Definition of different types of bipolar disorder

[LyndaNP]

From:
http://www.schizophrenia.com/ami/diagnosis/mrBIPOL.html

Definition of different types of bipolar disorder

By Dr. Neff Breen

The American Psychiatric Association has released an updated version of
the Diagnostic and Statistical Manual of Mental Disorder-the DSM-IV.
This manual is revised every few years to reflect the latest advances in
scientific research. One of the most important differences between
DSM-IV and its predecessors (DSM-III revised or DSM-IIIR)is in the area
of bipolar disorders. The DSM-IIIR listed only two types of bipolar
conditions: the diagnosis of bipolar disorder was given to people who
suffered a manic episode with or with out any history of depression; and
the diagnosis of cyclothymia was given to people who had suffered a
number of hypomanic episodes as well as some symptoms of depression.
Everything else was called "Bipolar Disorder Not Otherwise Specified"
(NOS).

The classification scheme was obviously inadequate, only two types of
bipolar conditions were classified. There was not enough emphasis on
describing an individual patients long term course. During the 1980's,
however, much effort was spent trying to separate out the different
subtypes of bipolar disorder. These subtypes basically differ in their
long-term course and in the intensity of their manic and depressive
symptoms.

The new categories include:

Bipolar I Disorder: This is the classic bipolar disorder. People with
Bipolar I have at least one full blown Manic or Mixed (manic and
depressed simultaneously) episode, with or without depression.

Bipolar II Disorder: This is a new diagnostic category. People with this
diagnosis have had at least one Major Depressive Episode and one
Hypomanic Episode, but have never had a full blown manic or mixed
episode.

Cyclothymic Disorder: Cyclothymic patients have a different long term
pattern than patients with the other bipolar disorders. Whereas people
people with Bipolar I or II have had a severe mood disturbance within
the first two years of their illness, cyclothymics start with at least
two years of more subtle depressive and hypomanic symptoms. They may
continue to have a number of these episodes throughout their lives
without ever having a complete Major Depressive or Manic Episode. They
also may go on to develop Bipolar I or II disorders.

New Subtypes:

Rapid Cycling: Rapid Cyclers are patients who have at least four
episodes of mania and/or major depression in one year. Their long-term
courses appear to be different from those of non-rapid cyclers, and
researchers are trying to discover whether these patients require
different combinations of medications or therapies.

Seasonal Pattern: Some people have predictable seasonal patterns to
their depressions, and may benefit from different treatment techniques
than other manic depressives.

Post-partum onset: If any epiosode of a major mood disorder occurs
within four weeks of childbirth , it is considered to have had
post-partum onset. It is especially important to recognize post-partum
disorders with psychotic features (hearing voices, having delusions),
since there is a 30 to 50 percent chance of similar attacks with later
births. Appropriate use of medications after childbirth can prevent or
minimize recurrences, but would prevent the mother from breastfeeding
her child.

The significance of more precision in diagnosis is the ability to better
predict what medications and treatment may be helpful.

Reprinted from BatMoods, SFDMDA