Bipolar Disorder occurs in approximately 1% of the population, that is, about 1 in every 100 will experience an episode that will probably require hospital care. About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life.

MANIC EPISODES

Mania is an extreme mood state of this disorder. It describes an abnormally elevated, euphoric, driven and/or irritable mood state. Hypomania is the term given to the more moderate form of elevated mood. It can be managed often without the need for hospitalization as the person remains in contact with reality. However, it is very easy to move rapidly from hypomania into a manic episode. Symptoms of mania include:

Irritability
Irritability as described in the Oxford dictionary means “quick to anger, touchy.” Many people, when in an elevated mood state, experience a rapid flow of ideas and thoughts. They often find that they are way ahead of other people in their thinking processes, already onto another idea before people around them have grasped the first concept. Because of this rapid thought process,
they become easily angered when people don’t seem to comprehend their ideas or enthusiasm for some new scheme.
Decreased need for sleep
One of the most common symptoms of mania and often an early warning sign is the increased experience of energy and lack of need for sleep. This is often because the rapid flow of thoughts and ideas tends to keep people awake, exploring new schemes and plans.
Rapid flow of ideas
People who are becoming manic experience an increase in the speed at which they think. They move more quickly from one subject to another. Sometimes thoughts can become so rapid that they begin to make no sense, developing into a jumbled, incoherent message that the listener can no longer understand.
Grandiose ideas
It is common for people who are manic to think that they are more talented than others, or have unique gifts. As the person’s mood becomes more elevated, these beliefs can become delusional in nature, with people often believing they are famous people, or that they have been put on this planet for a special purpose (often religious beliefs can become very intense, and take more significance that usual).
Uncharacteristically poor judgement
A person’s ability to make rational decisions can become impaired and they may make inappropriate decisions or decisions that are out of character.
Increased sexual drive
People when they become manic often experience increased libido, and may make less well-judged decisions about the sexual partners.

DEPRESSIVE EPISODES

 Depression is a mood state that is characterized by a significantly lowered mood. Its severity, persistence, duration, and the presence of characteristic symptoms can distinguish a major depressive episode, the other extreme mood state of bipolar disorder, from a milder episode of depression. The most common symptoms of depression include:
Persistent sad, anxious, or empty mood
People often describe depression as an overwhelming feeling of sadness and hopelessness. They may lose the motivation to eat and experience a loss of enjoyment in the activities of everyday life that they used to take a lot of pleasure in.
Poor or disrupted sleep
A person when they are depressed often experience sleep disturbances, and this can be due to increased anxiety. They then find it difficult to fall asleep, or wake up frequently during the night worrying about day-to-day events or wake early in the morning and are unable to get back to sleep.
Feelings of worthlessness or hopelessness
Sometimes people become overwhelmed with a sense of their own inability to be of use to anyone, and can become convinced that they are useless and worthless. Thoughts may revolve around the hopelessness of the situation and the future.
Decreased interest in sex
As the person becomes more depressed, they gradually become less interested in social activities and sex.
Poor concentration
Thinking can become slowed and the person can have difficulty in making decisions. They find it difficult to concentrate on reading a book or on the day to day tasks such as shopping. This can often create anxiety or agitation in a person.
Thoughts of suicide, or suicide attempts
When a person becomes overwhelmed by their feelings of hopelessness and despair, they may have thoughts of ending their lives or make plans to commit suicide.

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

  • talking about feeling suicidal or wanting to die
  • feeling hopeless, that nothing will ever change or get better
  • feeling helpless, that nothing one does makes any difference
  • feeling like a burden to family and friends
  • abusing alcohol or drugs
  • putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
  • writing a suicide note
  • putting oneself in harm’s way, or in situations where there is a danger of being killed


MIXED EPISODES
A mixed episode is characterized by the experience of both depressive and manic symptoms nearly everyday for a period of time. The person experiences rapidly alternating moods, eg, irritability, euphoria, sadness, and there may be insomnia, agitation, hallucinations and delusions, suicidal thoughts, etc.