- Hi, I'm Dr. Tracy Marks a psychiatrist, and I make mental health education videos. Today I'm talking about
two different presentations of bipolar disorder. A classic or textbook presentation, and a non classic or
atypical presentation. And these are not official
subtypes of bipolar disorder that you'll find in the diagnostic manual. This is a clinical description
of two different ways that bipolar disorder can present or look. This matters because the
classic form of bipolar disorder tends to respond much better to lithium and the atypical form
tends to respond better to anticonvulsant mood stabilizers like Depakote or Lamotrigine and the atypical antipsychotic medications like Abilify or Seroquel. I use and define a lot
of terms in this video. And I think it's good for you
to know the clinical terms so if you're listening to
someone else talk about this, or you're reading about it online, you'll understand what's being said. And sometimes when your
doctor's talking to you, he or she can slip into these terms without thinking about it because it takes some extra work to do the translation in your head to speak using nonclinical jargon. I'll review the terms
at the end of the video. So going back to the
atypical anti-psychotics, they're called atypical because they blocked
dopamine and serotonin. Whereas the older
anti-psychotics like Haldol block dopamine only, and they're considered
the first generation of anti-psychotics focused
only on treating psychosis. Then in 1990, the first of the second generation
anti-psychotic medications started with clozapine. And these are anti-psychotics that are mostly used today, and especially in
treating bipolar disorder and treatment resistant depression. Here's a comparison between
classic bipolar disorder and atypical bipolar disorder. When it comes to hypomania and mania with classic bipolar disorder, you start with euphoric or
happy or grandiose mania. As you age, though, your manias
can become more irritable, but it starts out bright. With atypical, you
predominantly get dysphoria or dark modes. You can also get mixed states. A mixed state is where you
get a mixture of depression and mania occurring at the same time. I talk about it in more detail in this video that I did on mixed mania. With classic bipolar, you get
full recovery between episodes and can have long stretches
in between episodes. So when you're not having an episode, you're back to your baseline state, and that can last for months or years before you have another episode. With atypical, you tend to
have these leftover symptoms of a lesser intensity in between episodes. So it may not feel like
you ever really got out of your last depression. Things got better, but
not all the way better. So you don't feel like you ever got back to the way you were before
you got sick the first time. And as far as terms go, the clinical term for the leftover symptoms is subsyndromal. These are symptoms that are not as severe enough
to be diagnosed as an illness or a syndrome all by themselves if you just look at them in isolation, but in this case, they're remnant symptoms
of your bipolar illness. Rapid cycling is having more
than four episodes in a year and is more common with
atypical bipolar disorder and rare with the classic form. With classic, you don't
tend to have other disorders like anxiety, addictions or OCD, and these other illnesses
are called co-morbidities because they co-occur
with other illnesses. Morbidity or morbid is a
clinical term for disease state. So if you ever read online or hear someone refer
to your premorbid state, it's how you were before you were ill. And if you have several illnesses like ADHD, anxiety, bipolar
disorder, et cetera, all of these illnesses are
considered co-morbidities. So we tend to think of classic bipolar as being more pure and not
affected by other illness. The age of onset of
classic bipolar disorder tends to be around age 15 to 19. And for atypical it's
earlier like ages 10 to 15. Generally psychiatric illnesses
that start to take shape in a defined way in childhood end up taking on a more
severe form and adulthood. It's like the illness has
more time to gain momentum and become a stronger version of itself. As for personality style, with classic bipolar
disorder, people tend to have either a normal personality
that doesn't cause much problem or what's called a
hyperthermic personality. Hyperthermic is a term we use to describe someone who has naturally high energy, a people person, or tends to be a leader. With atypical bipolar disorder, you see more personality disorders like borderline personality disorder or cyclothymic temperament. I talk about the combination
of bipolar disorder and borderline personality
disorder in this video. Cyclothymia temperament is
a psychological construct and not a diagnosis. A construct is a concept or
theory that someone develops, your temperament refers
to your hard wiring that you're born with. With cyclothymic
temperament, you're hardwired to be more moody and emotionally reactive. This reactivity comes from being more interpersonally sensitive. The last comparison is genetics. With classic disorder,
there's a clearer history of someone in the family
having bipolar disorder. Not everyone has a family
history of bipolar disorder but many do since it's strongly
heritable, another term. Heritable means capable of being inherited or passed down to another generation. And in psychiatry, the two most heritable
disorders that we have are bipolar disorder and schizophrenia. If you have a first degree
relative with this illness, it's not okay given that you'll get it, but you have a higher chance than someone who does not
have a relative with it. A first degree relative would be someone who
shares half of your DNA, like a parent or a sibling, not a cousin or an uncle. So with classic bipolar, it's more common that you have bipolar
disorder in the family. With atypical bipolar disorder, the family history is a little murkier, there maybe relatives
who have other disorders like depression, schizophrenia
or other illnesses. Psychiatric illnesses in
general can run in families such that if you have an
uncle with schizophrenia, you could end up having depression. You didn't inherit the
same illness as your uncle but you have a different mental disorder. As it turns out, the
classic bipolar picture is less common than the
atypical presentation. Even though the word atypical makes it sound like it's not that usual, it's called atypical because when the German
psychiatrist Emil Kraepelin first discovered bipolar disorder which at the time he
called manic depression, it was the classic form
that he first defined. Later on this other
variation became recognized. So it's similar to the
anti-psychotic story. The newer second generation
of anti-psychotics are called atypicals and they're a spinoff of the older ones, but they are the ones that
are more commonly used today. But the main significance to recognizing in these differences is that classic bipolar disorder tends to be more responsive to lithium. And lithium has a lot of benefits including being neuroprotective, which means it protects the
nerve cells in your brain from injury and degeneration. Despite the fact that lithium
has a lot of side effects, making people feel as though they're
cognitively slowed or dulled, lithium has been shown to have benefit in preventing dementia. But it's not always an easy drug to take and has other significant side effects. That said, if you have a
more atypical presentation to your bipolar disorder, you will probably get better results with the anticonvulsants and the atypicals
anti-psychotic medications. So to recap, here are the
terms I discussed today. Classic bipolar, atypical bipolar, atypical or second
generation anti-psychotics, subsyndromal, morbidity,
psychological construct, hyperthermic temperament, heritable, first degree and neuroprotective. That's a lot of stuff. If you wanna get used
to hearing the jargon and understanding it,
watch the video again. For more information on taking
lithium, watch this video. See you next time.
