User:Timqle/New sandbox

Bipolar Disorder is characterized by marked swings in mood, activity, and behavior. Bipolar II is characterized by periods of hypomania that occur before, after, and/or independent of a depressive episode

Hypomania
Hypomania is the signature characteristic of Bipolar II disorder, defined by an experience of elevated mood. A patient's mood is typically cheerful, enthusiastic, euphoric, or irritable. In addition, they can present with symptoms of inflated self esteem or grandiosity, decreased need for sleep, talkativeness or pressured speech, flight of ideas or rapid cycling of thoughts, distractability, increased goal-directed activity, psychomotor agitation, and/or excessive involvement in activities that have a high potential for painful consequences (engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments.

It is important to distinguish between hypomania and mania. During a typical hypomanic episode, patients may present as upbeat, may show signs of poor judgement, or display signs of increased energy despite lack of sleep, but do not meet the full criteria for an acute manic episode. Patients may display elevated confidence, but do not express delusional thoughts as in mania. Patients can experience increase in goal-directed activity and creativity, but do not reach the severity of aimlessness and disorganization. Speech may be rapid, but interruptible. By definition, patients with hypomania never present with psychotic symptoms and does not reach the severity to require psychiatric hospitalization.

For these reasons, is not uncommon for hypomania to go unnoticed. Often it is not until individuals are in a depressive episode that they seek treatment, and even then their history of hypomania may go undiagnosed. Although hypomania may increase functioning, episodes require treatment as they may precipitate a depressive episode.

Depressive episodes
It is during depressive episodes that BP-II patients often seek help. Symptoms may be syndromal or subsyndromal. Depressive BP-II symptoms may include five or more of the below symptoms (at least one of them must be either depressed mood or loss of interest/pleasure). In order to be diagnosed, they need to be present only during the same two-week period, as a change from previous hypomanic functioning:


 * Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (In children and adolescents, this could be irritable mood.)
 * Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
 * Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (e.g., in children, failure to make expected weight gain.)
 * Insomnia or hypersomnia nearly every day.
 * Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
 * Fatigue or loss of energy nearly every day.
 * Feelings of worthlessness or excessive or inappropriate guilt nearly every day (not merely self-reproach or guilt about being sick).
 * Diminished ability to think or concentrate, possible irritability or indecisiveness, nearly every day (either by subjective account or as observed by others).
 * Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for completing suicide.

Evidence also suggests that BP-II is strongly associated with atypical depression. Essentially, this means that many BP-II patients exhibit reverse vegetative symptoms. BP-II patients may have a tendency to oversleep and overeat, while typically depressed patients sleep and eat less than usual.

Mixed depression
Depressive mixed states occur when patients experience depression and non-euphoric, usually subsyndromal, hypomania at the same time. As mentioned previously, it is particularly difficult to diagnose BP-II when a patient is in this state.

In a mixed state, mood is depressed, but the following symptoms of hypomania present as well:


 * Irritability
 * Mental hyperactivity
 * Behavioral hyperactivity

Mixed states are associated with greater levels of suicidality than non-mixed depression. Antidepressants may increase this risk.

Relapse
In the case of a relapse, the following symptoms often occur and are considered early warning signs:


 * Sleep disturbance: patient requires less sleep and does not feel tired
 * Racing thoughts and/or speech
 * Anxiety
 * Irritability
 * Emotional intensity
 * Spending more money than usual
 * Binge behavior, including food, drugs, or alcohol
 * Arguments with family members and friends
 * Taking on many projects at once

People with bipolar disorder may develop dissociation to match each mood they experience. For some, this is done intentionally, as a means by which to escape trauma or pain from a depressive period, or simply to better organize one's life by setting boundaries for one's perceptions and behaviors.

Studies indicate that the following events may also precipitate relapse in BP-II patients:


 * Stressful life events
 * Relatives' or peers' criticism
 * Antidepressant use
 * Disrupted circadian rhythm

Comorbid conditions
Comorbid conditions are extremely common in individuals with BP-II. In fact, individuals are twice as likely to present a comorbid disorder than not. These include anxiety, eating, personality (cluster B), and substance use disorders. For bipolar II disorder, the most conservative estimate of lifetime prevalence of alcohol or other substance use disorders is 20%. In patients with comorbid substance use disorder and BP-II, episodes have a longer duration and treatment compliance decreases. Preliminary studies suggest that comorbid substance use is also linked to increased risk of suicidality. The question of which condition should be designated the index and which the comorbid condition is not self-evident and may vary in relation to the research question, the disease that prompted a particular episode of care, or of the specialty of the attending physician. A related notion is that of complication, a condition that coexists or ensues, as defined in the Medical Subject Headings (MeSH)-controlled vocabulary maintained by the National Library of Medicine (NLM).