she/her • 25 • bisexual • bpd • bipolar disorder type II • infp
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hi im really sorry if this is a disrespectful question but i cant find an answer online and ive been interested in bd and i wanted to ask somebody with experience are you required to have dilated pupils in manic episodes? what causes it? thank you, have a great day :-)
i'm so sorry, i saw the question only a few days ago! dilated pupils are not included in the DSM diagnostic criteria for mood disorders.
however, in the last few days, i've done some research about this topic and i've found super interesting evidences (thank you for the question!! super inspiring)
in 1840, the researcher Aleksander Morrison reported that his patients with bipolar disorder had sparkling eyes and dilated pupils.
now in literature, i found that mania/hypomania are linked to acetylcholine and norepinephrine (two neurotransmitters). in this case, acetylcholine is linked to pupil constriction, meanwhile norepinephrine is linked to the activation of the sympathetic nervous system, which causes pupil dilation.
there are two main hypotheses, in literature, regarding bipolar disorder: mania/hypomania are associated with a hypocholinergic state, which impairs pupil constriction, and with a hyperactivation of the norepinephrine system, which stimulates the sympathetic nervous system, leading to pupil dilation.
some researchers suggest that it could be a useful sign for clinicians to determine if a patient is in a manic or hypomanic phase.
i hope this answer was helpful!
some articles i found 4 this research:
Parker et al. (2023) – Bipolar eyes: Windows to the pole?
Sokolski & DeMet (1999) – Pupillary Cholinergic Sensitivity to Pilocarpine Increases in Manic Lithium Responders
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