If you think that Bipolar Disorder can be classified simply as a condition with extreme highs and lows – you are correct – to a certain extent. The presentation at the 153rd APA meeting (May 2000) by highly respected BP researcher Dr. Hagop Akiskal delved into “The Spectrum of Bipolarity”. Diagnoses within the DSM-IV and ICD-10 criteria for manic depression now expand to include Schneider-positive psychotic forms (often expressed during the manic phases), bipolar mixed states, and rapid-cycling states.
In General
Bipolar disorder type I (BP-I) is defined as those with extremes of mania and depression.
Bipolar disorder type II (BP-II) experience hypomania (not as severe as mania) rather than classic mania.
Bipolar disorder type III (BP-III) is defined as those who were depressed and became hypomanic due to antidepressant medication therapy.
Patients with Bipolar disorder type IV (BP-IV) experience cycles of depression and “hyperthymia”. Hyperthermia differs from hypomania as follows: in hypomania, the person’s high energy level is unlike the “usual” trait of that person. In hyperthymia, the person is being his or her usual cheerful self.
BP I to IV According to Akiskal
* BP-I Extremes of mania and depression
* BP-II Hypomania rather than classic mania
* BP-III Depressed and became hypomanic due to antidepressant medication therapy
* BP-IV Cycles of depression and “hyperthymia”
Not wanting to confuse you more (but I’ll have to), I’ve found yet another set of classification for bipolar disorder:
BP I to VI According to Klerman (1928-1992)
* Type I Mania and Depression
* Type II Hypomania and Depression
* Type III Cyclothymia
* Type IV Hypomania or mania precipitated by medication (particularly antidepressants)
* Type V Depressed patients with Bipolar relatives
* Type VI Mania without Depression
The inclusion of the spectrum of “softer expressions” of mania within the depression diagnoses bumped the prevalence of bipolar disorder from 1% in the U.S. to 5%. Even though I understood what I was reading, I admit to getting confused with the many variations of bipolar disorder. This underscores how important it is for patients to be proactive in communicating their symptoms to their physicians!
It is extremely critical that you make a list of symptoms which do not fall within the “normal” range of activities or behavior before you see the doctor. Don’t lock yourself into a label of a particular type of disorder by self-diagnosing. The majority of diagnoses for mental disorders happen within a primary care setting (general practitioners). This means you are seeing physicians who may not be fully equipped to recognize the subtle variations of a depressive disorder you may be suffering from. Help the physician help you by creating a list of symptoms and communicating this to the physician.
{ 5 comments… read them below or add one }
Hello, The information is great, now that I am understanding what type 3adn 4 is.
I fall into the catergory, triggered by an antidepressent.
Istarted with an injury of my knee from a fall in may 08, then I came depressed because it became worse, and when I went back to work, my boss became poisonous to me, by being consistantly nasty, and attempting to force me to do things I clearly physically unable to do.
Then I saw a Doctor in Oct08 and he didnt like my gait, or my patella, it was a mottled colour and swollen, he noticed I was depressed,he told me to seek a second opinion I saw a knee surgeon had an MRIwhich showed ?srd subluxation of patella.
After this consult I became very depressed because my original knee surgeon said it was fine and I didnt need to see him any more.
When I went to work I became even mor miserable as my boss was consistantly unpleasant to me, but I knew i had to turn up and try my best.
In early Nov08 I went to work, my boss wanted me to work at a work station I couldn’t work at, as it was too high for me( waist high desk)I found it hard as it was at the normal height. My boss then screamed at me are you refusing to work, to which I replied with tears in my eyes that I come to work in good faith, try the best I can, I dont know what more I can do.
My boss went into a flying rage and said it is inconvenient for you to be here today, come back to tomorrow, she stormed off, and the receptionist working behind me came up to my ear and said you heard the lady, you had better leave and now would be a good time.
I felt panicky and unsafe, so I left.Two days later Iwas admitted into a psyscharic Hospital, with severe depression.
Was place on lexapro, discharged 3 days later, became manic, and have been manic ever since although, the severe mania gradually subsided, to mania, then in july I had a severe episode of mania after taking Lovan. was p;aced on epilim and SAEROQUEL, eased them, I felt unwell, i had stone removed from CBD, with dilated bilary tree, filling defect in CBD Today I have mania but it is receeding, taking zyprexia.
WILL THIS MANIA GO AWAY OF ITS OWN ACCORD, ESPECIALLY NOW THAT IT IS MILDER, AND CAN RSD BE WHAT IS CAUSING THE MANIA?
Dear Jenny,
I’m so sorry to hear of your trials and tribulations at work – from what you’d described, it’s a nightmare work environment, and a nightmare boss to work for! It certainly does not help your mental state to deal with this type of workplace.
I’m assuming that you worked with a doctor to get the medication you were prescribed – and I’d definitely ask him about whether RSD may be causing the mania. My personal, non-licensed-medical opinion is that manic episodes may subside on its own, but that is a dangerous gamble you do not want to risk, even if milder – because you don’t know what or how mild symptoms may escalate to moderate or severe symptoms.
I’d work with a doctor who is willing to spend time with you and answer your questions about managing your mania – from what you have described – certain medications may trigger an episode, which means the doctor MUST monitor you carefully whenever you are given a new drug, or increase the dosage of a drug you have been taking.
My thoughts are with you -
Jane
I have been recently diagnosed with Bi-polar type 5. Which is difficult to understand because I do have times in my life where I have felt on top of the world and extremely happy then most recently I have been so depressed I have had thoughts of killing myself. I keep jumping from job to job, sometimes because I have been fired and other times because I have become bored with it. That being said overall even when I am in my extreme highs and lows I have great mood swings throughout the day and sometimes I suffer from severe social anxiety to the point that I have trouble breathing and my heart feels like it is going to explode. Other times during the day I feel so violent I could easily kill someone who upsets me. Is the diagnosis they gave me accurate in your opinion? Also they put me on bi-polar mood stabilizers which do seem to help.
Hi Aaron,
The spectrum may be in transition based on this entry:
http://en.wikipedia.org/wiki/Bipolar_spectrum
the entry cites this medscape reference which goes to I and II but not beyond:
http://www.medscape.org/viewarticle/441617
I think the spectrum warrants more discussion and clarification as well as an update – so I think the best bet is to work with your psychiatrist and physician to find the treatment regimen that gives the most relief for your symptoms.
Best wishes,
Jane
I have generalised anxiety disorder and a couple of months ago was placed on antidepressants to help with the anxiety. In that time I developed the highs and lows of what was diagnosed as bipolar II. However I now question whether it is type III because is caused by medication. I have been put on lithium for the bipolar. I question the doctor alot now. What do you think???
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