Health

Tuesday 23 September 2014

Mind & Meaning: What is bipolar II disorder?

Role Model: Catherine Zeta-Douglas

Exploring bipolar disorder II with our psychologist

WE HAVE recently learnt that Welsh actress Catherine Zeta Jones has been admitted to hospital for treatment of bipolar II disorder. Bipolar disorder is now familiar to the public but it is unlikely that the person on the street has heard of bipolar II disorder.

It is a milder form of bipolar disorder that affects about 1.5pc of the population in the US. Irish data on its prevalence is not available. Most people who experience bipolar disorder do so before the age of 50, commonly beginning in the 20s.

Whichever form of bipolar disorder is diagnosed, I or II, the condition is characterised by periods of depression and periods of being "high". In a high mood the person may be overtalkative, overactive, spend excessively and be elated or extremely irritable.

Delusions of grandure such as believing that one is a famous rock star, or has a special mission to save the world are also prominent in bipolar I. This cluster of symptoms is known as mania.

The presence of highs and lows explains why the condition is referred to as bipolar disorder. Formerly, it was called manic depression but this was replaced by bipolar disorder when it was recognised that some people did not have the manic symptoms outlined above but a milder form known as hypomania. The milder form of the illness itself is known as bipolar II.

The hypomanic person, like the manic patient, is likely to be overactive and may spend money they don't have. Their behaviour may be erratic and unpredictable. However, there is an absence of delusions.

While both bipolar I and II impair the person's day-to-day functioning, bipolar I is the more serious and is associated with greater dysfunction.

Indeed, bipolar II is often misdiagnosed because the hypomanic symptoms are often subtle and may be mistaken for normal high spirits or for naive optimism. Additionally, the episodes may be brief, lasting only for a few days, further rendering diagnosis difficult.

Bipolar II, like its more severe companion, is treatable. Medications that prevent mood swings are most frequently used and lithium, a naturally occurring salt, has the best evidence of benefit. Other treatments include antiepileptic drugs which additionally have a mood stabilising effect.

What about talking therapies? There is little evidence that these assist in controlling symptoms per se. However they are particularly useful in helping people with the illness accept it and instill a positive frame of mind. Nobody wants or welcomes a mental illness and many are angry that this has befallen them.

Most learn that it can be controlled and talking therapy is beneficial in assisting the person identify the relapse signatures.

Interestingly, the reports on Ms Jones' hospitalisation are that her stay will be short and that her admission is "proactive" and for maintenance. This suggests that perhaps she had identified early indicators of relapse.

The changes that herald relapse differ for each person, but typically a reduction in sleep or irritability is described. Some notice that their mood is slightly elevated or that their thoughts are somewhat speeded up.

As with physical illness, recalibration of medication is usually all that is required. When the individual is taking lithium, achieving a therapeutic response is aided by monitoring blood levels since benefit is most likely when certain levels are attained.

Catherine Zeta Jones is not the only famous person to suffer with bipolar disorder. Others include the actors Jim Carrey and Robin Williams, the poet Emily Dickinson and writer Virginia Woolf. One of those known on the world stage is Vincent van Geogh.

Of interest is the link with creativity that is now well documented and exemplified in the list. Some of these died tragically as a result of their illness because effective treatments were not available in their lifetime.

That is why Jones' admission to hospital for the purposes of seeking treatment or preventing relapse is positive.

It is a marker of her acceptance of her illness. She is a role model for others coping with bipolar disorder in all its forms.

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