There is more than one type of bipolar disorder. The following definition covers what is called Bipolar I and Bipolar II. Bipolar I is characterized by a manic episode after a depressive phase. Bipolar II is characterized by depressive episodes that alternate with hypomanias (mild).

A three consecutive generation family history of mood disorders is significant. There is strong evidence of a genetic influence.

Bipolar I - In a full-blown manic episode some behaviors demonstrated include:

• Elation, but hostility may be present

• Colorful, flamboyant dressing

• Unstoppable, rapid speech

• Racing thoughts (flight of ideas)

• Interpersonal friction which may lead to paranoid delusions

• Decreased sleep requirements

• Frenzied activity.

Bipolar II (mixed states) - A blend of hypomanic and depressive manifestations including some of the following behaviors:

• Switching to tears during mania

• Dysphoric mania (depressed symptoms superimposed on manic behavior)

• Thoughts of suicide

• Delusions and hallucinations

• Shortened sleep cycles

• Restlessness.

Diagnostic Criteria for Bipolar I: (single manic episode)

• Presence of only one manic episode and no past major depressive episodes (if there is recurrence, there has been an interval of at least 2 months without manic symptoms).

• The mania episode is not better classified in schizophrenic disorders. The five specifiers for Bipolar I disorders criteria that are used to indicate the most recent episode are as follows:

  • Most Recent Episode Hypomanic

  • Most Recent Episode Manic

  • Most Recent Episode Mixed

  • Most Recent Episode Depressed

  • Most Recent Episode Unspecified.

• In each Episode criteria, the consistent common themes are as follows:

  • The symptoms cause significant distress.

  • The mood episodes are not better accounted for in a schizoaffective disorder.

  • The mood symptoms are not due to the effects of substance or a general medical condition.

• Before any medication treatment is used, baseline tests of a complete blood count (CBC) urinalysis (UA), thyroid-stimulating hormone (TSH), serum electrolytes, blood urea nitrogen (BUN), and creatinine are usually done.

Diagnostic criteria for Bipolar II:

• Presence or history of one or more major depressive episodes

• Presence or history of at least one hypomanic (mild mania) episode

• There has never been a manic episode or a mixed(manic and depressive) episode

• The mood symptoms are not better accounted for by a schizoaffective disorder

• The symptoms cause significant distress in functioning.

If a patient presents with euphoric mania it can be an emergency, and may need in-patient treatment. After laboratory tests are performed (see above under Tests), Lithium is usually prescribed. This usually works best in uncomplicated euphoric mania. It may take ten days to attain an appropriate blood level. When a patient is extremely hyperactive and manic, another anti-psychotic drug is used initially before lithium to control the mania. Lithium's adverse effects include fine tremors, nausea, thirst, polyuria, and polydipsia. However, these effects can be short-lived by either reducing the dosage slightly or giving a slow-release form. An isolated manic episode should be treated for at least 6 months. After two classic bipolar episodes in less than three years, maintenance therapy should be instituted.

Patients families can be crucial in helping to prevent major episodes. Because patients feel that the drugs over-control them, they become non-compliant. Psychotherapy will assist in helping patients cope with their new identity. There is a need for counseling to avoid stimulant drugs and alcohol to prevent a relapse.