 Hi, this is Bob Cook and this is a presentation on the bipolar disorder, formerly known as the manic depression disorder, which brings, of course, elevated mood on the manic side and deep depression on the depression side, and usually the depression follows the manic or elevated mood. So let's look at the elevated mood or the manic side. So this is the mania which often brings, or can bring, psychosis or psychotic experiences where the individual experiences a break in reality. There's also hypomania, which is a milder form of the mania, or the step before the full-blow mania, and of course hypomania is common on the road to the full manic process. Okay, features of mania. So with mania will come high increased energy, people feel they can do anything, that they're unstoppable, and they'll have grandiose thoughts in this process. They will have increased racing thoughts with the high energy, and often feel confused, but their thoughts are tumbling one after the other so fast that often you can't keep up with their thinking, can't follow their thinking streams, they're so fast. They feel usually more more irritable as the manic phase continues. They don't sleep much, there's a need for sleep reduction, usually two or three hours, or even one hour, or maybe half an hour in terms of sleep. There's hypersexuality quite often and may in fact have a sense of impulsivity and excessive spending. Their concentration is zapped, they very much have a short attention span, they're impulsive, their speech is very rapid, inevitable, manner, very very nice, quick. More features of the manic phase, they have increased goal-oriented activities, but actually they don't get anything done because their racing thoughts, their manic energy means they don't get anything done or finished, certainly not finished. They're manically happy or they feel they aren't, and that's really the sort of happiness that comes with the high energy, false happiness in a way. And the above behaviors really do impair individuals' ability to work or function, known in a workplace but in relationships. They often have a history of substance abuse, which is a form of self-medication for them, and they certainly have grandiosity and delusional ideas, which may lead to violent behavior. Hypermania, as I said, is a minor form of mania. Hypermania is stressful, though, even though it's not a full-blown manic episode, and may not develop into a full-blown manic episode. In fact, you might have what's called a hypermanic event, and if it's not accompanied with depressive episodes, it's often not seen as problematic. Of course, the high energy comes with it, well, not so much as a full-blown process, but it's not seen as problematic unless the mood changes are uncontrollable or volatile. So the other side of this, which is the depression, which follows the manic or even the hypermania processes, with depression comes increased in capacitation and the ability to do anything, lack of motivation. There's bouts of crying and feeling very hopeless and worthless in the process. They have negative out-life of life and feel like they've got negative thoughts. They are far more internalized. There's limited external contact, and they're much more internal and very little eye contact, really. They have persistent feelings of sadness. They have problems in concentration. They often report thoughts of death and suicidal idolization, very common. They certainly face self-loathing. Severe depression here may bring psychosis and delusions or even hallucinations, and they have a lot of interest in life, hobbies, etc., and the passions they have before, which are certainly increased in the hypermania or the manic phases, or certainly decreased in this depression. Okay, you've got types of bipolar here as well. We'll talk about bipolar disorder. You've got the bipolar 1 disorder, and you've got the bipolar 2 disorder. If you look at the bipolar 1 disorder definition, it says that you have at least one manic episode with or without depressive episodes. Definition of bipolar 2 disorder is at least one hypermanic episode, but no manic episodes, and one major depressive episode. Classical diagnosis here. Bipolar disorders commonly diagnosed in childhood, but onset can occur during adolescence or early adulthood. Medication treatment given out for the bipolar process. You've got mood stabilizing, perhaps the one that's most known is lithium, and lithium is supposed to reduce risk of suicide, self-harm, and positive when treating the manic episodes and preventing future manic episodes. It's given out under psychotics if necessary, and you've got anti-convulsions if necessary, and of course this may lead to hospitalization if there's a risk to self for other people. And please remember that in periods of mania, antidepressants will be recommended to be stopped. Psychotherapy, then, is often recommended. You've got humanistic therapies that might cover counselling as well. Transaction analysis, etc. Gestalt, existential psychotherapy, and then there's psychodynamic therapies, which are often good in this sense. So psychotherapy treatment is aimed at elevating core symptoms, recognizing episode triggers, reducing negative thoughts, and helping people to connect past to present emotions through thoughts and behaviors. What I think I want to talk about briefly is the idea of rapid cycling, which often, like some people say, not so often, comes with the manic part and the depressive process in bipolar. So rapid cycling is at least four major depressive manic or hyper manic or mixed episodes to have occurred during a 12 month period. And then you've got ultra rapid, which means that it happens within two or three days. And you've got ultra rapid, which is cycling through the manic and depressive cycle within a day, sometimes in fact hours, which is particularly exhausting, or the morning or the afternoon, there might have been a cycle. Okay, thank you very much.