Clinical presentation

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It can be particularly challenging to treat people with bipolar disorder due to the broad range of emotions experienced, which can impact on the relationship between the client and the therapist [540]. Depending on which phase of the disorder a client is in, they may present with either symptoms of depression or mania/hypomania. If the person is in between episodes, they appear to be completely well. People with bipolar disorder predominantly present to services during the depressive phases of the disorder rather than during the periods of elation.

If experiencing a depressive episode, the client may present with low mood; markedly diminished interest or pleasure in all, or most activities; sleep disturbances; appetite disturbances; irritability; fatigue; psychomotor agitation or retardation; poor concentration; feelings of guilt, hopelessness, helplessness and worthlessness; and suicidal thoughts. When experiencing mania/hypomania however, a client’s mood is persistently elevated, and symptoms of grandiosity, flights of ideas, hyperactivity, decreased sleep, psychomotor agitation, talkativeness and distractibility may be present. Mania and hypomania may lead to a loss of insight, which can place the person at risk, and impact negatively on medication compliance.