Bipolar is characterised by high to low mood swings and is also known as manic-depression and bipolar affective disorder. More informally it is often referred to as ‘bipolar’. Gurney (1) describes bipolar as an umbrella term. Mood swings are extremely variable, from a person whose mood changes so rapidly and acutely that they are seriously disabled and compromised by the condition, to a person who has infrequent depression and rare episodes of feeling slightly elated who manages to keep up their normal routine.
It affects 1 in a 100 women and men and often begins in the teenage years. Its cause is unknown but genetics and the mechanics of our brains that control mood are implicated and sources of much research.
The Royal College of Psychiatrists (2) divides the experience of bipolar into emotional, cognitive, physical and behavioural experiences. For example in depression a person may be very slowed up, lose their self-confidence and feel hopeless whereas in mania they may be full of energy, self-importance and elation. Both states require careful risk assessment in relation to treatment options.
The biggest risks for depression are self-neglect, self-harm and suicide and for mania are grandiosity leading to risky, reckless behaviour, vulnerability to exploitation and self-neglect, such as dehydration and malnutrition.
Serious cases may require specialist psychiatric hospitalisation where the person can be nursed in a safer environment.
Hypo-mania and mania are easily recognised but in particularly acute cases can be confused with acute psychosis. The person’s family may recognise that the patient is behaving very oddly and bring it to the attention of the primary care team (PCT).
Treatment options vary according to the person’s current signs and symptoms but with regard to mania, treatment predominantly involves pharmacotherapy. Patients who are depressed should be offered an evidence-based psychological intervention, such as cognitive behavioural therapy