Bipolar Disorder

An estimated 2.3 million Americans have bipolar disorder, which was previously known as manic-depressive illness. A patient with bipolar disorder can experience changes in mood from feeling very high (called mania) to feeling very low (depression). When bipolar disorder is appropriately diagnosed and treated, patients’ mood swings can be treated so that they can lead fulfilling lives. Although rates of bipolar disorder among African Americans are comparable to those among other Americans, African Americans are less likely to be diagnosed with the disorder and, therefore, less likely to receive effective treatment.

Factors contributing to the under-diagnosis and under-treatment of bipolar disorder among African Americans are similar to those associated with other mental disorders, including:

  • Mistrust of healthcare professionals, based in part on historically higher-than-average institutionalization rates among African Americans with mental illness and on previous mistreatments, such as the Tuskegee syphilis study
  • Inadequate cultural competence skills among many healthcare practitioners
  • Reliance on family and religious communities rather than mental health professionals during times of emotional distress
  • Somatization—a tendency to discuss physical problems, rather than mental symptoms, or to mask symptoms with substance abuse or other medical conditions
  • Socioeconomic factors that can limit access to medical and mental healthcare services, with approximately 25% of African Americans lacking health insurance coverage
  • Continued misunderstanding and stigma about mental illness

The specific etiology of bipolar disorder remains undetermined, although contributing factors may include:

  • Imbalances in brain chemistry during both mania and depression
  • Genetics, with close relatives of bipolar patients being 10 to 20 times more likely to experience depression or bipolar disorder than other individuals
  • Drug and alcohol abuse, with > 50% of persons diagnosed with bipolar disorder having histories of substance abuse
  • Stressful or disturbing events that are associated with mood swings

Symptoms and Diagnosis

Because there are subtypes of bipolar disorder, accurate diagnosis and effective treatment are complex and challenging even for skilled clinicians. Following are the types of bipolar disorder:

  • Bipolar I disorder: ≥ 1 manic or 1 mixed episode, with or without a major depressive episode, with more specific diagnostic subcategories based on the particular signs and symptoms
  • Bipolar II disorder: ≥ 1 major depressive episode and ≥ 1 hypomanic episode (but not a fully manic or mixed episode), also with subcategories based on the particular signs and symptoms.
  • Cyclothymic disorder: numerous hypomanic episodes and periods of depression, but no full manic episode, major depressive episode, or mixed episode, with symptoms lasting ≥ 2 years (1 year in children and adolescents) and symptoms never remitting > 2 months

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