Symptoms

Classically, the illness includes a phrase call depressive (low) and a phase called manic (high), hence the terms manic depression or bipolar affective disorder. It should be remembered, however, that there is a ‘normal’ phase when the individual is functioning relatively appropriately. Among certain individuals who are carriers of the illness, phases called mixed can be seen, where the two phases merge.

Depressive phase

The depressive phase is characterized by:

• a sad mood

• a slowdown in thinking processes

• a slowdown in motor functions

Sad mood

The individual has a ‘heavy heart’, he loses all taste for enjoying life and is given to crying; he blames himself for things in the past, puts himself down, may think he has an incurable disease and wants to die. Everything is black.


Slowdown in thinking

The depressed person has difficulty formulating his thoughts. His ability to concentrate and his attention span are diminished, his responses are often monosyllabic, as if he is unable to form a complete sentence.


Slowdown in motor functions

All activities become painful for a depressed person, he has lost all interest in them. He might spend his days sleeping because he is constantly tired. Bathing, cleaning his teeth, dressing, feeding himself, become chores that he tries to avoid. His appetite alters, he gains or loses weight, has no energy or pleasure and becomes more and more solitary. He often stays in bed, but he suffers from insomnia, preoccupied as he is by his pessimistic ideas. Suicide may seem like the only solution to his unbearable suffering.


Manic phase

The manic phrase is the opposite of the depressive phase. It is characterized by:

• an exalted mood

• an accelerated thinking process

• motor hyperactivity

Exalted mood

The mood of the manic person is exuberant, exalted. But it’s not like the vitality and optimism seen in entrepreneurs.

He is extremely confident of his powers and his charm, is convinced and convincing, and brooks no criticism, becoming easily irritated and angry. On the emotional plane, he has affairs, for the pleasure of seducing and being seduced, to experience something different, without thinking about the possible consequences. Inhibitions and tact are totally absent, which may lead to unfortunate consequences with the family, at work, etc.


Accelerated thinking process

The thought processes of the manic person are rapid, accelerated. Thoughts tumble over each other so much that the verbal flow cannot keep up the pace and he abruptly jumps from one subject to another, talking, talking, talking incessantly, even if his audience is not listening.

Since writing takes even more time than talking, his writing can be so incoherent, even he cannot understand it.


Motor hyperactivity

The manic person is always on the move. He simultaneously undertakes several projects, getting involved without taking the time to examine the details in order to check their validity. His judgment is disturbed; his sexual activity increases and goes in all directions. He does not know his limits, does not take the time to eat, never feels tired, and has too many things to do to think about sleeping. He can also overspend and gamble compulsively.

If the people around him try to calm him or counsel him to sleep, he becomes irritable and considers that they are the ones who are ill. He disturbs them, often during the night due to his insomnia and excessive activity.

The patient in manic phase may become distrustful; think that those around him are out to get him and want his belongings. His grandiose projects may be accompanied by suspicion, by paranoid comments: he feels persecuted, threatened.

This paranoid aspect may, at any given time, be the principal symptom, which could lead an examiner to make an error and incorrectly diagnose paranoid psychosis or paranoid schizophrenia, and recommend a treatment that is inappropriate. 

 
Mixed phase

While the depressive, manic and normal phases usually follow each other in what is called a cycle, sometimes depressive symptoms intertwine with manic symptoms. This is called a mixed phase and is characterized, for example, by:

• a sad affect

• an acceleration in thinking process and a slowdown in motor functions

Rapid cycles

Generally, a cycle is made up of a manic, a depressive and a euthymic phase, i.e., normal, stable mood.

When someone goes through more than four cycles in one year, he is considered to have rapid cycles.

The same individual may have several manic and depressive periods in the same day. Usually periods of depression are spread over an average of ten months, while manic phases, characterized by great excitation, last from three to six months.