Anyone familiar with unipolar mania?

[keith74]

Hello all,
My wife has a diagnosis of classic bipolar 1. However, I'm trying to figure out what her sister has. We are pretty sure she has some mental illness. My wife thinks she is bipolar also, but she doesn't fully fit the usual criteria. She has had multiple episodes which fall into the classic manic criteria (both euphoric and dysphoric) and also mixed mania. But she has never really had what I would consider a depressive episode. The closest would be her mixed manic episodes where she would have moments of extreme emotional anxiety and sadness sprinkled in with her intense mania. At first, my wife and I dismissed the first two big episodes as postpartum psychosis since they happened after each of her kids were born. But then she had another huge episode in 2019 which was mostly due to overwork and work stress. Hence we can't blame that one on postpartum. When she comes down from these manic episodes, there is a time of melancholy as she reflects on what happens. But it is brief and then she wants to move on from it like it never happened. She never enters any kind of real depression. Her baseline is very emotional/social/friendly but a bit narcissistic and with a bit of a temper. In her manic episodes, this gets amplified 1000x. When doing some research, I found a bit of information about "unipolar mania" which seems to fit the bill. But the data on it is minimal as it is not commonly diagnosed. Just wondering if my sister-in-law does indeed get unipolar mania or if it could be something else. She is in denial that she has any real mental issues other than lack of "anger management" and some ptsd from past trauma. Even hinting that she may have a mental illness will set her off so she definitely will not go to a psychiatrist for a proper evaluation.

 

[HLon99]

Whilst unipolar mania is an unrecognised condition, I don't really see why its not possible for someone to have this, no matter how rare. Since, the DSM-V and ICD-10 don't list unipolar mania as a official dianosis, and since she has had periods of sustained elavated mood and mixed episodes; she will most likely be diagnosed with Bipolar if she goes to see a psychiatrist.

If you see all the classic symptoms of mania, which you are already well aware of, and there is a clear history of bipolar in the family its definitely worth seeing a psychiatrist. I wouldn't at this stage worry about the specific terminology of the diagnosis. However, make sure that the doctor she sees is experienced in treating bipolar patients. Otherwise, if you get an inexperienced one, they might stick a bullshit label such as mood dyregulation or emotional incontenance or some other crap and not give her the correct treatment, as was briefly the case with me. As long as you get a good psychiatrist you should be fine; she'll most likely get similar treatment to your wife, with either Lithium or Atypical Antipsychotics being offered. Its not unfamiliar ground.

 

[TheHeartHasAVoice]

Hello all,
My wife has a diagnosis of classic bipolar 1. However, I'm trying to figure out what her sister has. We are pretty sure she has some mental illness. My wife thinks she is bipolar also, but she doesn't fully fit the usual criteria. She has had multiple episodes which fall into the classic manic criteria (both euphoric and dysphoric) and also mixed mania. But she has never really had what I would consider a depressive episode. The closest would be her mixed manic episodes where she would have moments of extreme emotional anxiety and sadness sprinkled in with her intense mania. At first, my wife and I dismissed the first two big episodes as postpartum psychosis since they happened after each of her kids were born. But then she had another huge episode in 2019 which was mostly due to overwork and work stress. Hence we can't blame that one on postpartum. When she comes down from these manic episodes, there is a time of melancholy as she reflects on what happens. But it is brief and then she wants to move on from it like it never happened. She never enters any kind of real depression. Her baseline is very emotional/social/friendly but a bit narcissistic and with a bit of a temper. In her manic episodes, this gets amplified 1000x. When doing some research, I found a bit of information about "unipolar mania" which seems to fit the bill. But the data on it is minimal as it is not commonly diagnosed. Just wondering if my sister-in-law does indeed get unipolar mania or if it could be something else. She is in denial that she has any real mental issues other than lack of "anger management" and some ptsd from past trauma. Even hinting that she may have a mental illness will set her off so she definitely will not go to a psychiatrist for a proper evaluation.

If she doesn't have pressured speech "talking a mile a minute" which is related to a "flight of idea's" then it is hard to diagnose her as manic. Read about those symptoms.

Unipolar mania is real and I'm confused as to why it isn't given much attention. I think they diganose it as Bipolar 1 in the DSM-V.

 

[keith74]

Whilst unipolar mania is an unrecognised condition, I don't really see why its not possible for someone to have this, no matter how rare. Since, the DSM-V and ICD-10 don't list unipolar mania as a official dianosis, and since she has had periods of sustained elavated mood and mixed episodes; she will most likely be diagnosed with Bipolar if she goes to see a psychiatrist.

If you see all the classic symptoms of mania, which you are already well aware of, and there is a clear history of bipolar in the family its definitely worth seeing a psychiatrist. I wouldn't at this stage worry about the specific terminology of the diagnosis. However, make sure that the doctor she sees is experienced in treating bipolar patients. Otherwise, if you get an inexperienced one, they might stick a bullshit label such as mood dyregulation or emotional incontenance or some other crap and not give her the correct treatment, as was briefly the case with me. As long as you get a good psychiatrist you should be fine; she'll most likely get similar treatment to your wife, with either Lithium or Atypical Antipsychotics being offered. Its not unfamiliar ground.

The big issue is that she will not accept going to a psychiatrist to see if she has a mental illness. her pride/ego is too great for her to ever accept such a diagnosis. Part of the issue is that she sees her sister (my wife) as the "sick" one while she is the successful one, so it would be tough for her to swallow that she is also "sick". There was one time she was forced to see a psychiatrist because she was ordered by the court to do so as part of her deal (she was in court because she was arrested during one of her extremely intense "manic" episodes). She is very intelligent on top of being an ivy league educated lawyer and was able to convince the psychiatrist that she only has "anger" issues and was recommended anger management counselling. However I think her last manic episode made her reflect that there is something wrong. She gets regular therapy and I think deep down she knows she has something but will not admit it.... yet.

 

[keith74]

If she doesn't have pressured speech "talking a mile a minute" which is related to a "flight of idea's" then it is hard to diagnose her as manic. Read about those symptoms.

Unipolar mania is real and I'm confused as to why it isn't given much attention. I think they diganose it as Bipolar 1 in the DSM-V.

Yes I'm very aware of those symptoms. My wife was recently very manic and showed those symptoms very clearly. And her sister has shown those symptoms every time she had one of her episodes, in addition to many other symptoms common with euphoric and dysphoric mania.

 

[keith74]

interestingly I was browsing this site and saw this page:

Bipolar Disorder - A Personal Experience

A very personal introduction to bipolar disorder from a person with personal experience of it. The author is a member of the MHF Bipolar Forum.

www.mentalhealthforum.net

halfway down I saw this paragraph:

As I said before, the depression in bipolar 2 is often more frequent and severe. Some people with bipolar 1 never experience depression at all, but all people with bipolar 2 do. There is a commonly stated aspect of bipolar 2 that they can’t get psychotic symptoms but this just isn’t true. Hallucinations and delusions can happen, almost always in the depressive aspect.

If that is the case, then that would describe my sister-in-law.

 

[HLon99]

The big issue is that she will not accept going to a psychiatrist to see if she has a mental illness. her pride/ego is too great for her to ever accept such a diagnosis. Part of the issue is that she sees her sister (my wife) as the "sick" one while she is the successful one, so it would be tough for her to swallow that she is also "sick". There was one time she was forced to see a psychiatrist because she was ordered by the court to do so as part of her deal (she was in court because she was arrested during one of her extremely intense "manic" episodes). She is very intelligent on top of being an ivy league educated lawyer and was able to convince the psychiatrist that she only has "anger" issues and was recommended anger management counselling. However I think her last manic episode made her reflect that there is something wrong. She gets regular therapy and I think deep down she knows she has something but will not admit it.... yet.

Tough case, if things get really bad then maybe you can organise a family intervention. Won't be a pleasant experience but the only way you're going to get through to her is if the whole family comes together on this issue.

 

[keith74]

Tough case, if things get really bad then maybe you can organise a family intervention. Won't be a pleasant experience but the only way you're going to get through to her is if the whole family comes together on this issue.

Unfortunately an organized family intervention is simply not a possible reality due to the dynamics of the family. She will need to seek treatment on her own. There is minor hope as he has started to see a therapist regularly for various "issues". Hopefully through these sessions she will realize some facts about her past incidents.

 

[HLon99]

Unfortunately an organized family intervention is simply not a possible reality due to the dynamics of the family. She will need to seek treatment on her own. There is minor hope as he has started to see a therapist regularly for various "issues". Hopefully through these sessions she will realize some facts about her past incidents.

I don't know your sister in law personally, so I couldn't possibly comment on what her values and motivations are, but as is often the case, experience in the greatest teacher and being put into a postion when you have no choice but to face the music is probably the most effective way, for those that are stubborn and arrogant enough to continue denying that they have a problem despite all the evidence pointing to the contrary.

 

[Wishbone]

interestingly I was browsing this site and saw this page:

Bipolar Disorder - A Personal Experience

A very personal introduction to bipolar disorder from a person with personal experience of it. The author is a member of the MHF Bipolar Forum.

www.mentalhealthforum.net

halfway down I saw this paragraph:

As I said before, the depression in bipolar 2 is often more frequent and severe. Some people with bipolar 1 never experience depression at all, but all people with bipolar 2 do. There is a commonly stated aspect of bipolar 2 that they can’t get psychotic symptoms but this just isn’t true. Hallucinations and delusions can happen, almost always in the depressive aspect.

If that is the case, then that would describe my sister-in-law.

The reason for this is because essentially, you only need to experience one episode of mania to be diagnosed as Bipolar 1 (Mania being the differential from Bipolar 2, which only goes as 'high' as Hypomania). Bipolar 2's can turn into Bipolar 1's if their Hypo's progress to mania's but it can't go the other way. Once you've had mania, you're type 1.
So you will get those that only have Mania and no depression. You will get those that only have one episode in their lives. You will get those that have Mania and depression. You'll get those that have Mania, Hypomania and depression. And then you can throw mixed states and rapid cycling etc in there too, for good measure.
It gets pretty complicated and only a full and open disclosure from the patient can really reveal what's going on, without it becoming an emergency situation of course.. If she's unwilling to do that then it's going to be a case of one day having an episode that has an undeniable stamp of Bipolar all over it and she'll then have to accept it. But what she's doing by taking that route is playing a dangerous game. Mania is not to be taken lightly and there's no saying what the next episode can result in. For her own safety she should face up to what looks like a reality.