By Mario Maj, Hagop S. Akiskal, Juan José López-Ibor Jr., Norman Sartorius
Bipolar ailment is a significant psychological ailment regarding episodes of significant mania and melancholy and impacts nearly one to 3 percentage of the inhabitants. in response to the nationwide Institute of psychological overall healthiness approximately million contributors within the usa on my own are clinically determined with this ailment.
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Research by the present author  has shown that such a diagnosis should not be considered in a bipolar psychosis where mood-incongruent psychotic features can be explained on the basis of one of the following: a) affective psychosis superimposed on mental retardation, giving rise to extremely hyperactive and bizarre manic behaviour; b) affective psychosis complicated by concurrent cerebral disease, substance abuse, or substance withdrawal, all of which are known to give rise to numerous Schneiderian symptoms; c) mixed episodes of bipolar disorder, which are notorious for signs and symptoms of protracted psychotic disorganization.
A corollary of psychomotor activation, and another cardinal sign of mania, is decreased need for sleep, whereby the patient sleeps for only a few hours but feels energetic on awakening. Some may actually go sleepless for several days, which could lead to a dangerous escalation of manic activity, and sometimes, to physical exhaustion. Weight loss may occur because of such hyperactivity and neglect of nutritional needs. Delirious mania, an extremely severe, yet rare, expression of mania (also known as ``Bell's mania'')  involves frenzied physical activity that continues unabated, leading to a medical emergency that is life threatening.
Alcohol abuse and neuropsychiatric conditions are prevalent in mixed states . Mixed states have been best characterized in female inpatients [133, 150, 151], often arising from a prior course of illness with more depressive than manic episodes and with a tendency to repeat over time, though this is based on retrospective examination. Family history is more often depressive than manic , and suicidal behaviour is a distinct 26 BIPOLAR DISORDER risk [152±154]. Confusion and psychotic features, including mood incongruence, are also common clinical presentations [144, 150, 151].