By Mario Maj, Hagop S. Akiskal, Juan José López-Ibor Jr., Norman Sartorius
Bipolar affliction is a major psychological affliction concerning episodes of great mania and melancholy and impacts nearly one to 3 percentage of the inhabitants. based on the nationwide Institute of psychological wellbeing and fitness approximately million participants within the usa on my own are clinically determined with this affliction.
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By contrast, bipolar II variants with brief ( 4 days) hypomanic episodes and depressive mixed states (isolated hypomanic symptoms intruding into depressive states) are not officially recognized; also the boundaries between cyclothymic mood swings and borderline mood lability have not been clarified in these manuals. The overinclusive boundaries of bipolar disorder discussed in this chapter in part reflect the clinical judgement of investigators that depressed patients with soft pre-bipolar indicators will be spared the risk of antidepressant treatment with its attendant cycle acceleration and possible 34 BIPOLAR DISORDER chronicization [22, 208].
This study testifies to the fact that bipolar II disorder is a complex affective disorder with biographical instability deriving from an intense temperamental dysregulation. Mood labilityÐwith rapid shifts, often in a depressive polarityÐwas the hallmark of ``unipolar'' patients who switched to bipolar II disorder. The foregoing characteristics revealed in a prospective study on a large clinical sample in five university centres provide a pattern recognition which clinicians can use in their diagnostic evaluation for ascertaining bipolar II disorder diagnosis and its variants.
Perhaps it is deemed to be unreliable, in that manic mood is changeable. Bursting into tears is common, but not necessarily lasting. Also, for many patients the high is so excessive that it is experienced as intense nervousness. Moreover, when crossed, the patient can become extremely hostile. Thus, lability and irritable hostility are as much features of the manic mood as is elation, and appear as such in both ICD-10 and DSM-IV. Accelerated psychomotor activity, which for some investigators  constitutes the hallmark of mania, is characterized by an overabundance of energy and activity and by rapid and pressured speech.