Women's Mental Health in Primary Care

By Kathryn J. Zerbe | Go to book overview

Chapter 3
Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is one of the most severe psychiatric illnesses. It adversely affects the patient's mood, activity, and thought processes. (See Table 3-1 for a more definitive list of historical symptoms.) Characterized by one or more manic episodes and typically by one or more depressive episodes, the disorder manifests by an elevated, expansive, irritable mood and a host of behavioral symptoms. Because persons with mania are dangerous to themselves and to others, this disorder is considered one of the few emergencies in psychiatry (Bowden, 1996a).

Affecting 1% to 1.6% of both men and women, bipolar disorder occurs at about the same frequency in either gender, and without regard to national origin (Leibenluft, 1996; Weissman et al., 1996). Although gender differences have only begun to receive systematic study, there appear to be significant gender‐ related issues regarding the course of this illness and response to treatment. For women, pregnancy and the postpartum period are times of special risk for onset and recurrence. In addition, all the effective mood-stabilizing agents pose special risks during pregnancy.

Women have a higher rate of "rapid-cycling" and "mixed-state" forms of bipolar disorder. What constitutes diagnostic verifiability for each of these forms is still a matter of some controversy. Bipolar women appear to be at higher risk than bipolar men for development of depressive episodes. Although bipolar illness is inherently treatable (Bowden, 1996a, 1996b; Bowden et al., 1996; Bowden and McElroy, 1995; Cohen et al., 1995; Dunner, 1993; Keck et al., 1996a; Kupfer

Table 3-1. Historical Symptoms of Bipolar Spectrum
Mood Poor social boundaries
Inappropriate humor or euphoria Sexually overactive and provocative
Irritation or anger Frequent interrupting; boastfulness
Disinhibition Uncontrolled spending
Heightened sensory experiences (e.g., "That's the bluest tie I've ever seen!") Thought
Poor judgment
Distractibility
Activity Litigiousness
Increased energy Denial
Poor impulse control Flight of ideas
Decreased need for sleep Grandiose ideas and delusions
Pressure of speech Recurrent psychosis
Increased social contact Recurrent thought disorder; depression

-55-

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Women's Mental Health in Primary Care
Table of contents

Table of contents

  • Women's Mental Health in Primary Care *
  • Preface vii
  • Acknowledgments xi
  • Contents *
  • Chapter 1 - Anxiety Disorders 1
  • Chapter 2 - Depression 31
  • Chapter 3 - Bipolar Disorder 55
  • Chapter 4 - Misuse of Substances 73
  • Chapter 5 - Eating Disorders 109
  • Chapter 6 - Trauma and Violence 139
  • Chapter 7 - Insomnia 165
  • Chapter 8 - Somatization 181
  • Chapter 9 - Catastrophic Loss and Bereavement 199
  • Chapter 10 - Major Medical Illness 219
  • Chapter 11 - Menstruation, Pregnancy, and Menopause 247
  • Chapter 12 - Psychosis 273
  • Chapter 13 - Sexuality and Intimacy 291
  • Chapter 14 - The Older Patient 319
  • Afterword 347
  • General Resources for Patients 350
  • Index 353
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