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B   Dysthymic disorder

Dysthymic disorder is diagnosed when a patient presents with chronic depression for at least 2 years in duration that has not been severe enough to be major depressive disorder. The patient must present with two of the following symptoms: increased or decreased appetite, increased or decreased sleep, low energy, low self-esteem, poor concentration or decision-making ability, and hopelessness.

Major depressive disorder is characterized by a more severe depression for at least 2 weeks and it presents with at least 5 of the following symptoms: depressed mood most of the day felt by the patient, or observed by others, lack of interest in all activities(anhedonia-inability to experience pleasure), significant weight loss or gain or an increase or decrease in appetite, insomnia or hypersomnia every day, psychomotor agitation or retardation every day, fatigue or loss of energy every day, feelings of worthlessness or inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death with a suicidal attempt or a specific plan for committing suicide.

A single pole in which the patient experiences manic, hypomanic, or depressive symptoms characterizes Bipolar I disorder. If the first episode is not manic, sometimes the diagnosis is not made until a manic episode arises. If the symptoms arise due to the use of substances such as antidepressive medicines than it is not considered bipolar I disorder. Attempted and successful suicides are common in patients with bipolar I disorder. Sexually transmitted diseases are more frequent in this population when they are in the manic stage. There is also poor compliance in taking medicines due to impaired judgment. Bipolar I disorder is associated with eating disorders, anxiety disorders, and attention deficit hyperactivity disorder. The mean age in which it occurs is 21 years old.

Bipolar II disorder is diagnosed when a patient has had at least one episode of major depression and one hypomanic episode without the presence of any manic or mixed episodes. Suicide is common during the depressive episodes. It is seen in association with substance abuse or anxiety disorders as in the case of the bipolar I disorder. The lifetime risk of getting the disease is .5%, which is higher in females than in males. Unlike the bipolar I disorder, which presents with mania or mixed syndromes, the bipolar II disorder has no presence of mania or mixed syndromes.

Kindling is a phenomenon characterized by repeated subthreshold stimulations of the brain that result in seizure activity. It seems that bipolar disorders follow the same scenario. For example, a person may experience a certain stress that sets of their first episode of mania, then mania will appear with a lower grade of stress, and then eventually it will appear all by itself. Anticonvulsants such as valproic acid and carbamazepine are useful in treating patients with seizures, as well as patients with bipolar disorders.

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