 Have you ever wondered what would be the reason for the sudden unusual change in a person's behavior? Hello, I'm Dr. Krithishree, Consultant Psychiatrist from Manipal Hospital's Mangalore. Today I'm going to talk about bipolar effective disorder, its signs and symptoms, causes and treatment. Bipolar Effective Disorder is a major mental illness. It's primarily a mood disorder. It's actually an episodic illness. When I say episodic illness, here the person experiences episodes of changes in his mood. As I said, it's a primary mood disorder. Usually we see changes in the mood of a person. Like it can be a manic episode or a depressive episode. So talking about the symptoms, majorly I'll describe what a manic episode is like and then a depressive episode is like. So that we get a clarity of how these changes are there compared to the baseline. A person with regular mood, his functioning capability would not alter much. But when there is a manic episode based on his mood, the whole picture, his behavior will start getting colored because of the changes in his mood. For example, in mania, the patient might experience extreme elation or happiness or even irritability because of minor triggers. Sometimes it is even without any triggers like he experiences extreme irritability. And along with this, there can be increased activity level. Activity level is so much so that sometimes the patient doesn't even feel the need of sleep. Along with also the patient might start feeling increased self-esteem. Like feel more talented than before or more important about himself compared to his usual self. So coming to the depressive episode, which is the opposite of this manic episode. As I told bipolar means it is this particular illness has two poles. One is the manic pole and the other one is the complete opposite of it. That is the depressive episode. Here it is the patient feels much more low than his normal self. Like he feels mood-wise very dull, not able to enjoy the activities which he used to otherwise feel pleasurable about. There is reduced interest in activities, reduced energy level as such, not able to engage in conversation with his family members or friends. He might appear to be sleeping more than usual because of increased fatigue or in spite of sleeping more, the quality of sleep also might be much more disturbed compared to the usual one. An appetite also like is low along with this low self-esteem, not able to concentrate in activities, frequent suicidal ideation or other symptoms which we notice in depressive episode. So usually a patient would be having either a manic episode or a depressive episode. Sometimes the intensity of this episode changes and between the episode, patient might reach back to the normal pre-morbid level of functioning without any changes in his mood or he might not come back to his completely back to his normal self at all. Coming to genetics, it is considered as an inheritable disorder that is in a patient with a family member who has already had a bipolar effective disorder. Then the risk of having a bipolar effective disorder in another family member is much more compared to the general public. So it's not one gene which causes it, it's usually a multiple of genes which has been identified as per the research. Then coming to the stressors, yes stressors do precipitate bipolar effective disorder. That is some external stressors like relationship break up or extreme stress at work or sudden loss, sudden financial problems can precipitate. Also the internal stressors something like physical illness or changes in balance in the chemicals in the brain or even change in sleep pattern can precipitate bipolar effective disorder. Bipolar disorder is usually diagnosed based on complete mental state examination of a person. A detailed history based on how the patient's behaviour pre-morbidly was and how the symptoms have changed over the time needs to be evaluated not as I told the science and symptoms, what kind of changes in the mood or the thought process or his behaviour the person, the people living with him have noticed. These things has to be taken into consideration. Coming to examination, it is important to do physical examination along with lab tests to rule out other physical illness. Along with this mental state examination is a must. So bipolar effective disorder is a lifelong illness. Here the moods episodes can keep coming back based on the stressors and other external factors. So the treatment has to be a lifelong treatment. Treatment wise we use mood stabilizers, say typical antipsychotics. Along with medications, once this episode settle down cognitive behavioural therapy that's the CBT sessions especially for the patient suffering from depressive episodes and then IPSRT sessions that is interpersonal and social rhythm therapies. Psychoeducation to the patient as well as the family members are also an important part of the treatment.