missed or confused for other disorders in many younger patients. In such cases, the young patients may be given medications for ADHD or depression which can trigger symptoms of mania. In addition to inappropriate (or even dangerous) treatment, failure to accurately diagnose bipolar disorder in younger patients can lead to years of misery, feeling misunderstood, school and social difficulties, legal problems, substance abuse, and loss of trust in the mental health profession.

Recent studies of adult bipolar patients suggest that about 60% of them experienced their first symptoms before 18 years of age.

Mental health professionals who specialize in the assessment and treatment of bipolar disorders disagree over the specific symptom clusters that should be diagnosed as bipolar in younger patients. Some suggest that many younger patients previously identified as hyperactive or evidencing behavior of conduct disorder are actually suffering from bipolar disorder. Others are more cautious, warning that longitudinal studies of children diagnosed with ADHD and aggressive behavior suggests that only about 1/3 develops adult bipolar disorder (according to DSM-IV TR criteria). Part of the confusion appears to stem from the fact that bipolar disorder itself varies greatly in its symptom presentation and it also often co-exists with other disorders (like anxiety and ADHD).

There is not an easy solution to this conundrum. Individuals suffering from symptoms of volatile and unstable moods, provocative, impulsive, and/or aggressive behavior, substance and/or computer addiction, and changes in sleeping patterns should seek a formal assessment from a mental health professional familiar with the diagnostic issues described above. One factor that is especially important in such an assessment is an understanding of the individual's family history. Twin and adoption research provide strong evidence of a genetic predisposition for Bipolar I disorder.

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