BIPOLAR I and BIPOLAR II
The main difference between Bipolar I and Bipolar II is simply that those diagnosed with Bipolar II have not had a manic episode.
Bipolar I is characterized by one or more manic episodes and also consists of a history of depressive episodes. Bipolar II is characterized by depressive episodes with at least one hypomanic episode.
It is best to think of bipolar disorder in terms of a continuum or a spectrum.
MAJOR DEPRESSION
On the far left, you've got the lowest of lows -- the Major Depression Episodes. This is the place that most consider "the abyss" -- it's as though you're in the darkest of places and generally there's feeling of hopelessness, helplessness and worthlessness.
According to the diagnostic tools that clinicians use, in a Major Depressive Episode:
*Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
*The symptoms do not meet criteria for a Mixed Episode.
*The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
*The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
What I will term "Minor Depressions" falls somewhere between your normal/average moods. Unlike the Major Depressions, you're still able to function and thoughts or suicide are rare.
MANIA
On the other end of the spectrum, you've got the Manic episodes. Mania affects different people in different ways. Some folks become very hostile and often times very angry. Often, control is lost of impulses and so things you might normally never consider doing -- you start doing.
During this phase, thoughts of what others might think, or thoughts of the consequences of your actions are lost. It's not unusual for folks to have affairs during this time, take off on spur of the moment trips, or max out numerous credit cards. You lose your inhibitions and so you simply are in self-gratification mode. Some folks have extremely high thoughts of themselves -- perhaps even thinking they are God or some other super-human.
Manic episodes are diagnosed as such:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. flight of ideas or subjective experience that thoughts are racing
7. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
8. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
9. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
*The symptoms do not meet criteria for a Mixed Episode.
*The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
MIXED EPISODES
Sometimes folks experience both the highs and the lows all at once. This is called a "Mixed Episode" and is hell to go through.
During a Mixed Episode, one is often "wired and tired" -- you're so on edge, agitated and you feel like you can't sleep, yet at the same time you're so very tired. I can remember pacing back and forth, crying, and running my fingers through my hair -- constant movement, yet bone weary tired -- I wanted to sleep, but I couldn't stop moving.
Clinicians diagnose a Mixed Episode as:
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
*The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Bipolar I is characterized by the Manic Episode, and indeed it's what sets it apart from Bipolar II. There are some that might argue that Bipolar II is a "milder" form of Bipolar Disorder, but don't believe it.
Bipolar II is often confused for simply depression. Normally, a patient goes into the doctor because of the depression symptoms. The doctor hears about the sleeping all day, the loss or increase in appetite, the loss of wanting to do the things they normally do -- yet the doctor doesn't hear the flip side of things -- how just a couple of months before, the patient had been wondering how on earth they'd bounced yet another check and wondering when they'd bought all the clothes that now lined their closet.
HYPOMANIA
Hypomania is a tricky thing. It's elusive and you sometimes you don't even feel yourself sliding upward. Some folks get a little more "snappish" during this period -- things that someone might say that normally doesn't bother them, all of a sudden starts to really bug them.
During this time, inhibitions start to relax. There are still some thoughts of the consequences, but generally on the upper side of the hypomanic phase, thoughts of those consequences start to disappear as the desire to rush on ahead becomes the driving force. During this time, it's not unusual for folks to take on extra tasks and offer to do anything and everything -- the thoughts of "I can handle it..." and "I can do it..." enter the thinking much more than they normally do.
Hypomania and a hypomanic espidode are diagnosed as follows:
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed/average mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4.flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7.excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
*The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
*The disturbance in mood and the change in functioning are observable by others.
*The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.
Those diagnosed with Bipolar I generally fluctuate between Major Depression and Hypomania. Realize, not everyone is alike, and so some folks that have been diagnosed with Bipolar I might stay in the normal to major depression areas and rarely head up toward the hypomanic stage. Others might stay in the Minor Depression area up to the upper limits of hypomania. Once someone cross into a manic episode, the diagnosis then changes to Bipolar II.
Hope this helps...
Obie
Dum spiro, spero
While I breathe, I hope.
Strength is the capacity to break a chocolate bar into four pieces with your bare hands - and then eat just one of the pieces ~Judith Viorst~
The main difference between Bipolar I and Bipolar II is simply that those diagnosed with Bipolar II have not had a manic episode.
Bipolar I is characterized by one or more manic episodes and also consists of a history of depressive episodes. Bipolar II is characterized by depressive episodes with at least one hypomanic episode.
It is best to think of bipolar disorder in terms of a continuum or a spectrum.
MAJOR DEPRESSION
On the far left, you've got the lowest of lows -- the Major Depression Episodes. This is the place that most consider "the abyss" -- it's as though you're in the darkest of places and generally there's feeling of hopelessness, helplessness and worthlessness.
According to the diagnostic tools that clinicians use, in a Major Depressive Episode:
*Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
*The symptoms do not meet criteria for a Mixed Episode.
*The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
*The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
What I will term "Minor Depressions" falls somewhere between your normal/average moods. Unlike the Major Depressions, you're still able to function and thoughts or suicide are rare.
MANIA
On the other end of the spectrum, you've got the Manic episodes. Mania affects different people in different ways. Some folks become very hostile and often times very angry. Often, control is lost of impulses and so things you might normally never consider doing -- you start doing.
During this phase, thoughts of what others might think, or thoughts of the consequences of your actions are lost. It's not unusual for folks to have affairs during this time, take off on spur of the moment trips, or max out numerous credit cards. You lose your inhibitions and so you simply are in self-gratification mode. Some folks have extremely high thoughts of themselves -- perhaps even thinking they are God or some other super-human.
Manic episodes are diagnosed as such:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. flight of ideas or subjective experience that thoughts are racing
7. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
8. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
9. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
*The symptoms do not meet criteria for a Mixed Episode.
*The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
MIXED EPISODES
Sometimes folks experience both the highs and the lows all at once. This is called a "Mixed Episode" and is hell to go through.
During a Mixed Episode, one is often "wired and tired" -- you're so on edge, agitated and you feel like you can't sleep, yet at the same time you're so very tired. I can remember pacing back and forth, crying, and running my fingers through my hair -- constant movement, yet bone weary tired -- I wanted to sleep, but I couldn't stop moving.
Clinicians diagnose a Mixed Episode as:
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
*The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Bipolar I is characterized by the Manic Episode, and indeed it's what sets it apart from Bipolar II. There are some that might argue that Bipolar II is a "milder" form of Bipolar Disorder, but don't believe it.
Bipolar II is often confused for simply depression. Normally, a patient goes into the doctor because of the depression symptoms. The doctor hears about the sleeping all day, the loss or increase in appetite, the loss of wanting to do the things they normally do -- yet the doctor doesn't hear the flip side of things -- how just a couple of months before, the patient had been wondering how on earth they'd bounced yet another check and wondering when they'd bought all the clothes that now lined their closet.
HYPOMANIA
Hypomania is a tricky thing. It's elusive and you sometimes you don't even feel yourself sliding upward. Some folks get a little more "snappish" during this period -- things that someone might say that normally doesn't bother them, all of a sudden starts to really bug them.
During this time, inhibitions start to relax. There are still some thoughts of the consequences, but generally on the upper side of the hypomanic phase, thoughts of those consequences start to disappear as the desire to rush on ahead becomes the driving force. During this time, it's not unusual for folks to take on extra tasks and offer to do anything and everything -- the thoughts of "I can handle it..." and "I can do it..." enter the thinking much more than they normally do.
Hypomania and a hypomanic espidode are diagnosed as follows:
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed/average mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4.flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7.excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
*The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
*The disturbance in mood and the change in functioning are observable by others.
*The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
*The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.
Those diagnosed with Bipolar I generally fluctuate between Major Depression and Hypomania. Realize, not everyone is alike, and so some folks that have been diagnosed with Bipolar I might stay in the normal to major depression areas and rarely head up toward the hypomanic stage. Others might stay in the Minor Depression area up to the upper limits of hypomania. Once someone cross into a manic episode, the diagnosis then changes to Bipolar II.
Hope this helps...
ObieDum spiro, spero
While I breathe, I hope.
Strength is the capacity to break a chocolate bar into four pieces with your bare hands - and then eat just one of the pieces ~Judith Viorst~
