Bipolar I presentation
“I put my heart and soul into my work, and have lost my mind in the process.” – Vincent Van Gogh.
Case study # 2.
Sophia is a 20-year-old sophomore at a small Midwestern college. For the past five days she has gone without any sleep whatsoever and she has spent this time in a heightened state of activity which she herself describes as “out of control.”
Not sleeping but still feel energized? This is a classic sign of bipolar mania.
But bipolar disorder and insomnia, and the associated sleep loss isn’t just a symptom of mania; reduced sleep can also trigger manic episodes and is a good predictor of the onset of mania.
Trouble sleeping? See the Dr immediately as this is both a symptom and a trigger for bipolar mania.
For the most part, her behavior is characterized by strange and grandiose ideas that often take on a mystical or sexual tone. For example, she recently proclaimed to a group of friends that she did not menstruate because she was a “of a third sex, a gender above the human sexes.” When her friends questioned her on this, she explained that she is a “superwoman” who can avoid human sexuality and still give birth. That is, she is a woman who does not require sex to fulfill her place on earth.
People with signs of grandiosity often feel superior to others or that everyone around them is simply incompetent. This can lead to frustration and irritability in manic or hypomanic episodes when people don’t behave exactly as the person expects or wants them to. The person can come off as condescending, entitled and ungrateful.
A person may suddenly decide to quit their job to write the Great American Novel or become an artist when they have neither any artistic experience nor have expressed interest in art before.
The most extreme and potentially dangerous form of grandiosity is delusions of grandeur. These delusions are symptoms of a psychotic episode.In extension to wanting to write a novel, the person may think they have been contacted by a publisher who has offered them millions of dollars for their unique and superior talent.
These feelings and actions may be based on a smaller-scale desire for something new and different. Perhaps the person really would prefer to be an artist or they just want to be a better student. Grandiosity in bipolar disorder can bring these small thoughts out and distort them into something baffling or intolerable to those who don’t understand the illness.
Some of Sophia’s bizarre thinking centers on the political, such as believing that she had somehow switched souls with the senior senator from her state. From what she believed were his thoughts and memories, she developed six theories of government that would allow her to single-handedly save the world from nuclear destruction. She went around campus, explaining these theories to friends and even to her professors and began to campaign for an elected position in the U.S. government (even though no elections were scheduled at the time). She feels that her recent experiences with switching souls with the senator would make her particularly well suited for a high position in government; perhaps even the presidency.
Lack of insight. A person in a hypomanic or manic state may understand that other people see his or her ideas and actions as inappropriate, reckless or irrational. However, he or she is unlikely to personally accept that the behaviour is inappropriate, due to a lack of insight.
Sophia often worries that she will forget some of her thoughts and has begun writing notes to herself everywhere; in her notebooks, on her computer—even on the walls of her dormitory. Sophia’s family and friends, who have always known her to be extremely tidy and organized, have been shocked to find her room in total disarray with frantic and incoherent messages written all over the walls and furniture.
These messages reflect her disorganized, grandiose thinking about spiritual and sexual themes.
Sophia has experienced two previous episodes of wild and bizarre behavior similar to what she is experiencing now; both alternated with periods of intense depression. When she was in the depressed state, she could not bring herself to attend classes or any campus activities; she suffered from insomnia, poor appetite, and difficulty concentrating. At the lowest points of the depressive side of her disorder, Sophia contemplated suicide.
The National Institute of Mental Health (NIMH) lists the four types of bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Bipolar one includes symptoms of extreme mania, intense depression, or a mixture of the two that lasts a minimum of seven days. An acute bout of mania that requires immediate treatment in a hospital or mental health institution is another way to help a psychologist determine that the patient should be categorized as bipolar I.
Something worth noting is that these episodes of mania and depression have been associated with mild or severe psychotic episodes.
Some background information; Sophia grew up on what she terms a “traditional Irish home” with overprotective and demanding parents. Of the five children in her family, she was the one who always obeyed her parents and played the role of the good girl of the family, a role she describes as being “Little Miss Perfect.” Sophia describes herself as being quite dependent on her parents, who treated her as if she were much younger than she actually was. In contrast to their passive obedience, Sophia describes her siblings as rebellious.
Sophia’s family history shows evidence of mood disorders; her maternal grandfather received electroconvulsive therapy (ECT) for depression and her father’s aunt was diagnosed with depression when she went through menopause.
Studies show that there is a clear link between genetics and bipolar disorder but have been unable to identify exactly what the abnormality is. There have been numerous studies on monozygotic (MZ) twins, first generation relatives (i.e. mothers, fathers, sisters, and brothers), and unrelated people. All studies dealing with family and those who suffer from a bipolar disorder show that the closer the genetic ties the more prevalent bipolar is in those studied.
Studies show that there is a clear link between genetics and bipolar disorder but have been unable to identify exactly what the abnormality is.
“EVERYTHING IN NATURE IS BIPOLAR, OR HAS A POSITIVE AND A NEGATIVE POLE” – RALPH WALDO EMERSON.