Friday, June 17, 2011

signs and symptoms of bipolar disorder

Symptoms or Internal Affects?
Signs & Symptoms of Bipolar Disorder.

External behaviors observed by others?

There are only two sub-types of bipolar illness, which have been defined, clearly enough to be given their own DSM categories, Bipolar I and Bipolar II.

Defined by objective external observations that describe behaviors not what bipolar is internally?

Behavioral Symptoms or Internal Affective States?

External Signs, Symptoms, Behaviors vs Internal Affects?

DSM-IV - Diagnostic and Statistical Manual of Mental Disorders IV:
Diagnostic Categories for Manic Depression/ Bi-Polar Affective Disorder (BD)
From MDF the bipolar organization.

There are only two sub-types of bipolar illness, which have been defined, clearly enough to be given their own DSM categories, Bipolar I and Bipolar II.

Bipolar I
This disorder is characterized by manic episodes; the 'high' of the manic depressive cycle. Generally this manic period is followed by a period of depression, although some bipolar I individuals may not experience a major depressive episode. Mixed states, where both manic or hypo-manic symptoms and depressive symptoms occur at the same time, also occur frequently with bipolar I patients (for example, depression with the racing thoughts of mania). Also, dysphoric mania is common, this is mania characterized by anger and irritability.

Bipolar II
This disorder is characterized by major depressive episodes alternating with episodes of hypo-mania, a milder form of mania. Hypo-manic episodes can be a less disruptive form of mania and may be characterized by low-level, non-psychotic symptoms of mania, such as increased energy or a more elated mood than usual. It may not affect an individual's ability to function on a day to day basis. The criteria for hypo-mania differ from those for mania only by their shorter duration (at least 4 days instead of 1 week) and milder severity (no marked impairment of functioning, hospitalization or psychotic features).

If the depressive and manic symptoms last for two years and do not meet the criteria for a major depressive or a manic episode then the diagnosis is classified as a Cyclothymic disorder, which is a less severe form of bipolar affective disorder. Cyclothymic disorder is diagnosed over the course of two years and is characterized by frequent short periods of hypo-mania and depressive symptoms separated by periods of stability.

Rapid cycling occurs when an individual's mood fluctuates from depression to hypo-mania or mania in rapid succession with little or no periods of stability in between. One is said to experience rapid cycling when one has had four or more episodes, in a given year, that meet criteria for major depressive, manic, mixed or hypo-manic episodes. Some people who rapid cycle can experience monthly, weekly or even daily shifts in polarity (sometimes called ultra rapid cycling)

When symptoms of mania, depression, mixed mood, or hypo-mania are caused directly by a medical disorder, such as thyroid disease or a stroke, the current diagnosis is Mood Disorder Due to a General Medical Condition.
If a manic mood is brought about through an antidepressant, ECT or through an individual using street drugs, the diagnosis is Substance-Induced Mood Disorder, with Manic Features.

Occasionally one comes across a diagnosis of Bipolar 111. This has been used to categorize manic episodes, which occur as a result of taking an antidepressant medication, rather than occurring spontaneously. Confusingly, it has also been used in instances where an individual experiences hypo-mania or cyclothymia (i.e. less severe mania) without major depression.

Observed Definitions?

Manic Depression is comprised of two distinct and opposite states of mood, whereby depression alternates with mania. The DSM IV gives a number of criteria that must be met before a disorder is classified as mania. The first one is that an individual's mood must be elevated, expansive or irritable. The mood must be a different one to the individual's usual affective state during a period of stability. There must be a marked change over a significant period of time. The person must become very elevated and have grandiose ideas. They may also become very irritated and may well appear to be 'arrogant' in manner.

The second main criterion for mania emphasizes that at least three of the following symptoms must have been present to a significant degree:

* Inflated sense of self importance
* Decreased need for sleep
* Increased talkativeness
* Flight of ideas or racing thoughts
* Easily distracted
* Increased goal-directed activity

Excessive involvement in activities that can bring pleasure but may have disastrous consequences (e.g. sexual affairs and spending excessively.)

The third criterion for mania in the DSM-IV emphasizes that the change in mood must be marked enough to affect an individual's job performance or ability to take part in regular social activities or relationships with others. This third criterion is used to emphasize the difference between mania and hypo-mania.

The DSM-IV states that there are a number of criteria by which major depression is clinically defined: The condition must have been evident for at least two weeks and must have five of the following symptoms:

* A depressed mood for most of the day, almost every day
* A loss of interest or pleasure in almost all activities, almost every day
* Changes in weight and appetite
* Sleep disturbance
* A decrease in physical activity
* Fatigue and loss of energy
* Feelings of worthlessness or excessive feelings of guilt
* Poor concentration levels
* Suicidal thoughts

Both the depressed mood and a loss of interest in everyday activities must be evident as two of the five symptoms, which characterize a major depression. It is difficult to distinguish the symptoms of an individual suffering from the depressed mood of manic depression than from someone suffering from a major depression. Dysthymia is a less severe depression than unipolar depression, but it can be more persistent.

Psychosis is characterized by disorders in basic perceptual, cognitive, affective, and judgmental processes. For example, one might experience delusions, hallucinations, disorganized speech, disorganized behavior etc. A diagnosis of bipolar affective disorder does not mean that an individual will necessarily experience psychosis.

Schizo-affective Disorder
This relatively rare disorder is defined as, 'the presence of psychotic symptoms in the absence of mood changes for at least two weeks in a person who has a mood disorder'. The diagnosis is used when an individual does not fit diagnostic standards for either schizophrenia or mood disorders. There is often a failure to diagnose schizo-affective disorder because of the complex nature of the illness. Many individuals with schizo-affective disorder are originally diagnosed with manic depression.

Mood disorder? From Wikipedia, the free encyclopedia.
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR) classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in ICD 10.

English psychiatrist Henry Maudsley proposed an overarching category of affective disorder. The term was then replaced by mood disorder, as the latter term refers to the underlying or longitudinal emotional state, whereas the former refers to the external expression observed by others.

External Expression Observed by Others?
In a time of crisis we present to the medical profession for help in managing uncontrollable energies, behaviors beyond the normal expectation. Often at the behest of concerned family and friends who observe a shift in behavior that is disturbing them. For the sake of the individual under observation and the disturbed observers, something must be done to calm affective states which are causing disturbance ripples in the general affective atmosphere.

Affective Atmosphere?
We are instinctual creatures who group together for mutual support and protection, sharing a generally warm affective atmosphere? As an example of a disturbed affective atmosphere, think of a time when you have heard a two year old screaming in distress at the top of their lungs? Innate distress is a powerful emotional energy we all born with and for most it is the first reaction to this life, as the birth cry. Nine innate affects; Distress. Startle. Fear. Shame. Anger. Disgust. Dissmell. Excitement. Joy. These are the roots of all our complex emotions and behaviors and the underlying affective states which external observers label as symptoms when describing mental illness.

Looking at these facial expressions of emotion or mood, we can see the observable reality of innate affects, (affective states). Clockwise we see Anger. Startle. Distress. Joy. What we cannot see is the systemic interaction of brain and nervous system that produces such energy states.

Affective Neuroscience is only recently coming to understand the systemic complexity of a human organism capable of such amazing feedback stimulated responses.
Feedback Stimulated Responses? Complex metabolic energy states that defy description using our simple this thing or that thing objective observations.

The Reactive Response of Our Objective Judgements?

In the crises management situation of a needed intervention, action is called for not a subtle awareness of an underlying systemic reality. Stress demands reaction, and movement, muscular tensions stimulated by the motor cortex and triggered by mirror neuron perception, fire thoughts of objective judgement. A complex internal energy state like innate distress becomes an observable sign, a symptom, of what an observed behavior looks like, not what it is?

Nature's Yoke is still on Us?

Is Nature's Evolution Joke still on Us?
Nine innate affects are the hard wired instinctual responses which fire all our complex human emotions?
Nature still invigorates our daily lives, in vitality affects of human relationships and the bounty of her life sustaining gifts.
The sights, sounds, smells and tastes that enrich our lives and spur us to joy, perhaps the most exotic state available in this matter filled universe?
The human mind is dissociation from nature, born through the intense focusing power of mammalian terror states, in this life eats life world. Mental illness is truncated Instinct?

Faulty neuroception might lie at the root of several psychiatric disorders?

At a glance:
• Neuroception describes how neural circuits distinguish whether situations or people are safe, dangerous, or life threatening.
• Neuroception explains why a baby coos at a caregiver but cries at a stranger, or why a toddler enjoys a parent’s embrace but views a hug from a stranger as an assault.
• The Polyvagal Theory describes three developmental stages of a mammal’s autonomic nervous system: Immobilization, mobilization, and social communication or social engagement.
• Faulty neuroception might lie at the root of several psychiatric disorders, including autism, schizophrenia, anxiety disorders, depression, and Reactive Attachment Disorder.

Stephen Porges groundbreaking The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation describes the complexity of our triune autonomic nervous system, our auto pilot? His term "neuroception" captures the neurology/biology of our sixth sense, our animal instincts which operate at millisecond speeds within the brain/body, and below conscious awareness? Only as an afterthought does the mind catch up with instinct stimulated muscular tensions, in a "what is it" moment in time. Only the minds insistence on being the only observer, prevents nature taking its proper coarse in maintaining body/brain order through the nervous system?

"The essential role of feedback from bodily systems, especially facial and postural, underlies the generation of emotion." (P,49) Affect Regulation & the Origin of the Self by Allan N Schore.

The brains activity began about 500 milliseconds before the person was aware of deciding to act. The conscious decision came far too late to be the cause of the action. It was as though consciousness was a mere afterthought - a way of 'explaining to ourselves' an action not evoked by consciousness. Peter Levine "In an Unspoken Voice"

"This Shining Moment in the Now - When I am every day, all day all body and no mind, when I am physically, 
wholly and completely, in this world with the birds, the deer, the sky, the wind, the trees... 
this shinning moment in the now, devoid of mental rumination" _David Budbill

The Muscular Pre-Tensions of Mental Anguish?

I know its not easy to accept this notion of muscular tensions as the real source of our mental anguish? Please try relaxing the muscles of your face, your tongue, the tensions of the jaw & around the eyes and be aware of spontaneous shifts in the depth of your breathe. As your focus turns to awareness of body sensations, the grip of dissociation should ease within the mind and as the muscular system relaxes, the minds activity will follow? This is how I manage the excitement phase of coming up and out of myself, away from habitual withdrawal, that judgmental doctors like to call mania or a symptom.

Insights into our internal nature, the structure of our being allow a deeper awareness, beyond the us & them stress perceptions of an everyday reality. Feeling the muscular pre-tensions of my postured intelligence, I see myself in others and laugh that I ever thought of observable behaviors as anything more than a shallow sense, an objectified reality. There really is no Us & Them, only We?

Please educate yourself about YOU! “Education is the most powerful weapon
which you can use to change your world.” _ Nelson Mandela

Mental Illness: A Compass of Shame
Bipolar Mania
Bipolar Anger
Fear Filled Mental Anguish
Catch the Gap & Feel Your Mind
Unconscious Reactivity & the Pre-Tense of Intelligence?
Calming Your Bipolar Symptoms
Neuroception? An Unconscious Perception?