Dating with bipolar disorder

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Now that I have made this realization Over the past 4 months or so I have been trying to kindly enforce boundaries like actually going out of the house and stop trying to be her savior. Hello, I am Preethi from Ohio.

Hope you can give me some advice. Once I spoke to her on the file I got it out of her…. Everyone you date and care about is bound to live through some bad stuff. She has bipolar disorder, apparently the sex is out of this world although I thought it was pretty good with me. So imagine being a jesus growing up in an environment with BPD-like parents. As a young man with bipolar disorder, I agree with most of what this article says. The dopamine hypothesis states that the increase in dopamine results in secondary homeostatic down regulation of key systems and receptors such as an pan in dopamine mediated. Besides, you have done worse… Tracey Lloyd lives in Harlem, where she fights her cat for access to the keyboard. Some evidence suggests that some heritable component of bipolar disorder overlaps with heritable components of creativity. If you, or someone you know, may be glad from Bipolar Disorder, please see a mental health professional. What should I do?.

Her attraction for you has plummeted. However, only a few small studies of variable quality have been published and there is not enough evidence to draw any firm conclusions. Retrieved April 7, 2009.

Guide to Bipolar Disorder and Relationships - I heard a rumor from a distant friend that she was sleeping with my old best friend when we were broken up.

For the medical journal, see. Bipolar disorder Synonyms Bipolar affective disorder, bipolar illness, manic depression, manic depressive disorder, manic-depressive illness, manic-depressive psychosis, circular insanity, bipolar disease Bipolar disorder is characterized by episodes of depression and mania. Symptoms Periods of and elevated , Usual onset 25 years old Types , , others Causes and Family history, , long-term , , , Treatment , Medication , , Frequency 1-3% Bipolar disorder, previously known as manic depression, is a that causes periods of and periods of abnormally. The elevated mood is significant and is known as or , depending on its severity, or whether symptoms of are present. During mania, an individual or feels energetic, happy, or irritable. Individuals often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced during manic phases. During periods of depression, there may be crying, a negative outlook on life, and poor eye contact with others. The risk of among those with the illness is high at greater than 6 percent over 20 years, while occurs in 30—40 percent. Other mental health issues such as and are commonly associated. The causes are not clearly understood, but both and factors play a role. Many genes of small effect contribute to risk. Environmental risk factors include a history of , and long-term. About 85% of the risk is. The condition is divided into if there has been at least one manic episode, with or without depressive episodes, and if there has been at least one hypomanic episode but no manic episodes and one major depressive episode. In those with less severe symptoms of a prolonged duration, the condition may be diagnosed. If due to drugs or medical problems, it is classified separately. Other conditions that may present in a similar manner include , , and as well as a number of medical conditions. Treatment commonly includes as well as such as and. Examples of mood stabilizers that are commonly used include and various. Severe behavioral problems, such as agitation or combativeness, may be managed with short term antipsychotics or. In periods of mania, it is recommended that be stopped. If antidepressants are used for periods of depression, they should be used with a mood stabilizer. ECT , while not very well studied, may be tried for those who do not respond to other treatments. If treatments are stopped, it is recommended that this be done slowly. Many individuals have financial, social or work-related problems due to the illness. These difficulties occur a quarter to a third of the time, on average. The risk of death from such as is twice that of the general population. This is due to stressful life conditions and the side effects from medications. Bipolar disorder affects approximately 1% of the global population. In the United States, about 3% are estimated to be affected at some point in their life. The most common age at which symptoms begin is 25. Rates appear to be similar in females and males. A large proportion of this was related to a higher number of missed work days, estimated at 50 per year. People with bipolar disorder often face problems with social stigma. An 1858 lithograph captioned 'Melancholy passing into mania' Both and depression are characterized by disruptions in normal mood, psychomotor activity, circadian rhythm, and cognition. The core symptom of mania involves an increase in energy of psychomotor activity. Mania can also present with increased self esteem or grandiosity, rapid speech, the subjective feeling of rapid thoughts, disinhibited social behavior, or impulsivity. Mania is distinguished from hypomania by length, where hypomania requires four consecutive days, and mania requires more than a week. Unlike mania, hypomania is not always associated with impaired functioning. The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode, or vice versa, remain poorly understood. To meet the definition for a manic episode, these behaviors must impair the individual's ability to socialize or work. If untreated, a manic episode usually lasts three to six months. People with hypomania or mania may experience a decreased need of sleep, impaired judgment, and speak excessively and very rapidly. At the more extreme, a person in a full blown manic state can experience psychosis; a break with reality, a state in which thinking is affected along with mood. This may lead to violent behavior and, sometimes, hospitalization in an inpatient. The severity of manic symptoms can be measured by rating scales such as the , though questions remain about the reliability of these scales. The onset of a manic or depressive episode is often foreshadowed by. Mood changes, and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops. Hypomanic episodes is the milder form of mania, defined as at least four days of the same criteria as mania, but does not cause a significant decrease in the individual's ability to socialize or work, lacks psychotic features such as or hallucinations, and does not require psychiatric hospitalization. Overall functioning may actually increase during episodes of hypomania and is thought to serve as a defense mechanism against depression by some. Hypomanic episodes rarely progress to full blown manic episodes. Some people who experience hypomania show increased creativity while others are irritable or demonstrate poor judgment. Hypomania may feel good to some persons who experience it, though most people who experience hypomania state that the stress of the experience is very painful. Bipolar people who experience hypomania, however, tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings, the individual will often deny that anything is wrong. Most commonly, symptoms continue for a few weeks to a few months. Depressive episodes 'Melancholy' by W. In severe cases, the individual may develop symptoms of , a condition also known as severe bipolar disorder with psychotic features. These symptoms include and. A major depressive episode persists for at least two weeks, and may result in suicide if left untreated. The earlier the age of onset, the more likely the first few episodes are to be depressive. Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having and then incorrectly treated with prescribed antidepressants. Mixed affective episodes Main article: In bipolar disorder, is a condition during which symptoms of both mania and depression occur simultaneously. Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal. Mixed states are considered to be high-risk for suicidal behavior since depressive emotions such as hopelessness are often paired with or. Substance abuse including also follows this trend, thereby appearing to depict bipolar symptoms as no more than a consequence of substance abuse. Associated features Main article: Associated features are clinical phenomena that often accompany the disorder but are not part of the diagnostic criteria. In adults with the condition, bipolar disorder is often accompanied by changes in processes and abilities. These include reduced and capabilities and impaired. How the individual processes the universe also depends on the phase of the disorder, with differential characteristics between the manic, hypomanic and depressive states. Some studies have found a significant association between bipolar disorder and. Those with bipolar disorder may have difficulty in maintaining relationships. There are several common childhood precursors seen in children who later receive a diagnosis of bipolar disorder: mood abnormalities including major depressive episodes and ADHD. Comorbid conditions The diagnosis of bipolar disorder can be complicated by coexisting comorbid psychiatric conditions including the following: , , , attention deficit hyperactivity disorder, , including , or. A careful longitudinal analysis of symptoms and episodes, enriched if possible by discussions with friends and family members, is crucial to establishing a treatment plan where these comorbidities exist. The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear. Genetic influences are believed to account for 60—80 percent of the risk of developing the disorder indicating a strong hereditary component. The overall of the has been estimated at 0. For bipolar disorder type I, the rate at which same genes will both have bipolar disorder type I concordance is estimated at around 40 percent, compared to about 5 percent in. A combination of bipolar I, II, and similarly produced rates of 42 percent and 11 percent identical and fraternal twins, respectively , with a relatively lower ratio for bipolar II that likely reflects. There is overlap with major unipolar depression and if this is also counted in the co-twin the concordance with bipolar disorder rises to 67 percent in identical twins and 19 percent in fraternal twins. The relatively low concordance between fraternal twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes. Genetic studies have suggested that many regions and are related to bipolar disorder susceptibility with. The risk of bipolar disorder is nearly ten-fold higher in first degree-relatives of those affected with bipolar disorder when compared to the general population; similarly, the risk of major depressive disorder is three times higher in relatives of those with bipolar disorder when compared to the general population. Although the first finding for mania was in 1969, the linkage studies have been inconsistent. The largest and most recent GWAS failed to find any particular locus that exerts a large effect reinforcing the idea that no single gene is responsible for bipolar disorder in most cases. Polymorphisms in , , , and have been frequently associated with bipolar disorder and were initially successful in a meta-analysis, but failed after correction for multiple testing. On the other hand, two polymorphisms in were identified as being associated with bipolar disorder. Due to the inconsistent findings in GWAS, multiple studies have undertaken the approach of analyzing SNPs in biological pathways. Signaling pathways traditionally associated with bipolar disorder that have been supported by these studies include signaling, cardiac signaling, signaling, receptor signaling, cardiac hypertrophy signaling, , , and signaling. Of the 16 genes identified in these pathways, three were found to be dysregulated in the portion of the brain in post-mortem studies, , , and. Findings point strongly to heterogeneity, with different genes being implicated in different families. Robust and replicable genome-wide significant associations showed several common SNPs, including variants within the genes , , and. Environmental Environmental factors play a significant role in the development and course of bipolar disorder, and individual psychosocial variables may interact with genetic dispositions. It is probable that recent life events and interpersonal relationships contribute to the onset and recurrence of bipolar mood episodes, just as they do for unipolar depression. The number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without, particularly events stemming from a harsh environment rather than from the child's own behavior. Neurological Less commonly, bipolar disorder or a bipolar-like disorder may occur as a result of or in association with a neurological condition or injury. Conditions like these and injuries include but are not limited to , , , , , and rarely. Increases have been reported in the volume of the , , , and as well as in the rates of deep. Pharmacological treatment of mania increases ventral prefrontal cortex vPFC activity, normalizing it relative to controls, suggesting that vPFC hypoactivity is an indicator of mood state. On the other hand, pretreatment hyperactivity in the amygdala is reduced post treatment but still increased relative to controls, suggesting that it is a trait marker. Manic and depressive episodes tend to be characterized by ventral versus dorsal dysfunction in the ventral prefrontal cortex. During attentional tasks and resting, mania is associated with decreased activity, while depression is associated with increased resting metabolism. Consistent with affective disorders due to lesions, mania and depression are lateralized in ventral prefrontal cortex vPFC dysfunction, with depression primarily being associated with the left vPFC, and mania the right vPFC. Abnormal vPFC activity, along with amygdala hyperactivity is found during euthymia as well as in healthy relatives of those with bipolar, indicating possible trait features. People with bipolar have increased activation of left hemisphere ventral limbic areas and decreased activation of right hemisphere cortical structures related to cognition. One proposed model for bipolar suggests that hypersensitivity of reward circuits consisting of fronto-striatal circuits causes mania and hyposensitivity of these circuits cause depression. There is evidence supporting an association between early-life stress and dysfunction of the HPA axis leading to its over activation, which may play a role in the pathogenesis of bipolar disorder. Some of the brain components which have been proposed to play a role are the and a sodium pump. Neurochemical , a known neurotransmitter responsible for mood cycling, has been shown to have increased transmission during the manic phase. The dopamine hypothesis states that the increase in dopamine results in secondary homeostatic down regulation of key systems and receptors such as an increase in dopamine mediated. This results in decreased dopamine transmission characteristic of the depressive phase. The depressive phase ends with homeostatic up regulation potentially restarting the cycle over again. The increase in is possibly caused by a disturbance in early development causing a disturbance of cell migration and the formation of normal lamination, the layering of brain structures commonly associated with the. Medications used to treat bipolar may exert their effect by modulating intracellular signaling, such as through depleting myo- levels, inhibition of , and through altering G coupled proteins. Consistent with this, elevated levels of , , and have been reported in brain and blood samples, along with increased expression and sensitivity. Decreased levels of , a byproduct of , are present in the of persons with bipolar disorder during both the depressed and manic phases. Increased dopaminergic activity has been hypothesized in manic states due to the ability of agonists to stimulate mania in people with bipolar disorder. Decreased sensitivity of regulatory α 2 as well as increased cell counts in the locus ceruleus indicated increased noradrenergic activity in manic people. Low plasma GABA levels on both sides of the mood spectrum have been found. One review found no difference in monoamine levels, but found abnormal norepinephrine turnover in people with bipolar disorder. Bipolar disorder is commonly diagnosed during adolescence or early adulthood, but onset can occur throughout the life cycle. The disorder can be difficult to distinguish from unipolar depression and the average delay in diagnosis is 5—10 years after symptoms begin. Diagnosis of bipolar disorder takes several factors into account and considers the self-reported experiences of the symptomatic individual, abnormal behavior reported by family members, friends or co-workers, observable signs of illness as assessed by a clinician, and often a medical work-up to rule-out medical causes. In diagnosis, caregiver-scored rating scales, specifically the mother, has been found to be more accurate than teacher and youth report in predicting identifying youths with bipolar disorder. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from the 's APA DSM-5 and the 's WHO ICD-10. The ICD-10 criteria are used more often in clinical settings outside of the U. The DSM-5, published in 2013, included further and more accurate specifiers compared to its predecessor, the. Several for the screening and evaluation of bipolar disorder exist, including the , , the and the. The use of evaluation scales cannot substitute a full clinical interview but they serve to systematize the recollection of symptoms. On the other hand, instruments for screening bipolar disorder tend to have lower. Differential diagnosis There are several other mental disorders with symptoms similar to those seen in bipolar disorder. These disorders include , major depressive disorder, attention deficit hyperactivity disorder ADHD , and certain personality disorders, such as. Neurologic diseases such as , complex , , brain tumors, , , , and complex can mimic features of bipolar disorder. An may be used to exclude such as , and a or of the head may be used to exclude brain lesions. Additionally, disorders of the such as , , and are in the differential as is the. Infectious causes of mania that may appear similar to bipolar mania include , , , or. Certain vitamin deficiencies such as deficiency , , , and can also lead to mania. A review of current and recent medications and drug use is considered to rule out these causes; common medications that can cause manic symptoms include antidepressants, , medications, , stimulants including and methamphetamine , and certain. Bipolar spectrum Since Emil Kraepelin's distinction between bipolar disorder and schizophrenia in the 19th century, researchers have defined a spectrum of different types of bipolar disorder Bipolar spectrum disorders includes: bipolar I disorder, bipolar II disorder, cyclothymic disorder and cases where subthreshold symptoms are found to cause clinically significant impairment or distress. These disorders involve major depressive episodes that alternate with manic or hypomanic episodes, or with mixed episodes that feature symptoms of both mood states. The concept of the bipolar is similar to that of 's original concept of manic depressive illness. Unipolar hypomania without accompanying depression has been noted in the medical literature. There is speculation as to whether this condition may occur with greater frequency in the general, untreated population; successful social function of these potentially high-achieving individuals may lead to being labeled as normal, rather than as individuals with substantial dysregulation. Criteria and subtypes The DSM and the ICD characterize bipolar disorder as a spectrum of disorders occurring on a continuum. Hypomanic episodes do not go to the full extremes of mania i. When relevant, specifiers for peripartum onset and with rapid cycling should be used with any subtype. Individuals who have subthreshold symptoms that cause clinically significant distress or impairment, but do not meet full criteria for one of the three subtypes may be diagnosed with other specified or unspecified bipolar disorder. Other specified bipolar disorder is used when a clinician chooses to provide an explanation for why the full criteria were not met e. Rapid cycling Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0. Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more mood disturbance episodes within a one-year span and is found in a significant proportion of individuals with bipolar disorder. These episodes are separated from each other by a remission partial or full for at least two months or a switch in mood polarity i. The definition of rapid cycling most frequently cited in the literature including the DSM is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period. Ultra-rapid days and ultra-ultra rapid or within a day cycling have also been described. The literature examining the pharmacological treatment of rapid cycling is sparse and there is no clear consensus with respect to its optimal pharmacological management. Main article: There are a number of and techniques used to treat bipolar disorder. Individuals may use and pursue. Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or if mental health legislation allows and varying state-to-state regulations in the USA involuntary called civil or. Long-term inpatient stays are now less common due to , although these can still occur. Following or in lieu of a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or an team, supported employment and patient-led support groups, intensive outpatient programs. These are sometimes referred to as partial-inpatient programs. Psychosocial is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing symptoms before full-blown recurrence, and, practicing the factors that lead to maintenance of. Most studies have been based only on bipolar I, however, and treatment during the acute phase can be a particular challenge. Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a in support of. Medication Lithium is often used to treat bipolar disorder and has the best evidence for reducing suicide. A number of medications are used to treat bipolar disorder. The medication with the best evidence is , which is an effective treatment for acute manic episodes, preventing relapses, and bipolar depression. Lithium reduces the risk of suicide, self-harm, and death in people with bipolar disorder. It is unclear if is useful in bipolar as of 2015. Mood stabilizers Lithium and the , , and are used as mood stabilizers to treat bipolar disorder. These mood stabilizers are used for long-term mood stabilization but have not demonstrated the ability to quickly treat acute bipolar depression. Lithium is preferred for long-term mood stabilization. Carbamazepine effectively treats manic episodes, with some evidence it has greater benefit in rapid-cycling bipolar disorder, or those with more psychotic symptoms or a more schizoaffective clinical picture. It is less effective in preventing relapse than lithium or valproate. Since then, valproate has become a commonly prescribed treatment, and effectively treats manic episodes. Lamotrigine has some efficacy in treating bipolar depression, and this benefit is greatest in more severe depression. It has also been shown to have some benefit in preventing bipolar disorder relapses, though there are concerns about the studies done, and is of no benefit in rapid cycling subtype of bipolar disorder. The effectiveness of is unknown. Antipsychotics medications are effective for short-term treatment of bipolar manic episodes and appear to be superior to lithium and anticonvulsants for this purpose. Atypical antipsychotics are also indicated for bipolar depression refractory to treatment with mood stabilizers. Antidepressants are not recommended for use alone in the treatment of bipolar disorder and have not been found to be of any benefit over that found with mood stabilizers. Atypical antipsychotic medications e. Other Short courses of may be used in addition to other medications until mood stabilizing become effective. ECT is an effective form of treatment for acute mood disturbances in those with bipolar disorder, especially when psychotic or features are displayed. ECT is also recommended for use in pregnant women with bipolar disorder. Contrary to widely held views, stimulants are relatively safe in bipolar disorder, and considerable evidence suggests they may even produce an antimanic effect. In cases of comorbid ADHD and bipolar, stimulants may help improve both conditions. Alternative medicine Several studies have suggested that may have beneficial effects on depressive symptoms, but not manic symptoms. However, only a few small studies of variable quality have been published and there is not enough evidence to draw any firm conclusions. A lifelong condition with periods of partial or full recovery in between recurrent episodes of relapse, bipolar disorder is considered to be a major health problem worldwide because of the increased rates of disability and premature mortality. It is also associated with co-occurring psychiatric and medical problems, and high rates of initial under- or misdiagnosis, causing a delay in appropriate treatment interventions and contributing to poorer prognoses. After a diagnosis is made, it remains difficult to achieve complete remission of all symptoms with the currently available psychiatric medications and symptoms often become progressively more severe over time. Compliance with medications is one of the most significant factors that can decrease the rate and severity of relapse and have a positive impact on overall prognosis. However, the types of medications used in treating BD commonly cause side effects and more than 75% of individuals with BD inconsistently take their medications for various reasons. Of the various types of the disorder, rapid cycling four or more episodes in one year is associated with the worst prognosis due to higher rates of and suicide. Early onset and psychotic features are also associated with worse outcomes, as well as subtypes that are nonresponsive to lithium. Early recognition and intervention also improve prognosis as the symptoms in earlier stages are less severe and more responsive to treatment. Onset after adolescence is connected to better prognoses for both genders, and being male is a protective factor against higher levels of depression. For women, better social functioning prior to developing bipolar disorder and being a parent are protective towards suicide attempts. Functioning People with bipolar disorder often experience a decline in cognitive functioning during or possibly before their first episode, after which a certain degree of cognitive dysfunction typically becomes permanent, with more severe impairment during and moderate impairment during periods of remission. As a result, two-thirds of people with BD continue to experience impaired in between episodes even when their mood symptoms are in full remission. A similar pattern is seen in both BD-I and BD-II, but people with BD-II experience a lesser degree of impairment. Cognitive deficits typically increase over the course of the illness. Higher degrees of impairment correlate with the number of previous manic episodes and hospitalizations, and with the presence of psychotic symptoms. Early intervention can slow the progression of cognitive impairment, while treatment at later stages can help reduce distress and negative consequences related to cognitive dysfunction. Despite the overly ambitious goals that are frequently part of manic episodes, symptoms of mania undermine the ability to achieve these goals and often interfere with an individual's social and occupational functioning. One third of people with BD remain unemployed for one year following a hospitalization for mania. Depressive symptoms during and between episodes, which occur much more frequently for most people than hypomanic or manic symptoms over the course of illness, are associated with lower functional recovery in between episodes, including unemployment or underemployment for both BD-I and BD-II. However, the course of illness duration, age of onset, number of hospitalizations, and presence or not of rapid cycling and cognitive performance are the best predictors of employment outcomes in individuals with bipolar disorder, followed by symptoms of depression and years of education. Recovery and recurrence A naturalistic study from first admission for mania or mixed episode representing the hospitalized and therefore most severe cases found that 50 percent achieved syndromal recovery no longer meeting criteria for the diagnosis within six weeks and 98 percent within two years. Within two years, 72 percent achieved symptomatic recovery no symptoms at all and 43 percent achieved functional recovery regaining of prior occupational and residential status. However, 40 percent went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19 percent switched phases without recovery. Symptoms preceding a relapse , specially those related to mania, can be reliably identified by people with bipolar disorder. There have been intents to teach patients when noticing such symptoms with encouraging results. Suicide Bipolar disorder can cause suicidal ideation that leads to attempts. Individuals whose bipolar disorder begins with a depressive or mixed affective episode seem to have a poorer prognosis and an increased risk of suicide. One out of two people with bipolar disorder attempt suicide at least once during their lifetime and many attempts are successfully completed. The annual average suicide rate is 0. The from in bipolar disorder is between 18 and 25. The lifetime risk of suicide has been estimated to be as high as 20 percent in those with bipolar disorder. However, a reanalysis of data from the National Epidemiological Catchment Area survey in the United States suggested that 0. Including sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, an additional 5. A more recent analysis of data from a second US found that 1 percent met lifetime prevalence criteria for bipolar I, 1. There are conceptual and methodological limitations and variations in the findings. In addition, diagnoses and therefore estimates of prevalence vary depending on whether a categorical or is used. This consideration has led to concerns about the potential for both underdiagnosis and overdiagnosis. The incidence of bipolar disorder is similar in men and women as well as across different cultures and ethnic groups. A 2000 study by the found that prevalence and incidence of bipolar disorder are very similar across the world. Age-standardized prevalence per 100,000 ranged from 421. However, severity may differ widely across the globe. Disability-adjusted life year rates, for example, appear to be higher in developing countries, where medical coverage may be poorer and medication less available. Within the United States, have significantly lower rates than their and counterparts. Late adolescence and early adulthood are peak years for the onset of bipolar disorder. One study also found that in 10 percent of bipolar cases, the onset of mania had happened after the patient had turned 50. Within the humoral theories, mania was viewed as arising from an excess of yellow bile, or a mixture of black and yellow bile. The linguistic origins of mania, however, are not so clear-cut. There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic poetry and mythology. In the early 1800s, French psychiatrist 's lypemania, one of his affective , was the first elaboration on what was to become modern depression. These concepts were developed by the German psychiatrist 1856—1926 , who, using 's concept of cyclothymia, categorized and studied the natural course of untreated bipolar patients. He coined the term manic depressive psychosis, after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally. The subtypes bipolar II and rapid cycling have been included since the DSM-IV, based on work from the 1970s by , , , , and. Singer 's public revelation of bipolar disorder made her an early celebrity spokeswoman for mental illness. There are widespread problems with , stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder. In his autobiography 2008 , describes his struggle between the creative dynamism which allowed the creation of his multimillion-pound advertising agency , and the money-squandering dark despair of his bipolar illness. Several dramatic works have portrayed characters with traits suggestive of the diagnosis that has been the subject of discussion by psychiatrists and film experts alike. A notable example is 1993 , in which Mr. Jones swings from a manic episode into a depressive phase and back again, spending time in a psychiatric hospital and displaying many of the features of the syndrome. In 1986 , Allie Fox displays some features including recklessness, grandiosity, increased goal-directed activity and mood lability, as well as some. Psychiatrists have suggested that , the main character in 's classic play , suffers from bipolar disorder, though that specific term for the condition did not exist when the play was written. On April 7, 2009, the nighttime drama on the network, aired a where the character Silver was diagnosed with bipolar disorder. The storyline was developed as part of the BBC's Headroom campaign. The soap had earlier featured a story about bipolar disorder when the character was diagnosed with the condition. In April 2014, premiered a medical drama, , in which the main character, a world-renowned neuroscientist, is bipolar. Creativity A link between mental illness and professional success or creativity has been suggested, including in accounts by , , and. Despite prominence in popular culture, the link between creativity and bipolar has not been rigorously studied. This area of study also is likely affected by. Some evidence suggests that some heritable component of bipolar disorder overlaps with heritable components of creativity. Probands of people with bipolar disorder are more likely to be professionally successful, as well as to demonstrate temperamental traits similar to bipolar disorder. Furthermore, while studies of the frequency of bipolar disorder in creative population samples have been conflicting, studies that have a positive finding report that full blown bipolar disorder is rare. In general, bipolar disorder in children was not recognized in the first half of the twentieth century. This issue diminished with an increased following of the DSM criteria in the last part of the twentieth century. The does not specifically have bipolar disorder in children and instead refers to it as. While in adults the course of bipolar disorder is characterized by discrete episodes of depression and mania with no clear symptomatology between them, in children and adolescents very fast mood changes or even chronic symptoms are the norm. Pediatric bipolar disorder is commonly characterized by outbursts of anger, irritability and , rather than , which is more likely to be seen in adults. Early onset bipolar disorder is more likely to manifest as depression rather than mania or hypomania. The diagnosis of childhood bipolar disorder is controversial, although it is not under discussion that the typical symptoms of bipolar disorder have negative consequences for minors suffering them. The debate is mainly centered on whether what is called bipolar disorder in children refers to the same disorder as when diagnosing adults, and the related question of whether the criteria for diagnosis for adults are useful and accurate when applied to children. Regarding diagnosis of children, some experts recommend following the DSM criteria. Others believe that these criteria do not correctly separate children with bipolar disorder from other problems such as ADHD, and emphasize fast mood cycles. Still others argue that what accurately differentiates children with bipolar disorder is irritability. The practice parameters of the encourage the first strategy. American children and adolescents diagnosed with bipolar disorder in community hospitals increased 4-fold reaching rates of up to 40 percent in 10 years around the beginning of the 21st century, while in clinics it doubled reaching 6 percent. Studies using DSM criteria show that up to 1 percent of youth may have bipolar disorder. Treatment involves medication and psychotherapy. Drug prescription usually consists in and. Among the former, is the only compound approved by the for children. Psychological treatment combines normally , and. Current research directions for bipolar disorder in children include optimizing treatments, increasing the knowledge of the genetic and neurobiological basis of the pediatric disorder and improving diagnostic criteria. Some treatment research suggests that interventions that involve the family, psychoeducation, and skills building through therapies such as , , and can benefit in a pharmocotherapy. Unfortunately, the literature and research on the effects of psychosocial therapy on BPSD is scarce, making it difficult to determine the efficacy of various therapies. The DSM-5 has proposed a new diagnosis which is considered to cover some presentations currently thought of as childhood-onset bipolar. Elderly There is a relative lack of knowledge about bipolar disorder in late life. There is evidence that it becomes less prevalent with age but nevertheless accounts for a similar percentage of psychiatric admissions; that older bipolar patients had first experienced symptoms at a later age; that later onset of mania is associated with more neurologic impairment; that substance abuse is considerably less common in older groups; and that there is probably a greater degree of variation in presentation and course, for instance individuals may develop new-onset mania associated with vascular changes, or become manic only after recurrent depressive episodes, or may have been diagnosed with bipolar disorder at an early age and still meet criteria. There is also some weak and not conclusive evidence that mania is less intense and there is a higher prevalence of mixed episodes, although there may be a reduced response to treatment. Overall, there are likely more similarities than differences from younger adults. 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