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Bipolar disorder is an illness that is presented in the form of episodes or phases. There are two types: the depressive phases, in which the person feels sad or gloomy and shows little interest, and the manic phases, which, depending on their severity, can be classified as hypomania (if they are milder) and are usually manifested by great euphoria, excess of energy, or irritability.
Some patients appear emotionally stable (euthymia) between episodes, that is to say, they do not have any type of psychiatric symptom if they are not in an acute phase. However, between episodes it is common for minor symptoms to appear in the form of anxiety, tiredness, difficulties in concentration, and irritability, among others.
Symptoms of Mania
Mania is a pathological elevation in mood and/or energy. The individual that is in a manic phase usually has some of these symptoms (it is not necessary that they have all of them):
Decrease in the need to sleep
Increase in sociability
Increase in energy
Increase in financial spending, generally on unnecessary objects or activities
Increase in sexual impulse
Increase in speed of thought
Occasional neglect their physical appearance or dress extravagantly or flamboyantly
Incapable of staying still
Usually imagine new projects—generally grandiose and absurd—and, in the more severe cases, can have psychotic symptoms (delusions and/or hallucinations).
Symptoms of Depression
Depression is not only to be very sad, but it also includes other common symptoms, such as:
Loss of hope/dreams for things
Increase in hours of sleep—although there may also be insomnia
None of these symptoms are essential in order to diagnose a depression: it is sufficient that some of them may be present. On the other hand, one does not have to be sad to be depressed: there are depressions without sadness, characterised mainly by fatigue, feeling of emptiness, and an increase in drowsiness, among others.
They are called mixed symptoms when manic symptoms appear in a depressive phase, or depressive symptoms, in a manic phase. They are particularly complex periods to diagnose in those that have them, as they involve much suffering. It is common in these phases for there to be hyperactivity and acceleration of thoughts, at the same time as negative ideas and depressive thoughts. Some symptoms are:
Speed of thought
Lack of enthusiasm
Rapid mood changes
There are two types of psychotic symptoms: delusions and hallucinations.
The delusions are ideas with no real basis, often based on an erroneous interpretation of the information. For example, the patients believe that there is a conspiracy against them because the cars on the motorway are following them.
Hallucinations are perceptions with no object: to hear voices or noises that do not exist (auditory hallucinations), see faces or appearances (visual hallucinations), perceive smells, etc.
The delusions are much more frequent than the hallucinations. The psychotic symptoms may appear in the depression as well as in the mania and generally, their content tends to be in keeping with the mood state. It is likely, for example, that a patient in the manic phase thinks that he/she has superpowers and, in the depressive phase, may have the delusional conviction the he/she and his/her family suffer from a deadly disease.
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Substantiated information by:
Ana Isabel Martínez AránPsychologyPsychiatry and Psychology Department
Diego Alberto Hidalgo MazzeiPsychiatristPsychiatry and Psychology Department
Eduard Vieta PascualPsychiatristPsychiatry and Psychology Head of Department
Mercè Comes ForasteroNurse Specialist in Mental HealthPsychiatry and Psychology Department
Published: 20 March 2018
Updated: 20 March 2018
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