Bipolar II Diagnostic Analysis

There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each mood episode comes with a series of symptoms. In the manic phase of bipolar disorder, feelings of increased energy and extreme happiness are the most common. People who are experiencing a manic episode often cannot stop talking, their talking is fast and very hard to understand, they sleep very little, and are very hyperactive. They feel they are invincible and can do anything in the world. Hypomania is a less severe type of mania.

Bipolar Disorder is a brain disorder that is characterized by abnormal changes in mood, energy and activity levels (“National Institute of Mental Health”). Manic-depressive illness is also another name that bipolar disorder is commonly referred to as (“National Institute of Mental Health”). This disorder has four basic types including, bipolar I, bipolar II, cyclothymic, and any other which do not perfectly fit the first three. All four of the types have episodes of extreme highs, manic periods, and extreme lows, depressive periods. Symptoms can range greatly and depend on what type of episode the affected is having. Manic episodes can include, but are not limited to: having extraordinarily high amounts of energy, activity,

* Bipolar II: one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes. Also the highs in bipolar II, called hypomania’s, and are not as high as those in bipolar I.

People with bipolar I disorder have full manic and major depressive episodes. Most of them experience an alternation of the episodes; for example, weeks of mania may be followed by a period of wellness, followed, in turn, by an episode of depression. Some, however, have mixed episodes, in which they display both manic and depressive symptoms within the same episode—for example, having racing thoughts amidst feelings of extreme sadness. In bipolar II disorder, hypomanic—that is, mildy manic—episodes alternate with major depressive episodes over the course of time. When a person experiences numerous periods of hypomanic symptoms and mild depressive symptoms, but not full-blown episodes, DSM-5 assigns a diagnosis of cyclothymic disorder. The symptoms of this milder form of bipolar disorder continue for two or more years, interrupted occasionally by normal moods that may last for only days or weeks.

Bipolar disorder is characterised by episodes of mania or hypomania (overactivity, insomnia, inability to concentrate, irritability, excitement, euphoria and delusions) and depression

The two major types of Bipolar Disorder (BPD) set out in this paper are Bipolar 1 and 2. Bipolar 1 is diagnosed as guide lined by the DSM5. As the occurrence of a least one maniac episode preceding or post an episode of hypomania and/or Major depression. The DSM 5 highlights that Bipolar 2 is diagnosed by one major depressive episode in occurrence with one hypomanic episode with an absence of Mania. (Association:, 2013) Mania as defined by DSM5: “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day.” Hypomania being: “A distinct period of abnormally and

Psychiatric mood disorders of such as Bipolar are often complex to diagnosis. Bipolar I is differentiated from Bipolar II by a history of at least one manic episode in a person’s life, with Bipolar II being diagnosed and characterized by a history of major depression with at least one episode of hypomania (Sadock, Sadock, and Ruiz, 2015). Bipolar is often misdiagnosed as major depression, especially in the presence of a dual diagnosis of substance use disorders. Individuals with Bipolar often have a history of self-medicating their mood symptoms of mania and

For an episode to be categorized as manic, the patients’ mood has been irritable or abnormally elevated for at least 1 week. A person must also exhibit at least 3 of the following symptoms (4 if the mood is only irritable): extreme feelings of personal greatness; a decreased need for sleep, marked talkativeness; distractibility; extreme focus on a goal-directed activity; reports of ‘racing’ thoughts or a flight of ideas; or excessive involvement in pleasurable activities that have a high potential for painful consequences (i.e. sexual indiscretions or unintelligent business investments). As in the criteria for a depressed episode, the DSM-IV specifies that these symptoms should not be better explained as being a side effect of a drug or illness to qualify as a manic episode. These symptoms must interfere with the person’s normal functioning and must not meet the criteria for a mixed episode. As with adults, childhood-onset bipolar disorder has many faces. Children with Bipolar I Disorder have episodes of mania and episodes of depression, sometimes there are long periods of normal moods between episodes. Adults usually tend to have more depressed episodes than manic episodes. However, some children will have chronic mania (symptoms of mania lasting for long periods of time or marked by frequent recurrence) and seldom experience a depressed episode.

Bipolar disorder is a rollercoaster no one wants to ride, it’s a constant up and down loop until you stabilize, coasting the ride back in. Many studies and research has been performed to understand how this disorder works. Articles “Bipolar 1 Disorder and Bipolar 2 Disorder: What Are the Differences?” by James Roland, and “Differences Between Bipolar I and Bipolar II Disorders in Clinical Features, Comorbidity, and Family History” by Ji Hyun Bark et al, are great articles informing the reader of what bipolar disorder is and the difference between bipolar one and bipolar two. Knowing the difference between bipolar one and two is very important for the patient to understand as well as their family and

Bipolar Disorder or manic-depressive disorder is a disorder characterized by highs, manias, and lows, depressions, and can therefore be easily distinguished from unipolar depression, a major depressive disorder in DSM-5, by the presence of manic or hypomanic episodes (Miklowitz & Gitlin, 2014). Bipolar disorder is generally an episodic, lifelong illness with a variable course (American Psychiatric Association, 2010). There are two classifications of bipolar disorder; bipolar I disorder and bipolar II disorder. If the episodes are primarily manic but there has been at least one depressive episode, the diagnosis is bipolar I disorder (Early, 2009). If the episodes are primarily depressed but there has been at least one episode of hypomania, increased mood that is more euphoric than normal but not quite manic, the diagnosis is bipolar II disorder (Early, 2009).

Bipolar I is our modern understanding of the 19th Century manic-depressive disorder or affective psychosis, however, it differs in that neither psychosis nor a lifetime experience of a major depressive episode is required. It requires one or more extreme manic episode, or symptoms of both a mania and a depression. It may be preceded by, or followed by, hypomanic or major depressive episodes. Mania symptoms cause significant impairment in life and may require hospitalization or trigger psychosis. In contrast, bipolar II is defined by the lifetime experience of at least one hypomanic episode and at least one major depressive episode. Criteria for hypomania are like those of mania, but in a milder form. Instead of impairment, hypomania is marked by a distinct change in functioning. (APA, 2013)

The National Institute of Mental Health describes bipolar I disorder as the occurrence of manic episodes that can last up to seven days, or experiencing a state of mania so severe that one must be hospitalized. With manic episodes, it is common to experience depressive symptoms as well, which can last two weeks or more. The NIMH defines bipolar II disorder as a pattern of depressive episodes with the addition of hypomanic episodes, which are not as intense and distressing as the manic episodes in bipolar I disorder. During a manic episode one might be experiencing feelings of having a lot of energy, feeling jumpy or wired, talking fast about a variety of topics, racing thoughts, and wanting to do risky things. During an episode of depression,

It has been said that people do not use drugs to feel good, but that they use them to avoid feeling bad. Regardless of anyone’s opinions on drug abuse, this concept holds a lot of truth in regards to substance abuse in those with bipolar disorder. Many times this abuse is referred to as “self-medicating”. This means the use of medicine (or drugs) without medical supervision to treat one’s own ailment. While self-medicating can be healthy, like taking pain killer for a headache, it can also be detrimental to someone’s health as many drugs have nasty side effects. Self-medicating can relieve psychological symptoms, but many people with bipolar end up abusing substances more often than those without it. In both manic and depressive states somebody with bipolar may be motivated to use. Someone in a manic state may be more impulsive, and feel invulnerable, inclining them to take illicit substance. Someone who is depressive may use to escape their feelings. Using illicit substances and finding pleasure or short-term symptom alleviation has, many times, lead to addiction or a substance abuse disorder. Bipolar disorder and substance abuse disorder are considered separate mental illnesses, but research has found a strong comorbidity between the two.

Bipolar II disorder is a relatively common mental illness that affects upwards of 6 million United States citizens. This disease is very complex and often difficult to diagnose. What makes this illness clinically unique is that it is characterized by extreme mood swings that alternate between extreme highs and extreme lows. Bipolar II differs from bipolar I disorder, as that the high moods of bipolar II are milder than bipolar I, which means that bipolar II patients spend more time in the low depressive states of their cycling mood. Bipolar II is often much more difficult to diagnose than bipolar I (Parker 18), which is why it is the subject of this literature review. The criteria used to diagnose bipolar II and the interpretation of these criteria is subject of continuous scholarly debate. Researchers suggest that the difficulty in diagnosing bipolar II disorder stem from an inconsistency in diagnostic criteria, an underrepresentation of hypomanic symptoms and most notably, confusion between other psychiatric disorders.