What is Bipolar 2?

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According to The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which is the diagnostic standard for mental health professionals in the United States, there are four categories ascribed to the illness of bipolar disorder: bipolar I, bipolar II, cyclothymia, and bipolar not-otherwise-specified (NOS). The illness of bipolar 2 disorder was only recognised fairly recently, in 1976 by Elliot Gershon, David Dunner, and Frederick Goodwin in a paper presented at the U.S. research centre of the National Institute of Mental Health.

Diagnosis and Symptoms

While there are differences between each category, bipolar disorder is always characterised by mood swings – from depressive lows to the extreme highs of mania. The severity, duration, and length of these episodes are what determines the proper designation.

Bipolar II disorder involves phases of depression which alternate with manic episodes, although the mania phase is less severe and referred to as hypomania. As well, psychosis is absent during the hypomanic phase (psychosis is present in bipolar I). Oftentimes, it is difficult to diagnose a patient with bipolar 2 as the symptoms are very similar to that of unipolar major depression. Since the history of hypomanic episodes is used to determine the presence of the illness, this presents another challenge in that it relies on the often faulty memory of the patient and the clinical skills of the consulting physician. It is estimated that the illness affects 5% of the population.

Those people diagnosed with bipolar II disorder exhibit the following symptoms and behaviours during the depression phase:

•    Very low energy
•    Retarded physical and mental processes
•    Extreme fatigue; excessive sleepiness
•    Subsyndromal (mixed with symptoms of hypomania)

Conversely, in the phase of hypomania, symptoms may include:

•    Euphoric, yet irritable, mood
•    Increased energy; overactivity
•    Grandiose thinking
•    Self-confidence
•    Decisive behaviour
•    Increase in talking
•    Racing thoughts
•    Risky activity

Found in both bipolar I and II disorder patients up to 20% of the time, a condition known as rapid cycling can occur. Rapid cycling refers to the frequent cycling of depressive and manic episodes. Further, a patient who exhibits signs of ultra-rapid cycling may experience the transition from depression to mania more than once in a single day.

Treatment

Treatment of bipolar 2 disorder generally follows that of bipolar 1: mood stabiliser medications, antipsychotics, and clinical counselling. Lithium is the most often prescribed treatment for any form of bipolar disorder in the UK. Teaching patients how to recognise the warning signs of upcoming mood swings seems to be effective as an adjunct to drug therapy.

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