Bi-Polarity Disorder Type I
Bipolar I disorder (also referred to as BD-I or type one bipolar disorder) is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features.[2] Symptoms of bipolar I disorder typically begin at age 15-25 years of age, with depression being the most common initial symptom[3]. People may also have one or more depressive episodes.[4] Typically, manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks.[5] The prevalence of bipolar disorders is about 1% worldwide.[6]
It is a type of bipolar disorder and conforms to the classic concept of manic-depressive illness, which can include psychosis during mood episodes.[7]
Signs and Symptoms
Bipolar disorder is characterized by severe, recurrent mood changes and behavioral changes. Sometimes, they may display psychotic features.[8]
Graph illustrating mood fluctuations in bipolar disorders
Manic Episode
A manic episode is a distinct period of time, lasting at least 1 week and for most of the day, where an individual experiences persistent, irritable mood, and or persistent euphoria or elation that is disproportionately out of norm.[9] These symptoms are severe, and causes either significant impairment in an individual's life or require hospitalization.[9] Furthermore, these symptoms and changes are not caused by medications, illicit substances, or another medical condition.[9]
Psychosis
Patients with bipolar disorder may also experience psychotic symptoms during their lifetimes.[10] Symptoms of psychosis include delusions, hallucinations, or both and may be seen more often during manic episodes rather than depressive episodes.[10]
Risk Factors
Currently, there are no single, clear causes of bipolar disorder.[11] However, there are evidence that suggest there may be a genetic component that contribute to the development of bipolar disorder.[11] Studies from identical twins suggest that there is a 5-10% lifetime risk (about seven times greater compared to the general population) of developing bipolar disorder if there is a first-degree relative diagnosed with bipolar disorder. [11]
Bi-Polarity Disorder Type II
Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression.[1][2][3][4] Diagnosis for BP-II requires that the individual must never have experienced a full manic episode.[5] Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).[2]
Bipolar II Disorder is a mood disorder characterized by alternating periods of depression and hypomania, a less severe form of mania. Individuals with Bipolar II experience episodes of major depression, marked by symptoms like persistent sadness, fatigue, and loss of interest in activities, as well as episodes of hypomania, which involve elevated mood, increased energy, and impulsivity, but without the full-blown manic episodes seen in Bipolar I Disorder.
The disorder is often underdiagnosed because the hypomanic episodes may not be as disruptive as full mania. Bipolar II tends to be chronic and can significantly impact a person's social, professional, and emotional life. Though the causes are not fully understood, a combination of genetic, environmental, and neurobiological factors is believed to play a role.
Bipolar II is typically managed through a combination of medication, such as mood stabilizers, atypical antipsychotics, as well as psychotherapy.[6] Antidepressant use in bipolar disorder is controversial, with some studies finding benefit, while others find risks of switching to hypomania or worsening of rapid cycling.[6][7][8]
Early diagnosis and treatment can help mitigate the intensity and frequency of mood episodes. Hypomania is a sustained state of elevated or irritable mood that is less severe than mania yet may still significantly affect the quality of life and result in permanent consequences including reckless spending, damaged relationships and poor judgment.[9]: 1651 Unlike mania, hypomania cannot include psychosis.[1][10] The hypomanic episodes associated with BP-II must last for at least four days.[2][11]
Commonly, depressive episodes are more frequent and more intense than hypomanic episodes.[2] Additionally, when compared to BP-I, type II presents more frequent depressive episodes and shorter intervals of well-being.[1][2] The course of BP-II is more chronic and consists of more frequent cycling than the course of BP-I.[1][12] Finally, BP-II is associated with a greater risk of suicidal thoughts and behaviors than BP-I or unipolar depression.[1][12] BP-II is no less severe than BP-I, and types I and II present equally severe burdens.[1][13]
BP-II is notoriously difficult to diagnose. Patients usually seek help when they are in a depressed state, or when their hypomanic symptoms manifest themselves in unwanted effects, such as high levels of anxiety, or the seeming inability to focus on tasks. Because many of the symptoms of hypomania are often mistaken for high-functioning behavior or simply attributed to personality, patients are typically not aware of their hypomanic symptoms. In addition, many people with BP-II have periods of normal affect. As a result, when patients seek help, they are very often unable to provide their doctor with all the information needed for an accurate assessment; these individuals are often misdiagnosed with unipolar depression.[1][2][12] BP-II is more common than BP-I, while BP-II and major depressive disorder have about the same rate of diagnosis.[14] Substance use disorders (which have high co-morbidity with BP-II) and periods of mixed depression may also make it more difficult to accurately identify BP-II.[2] Despite the difficulties, it is important that BP-II individuals be correctly assessed so that they can receive the proper treatment.[2] Antidepressant use, in the absence of mood stabilizers, is correlated with worsening BP-II symptoms.[1]
ZETA-PROTOCOL
Level Two (Code Yellow):
[Increase Communication & Care]
A family meeting with Dr. Costa will be scheduled to ascertain Ainsley's condition.
If Ainsley's condition does not improve after Phase 1, then intervention by family and medical professionals make Ainsley aware and recommend any of the following:
Physician and Psychiatrist will assess any need for Inpatient, PHP, IOP, & Meds
Check-ins via video/phone/text with family/friends
Psychiatrist/Psychologist Bi-Weekly DBT Therapy for one month
Physician Bi-Monthly Visits and Med Checks
Weekly TEAM meetings/visits for one month
Reduce Stressors and specific activities temporarily
Increase Intensity and Structure
Appointments with Medical & Mental Health Professionals
Increase monitoring of sleep and adjust period during cycle if needed
Increase Family Involvement: Invite to TEAM or Family/Couples Counseling
Re-Evaluate Meds & Evaluate alternative options like a new medication with Primary Physician
Schedule Routine and Reiterate it daily
Add Financial Metrics to Zeta-Protocol