BIPOLAR AFFECTIVE DISORDER
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Royal Brisbane and Women’s Hospital
Metro North Hospital and Health Service
Inner North Brisbane Mental Health Service
Mental Health Services
BIPOLAR AFFECTIVE DISORDER
What is Bipolar Affective Disorder?
People at different times experience fluctuations in mood in response to events and situations that occur.
However, this is different to the medical condition of bipolar disorder. Bipolar involves the experience of
severe swings in mood that can impact very significantly on life roles, ability to make decisions and social
interactions.
Bipolar Affective Disorder, previously known as ‘manic depression’, is the recurrent experience of episodes
of mood swings (severe changes in mood and behaviour). These mood changes can span from elevated
and irritable (mania or ‘highs’) to sad, hopeless & depressed (‘lows’). Sometimes these changes in mood
are over a matter of days, sometimes more gradually. Therefore the person may have long periods of
settled mood in between. Rapid shifting of mood can be common, for example from anger to elation to
depression. Some people with Bipolar have a mixed affective state, where the symptoms of both mania and
depression occur at the same time. In states of extreme mania or depression, people can also experience
psychotic symptoms, where they may hear voices, have delusions and lose touch with reality for a time.
The frequency and duration of the mood swings, and the intervals between episodes of Bipolar can vary
from individual to individual. Most people with Bipolar will experience more than one episode throughout
their lifetime.
Why learn about Bipolar Affective Disorder?
Having a clear knowledge & understanding of:
The bipolar illness
Treatments and how to better manage the illness
can lead to greater personal control over the illness, thus reducing its impact on quality of life and life roles.
This process of acquiring knowledge and increasing understanding of mental illness and related issues is
referred to as psychoeducation.
How common is Bipolar?
Bipolar is much less common that depression.
1 person in 10 experience major depression
1 to 2 in 100 experience bipolar disorder
3 in 100 experience psychosis
1 in 100 experience schizophrenia
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Bipolar can be diagnosed at any time during or after the teenage years, and affects men and women in
equal numbers. Sometimes bipolar can be difficult to recognise and diagnose, leading to some people
experiencing symptoms for lengthy periods of time before seeking treatment.
What Causes Bipolar Disorder?
While the exact cause of bipolar is not yet fully understood, it is thought that it is influenced by a
combination of factors, including:
Genetic Factors.
Research indicates that bipolar tends to run in families. People with a close relative who has bipolar have a
greater chance of developing the disorder compared to the general population. For example:
There is a 25% chance of developing bipolar if one parent has the illness.
There is a 50-75% chance if both parents have bipolar.
Biochemical Factors.
Mania is believed to be associated with a chemical imbalance in the brain that can be minimised with the
use of certain medications. Current evidence suggests that there are unusually high levels of the
neurotransmitters serotonin & noradrenaline during a manic episode and lower levels during a depressive
episode.
Environmental Factors.
It is believed that high stress levels can exacerbate or even trigger an episode of bipolar. Contributory
environmental factors include limited personal support, traumatic events, physical illness, excessive alcohol
or illicit substance use.
Seasonal Factors.
Mania seems to occur more commonly in spring and depression in winter. The reasons for this remain
uncertain.
What are the Symptoms of Bipolar Disorder?
The symptoms of bipolar disorder are different depending on whether the person is experiencing a manic
episode or a depressive episode.
Symptoms of a manic episode may include:
Feeling Thinking Behaving
Elevated mood Disorganised and racing In a reckless or
thoughts dangerous manner
Feeling invincible
Flight of ideas Use of illicit substances
Increased energy
Creative and fanciful Excessive gambling,
Unable or unwilling to ideas spending or alcohol use
sleep
Grandiose beliefs Social or sexual
Overfriendliness disinhibition
Distractibility
Inflated self confidence
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Difficulty concentrating Excessive, loud and
Increased irritability pressured speech
Disinhibition Impaired decision
making and judgement Impulsive actions
Overwhelming feeling of Physical agitation
self importance Lack of insight into
mania
Sleep disturbances
Depressed and sad
Hearing voices (unable to sleep or
excessive sleep)
Cranky or irritable Negative or pessimistic
thoughts Changes in appetite
Worthless or an extreme (over or under eating)
sense of guilt Persecutory thoughts
Fatigue and physical
Reduced confidence Indecisiveness slowing
and self esteem
Difficulty concentrating Difficulty tackling day to
Diminished enjoyment in day activities and work
pleasurable activities Difficulty thinking
through and sorting out Reduced contact with
Physically unwell problems friends and community
Physically exhausted Thoughts of self harm,
suicide or death.
What Treatments are Available for Bipolar Disorder?
1. Medication
Medication is a significant factor in the recovery and health maintenance of individuals with bipolar. It
reduces the frequency and severity of symptoms by helping to restore the chemical balance of the brain.
Research shows the average risk of relapse reduces to 30% for people who adhere with medication,
compared to 70% for those who do not.
The main type of medications prescribed for bipolar are the ‘mood stabilisers’. They act to even out the
extreme highs and lows of the illness. Mood stabilisers used are:
Lithium
Sodium Valproate (Epilim)
Carbamazepine (Tegretol)
Lamictal (Lamotrigine)
Other medications that may also be prescribed include:
Antipsychotic medication
Antidepressant medication
Antianxiety medication
Medications to reduce side effects
Page 3 of 5Royal Brisbane and Women’s Hospital Metro North Hospital and Health Service 2. Cognitive Behavioural Therapy (CBT) CBT helps individuals to identify and correct negative, irrational thoughts that are unhelpful and may exacerbate illness symptoms. By learning to think about life situations in a more realistic and constructive manner, people are more able to cope with the day to day challenges they face, and learn to better control how they react to given circumstances. CBT may be taught in an individual or group environment, and may include assistance with problem solving and goal planning. 3. Rehabilitation Rehabilitation services aim to provide practical support and guidance and may include: community follow up/ case management, counselling, psychotherapy, family education, occupational (employment) rehabilitation, social skills training, budgeting support, or drug and alcohol programs. 4. Electroconvulsive Therapy (ECT) ECT is a medical procedure available for the treatment of a number of different mental illnesses. It involves the application of an electrical stimulus to the scalp, which induces the brain to release neurotransmitters, assisting in the reduction of the severity of the illness and frequency of symptoms. While a number of misconceptions and misgivings exist around the use of ECT, it has been proven to be an effective and safe treatment: For people experiencing extreme psychotic, manic or depressive symptoms. Where previous responses to ECT have been effective. Where other treatment strategies have been ineffective. Where rapid treatment response is required. What Helps a Person Better Manage Bipolar? Understanding the illness Adhering to medication as discussed with your treating doctor Actively participating in programs and interventions aimed to improve coping strategies. Maintenance of regular routines and activities (including sleep patterns) Supportive friends, family and contact with health care workers Page 4 of 5
Royal Brisbane and Women’s Hospital Metro North Hospital and Health Service References Mondimore, MF (1999) Bipolar Disorder: A Guide for Patients & Families. Maryland: John Hopkins University Press. Inner North Brisbane Mental Health Service (2001) Bipolar Affective Disorder - Family Psychoeducation Program. Family Manual: Brisbane. Stahl, SM (2000) Essential Pharmacology of Depression & Bipolar Disorder. Cambridge University Press: Cambridge. Treatment Protocol Project (1997) Management of Mental Disorders, World Health Organisation Collaborating Centre for Mental Health & Substance Abuse, Sydney. Further Information Phone: ARAFMI Association for Relatives & Friends of the Mentally Ill (07) 3254 1881 MHAQ Mental Health Association of Queensland (07) 3271 5544 Websites www.wfmh.org World Federation for Mental Health www.sane.org Sane Australia www.mental-health-matters.com www.manicdepressive.org www.psychcentral.com www.bipolarawareness.com www.mhsource.com www.nimh.nih.gov/publicat/bipolarmenu.cfm www.mentalhelp.net Page 5 of 5
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