BSB YouTube Channel

BSB now has its very own youtube Channel You can find us HERE

Here are the videos we have to date

BSB Intro

About BSB

BSB Newsflash

Bipolar Disorder Introduction

An Introduction to Bipolar: Mania and Depression

An Introduction to Bipolar: Relationships

An Introduction to Bipolar: Suicide

An Introduction to Bipolar: Motivation

 

We only started doing these videos a few days ago, but as you can see, we’ve already done a few. If there is a topic that you would like us to make a video on, then please do let us know.

Group News: The group is running really well and we’re very busy. If your not already a member of BSB you can find us HERE

Your support is needed on Facebook

We are running an event on FB and would love your support to help raise awareness of Bipolar Disorder

The link for this event is

http://www.facebook.com/event.php?eid=132829203457971

Does Medication Hinder Creativity in Bipolar Disorder

21.10.2010 | Author: Michael Mclaren

While I happend to have bipolar disorder, and feel very equipped to answer the title question, I decided I should consult at least a couple of sources for a more rounded view point. Over the years I have heard many ask whether or not I feel a difference in my creative drive since medication, and I’ve often heard the fear of losing such a drive as the reason for individuals to not be medicated. The individual has bipolar and often struggles with taking medication because they feel they lose something of themselves in trying to be a part of society and they feel that survival is not worth compromising uniqueness.

One of the books I’ve used as a reference here was written by Kay Redfield Jamison who is not only a psychiatrist but also has bipolar disorder. I tend to use her work in much of my research because I feel she is able to give a well rounded view having been both the doctor and the patient.

Many who have found success through the arts by the expressions of extreme mood experiences have refused to embrace medication in order to gain some freedom from the illness because of the fear they may lose some of their very essence. As Edward Thomas put it, “I wonder whether for a person like myself whose most intense moments are those of depression a cure that destroys a depression may not destroy the intensity-a desperate remedy?”(Jamison, 1993)

Those who have found healing in their creative endeavors have often contributed greatly to our society and one wonders whether, if lithium had been used long before, we would have had such brilliant contributions from Mozart, Van Gogh, and Byron. If our world would have to go without such contributions, maybe it is crucial that we find out whether, in fact, medication eliminates creative drive.

According to a study done by Morgan Schou who pioneered the use of lithium in psychiatric patients, artists were asked whether lithium “increased, decreased, or had little impact on their productivity” (Mondimore, 1999). Schou learned that 57% reported that lithium had actually increased their creativity, while another 20% percent reported there had been no difference, and one quarter felt there had been adverse affects (Mondimore, 1999). However, one of the side effects of lithium is dulling of the thinking processes and it is possible that many in the one quarter grouping were suffering from side effects rather than mood stabilizing effects (Mondimore, 1999).

“In the great majority of instances the affective treatments now available do not hinder creative ability. Indeed, competent treatment almost always results in longer periods of sustained productivity.” (Jamison, 1993) This suggests that lithium actually assists in helping creativity. So why do not people with mental illness want to take medications that not only help regulate, do not hinder creativity, but actually increase it? It may have little to do with the loss of creativity and more to do with “reluctance to accept a diagnosis of bipolar disorder and ambivalence about taking a medication that they felt would control them” (Mondimore, 1999).

When I first began taking a mood stabilizer, I was terrified that who I thought I was would disappear altogether. I had done a lot of research on bipolar disorder and so I wasn’t ignorant but there aren’t any absolutes. I had heard stories from others who hated medication and said it made them lethargic and unable to express complete thought. Luckily for me, I had just come out of a deathly depressive episode so I was not stranger to lethargy and inexpressible thoughts. I figured it was worth a shot if that was as bad as it could get.

It took many years for me to become regulated. I tried just about every medication out there and finally was put on lithium. During my journey through the world of medication I began to write. I noticed that for the first time in my life I could put on paper what I was thinking. I could find a way to express myself that was similar to what was going on in my head. Never in my life had I ever had such an experience. I have discovered that using headphones help me to contain my thoughts but the lithium definitely helps create a long lasting tunnel for me to move everything through to fruition. I don’t think that mania and depression helped me be creative. I think they just deployed the creative juices in force. Sometimes that was an almost out of body experience and sometimes it was like a stampede. Now I have some semblance of control over what is going on and can be productive over a longer period of time.

I have heard people who do not have mental illness criticize medication, saying that it’s not a good idea to take a pill. I understand their good intentions but insanity is not something I choose over life experience. I think that medication is quite helpful but it depends on what you are looking for. It has taken me a long time but I think I know now what I am looking for. I am looking for balance between the creativity and madness within and the desire to have a life, to be able to be married, have a family, and have a career. I would take smaller bites of it all rather than a big bite of creative insanity. I believe medication can provide that and at the end of the day, I will sit down at my computer and pour out every inspiration because I still have creativity.

 

References

Jamison, K.R. (1993). Touched with fire. New York: Simon and Schuster.

Mondimore, F.M. (1999). Bipolar disorder: A guide for patients and families.

Baltimore and London: The Johns Hopkins University Press.

http://articles.vp.ly/does-medication-hinder-creativity-in-bipolar-disorder/

New Theory Links Depression to Chronic Brain Inflammation

ScienceDaily (Oct. 19, 2010) — Chronic depression is an adaptive, reparative neurobiological process gone wrong, say two University of California, San Diego School of Medicine researchers, positing in a new theory that the debilitating mental state originates from more ancient mechanisms used by the body to deal with physical injury, such as pain, tissue repair and convalescent behavior.

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In a paper published in the September online edition of Neuroscience and Biobehavioral Reviews, Athina Markou, PhD, professor of psychiatry, and Karen Wager-Smith, a post-doctoral researcher, integrate evidence from diverse clinical, biological and behavioral studies to create a novel theory they hope will lead to a shift in thinking about depression.

“In contrast to other biological theories of depression, we started with a slightly different question,” said Wager-Smith. “Other theories address the question: ‘What is malfunctioning in depression?’ We took a step back and asked the question: ‘What is the biology of the proper function of the depressive response?’ Once we had a theoretical model for the biology of a well-functioning depressive response, it helped make sense of all the myriad differences between depressed and non-depressed subjects that the biomedical approach has painstakingly amassed.”

According to the new theory, severe stress and adverse life events, such as losing a job or family member, prompt neurobiological processes that physically alter the brain. Neurons change shape and connections. Some die, but others sprout as the brain rewires itself. This neural remodeling employs basic wound-healing mechanisms, which means it can be painful and occasionally incapacitating, even when it’s going well.

“It’s necessary and normal so that an individual can adapt, change behavior and deal with altered circumstances,” Markou said. Real problems occur only “when these restructuring processes go into overdrive, beyond what is necessary and adaptive, and for longer periods of time than needed. Then depression becomes pathological.”

The theory extends findings made by other researchers that the neurobiological substrates of physical and emotional pain overlap. Just as the body’s repair mechanisms for physical injury can sometimes result in chronic pain and inflammation, so too can the response to psychological trauma, resulting in chronic depression.

Markou and Wager-Smith argue that existing, conflicting views about depression actually describe different aspects of the same phenomenon. Psychoanalytic and sociological theories refer to the psychological transformation that occurs during a productive depressive episode. Biomedical theories relate to the neural remodeling that underlies this psychological change. And neurodegenerative theories account for remodeling malfunctions.

“The big question, of course, is why aren’t all people affected the same way,” said Markou. “Why do some people deal effectively with stress, but others perpetuate a pathological state? This is an interesting question for future research.”

The researchers’ findings may have clinical ramifications as well. If psychological and physical pain responses share similar biological mechanisms, then analgesic agents could be useful in treating at least some symptoms of depression. Similarly, if chronic depression is proven to be a neuroinflammatory condition, then anti-inflammatory treatments should also have some antidepressant effects. Several small trials with depressed patients have already been published that support this possibility, though Markou cautioned that much more specific research and larger clinical trials are required.

Funding for this work came from a National Institutes of Health National Research Service Award and a grant from the National Institute of Mental Health.

Mental Illness: The Stigma of Silence

Glenn Close

Emmy, Golden Globe and Tony Award winning actress

Posted: October 21, 2009 12:03 PM

Mental Illness: The Stigma of Silence

// Mental illness and I are no strangers.

From Alex Forrest in Fatal Attraction to Blanche Dubois in A Streetcar Named Desire to Norma Desmond in Andrew Lloyd Weber’s Sunset Boulevard, I’ve had the challenge — and the privilege — of playing characters who have deep psychological wounds. Some people think that Alex is a borderline personality. I think Blanche suffers from post-traumatic stress disorder and everyone knows that Norma is delusional.

I also have the challenge of confronting the far less entertaining reality of mental illness in my own family. As I’ve written and spoken about before, my sister suffers from a bipolar disorder and my nephew from schizoaffective disorder. There has, in fact, been a lot of depression and alcoholism in my family and, traditionally, no one ever spoke about it. It just wasn’t done. The stigma is toxic. And, like millions of others who live with mental illness in their families, I’ve seen what they endure: the struggle of just getting through the day, and the hurt caused every time someone casually describes someone as “crazy,” “nuts,” or “psycho”.

Even as the medicine and therapy for mental health disorders have made remarkable progress, the ancient social stigma of psychological illness remains largely intact. Families are loath to talk about it and, in movies and the media, stereotypes about the mentally ill still reign.

Whether it is Norman Bates in Psycho, Jack Torrance in The Shining, or Kathy Bates’ portrayal of Annie Wilkes in Misery, scriptwriters invariably tell us that the mentally ill are dangerous threats who must be contained, if not destroyed. It makes for thrilling entertainment.

There are some notable exceptions, of course — Dustin Hoffman in Rainman, or Russell Crowe’s portrayal of John Nash in A Beautiful Mind. But more often than not, the movie or TV version of someone suffering from a mental disorder is a sociopath who must be stopped.

Alex Forrest is considered by most people to be evil incarnate. People still come up to me saying how much she terrified them. Yet in my research into her behavior, I only ended up empathizing with her. She was a human being in great psychological pain who definitely needed meds. I consulted with several psychiatrists to better understand the “whys” of what she did and learned that she was far more dangerous to herself than to others.

The original ending of Fatal Attraction actually had Alex commit suicide. But that didn’t “test” well. Alex had terrified the audiences and they wanted her punished for it. A tortured and self-destructive Alex was too upsetting. She had to be blown away.

So, we went back and shot the now famous bathroom scene. A knife was put into Alex’s hand, making her a dangerous psychopath. When the wife shot her in self-defense, the audience was given catharsis through bloodshed — Alex’s blood. And everyone felt safe again.

The ending worked. It was thrilling and the movie was a big hit. But it sent a misleading message about the reality of mental illness.

It is an odd paradox that a society, which can now speak openly and unabashedly about topics that were once unspeakable, still remains largely silent when it comes to mental illness. This month, for example, NFL players are rumbling onto the field in pink cleats and sweatbands to raise awareness about breast cancer. On December 1st, World AIDS Day will engage political and health care leaders from every part of the globe. Illnesses that were once discussed only in hushed tones are now part of healthy conversation and activism.

Yet when it comes to bipolar disorder, post-traumatic stress, schizophrenia or depression, an uncharacteristic coyness takes over. We often say nothing. The mentally ill frighten and embarrass us. And so we marginalize the people who most need our acceptance.

What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well. Our society ought to understand that many people with mental illness, given the right treatment, can be full participants in our society. Anyone who doubts it ought to listen to Kay Redfield Jamison, a psychiatry professor at Johns Hopkins, vividly describe her own battles with bipolar disorder.

Over the last year, I have worked with some visionary groups to start BringChange2Mind.org, an organization that strives to inspire people to start talking openly about mental illness, to break through the silence and fear. We have the support of every major, American mental health organization and numerous others.

I have no illusions that BringChange2Mind.org is a cure for mental illness. Yet I am sure it will help us along the road to understanding and constructive dialogue. It will help deconstruct and eliminate stigma.

The World Health Organization (WHO) estimates that by the year 2020 mental illness will be the second leading cause of death and disability. Every society will have to confront the issue. The question is, will we face it with open honesty or silence?

ICD 10 for Bipolar Disorder

Mental and behavioural disorders
(F00-F99)

 

Mood [affective] disorders
(F30-F39)

This block contains disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity; most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.

F30 Manic episode

All the subdivisions of this category should be used only for a single episode. Hypomanic or manic episodes in individuals who have had one or more previous affective episodes (depressive, hypomanic, manic, or mixed) should be coded as bipolar affective disorder (F31.-).
Includes: bipolar disorder, single manic episode

F30.0 Hypomania

A disorder characterized by a persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, over-familiarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability. The disturbances of mood and behaviour are not accompanied by hallucinations or delusions.

F30.1 Mania without psychotic symptoms

Mood is elevated out of keeping with the patient’s circumstances and may vary from carefree joviality to almost uncontrollable excitement. Elation is accompanied by increased energy, resulting in overactivity, pressure of speech, and a decreased need for sleep. Attention cannot be sustained, and there is often marked distractibility. Self-esteem is often inflated with grandiose ideas and overconfidence. Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and out of character.

F30.2 Mania with psychotic symptoms

In addition to the clinical picture described in F30.1, delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) are present, or the excitement, excessive motor activity, and flight of ideas are so extreme that the subject is incomprehensible or inaccessible to ordinary communication.

Mania with:
· mood-congruent psychotic symptoms
· mood-incongruent psychotic symptoms
Manic stupor

F30.8 Other manic episodes

F30.9 Manic episode, unspecified Mania NOS

F31 Bipolar affective disorder

A disorder characterized by two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). Repeated episodes of hypomania or mania only are classified as bipolar.

Includes: manic-depressive:
· illness
· psychosis
· reaction
Excludes: bipolar disorder, single manic episode ( F30.- ) cyclothymia ( F34.0 )

F31.0 Bipolar affective disorder, current episode hypomanic

The patient is currently hypomanic, and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.1 Bipolar affective disorder, current episode manic without psychotic symptoms

The patient is currently manic, without psychotic symptoms (as in F30.1), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms

The patient is currently manic, with psychotic symptoms (as in F30.2), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.3 Bipolar affective disorder, current episode mild or moderate depression

The patient is currently depressed, as in a depressive episode of either mild or moderate severity (F32.0 or F32.1), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.4 Bipolar affective disorder, current episode severe depression without psychotic symptoms

The patient is currently depressed, as in severe depressive episode without psychotic symptoms (F32.2), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms

The patient is currently depressed, as in severe depressive episode with psychotic symptoms (F32.3), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.6 Bipolar affective disorder, current episode mixed

The patient has had at least one authenticated hypomanic, manic, depressive, or mixed affective episode in the past, and currently exhibits either a mixture or a rapid alteration of manic and depressive symptoms.
Excludes: single mixed affective episode ( F38.0 )

F31.7 Bipolar affective disorder, currently in remission

The patient has had at least one authenticated hypomanic, manic, or mixed affective episode in the past, and at least one other affective episode (hypomanic, manic, depressive, or mixed) in addition, but is not currently suffering from any significant mood disturbance, and has not done so for several months. Periods of remission during prophylactic treatment should be coded here.

F31.8 Other bipolar affective disorders
Bipolar II disorder
Recurrent manic episodes NOS

F31.9 Bipolar affective disorder, unspecified

F32 Depressive episode

In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called “somatic” symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe.

Includes: single episodes of:
· depressive reaction
· psychogenic depression
· reactive depression

Excludes: adjustment disorder ( F43.2 ) recurrent depressive disorder ( F33.- )
when associated with conduct disorders in F91.- ( F92.0 )

F32.0 Mild depressive episode

Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities.

F32.1 Moderate depressive episode

Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities.

F32.2 Severe depressive episode without psychotic symptoms

An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of “somatic” symptoms are usually present.
Agitated depression
Major depression
Vital depression
single episode without psychotic symptoms

F32.3 Severe depressive episode with psychotic symptoms

An episode of depression as described in F32.2, but with the presence of hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary social activities are impossible; there may be danger to life from suicide, dehydration, or starvation. The hallucinations and delusions may or may not be mood-congruent.

Single episodes of:
· major depression with psychotic symptoms
· psychogenic depressive psychosis
· psychotic depression
· reactive depressive psychosis

F32.8 Other depressive episodes Atypical depression Single episodes of “masked” depression NOS

F32.9 Depressive episode, unspecified Depression NOS Depressive disorder NOS

F33 Recurrent depressive disorder

A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment. The more severe forms of recurrent depressive disorder (F33.2 and F33.3) have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder (F31.-).

Includes: recurrent episodes of:
· depressive reaction
· psychogenic depression
· reactive depression
seasonal depressive disorder

Excludes: recurrent brief depressive episodes ( F38.1 )

F33.0 Recurrent depressive disorder, current episode mild

A disorder characterized by repeated episodes of depression, the current episode being mild, as in F32.0, and without any history of mania.

F33.1 Recurrent depressive disorder, current episode moderate

A disorder characterized by repeated episodes of depression, the current episode being of moderate severity, as in F32.1, and without any history of mania.

F33.2 Recurrent depressive disorder, current episode severe without psychotic symptoms

A disorder characterized by repeated episodes of depression, the current episode being severe without psychotic symptoms, as in F32.2, and without any history of mania.

Endogenous depression without psychotic symptoms
Major depression, recurrent without psychotic symptoms
Manic-depressive psychosis, depressed type without psychotic symptoms
Vital depression, recurrent without psychotic symptoms

F33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms

A disorder characterized by repeated episodes of depression, the current episode being severe with psychotic symptoms, as in F32.3, and with no previous episodes of mania.

Endogenous depression with psychotic symptoms
Manic-depressive psychosis, depressed type with psychotic symptoms
Recurrent severe episodes of:
· major depression with psychotic symptoms
· psychogenic depressive psychosis
· psychotic depression
· reactive depressive psychosis

F33.4 Recurrent depressive disorder, currently in remission

The patient has had two or more depressive episodes as described in F33.0-F33.3, in the past, but has been free from depressive symptoms for several months.

F33.8 Other recurrent depressive disorders

F33.9 Recurrent depressive disorder, unspecified Monopolar depression NOS

F34 Persistent mood [affective] disorders

Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes. Because they last for many years, and sometimes for the greater part of the patient’s adult life, they involve considerable distress and disability. In some instances, recurrent or single manic or depressive episodes may become superimposed on a persistent affective disorder.

F34.0 Cyclothymia

A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This disorder is frequently found in the relatives of patients with bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder.

Affective personality disorder
Cycloid personality
Cyclothymic personality

F34.1 Dysthymia

A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder (F33.-).

Depressive:
· neurosis
· personality disorder
Neurotic depression
Persistent anxiety depression

Excludes: anxiety depression (mild or not persistent) ( F41.2 )

F34.8 Other persistent mood [affective] disorders

F34.9 Persistent mood [affective] disorder, unspecified

F38 Other mood [affective] disorders

Any other mood disorders that do not justify classification to F30-F34, because they are not of sufficient severity or duration.

F38.0 Other single mood [affective] disorders Mixed affective episode

F38.1 Other recurrent mood [affective] disorders Recurrent brief depressive episodes

F38.8 Other specified mood [affective] disorders

F39 Unspecified mood [affective] disorder
Affective psychosis NOS

Mental and behavioural disorders
(F00-F99) 

Mood [affective] disorders
(F30-F39)

This block contains disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity; most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.

F30 Manic episode

All the subdivisions of this category should be used only for a single episode. Hypomanic or manic episodes in individuals who have had one or more previous affective episodes (depressive, hypomanic, manic, or mixed) should be coded as bipolar affective disorder (F31.-).
Includes: bipolar disorder, single manic episode

F30.0 Hypomania

A disorder characterized by a persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, over-familiarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability. The disturbances of mood and behaviour are not accompanied by hallucinations or delusions.

F30.1 Mania without psychotic symptoms

Mood is elevated out of keeping with the patient’s circumstances and may vary from carefree joviality to almost uncontrollable excitement. Elation is accompanied by increased energy, resulting in overactivity, pressure of speech, and a decreased need for sleep. Attention cannot be sustained, and there is often marked distractibility. Self-esteem is often inflated with grandiose ideas and overconfidence. Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and out of character.

F30.2 Mania with psychotic symptoms

In addition to the clinical picture described in F30.1, delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) are present, or the excitement, excessive motor activity, and flight of ideas are so extreme that the subject is incomprehensible or inaccessible to ordinary communication.

Mania with:
· mood-congruent psychotic symptoms
· mood-incongruent psychotic symptoms
Manic stupor

F30.8 Other manic episodes

F30.9 Manic episode, unspecified Mania NOS

F31 Bipolar affective disorder

A disorder characterized by two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). Repeated episodes of hypomania or mania only are classified as bipolar.

Includes: manic-depressive:
· illness
· psychosis
· reaction
Excludes: bipolar disorder, single manic episode ( F30.- ) cyclothymia ( F34.0 )

F31.0 Bipolar affective disorder, current episode hypomanic

The patient is currently hypomanic, and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.1 Bipolar affective disorder, current episode manic without psychotic symptoms

The patient is currently manic, without psychotic symptoms (as in F30.1), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms

The patient is currently manic, with psychotic symptoms (as in F30.2), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.

F31.3 Bipolar affective disorder, current episode mild or moderate depression

The patient is currently depressed, as in a depressive episode of either mild or moderate severity (F32.0 or F32.1), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.4 Bipolar affective disorder, current episode severe depression without psychotic symptoms

The patient is currently depressed, as in severe depressive episode without psychotic symptoms (F32.2), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms

The patient is currently depressed, as in severe depressive episode with psychotic symptoms (F32.3), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.

F31.6 Bipolar affective disorder, current episode mixed

The patient has had at least one authenticated hypomanic, manic, depressive, or mixed affective episode in the past, and currently exhibits either a mixture or a rapid alteration of manic and depressive symptoms.
Excludes: single mixed affective episode ( F38.0 )

F31.7 Bipolar affective disorder, currently in remission

The patient has had at least one authenticated hypomanic, manic, or mixed affective episode in the past, and at least one other affective episode (hypomanic, manic, depressive, or mixed) in addition, but is not currently suffering from any significant mood disturbance, and has not done so for several months. Periods of remission during prophylactic treatment should be coded here.

F31.8 Other bipolar affective disorders
Bipolar II disorder
Recurrent manic episodes NOS

F31.9 Bipolar affective disorder, unspecified

F32 Depressive episode

In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called “somatic” symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe.

Includes: single episodes of:
· depressive reaction
· psychogenic depression
· reactive depression

Excludes: adjustment disorder ( F43.2 ) recurrent depressive disorder ( F33.- )
when associated with conduct disorders in F91.- ( F92.0 )

F32.0 Mild depressive episode

Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities.

F32.1 Moderate depressive episode

Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities.

F32.2 Severe depressive episode without psychotic symptoms

An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of “somatic” symptoms are usually present.
Agitated depression
Major depression
Vital depression
single episode without psychotic symptoms

F32.3 Severe depressive episode with psychotic symptoms

An episode of depression as described in F32.2, but with the presence of hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary social activities are impossible; there may be danger to life from suicide, dehydration, or starvation. The hallucinations and delusions may or may not be mood-congruent.

Single episodes of:
· major depression with psychotic symptoms
· psychogenic depressive psychosis
· psychotic depression
· reactive depressive psychosis

F32.8 Other depressive episodes Atypical depression Single episodes of “masked” depression NOS

F32.9 Depressive episode, unspecified Depression NOS Depressive disorder NOS

F33 Recurrent depressive disorder

A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment. The more severe forms of recurrent depressive disorder (F33.2 and F33.3) have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder (F31.-).

Includes: recurrent episodes of:
· depressive reaction
· psychogenic depression
· reactive depression
seasonal depressive disorder

Excludes: recurrent brief depressive episodes ( F38.1 )

F33.0 Recurrent depressive disorder, current episode mild

A disorder characterized by repeated episodes of depression, the current episode being mild, as in F32.0, and without any history of mania.

F33.1 Recurrent depressive disorder, current episode moderate

A disorder characterized by repeated episodes of depression, the current episode being of moderate severity, as in F32.1, and without any history of mania.

F33.2 Recurrent depressive disorder, current episode severe without psychotic symptoms

A disorder characterized by repeated episodes of depression, the current episode being severe without psychotic symptoms, as in F32.2, and without any history of mania.

Endogenous depression without psychotic symptoms
Major depression, recurrent without psychotic symptoms
Manic-depressive psychosis, depressed type without psychotic symptoms
Vital depression, recurrent without psychotic symptoms

F33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms

A disorder characterized by repeated episodes of depression, the current episode being severe with psychotic symptoms, as in F32.3, and with no previous episodes of mania.

Endogenous depression with psychotic symptoms
Manic-depressive psychosis, depressed type with psychotic symptoms
Recurrent severe episodes of:
· major depression with psychotic symptoms
· psychogenic depressive psychosis
· psychotic depression
· reactive depressive psychosis

F33.4 Recurrent depressive disorder, currently in remission

The patient has had two or more depressive episodes as described in F33.0-F33.3, in the past, but has been free from depressive symptoms for several months.

F33.8 Other recurrent depressive disorders

F33.9 Recurrent depressive disorder, unspecified Monopolar depression NOS

F34 Persistent mood [affective] disorders

Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes. Because they last for many years, and sometimes for the greater part of the patient’s adult life, they involve considerable distress and disability. In some instances, recurrent or single manic or depressive episodes may become superimposed on a persistent affective disorder.

F34.0 Cyclothymia

A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This disorder is frequently found in the relatives of patients with bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder.

Affective personality disorder
Cycloid personality
Cyclothymic personality

F34.1 Dysthymia

A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder (F33.-).

Depressive:
· neurosis
· personality disorder
Neurotic depression
Persistent anxiety depression

Excludes: anxiety depression (mild or not persistent) ( F41.2 )

F34.8 Other persistent mood [affective] disorders

F34.9 Persistent mood [affective] disorder, unspecified

F38 Other mood [affective] disorders

Any other mood disorders that do not justify classification to F30-F34, because they are not of sufficient severity or duration.

F38.0 Other single mood [affective] disorders Mixed affective episode

F38.1 Other recurrent mood [affective] disorders Recurrent brief depressive episodes

F38.8 Other specified mood [affective] disorders

F39 Unspecified mood [affective] disorder
Affective psychosis NOS

A Carer’s Guide to Bipolar Disorder

October 30 2010

Product Description

Bipolar Disorder is a condition affecting many thousands across the UK. The condition has a massive impact upon the lives of not only those diagnosed with the illness, but also, their families, carers and friends. Written by an expert in the field, this “Carer’s Guide” aims to provide answers to the wide-ranging questions that carers may have about family members or friends suffering from Bipolar Disorder, including how to recognise classic symptoms and treatment options available. Also included are details of those who can provide help and support for the carers, as their needs are often overlooked.

Product Details

• Paperback: 76 pages
• Publisher: Royal Society of Medicine Press; 1 edition (October 30, 2010)
• Language: English
• ISBN-10: 1853156752
• ISBN-13: 978-1853156755

The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know

December 15 2010

Product Description

A bipolar diagnosis can be overwhelming to sufferers and their family members. They need trustworthy information and support for finding the right treatment and coping with the illness’s devastating ups and downs. Over 200,000 readers have already found exactly that in this indispensable guide from a leading expert. Explaining the disorder’s causes, diagnosis, and best current treatments, David J. Miklowitz shows how to plan for and reduce recurrences of mood symptoms, make needed lifestyle changes to stay well, and strengthen relationships strained by the illness. Readers love the user-friendly tone, true-to-life stories, checklists, worksheets, and practical problem-solving advice. Updated throughout, the second edition has a new chapter, “For Women Only”; the latest facts on medications and therapy; and an expanded discussion of parenting issues for bipolar adults.

Product Details

• Paperback: 340 pages
• Publisher: The Guilford Press; Second Edition edition (December 15, 2010)
• Language: English
• ISBN-10: 1606235427
• ISBN-13: 978-1606235423

Bi-Polar Girl: An Irreverent Look at Bipolar Disorder

February 2011

No Details available

Product Details

• Paperback: 176 pages
• Publisher: Crown House Publishing (February 2011)
• Language: English
• ISBN-10: 184590446X
• ISBN-13: 978-1845904463

A Bipolar Life: 50 Years of Battling Manic-Depressive Illness Did Not Stop Me From Building a 60 Million Dollar Business

March 1, 2011

Product Description

For more than 45 years, Steve Millard has struggled with bi-polar disorder. At his lowest, he was on the absolute brink of suicide, looking down into the abyss.  Through his own methods of dealing with this disease, arrived at by trial and error, and the generous help of friends, and the teachings of a wonderful support group called Recovery Inc., he not only survived, he prospered, founding one of the most successful and profitable businesses in the direct marketing industry. “A Bipolar Life” is the story of his struggle.

Product Details

• Paperback: 232 pages
• Publisher: Morgan James Publishing (March 1, 2011)
• Language: English
• ISBN-10: 1600378161
• ISBN-13: 978-1600378164