istics begin to manifest. The third stage of maniais evident when the patient experiences delusions with often paranoidthemes. Speech is generally rapid and hyperactive behavior manifestssometimes associated with violence (Hirschfeld, 1995). When both manic and depressive symptoms occur at the same time itis called a mixed episode. Those afflicted are a special risk becausethere is a combination of hopelessness, agitation, and anxiety thatmakes them feel like they "could jump out of their skin"(Hirschfeld,1995). Up to 50% of all patients with mania have a mixture of depressedmoods. Patients report feeling dysphoric, depressed, and unhappy; yet,they exhibit the energy associated with mania. Rapid cycling mania isanother presentation of bipolar disorder. Mania may be present withfour or more distinct episodes within a 12 month period. There is nowevidence to suggest that sometimes rapid cycling may be a transientmanifestation of the bipolar disorder. This form of the diseaseexhibits more episodes of mania and depression than bipolar. Lithium has been the primary treatment of bipolar disorder sinceits introduction in the 1960's. It is main function is to stabilize thecycling characteristic of bipolar disorder. In four controlled studiesby F. K. Goodwin and K. R. Jamison, the overall response rate forbipolar subjects treated with Lithium was 78% (1990). Lithium is alsothe primary drug used for long- term maintenance of bipolar disorder. In a majority of bipolar patients, it lessens the duration, frequency,and severity of the episodes of both mania and depression. Unfortunately, as many as 40% of bipolar patients are eitherunresponsive to lithium or can not tolerate the side effects. Some ofthe side effects include thirst, weight gain, nausea, diarrhea, andedema. Patients who are unresponsive to lithium treatment are oftenthose who experience dysphoric mania, mixed states, or rapid cyclingbipolar disorde...
