Bipolar Disorder: Signs, Symptoms, and Next Steps for Care

Q: Bipolar Disorder: Signs, Symptoms, and Next Steps for Care

Hello, Xiao Di： My father is clearly not suffering from bipolar disorder, as he does not exhibit the manic and depressive episodes characteristic of the condition. <br>Many people mistakenly believe that feeling irritable equates to bipolar disorder, but this is not the case. <br

Dad may have bipolar disorder?

Hello, doctor.
I would like to ask a question.
My father has always had a rather impatient personality and a strong sense of masculinity.
In recent years, those around him have noticed that his temper has become more irritable, easily angered, and suspicious.
He constantly fears that others are trying to steal his money and often repeats the same things.
He frequently brings up the harm caused by my grandmother, who has since passed away, and he becomes very agitated and cannot stop when discussing it.
He previously visited Lixin Hospital, where a doctor assessed him and stated that he did not have bipolar disorder but was on the borderline.
An EEG was performed, and the results were normal.
I would like to confirm that the purpose of the EEG was to rule out conditions like dementia and other symptoms, rather than to diagnose bipolar disorder, correct? Recently, his irritability, anger, and suspicion have worsened.
If we suspect he has bipolar disorder, should we take him to a psychosomatic medicine department, a neurology department, or a general psychiatry department? Additionally, could you explain the difference between psychosomatic medicine and psychiatry? Thank you for your response!

Xiao Di, 20~29 year old female. Ask Date: 2015/09/23

Dr. Wu Enliang reply Psychiatry

Hello, Xiao Di: My father is clearly not suffering from bipolar disorder, as he does not exhibit the manic and depressive episodes characteristic of the condition.
Many people mistakenly believe that feeling irritable equates to bipolar disorder, but this is not the case.
Bipolar disorder, also known as manic-depressive illness or bipolar affective disorder, is a common condition seen in psychiatric outpatient clinics.
The lifetime prevalence of bipolar disorder in the general population is approximately 2-8%.
The manifestations of bipolar disorder can vary significantly among patients; generally, during episodes, individuals may experience either mania or depression, which can alternate.

The primary features of mania include an abnormally elevated, expansive, or irritable mood, increased energy levels, heightened sexual drive, decreased need for sleep, increased talkativeness, excessive generosity, spending sprees, impulsive investments, racing thoughts, grandiosity, risk-taking behaviors, and agitation.
Some individuals may experience milder symptoms that still allow them to maintain social and occupational functioning, while more severe cases may present with delusions, hallucinations, disorganized behavior, or violent tendencies.
Regardless of symptom severity, the presence of manic symptoms is necessary for a diagnosis of bipolar disorder.

However, some patients predominantly experience depressive episodes, which may resemble typical major depressive disorder.
Severe depression can also include delusions, hallucinations, suicidal ideation, or violent tendencies.
It is possible for patients to exhibit both manic and depressive symptoms simultaneously during certain periods.
Most patients experience multiple manic episodes throughout their lives.
Without treatment, the duration of each episode can last from several weeks to several months.
As the number of episodes increases, the intervals between episodes often shorten.
During non-episode periods, patients may behave similarly to those without the disorder; however, with more frequent episodes, their social functioning may decline more easily.

Bipolar disorder is a chronic brain condition associated with abnormalities in brain physiology (such as endocrine function).
Pharmacological treatment is the most crucial therapeutic approach.
The goal of treatment is to shorten the duration of each acute episode, reduce the severity of symptoms, prolong stable periods, minimize the likelihood of future episodes, and maintain the patient's quality of life and social functioning.

Electroencephalography (EEG) can only assess whether there are abnormal electrical discharges in the brain (such as in epilepsy) but cannot diagnose bipolar disorder or dementia.
There are many reasons for irritability and suspicion; therefore, it is advisable to consult a psychiatrist rather than a neurologist.
Although psychiatry and psychosomatic medicine are similar, some individuals feel uncomfortable seeking psychiatric care, leading some hospitals to label it as psychosomatic medicine, but they are essentially the same field.
Li Hsin Hospital also has a psychiatry department (or psychosomatic medicine), and it seems you took your father to see a neurologist last time.

Reply Date: 2015/09/23

More Info

Bipolar disorder, also known as manic-depressive illness, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Understanding the signs and symptoms of bipolar disorder is crucial for timely intervention and effective management.
From your description, it seems your father is exhibiting several concerning behaviors that could be indicative of bipolar disorder or another mood disorder. His increased irritability, paranoia about others stealing from him, repetitive thoughts about past grievances, and difficulty controlling his anger are significant red flags. These symptoms can lead to distress not only for him but also for those around him.

Signs and Symptoms of Bipolar Disorder
1. Mood Episodes: Individuals with bipolar disorder experience distinct mood episodes. These can be manic, hypomanic, or depressive. In mania, a person may feel overly euphoric, energetic, or irritable, while depressive episodes can lead to feelings of sadness, hopelessness, and a lack of interest in activities.

2. Irritability and Anger: As you've noted, your father's increased irritability and anger can be a part of manic episodes. This can manifest as a short temper, frustration over minor issues, or aggressive behavior.

3. Paranoia and Suspicion: The fear that others are trying to steal from him may indicate a paranoid thought process, which can occur during manic or hypomanic episodes.

4. Repetitive Thoughts: The fixation on past grievances, such as his relationship with your grandmother, can be a sign of rumination, which is common in both mood disorders and anxiety disorders.

Next Steps for Care
Given your father's symptoms, it is essential to seek professional help. Since he has previously been evaluated and found to be on the borderline of bipolar disorder, it may be time to revisit this assessment, especially since his symptoms have worsened.

1. Choosing the Right Specialist: You mentioned the possibility of taking him to a mental health facility (桃療), a neurology department, or a general psychiatry clinic. In this case, a psychiatrist specializing in mood disorders would be the most appropriate choice. They can conduct a thorough evaluation and determine if he meets the criteria for bipolar disorder or another mental health condition.

2. Understanding the Difference Between Mental Health Specialties:
- Psychiatry: This is a branch of medicine focused on diagnosing and treating mental health disorders. Psychiatrists can prescribe medication and provide therapy.

- Psychosomatic Medicine (身心科): This specialty focuses on the interaction between physical and mental health. It often deals with how psychological factors affect physical health and vice versa. This can be beneficial if your father has physical symptoms related to his mental health.

- Neurology: This field focuses on disorders of the nervous system. While it can be relevant if there are concerns about neurological conditions, it is not the primary specialty for diagnosing mood disorders.

3. Further Evaluation: While an EEG (brain wave test) can help rule out certain neurological conditions, it is not a definitive test for bipolar disorder. A comprehensive psychiatric evaluation, including a detailed history of symptoms and behaviors, is necessary for an accurate diagnosis.

4. Treatment Options: If diagnosed with bipolar disorder, treatment typically involves a combination of medication (mood stabilizers, antipsychotics, or antidepressants) and psychotherapy (cognitive-behavioral therapy, family therapy, etc.). Early intervention can significantly improve outcomes and help manage symptoms effectively.

Conclusion
It is commendable that you are seeking help for your father. The symptoms you describe warrant a thorough evaluation by a mental health professional. Encourage your father to attend appointments and be supportive throughout the process. Early diagnosis and treatment can lead to better management of symptoms and improved quality of life. If he is resistant to seeking help, consider discussing your concerns openly with him, emphasizing the importance of his well-being and the potential benefits of treatment.

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