Bipolar disorders description

An important body of evidence from descriptive, clinical, and genetic sources finds that bipolar disorder is a separate entity from unipolar disorder (i.e., genetically the two variants breed true see also the section Mechanism of Action earlier in this chapter). When we pooled data from several studies that investigated bipolar or unipolar disorders, lithium was more effective than placebo in preventing relapse in bipolar, as well as unipolar, disorders ( Table 10-11 and Table 10-12). 

This is perhaps the earliest documented clinical description of bipolar disorder. Keen observers noticed not only that certain individuals suffered from depression but also that, seemingly inexplicably, their mood would suddenly switch into the polar opposite from dejection to unbridled excitement, from profound despair to limitless optimism, or from paralyzing fatigue to superhuman levels of activity and energy. Bipolar disorder, as it is presently termed, historically has been called manic-depressive insanity (as it was called in Kraepelin s [1919/1971, 1976] time) or manic-depressive illness. The term bipolar was coined several decades ago in an effort to reflect the hallmark of the disorder two opposite poles of the affective continuum. 

Psychotherapy is not only possible but can be very productive with the bipolar patient. Miklowitz (1996), in addressing combined psyAotherapy and medication treatment for bipolar disorder, offers a comprehensive and detailed description of two approaches, family psychoeducation and individual therapy. The latter incorporates elements of interpersonal therapy for affective disorders with strategies to stabilize social rhythms. However, the therapist must be skilled at identifying symptoms of hypomania, mania, and depression, and the necessity for medication adjustment referrals. The therapist can be tested especially by the effects of medication noncompliance, when symptoms return and judgment and insight diminish. 

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