What is Bipolar Disorder?

(bell chiming) - What is bipolar depression or bipolar disorder rather? - So bipolar disorder is, it's a mental illness that's classified by extreme highs and extreme lows. So much so Kyle, that it changes your activity levels, it changes your sleep patterns, it changes the way that you think, and subsequently changes your behavior.

The most important thing is that it affects your life in an incredibly negative way. Right? And there's various levels of bipolar disorder and different types of bipolar disorder.

So it's very, very important to understand the different types. - Okay, let's go through those types. I feel like everybody's heard of bipolar disorder, but not many people know that there's bipolar I, and bipolar II.

Let's start with bipolar I. - Absolutely right. So let's start with bipolar I, because that is just such a significant illness, right?

So bipolar I again, what we're gonna talk about, and make this as easy as possible for everyone to understand, bipolar I is mania. That's the word of the day with bipolar I. We're gonna focus on the manic symptoms.

Okay? So bipolar I is this. And this is per the DSM-5.

Bipolar I is expansive, elevated mood, sometimes irritable, right, for seven days or more. And that's important. The time and the intensity are important.

Seven days or more, with symptoms of that elevated, expansive mood, most of the day, every day, for seven days or more. Now there's a list of elevated, expansive symptoms. And those are important, because you need at least three of those, for that seven-day period.

And those are this. Distractability. Okay.

This is somebody that cannot sit still, they can't pay attention at all. They can't finish any tasks at all. Completely distracted.

Impulsivity is the next one. Impulsivity so much so Kyle, that you're gonna do things that you are not thinking through. You're getting yourself into trouble potentially.

You're just making rush, impulsive decisions. The next one is grandiosity. Grandiosity is a big one, right?

Grandiosity means that you have this inflated self-worth. I've seen cases where it gets so bad, into the realm of psychosis, where people think they're God. Or they think they're a superhero.

But it can be much lower as well. Just feeling really, really high about yourself. Right?

The other thing you'll notice is flight of ideas. You may hear that term thrown out. Flight of ideas is just that.

When you're listening to these people talk in a manic episode, their ideas are just flying out at you. And they're not really making a whole lot of sense. They're linear.

but you'll talk to someone for five minutes, and you would have heard like 100 different topics, right? So that's flight of ideas. You're gonna see sometimes agitation, or activity levels increased as well.

Sleep. That's a big one. Sleep issues.

Now people with mania, tend to not need sleep. All right? So very, very piece.

People can go with mania. I've had people come into my office, or that I've seen in the hospital, and say, doc, I haven't slept in a week. No sleep, nothing.

- And they're functioning? - And they're okay with it. That's the important thing.

Oh no, I'm fine, I'm totally good. So sleep issues is a really big deal. Most likely it's insomnia or decreased need for it.

You just don't want it, and you don't need it. And the other piece is really rapid and pressured speech. So we talked about the idea portion, which is what's in your head, but what you're seeing presented to you is very pressured speech.

So I just went through about eight or nine things, right? You need at least three of those, for seven days straight, most of the day, every day. Okay.

That's the bulk of the criteria for a mania to get a diagnosis of bipolar I. But this is what a lot of people don't pay attention to, and this is probably some of the most important diagnostic criteria. Ready for this?

And I know, I love this. Because this is what people don't pay attention to. Number one, it cannot be caused by a medical illness, or another psychiatric issue.

Okay? The importance with this is that mania, can be caused by so many different things. Medically, a thyroid issue can do it.

Traumatic brain injury can do it. Temporal lobe seizures can do it. You know, all types of medical issues can do it.

Medicines can do it. Corticosteroids for example. If you have asthma and you're on a corticosteroid, it can induce mania.

So you need to rule out all of these medical, and medicine aspects, not causing the mania. Okay. Make sure it's not induced by an illicit drug There are illicit drugs that can do this.

Right? Cocaine. I'll tell you what you give somebody cocaine, they're gonna present pretty manic, right?

So you have to rule all of that out. And then it can't be better defined by another mental illness. Those are super important.

All right. So that's the criteria for bipolar I, and what a lot of people misinterpret, is that they think you have to have a depressive episode, for a bipolar I diagnosis, and you don't, If you have had one manic episode in your entire life, you are bipolar I. - Wow.

- And that's it. - Now, I interviewed Kevin Hines, who jumped off the Golden Gate Bridge, survived, and tells his remarkable story on how he's dealt with his mental health. He has bipolar disorder.

And he said in his book, "Cracked But Not Broken" when he was in a manic state and not sleeping, he would start, at 17 years old, would start campaigning for presidency of the United States. And not as a joke, not because he thought it was funny or cool, because in his brain, his reality was that his next step in life was to become the president of the United States. - Grandiosity.

- Grandiosity. Are there examples like that, that will demonstrate some of these traits that you're aware of? - Oh, thanks Kyle.

One thing that I do is work in an emergency psychiatric unit. And unfortunately, or fortunately, because you're coming for help, in bipolar I, you're most likely gonna see people present to you in mania. Because they're coming to the hospital because it's emergent.

They're getting themselves into trouble. Something has gone wrong in their lives. They're going off the rails.

Okay? I have stories of people that were professionals, you know, accountants and lawyers and physicians, that would disappear for a week. No one knows where they are.

Family is a nervous wreck. They have no idea where they are. They turn up a week or two later, they decided to go into Manhattan, get the Presidential Suite at the Plaza, run up all of their credit cards, gamble, prostitution, party, right?

Do things that they would never ever do. Get to start new businesses. People start a new business.

They think they have this grandiosity and flight of ideas, and then when that's over, it can be so traumatic because you can crash and get very, very low. So there are so many stories that I've seen of that grandiosity. And I used one example of, sometimes mania, unfortunately, can lead into psychosis, and we'll talk about that.

But people get to a point where they go, Doc, God's talking to me, I hear him. I hear him and you know what he told me? He told me that I need to save the world, and I believe it.

He's right. He's right, I was thinking about this I gotta save the world. I have to do X, Y, and Zee.

I gotta do it. I can't be sitting here talking to you right now, you can't put me in a psych unit right now, I have to save the world. God is talking to me.

I hear Him right now. - Wow. - So that's mania psychosis.

- I'm really glad that you're giving these types of examples, because here's what. People throw around mental illness terms all the time, and one of them that they throw around all the time is bipolar disorder. They'll go, oh my gosh, I just got off the phone with my mom.

I swear she's bipolar, because she was upset about something. And just because you get upset, doesn't mean you have bipolar disorder. Just because you're happy on Monday, and upset on Tuesday, doesn't even mean you have bipolar disorder.

Those are normal emotions. - Exactly. Normal emotions.

I think something that we'll do today in discussion is understand what's normal and what's not. - Yes. - But you're right.

And that sort of becomes a little pet peeve in psychiatry. That people do use that terminology. Oh, you're bipolar.

Exactly what you said. But the truth of the matter is, true bipolar disorder Kyle, is so significantly different. If mood swings are a campfire, bipolar disorder is a forest fire out of control.

That's the difference? - Perfect. Bipolar II disorder.

What is that? - So bipolar II. Now we're getting into a different realm and the difference here, the main difference.

So wanna make this as easy as possible for everyone to understand, is bipolar II, instead of full-blown mania, it's called hypomania. And there's only one difference, the length of time. Okay.

We talked about bipolar I mania being seven days or more of that constant manic experience, bipolar II, four days. Okay? So four days.

So you only really need four days of those manic symptoms, three of that list that I provided earlier, okay, to have hypomania and bipolar II. Now hypomania doesn't get as bad, or as severe, as bipolar I mania. So you'll still have the grandiosity, and the flight of ideas, and you know, that fast speech, and all that, but it's not as severe.

It's a little bit lower. And it doesn't last as long. Now with bipolar II, the only other difference, is that, there's a depressive phase.

So not only does the person have to have four days of a manic episode, with that list of symptoms, three of those symptoms, but they have a depressive phase too. Okay. Depressive phase really fits the criteria of a major depressive episode.

It's a few weeks, or two weeks, of feeling severely depressed and hedonic. You don't like doing things you used to like to do, you're sleeping a lot, or too little, hypersomnia or insomnia, changes in appetite, maybe suicidality. So those are the criteria for depression, the depressed phase of the hypomania and depression.

Now important, is people think that bipolar disorder is a sign wave. It's up and down, and up and down, not the case at all. Not the case at all.

Someone with bipolar disorder can be manic, go back to euthymia, which is normal, for months. Depressed, up, depressed, up, mania up, or it could follow a typical pattern. And sometimes it does follow that pattern because, mania takes so much out of someone, that they tend to crash.

The way I look at it is this. Mania is like, you are a Ferrari, running in the red, flawed, with no brakes, on a windy road. Right.

You're eventually gonna lose control, and crash, or the engine is gonna blow. And then you're gonna go down into a really low place. Right.

- But if I'm bipolar II, it doesn't necessarily have to follow a pattern. It can be mania, normal, and then you can go to mania again, couldn't that be misdiagnosed as bipolar I? If the depressive episode didn't come until three months later?

- It's a good question. But don't forget the intensity, and the duration. - Oh, that's right.

So someone presents with you and they say-- - You got the four days. - You know, yeah, I get manic. I do have this.

How long does it last? A couple of days, four days maybe. - Got it.

- Five days you know? - Yeah. But it's not that full blown week, and it's not as severe.

- Yeah.