[Music] what is bipolar depression or bipolar disorder right so bipolar disorder is it's a mental illness that's classified by extreme highs and extreme lows so much so kyle that it changes your activity levels it changes your sleep patterns it changes the way that you think and subsequently changes your behavior the most important thing is it affects your life in an incredibly negative way right now there's various levels of bipolar disorder and different types of bipolar disorder so it's very very important to understand the different types okay let's go through those types we i feel like everybody's heard of bipolar disorder but not many people know that there's bipolar one and bipolar two let's start with bipolar absolutely right so let's start with bipolar one because that is is just such a significant illness right so bipolar one again what we're going to talk about and make this as easy as possible for everyone to understand bipolar one is mania that's the word of the day with bipolar one we're going to focus on the manic symptoms okay so bipolar one is this and this is per the dsm-5 bipolar one is expansive elevated mood sometimes irritable right for seven days or more right and that's important the time and the intensity are important seven days or more with symptoms of that elevated expansive mood most of the day every day for seven days or more right now there's a list of elevated expansive symptoms and those are important because you need at least three of those for that seven day period and those are this distractibility okay this is somebody that cannot sit still they can't pay attention at all they can't finish any tasks at all completely distracted impulsivity is the next one impulsivity so much so kyle that you're going to do things that you are not thinking through you're getting yourself into trouble potentially you're just making rash impulsive decisions the next one is grandiosity grandiosity is a big one right grandiosity means that you have this inflated self-worth i've seen cases where it gets so bad into the realm of psychosis where people think they're god or they think they're a superhero but it can be much lower as well just feeling really really high about yourself right the other thing you'll notice is flight of ideas you may hear that term thrown out flight of ideas is just that when you're listening to these people talk in a manic episode their ideas are just flying out at you and they're not really making a whole lot of sense they're just they're linear but you'll talk to someone for five minutes and you would have heard like 100 different topics right so that's flight of ideas you're gonna see sometimes agitation or activity levels increase as well sleep that's a big one sleep issues now people with mania tend to not need sleep all right it's a very very important piece people can go with mania i've had people come into my office or that i've seen the hospital and say doc i haven't slept in a week no sleep nothing and they're functioning and they're okay with it that's the important thing no i'm fine i'm totally good so sleep issues is a really big deal most likely it's insomnia or decreased need for it you just don't want it and you don't need it and the other piece is really rapid and pressured speech so we talked about the idea portion which is what's in your head but what you're seeing presented to you is very pressured speech so i just went through about eight or nine things right you need at least three of those for seven days straight most of the day every day okay that's the bulk of the criteria for mania to get a diagnosis of bipolar one but this is what a lot of people don't pay attention to and this is probably some of the most important diagnostic criteria ready for this and i know i love these because this is what people don't pay attention to number one it cannot be caused by a medical illness or another psychiatric issue okay the importance with this is that mania can be caused by so many different things medically a thyroid issue can do it traumatic brain injury can do it temporal lobe seizures can do it you know all types of medical issues can do it medicines can do it corticosteroids for example if you have asthma you're on a corticosteroid it can induce mania so you need to rule out all these medical and medicine aspects not causing the mania okay make sure it's not induced by an illicit drug there are illicit drugs that can do this right cocaine i'll tell you what you give somebody cocaine they're going to present pretty damn manic right so you have to rule all of that out okay and then it can't be better defined by another mental illness those are super important all right so that's the criteria for bipolar one and what a lot of people misinterpret is that they think you have to have a depressive episode for a bipolar one diagnosis and you don't if you have had one manic episode in your entire life you are bipolar one wow now i interviewed kevin hines who jumped off the golden gate bridge survived and tells his remarkable story on how he's dealt with his mental health he has bipolar disorder and he said in his book cracked but not broken when he was in a manic state and not sleeping he would start at 17 years old would start campaigning for presidency of the united states and not as a joke not because he thought it was funny or cool because in his brain his reality was that his next step in life was to become the president of the united states grandiosity grandiosity are there examples like that that will demonstrate some of these traits that you're aware of oh yeah it's kyle one thing that i do is work in an emergency psychiatric unit and unfortunately or fortunately because they're coming for help in bipolar one you're most likely going to see people present to you in mania because they're coming to the hospital because it's emergent they're getting themselves into trouble something has gone wrong in their lives they're going off the rails okay i have stories of people that were professionals that you know accountants and lawyers and physicians that would disappear for a week no one knows where they are family is a nervous wreck they have no idea where they are they turn up a week or two later they decided to go into manhattan get the presidential suite at the plaza run up all of their credit cards gamble prostitution party right do things that they would never ever do get start new businesses people start a new business they they think they have this grandiosity and flight of ideas and then when that's over it can be so traumatic because you can crash and get very very low yeah so there are so many stories that i've seen of that grandiosity and and i used one example of sometimes mania unfortunately can lead into psychosis and we'll talk about that but people get to a point where they go doc god's talking to me i hear him i hear him and you know what he told me he told me that i need to save the world and i believe it he's right he's right i was thinking about this i got to save the world i have to do x y and z i got to do it i can't be sitting here talking to you right now you can't put me in a psych unit right now i have to save the world god is talking to me i hear him right now wow so that's mania with psychosis i'm really glad that you're giving these types of examples because here's why people throw around mental illness terms all the time and one of them that they throw around all the time is bipolar disorder they'll go oh my gosh i just got off the phone with my mom i swear she's bipolar because she was upset about something and just because you get upset doesn't mean you have bipolar disorder just because you're happy on monday and upset on tuesday doesn't even mean you have bipolar disorder those are normal emotions and honest exactly normal emotions i think something that we'll do today in in discussion is understand what's normal and what's not yes but you're right and that sort of becomes a little pet peeve in psychiatry that people do use that terminology oh they're bipolar exactly what you said but the truth of the matter is true bipolar disorder kyle is so significantly different if mood swings are a campfire bipolar disorder is a forest fire out of control that's the difference perfect bipolar 2 disorder what is that so bipolar 2 now we're getting into a different realm and the difference here the main difference because i want to make this as as easy as possible for everyone to understand is bipolar 2 instead of full-blown mania it's called hypomania and there's only one real difference the length of time okay we talked about bipolar one mania being seven days or more of that constant manic experience bipolar two four days okay so four days so you only really need four days of those manic symptoms three of that list that i provided earlier okay to have hypomania and bipolar two now hypomania doesn't get as bad or as severe as bipolar one mania so you'll still have the grandiosity in the flight of ideas and you know that that fast speech and all that but it's not as severe it's a little bit lower and it doesn't last as long now with bipolar 2 the only other difference is that there's a depressive phase so not only does a person have to have four days of a manic episode with that list of symptoms three of those symptoms but they have a depressive phase two okay depressive phase really fits the criteria of a major depressive episode it's a few weeks or two weeks of you know feeling severely depressed and hedonic you don't like doing things you used to like to do you're sleeping a lot or too little hypersomnia or insomnia changes in appetite maybe suicidality so those are the criteria for depression the depressed phase of the hypomania and depression now important is people think that bipolar disorder is a sine wave it's up and down and up and down not the case at all not the case at all someone with bipolar disorder can be manic go back to euthymia which is normal for months depressed up depressed up mania up or it could follow a typical pattern and sometimes it does follow that pattern because mania takes so much out of someone that they tend to crash the way i look at it is this mania is like you are a ferrari running in the red floored with no breaks on a windy road right you're eventually going to lose control and crash or the engine is going to blow and then you're going to go down to a really low place right but if in bipolar 2 it doesn't necessarily have to follow a pattern it can be mania normal and then you can go to mania again couldn't that be misdiagnosed as bipolar one if the depressive episode didn't come until three months later it's a good question but don't forget the intensity and the duration so oh someone presents with you and they said you got the four days you know yeah i get manic i do have these how long does it last a couple of days four days maybe five days you know yeah but it's not that full-blown week and it's not as severe yeah