The exact cause of bipolar disorder has yet to be determined, and most theories implicate a combination of neurotransmitter dysregulation and genetic factors. For example, it is believed that there is excess cholinergic transmission during depressive phases, which decreases during mania. Mania may also be associated with excess dopamine and serotonin transmission. Genetic predisposition also likely contributes to the development of bipolar disorder, with multiple different genes currently being investigated.
When patients are manic, there is euphoria and elation. This person appears to be on a continuous "high." With this said, the patient's mood is always subject to frequent variation.
In the manic phase, patients have excessive psychomotor activity. They have poor impulse control and their energy seems inexhaustible. They have a diminished need for sleep and may seem very extroverted.
They have a heightened sense of perception and cognition, but these patients are easily distracted. Thinking is flighty, with a rapid flow of ideas and disjointed logic.
Speech may be rapid, and can be displayed as a continuous flow of accelerated speech. The sentence structure may be disorganized and incoherent, and speech can seem pressured.
Patients have mood swings, going from episodes of mania to depression. With depressive episodes, feelings of hopelessness, worthlessness and despair can arise. Often, their mood and functioning usually returns to normal between episodes of mania and depression.
Just like they can develop mania, patients can also develop depressive episodes. Patients display sadness, crying, and a sense of worthlessness.
Furthermore, patients in the depressive phase of bipolar disorder have physical symptoms. They show psychomotor retardation that is manifested as loss of energy, slow movements, and sleep problems.
This depressive phase of bipolar disorder can lead to suicidal thoughts in patients. Caregivers should be attentive to bipolar patients experiencing suicidal thoughts during a depressive stage.
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