Bipolar disorder is a chronic episodic illness associated with behavioural disturbances. It is characterised by episodes of mania (or hypomania) and depression. Either one can occur first and one may be more dominant than the other but all cases of mania eventually develop depression.
Mania is characterised by elevated mood and increase in quantity and speed of physical and mental activity. Self-important views and ideas are greatly exaggerated. Some patients may be excessively happy, whilst others may be irritable and easily angered.
During the manic phase the following may be present:
In severe cases there may be grandiose delusions (e.g. belief that they are world leaders or monarchs), auditory hallucinations, delusions of persecution and lack of insight. The lack of insight is very dangerous as patients are unable to see the need for them to change their behaviour.
Hypomania is a lesser degree of mania with persistent mild elevation of mood and increased activity and energy but without hallucinations or delusions. There is also no significant effect on functional ability.
In the depressive phase, patients experience low mood with reduced energy. Patients have no joy in daily activities and have negative thoughts. They lack facial expressions and have poor eye contact and may be tearful and unkempt. Low mood is worse in the mornings and is disproportionate to the circumstances. There may be feelings of despair, low self-esteem and guilt for which there may be no clear reason. There may be weight loss, reduced appetite, altered sleep pattern with early morning wakening and loss of libido.