Bipolar Disorder: Symptoms, Treatment, and Its Link to Schizophrenia

What Is Bipolar Disorder?

It is normal to experience mood changes because of the problems and obstacles we face during the day. These changes are not a problem when they are tied to a particular circumstance and end when that circumstance passes. The problem arises when a person's life and work become governed by these mood changes—when they interfere with daily duties and tasks, leaving activity, concentration, and the ability to think dependent on the person's current mood. This is what we call bipolar disorder. Given its importance, Tatmeen presents this article to introduce bipolar disorder, its types, and its causes, and to answer key questions that may arise, such as:How do I know if I have bipolar disorder?What is the difference between bipolar disorder and schizophrenia? Can bipolar disorder be cured?

What Is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a chronic mental health condition that causes changes in mood and emotions. These include elevated states involving mania or hypomania, which can make you feel elated, full of energy, or unusually irritable. The corresponding low states can involve depression, which can leave you feeling sad or hopeless and cause you to lose interest or pleasure in most activities. These mood changes may occur rarely, although some people experience emotional symptoms most of the time. As a result, these changes in mood and emotions can affect sleep, energy, activity, decision-making, behavior, and the ability to think clearly.

Although bipolar disorder is a chronic condition, this does not mean that you cannot manage its mood changes and other accompanying symptoms. This can be achieved by following the necessary treatment plans, which will be explained later. These plans often include medication and psychological counseling (psychotherapy).

Types of Bipolar Disorder

There are several types of bipolar disorder, and a number of other mental health disorders are associated with them. They may involve mania, hypomania, and depression. The symptoms are among the main causes of sudden changes in mood and emotions, which can lead to a persistent sense that life is difficult.

1. Bipolar I Disorder

This involves having at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes in some cases. Mania may be severe enough to cause a break from reality and lead to psychotic disorders.

2. Bipolar II Disorder

This involves having at least one major depressive episode and at least one hypomanic episode.

3. Cyclothymic Disorder

This involves having many periods of hypomanic symptoms over at least approximately two years—or one year in children and adolescents—or periods of depressive symptoms that are less severe than major depression.

4. Bipolar Disorder Related to Other Conditions

Examples include bipolar and related disorders caused by the use of certain drugs, alcohol consumption, or a medical condition such as multiple sclerosis or stroke.

How Do I Know If I Have Bipolar Disorder?

To begin, it should be noted that people with bipolar disorder may experience mixed episodes of mania or hypomania and depression at the same time. These episodes occur at equal rates among males and females, although symptoms of bipolar disorder usually appear at an earlier age in males than in females. It is also worth noting that symptoms in older adults occur more frequently and are more severe than in younger people.

The nature, severity, and frequency of bipolar disorder symptoms vary from person to person. Some people are more prone to manic episodes, while others are more prone to depressive episodes. For some, manic and depressive episodes alternate equally. Some people with bipolar disorder experience frequent episodes, while others have only a few episodes throughout their lives.

Symptoms of bipolar disorder, based on its types, include the following:

1. Symptoms of Bipolar I Disorder

Symptoms include manic episodes lasting a week or longer, or severe manic episodes that require medical intervention. Some people may also experience severe depressive episodes lasting two weeks or longer. A single manic episode is sufficient for a diagnosis of bipolar I disorder.

2. Symptoms of Bipolar II Disorder

This type involves manic episodes that are less severe than those in bipolar I disorder. They last three to four days and are known as hypomanic episodes. It also includes episodes of severe depression lasting two weeks, which may precede or follow the manic episode.

3. Symptoms of Cyclothymic Disorder

This type resembles bipolar disorders and involves numerous hypomanic and depressive episodes. These episodes persist for two years or longer in adults, or one year in children and adolescents.

4. Symptoms of Manic and Hypomanic Episodes

At first, a person experiencing mania may feel good because of a tremendous amount of energy, enthusiasm, hyperactivity, and increased movement. However, this exaggerated sense of exhilaration may cause some patients to lose control of themselves, leading them to act without considering the consequences.

This can result in irresponsible behavior such as wasting large sums of money, driving recklessly, or using drugs and alcohol. During a manic episode, the person may also feel angry, become excessively agitated, and adopt aggression as a way of resolving problems. It should be noted that hypomanic symptoms are less severe than manic episodes and are not accompanied by hallucinations or delusions.

Symptoms of bipolar disorder associated with mania also include:

• Excessive self-confidence, an exaggerated sense of self-worth, and feelings of grandeur and power.
• Feeling happy and having boundless energy.
• Feeling powerful and able to do anything.
• Engaging in many activities at the same time.
• Talking more than usual, rapidly and loudly, and moving from one subject to another.
• Conflicting thoughts and being easily distracted.
• A reduced need for sleep..
• Increased sexual desire.
• Delusions and hallucinations in severe cases.

5. Symptoms of a Depressive Episode

The duration and severity of a depressive episode can vary from one episode to another and from one person to another. Women are more likely to experience depressive episodes in bipolar disorder.

Symptoms of bipolar disorder associated with a depressive episode include:

• Feeling deeply depressed and sad, with intense hopelessness.
• Low energy and loss of interest and passion.
• Feeling helpless and worthless.
• Lack of self-confidence..
• Feelings of guilt.
• Fatigue and lethargy.
• Difficulty concentrating, remembering, and making decisions.
• Being unable to go to work or school.
• Insomnia or excessive sleeping.
• Sensitivity to noise, smells, and other things.
• Increased or decreased appetite, leading to weight gain or loss.
• Thinking about death and suicide in severe cases.

6. Symptoms of Mixed Episodes

Mixed episodes involve symptoms of mania and depression occurring at the same time. The person may feel depressed and irritable, anxious, unable to sleep, distracted, and overwhelmed by racing thoughts. They may shift from happiness to frustration and hopelessness, then soon return to feeling euphoric and energetic.

Causes of Bipolar Disorder

The direct causes of bipolar disorder remain unknown. However, several factors are thought to play a role when they occur together, while certain triggers may prompt symptoms to appear or become more severe. Possible causes of bipolar disorder include:

1. Genetic Factors

Many studies indicate that mental illnesses, like physical illnesses, can be inherited. In other words, many mental illnesses may be hereditary when there is a family history of the condition. Examples include psychotic illnesses such as schizophrenia and depression. Although this has not been conclusively established, many studies suggest that certain genes are responsible for causing depression and that one case of depression in a family member is enough to double the likelihood among other family members.

As with most mental illnesses, heredity plays a fundamental role in bipolar disorder, and certain genes are thought to be among its causes. People with a family history—meaning an affected first-degree relative such as a father, son, or sibling with bipolar disorder—have an approximately tenfold higher likelihood of developing it. It should also be noted that many people carry genes that increase their risk but do not develop bipolar disorder. Genetic factors that increase the likelihood of bipolar disorder include, for example, having a family member with depression; a family history of schizophrenia, as schizophrenia and bipolar disorder have some genetic overlap; several family members with bipolar disorder or other mental disorders; and the degree of kinship between the person and affected family members.

The points mentioned above are sufficient to confirm that bipolar disorder is associated with genetic factors. However, no specific gene has yet been identified as its primary cause. The disorder is thought to be associated with several genes, each of which has a small effect on increasing the likelihood of developing it.

2. Physical Factors

Sex is the first biological factor that affects the likelihood of bipolar II disorder, which is more common among women than men. Rates of bipolar I disorder are equal in both sexes, and the reason for this remains unknown. Biological changes in the brain may also have an effect and could be among the causes of bipolar disorder. Hormonal changes, particularly those involving the thyroid gland, can affect brain function. Depression and bipolar disorder are associated with thyroid dysfunction, and people with bipolar disorder often have an underactive thyroid.

Damage to or loss of brain cells is considered a contributing factor in mood disorders, particularly when it affects cells associated with brain function. Dysfunction of neurotransmitters may also contribute. Neurotransmitters are chemicals that help brain cells communicate and regulate mood. An imbalance in brain neurotransmitters, including norepinephrine, serotonin, and dopamine, may be among the causes of bipolar disorder.

Disruption of neurotransmitters or an imbalance in the level of one or more neurotransmitters can lead to some symptoms of bipolar disorder. Manic episodes may be attributed to a very high level of norepinephrine, while depressive episodes may be associated with a low level of norepinephrine.

Disruptions are not limited to brain cells or the thyroid gland; they may also affect the energy-producing structures known as mitochondria. Mitochondrial problems may play a role in mental disorders and could be one of the causes of bipolar disorder. Mitochondria are the cell's energy centers, so a disruption in their function may alter patterns of energy production and use. This might explain some behaviors seen in people with mental disorders.

Overall, many published studies confirm that excessive activity in parts of the brain can affect the coordination of voluntary movement. This can be seen clearly on a brain MRI, which reveals the nature of cellular activity and whether the person has bipolar disorder.

Age also plays a role in the onset and development of bipolar disorder. It usually develops between the ages of 15 and 25, and at least half of cases are diagnosed before age 25. However, symptoms may not appear in some people until they are in their thirties or forties.

3. Environmental Factors

The environment in which a person grows up is one of the main factors affecting mental health. Here, we mean the basic concept of the environment—the setting in which a person was born and raised. Growing up in a family environment that uses abuse and harsh treatment as methods of upbringing can cause children to develop many mental health disorders. Although a person's environment extends beyond the family to much wider circles, the family can be considered the foundation of a person's mental health.

As noted above, the social factors affecting mental health are not limited to the family. A person also interacts with other environments that can affect mental well-being. These may include a stressful, exhausting, and discouraging workplace that can cause burnout; an environment dominated by discrimination, division, and hostility, which may push a person toward isolation or violence; or difficult economic circumstances such as poverty or poor living conditions. Living amid all of this will inevitably lead to poorer mental health.

The same applies to bipolar disorder. Several environmental factors, when combined, may trigger bipolar symptoms and episodes of mania and depression. These include:

• Disrupted sleep or sleep deprivation..
• Traumatic life events, such as the death of a relative or experiencing an assault.
• The pressures of daily life.
• Developing an illness or sustaining a physical injury.
• Menstrual periods.
• Lack of exercise.
• Triggers of Manic Episodes
• Attending loud parties.
• Listening to loud music.
• Misusing certain medications or using drugs.
• The postpartum period..

Is Bipolar Disorder the Same as Schizophrenia?

Schizophrenia and bipolar disorder are both classified as mental disorders that usually appear in a person's early twenties. Bipolar disorder is a mental illness involving severe mood changes, recurrent depressive episodes, and at least one manic episode—a state of abnormally heightened mood or agitation. As for schizophrenia, it is also a mental illness classified as severe, chronic, and debilitating. A person with schizophrenia may be completely detached from reality. It is worth noting that anyone who develops either condition is more vulnerable to suicide, drug use, or other mental health problems and illnesses later in life.

The direct cause of schizophrenia has not been scientifically identified. However, a combination of genetic, biological, and environmental factors may contribute to its development. These include:

1. Genetic Factors

Having a family history of schizophrenia increases the likelihood of developing it sixfold.

2. Environmental Factors

Environmental factors may include growing up in a home that relies on abuse and harshness as methods of upbringing, or a mother experiencing malnutrition or taking medications that could affect the brain's chemical composition.

3. Biological Factors

These include a fault in the brain's chemical composition that disrupts neurotransmitter function, or taking medications to control psychological changes during adolescence that may affect brain function.

Overall, some studies have shown that a genetic component contributes to the development of both illnesses. They have also found that identical twins are more likely than non-identical twins to share either illness. Studies have also indicated that prenatal problems—such as maternal emotional stress, infection, birth complications, low oxygen levels, or fetal distress—increase the risk of schizophrenia later in life. Environmental factors do not cause either illness, but their presence can increase the appearance of symptoms in people who are genetically at risk.

Bipolar disorder has several types and related disorders and problems, including mania, hypomania, and depression, which we explained earlier. The symptoms of schizophrenia are as follows:

• A clear change in behavior that differs from the person's usual nature.
• A change in the person's original personality.
• Adopting habits, customs, and behaviors that differ from the person's original personality.
• Confused thoughts and difficulty expressing them.
• Psychotic disturbances characterized by withdrawal from reality.
• Inappropriate emotional responses.
• The patient may have an unusual way of speaking and thinking, along with abnormal motor symptoms.

Can Bipolar Disorder Be Cured?

Unfortunately, no cure for bipolar disorder has yet been found. However, many treatment approaches can ease its symptoms and enable the patient to manage every aspect of daily life.

It is worth noting that, in severe cases, this disorder may interfere with a patient's ability to work and lead a normal life. However, when patients follow the long-term treatment plans established for their condition by a psychiatrist, some may remain in a stable mood for long periods without any symptoms or with only a few symptoms. Symptoms can therefore be eased for a relatively long time, although they may reappear.

The duration of symptoms varies, and they may persist in some patients despite receiving and adhering to treatment. Every person with bipolar disorder has a different condition and experience. Manic episodes in bipolar I disorder can be severe and dangerous, while people with bipolar II disorder may experience depression for longer periods. The types and doses of prescribed medications therefore depend on the patient's specific symptoms. Whether the patient has bipolar I or bipolar II disorder, treatment may include:

1. 1. Medication

Examples include mood stabilizers, anti-seizure medications, and antidepressants. These medications must not be taken without consulting your specialist psychiatrist. You may need to try different medications or a combination of medications to determine what suits you best. It is therefore important to meet regularly with your mental health care provider to assess how well the treatment is working. If necessary, your provider may periodically adjust your medication to keep symptoms and side effects under control.

2. Psychotherapy Sessions

One example is cognitive behavioral therapy, which enables patients to identify negative behaviors and work to replace them. This means helping to identify the causes of bipolar episodes. A mental health care provider may recommend cognitive behavioral therapy to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Other types of therapy may also help, such as social rhythm therapy, which establishes a consistent routine to improve mood management.

3. Electroconvulsive Therapy

This treatment is intended for people experiencing severe depressive periods accompanied by suicidal tendencies or thoughts.

4. Establishing a Healthy Routine

This aims to regulate the patient's sleep, alongside maintaining a healthy diet and exercising. Following a regular schedule, participating in social activities, and joining a support group may also help. If you need advice in these areas, speak with your care provider.

5. Family Therapy

This family-focused treatment is based on the belief that family communication with the patient helps them follow their treatment plan more effectively.

Can Bipolar Disorder Be Treated Without Medication?

1. Try to persuade the patient to seek treatment calmly, and avoid threatening to take them to the hospital for treatment.
2. Work to support and reassure the patient by avoiding harassment and continuous personal criticism.
3. Do not force the patient to change their behavior, and understand that they do not have complete control over it.
4. Make the necessary effort to show and explain reality to the patient so that there is no room for the fantasies and doubts affecting them.
5. Supporting the patient never means accepting their unhealthy ideas. Instead, challenge those ideas in a healthy, constructive way to help the patient recognize their unhealthy behavior.

The best treatment for bipolar disorder combines medication and psychotherapy sessions. No specific treatment duration can be set, and the patient may receive treatment throughout life. The success of bipolar disorder treatment depends on the severity of the condition, the patient's adherence to the treatment plan prepared by their doctor, and the level of support they receive from their environment and those close to them.