Bipolar I Disorder versus Bipolar II Disorder

[David Baxter PhD]

Bipolar I Disorder

Diagnosis of this Bipolar Disorder requires at least one Manic or Mixed episode, but there may be episodes of Hypomania or Major Depression as well. (This diagnosis conforms to the classic concept of manic depressive illness.)

Bipolar II Disorder

Diagnosis of this Bipolar Disorder requires neither a Manic nor a Mixed Episode, but does require at least one episode of hypomania in addition to an episode of Major Depression.

Diagnostic criteria for 296.89 Bipolar II Disorder

A. Presence (or history) of one or more Major Depressive Episodes.

B. Presence (or history) of at least one Hypomanic Episode.

C. There has never been a Manic Episode or a Mixed Episode.

D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

 

[stargazer]

Thanks for posting this info, David. I'd read these descriptions in the DSM IV, and also similar accounts and descriptions on various sites. I think I can accept that my diagnosis is Bipolar I & Hypomanic, as they usually tell me. Last summer (2005) when I began treatment briefly before re-locating in the Bay Area for my job, the doctor in Stockton said she wasn't convinced I was Bipolar I. But she didn't say if she thought I was Bipolar II or not. It will be interesting to see what the doctor says on Friday.

 

[foghlaim]

the actual word bipolar...
means?????

 

[ThatLady]

In this context, it means having two distinct emotional states, nsa, one manic, the other depressed.

 

[foghlaim]

Thank you TL...

I figured as much but wanted to be sure...

 

[stargazer]

Is there a Bipolar III disorder? I was talking with my friend Barbara the other day, and she said they had her bipolar something-or-another, but she doesn't think it's I or II. They used to have her on lamictal, but took her off of it, and now she only takes clonazepam as needed.

 

[David Baxter PhD]

There's no Bipolar III to my knowledge, SG. She mat be thinking of cyclothymia.

 

[stargazer]

I think that's what she's thinking of. I said "schizothymic" because I couldn't remember the word, but now it hits me, "cyclothymic." When I said, "schizothymic," it didn't sound quite right to either of us.

 

[healthbound]

And I suppose that if someone alternates from "normal" to depressed, but doesn't experience hypomania or a manic episode, they have major depressive disorder?

 

[stargazer]

That would make sense to me, but my knowledge is limited. I'd be interested in hearing what Dr. Baxter would say. I *have* read that bipolar people do experience periods of feeling "normal" --not just (hypo)manic or depressed--and that makes sense with my experience.

 

[healthbound]

And, I guess some might argue that my "normal" time wasn't that normal. I didn't hallucinate or have any psychosis, but I certainly over-achieved and managed to maintain a very busy lifestyle.

I could acheive so much. I actually miss those times and wonder if I will ever return them.

 

[David Baxter PhD]

If there has never been even a single hypomanic or manic episode, then the diagnosis would be Major Depressive Disorder, Recurrent.

 

[healthbound]

What constitutes a hypomanic episode?

edit:
I just found this from HealthyPlace.com

A. A distinct period of persistently elevated, expansive; or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B. 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)


C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. 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.

F. 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.

 

[David Baxter PhD]

Yes. And note this part:

F. 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).

 

[healthbound]

Heh heh...I know...I saw it thanks.

 

[stargazer]

You or someone you know has hyperthyroid? One of my best friends had, I think, "hypothyroid" -- whichever one makes you slow down and lose your hair and start talking like you're drunk all the time. We all thought it was just the way he was. Then they gave him some medication, and his energy returned to normal level. That was about 10 years ago. Now he's actually rather high-energy, in general.

 

[healthbound]

I recently had blood taken showing that I have hyperthyroidism. I've definitely been showing signs of it recently but after reading the symptoms could have sworn I had hypothyroidism over the past 2 years.

I guess it just goes to show how much crossover there is when it comes to a certain set of symptoms.

The weird thing is that I got my thyroid tested on August 1 and it showed that I was in the normal range. But, I'd already started feeling symptoms that might indicated hyperthyroidism. I just thought I was finally coming out of my depression. And that may still be. I quit using a medication that I was on for over a decade a couple of months ago and it seems I've had a few symptoms become noticible since then. I've read that the medication I was on could mask some of them...so, who knows. I also got off all of the sedating drugs I was on a few months back and am only on 300mg/day of effexor now. So that could also be contributing to my recent mood changes.

I definitely have been feeling better ---my mind seems to be working again, I'm planning and doing things that will effect my future (instead of acting as if there will be no future), and I have energy. BUT I'm still sleeping A LOT, but I'm also drinking A LOT. I'm acting very "extreme" and am certainly engaging in many activities that are dangerous and destructive. This is concerning especially since it seems to be getting to the point where I'm not caring as much about whether my son is home or not (ie: I will drink after he goes to sleep) which is VERY out of charecter for me.

And while I just slept for a day, night and day, I feel pretty shaky and "speedy" right now.

Bizarro. Anway, I'm just about to make an appointment with my GP. I'll see what he says (I was going to see him Friday, but didn't).

 

[David Baxter PhD]

HB, your thyroid has probably been alternating between hypothyroidism and hyperthyroidism for a few years. That is usually the case by the time someone is diagnosed. The thyroid basically tries to regulate itself initially by "speeding up" and then "slowing down", which is one of the reasons that thyroid function should be tested whenever bipolar disorder is suspected.

It is also common in women who have been pregnant.

 

[healthbound]

HB, your thyroid has probably been alternating between hypothyroidism and hyperthyroidism for a few years.

Well, actually that would make perfect sense becuase I feel like I've had more HYPOthyroid symptoms over the past 2 years. Although there are a few times I've felt like this over the past 2 years, but only for about 1-2 months at a time. I just equated it with anxiety --especially because I felt a lump in my throat and sometimes felt like I was choking. Maybe it is my thyroid gland though?

Anyway, there has absolutly been a distinct difference in the way I've been feeling and acting withing the last couple of months. I've been very impulsive and drinking lots with little concern for consequences.

I'm also still waiting for an appointment with a otoligist/neurologist because I have tinnitus and I'm feeling pressure inside my head. I thought I remembered reading that the thyroid is somehow connected to the hypothalamus, pituitary, serotonin and norepinephrine. Maybe the tinnitus and head pressure are connected.

 

[stargazer]

I could acheive so much. I actually miss those times and wonder if I will ever return to them.

What I've noticed for myself is that, in slowing down, I actually accomplish more. But it can't just be a total slow-down, without faith or confidence. It has to have faith and confidence, otherwise it's just a burn-out. And there has to be self-care, and the love of that.

In speeding up (which has been my usual tendency), I tend to scatter my energies, and accomplish less, though I'm functioning at a faster pace. So I don't know if that will help or not. I've spoken with friends of mine who are in 12-Step programs such as AA who report the same phenomenon.