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"Lately, I've been hard to reach

I've been too long on my own

Everybody has a private world

Where they can be alone

Are you callin me?

Are you tryin' to get through?

Are you reachin' out for me?

I'm reachin' out for you..."

Eminem in Beautiful (2009)

My name is Ruth (fictitious name), but people identify me better by By.polar, she says. How do they know me? she says. They don't! I don't even know myself, she adds. Why did I choose this name By.polar? I didn't! Actually it was the succession of events in my life, she says. She always wears the same polar. Whether it was winter, or summer. Always the same polar. Why was that? Because yes, because I liked it! she says. And when she passed by, she heard them say: there goes the polar, there goes the polar! It's no mistake! I'm from Ermesinde and that's what I understood them to say, lá bai o polar. And later, when I started school I spent the breaks singing. Why did I do that? Because nobody came near me! Why didn't anyone? Ask them! They never told me. A new auxiliary from the school used to be in the breaks with some earphones. I couldn't, but she used to hide her headphones well. She used to tease me! Why did she do that? Ask her! She never told me. But she'd come up to me. And once she told me I was a very good singer. No one had ever said that. Actually what they told me was that they didn't understand anything. People have never understood rap, but that's not why they stop loving it, he says. And I started rapping. And more and more I started to improve my technique and write my own lyrics. And when the time came to create a name it wasn't a difficult decision and it was By.polar! he concludes. People wouldn't listen to me. They never listened to me, either inside or outside the house. But outside the house they started gathering around me when I was singing. At first it was just one or two. Then a few of those who used to rap a few things came in. And that seems to have made all the difference, because from then on more colleagues started arriving. It's funny to think that some of them didn't even talk to me in the cafeteria, but came to listen to me dribbling the verses," he says. It's nothing new, and I had already heard of similar situations with other people, but what is certain is that music saved me, she concludes.

Bipolar Disorder is a disorder characterised by manic or depressive episodes that may be interspersed with moments of remission. The assessment of the comorbidity of autism spectrum disorder and bipolar disorder is challenging because of both the diagnostic limitations resulting from the specificity of both disorders, as well as the possibility of altering their course in a situation of simultaneous occurrence. Both types of conditions persist from childhood to adulthood. However, their expression varies depending on the age of the persons. In the case of adult people, autism spectrum disorder are often not properly diagnosed for a long time, which results from differences in the severity of people's symptoms, as well as their misinterpretation. In addition, several characteristics of autistic people (e.g., abstract thinking difficulties, more limited emotional expression and reduced verbal and non-verbal competence) significantly limit one's ability to identify affective symptoms.

Besides, several autistic people have difficulties in describing their emotional states. The clinical information on their state of health is often derived from family members or from observing the person in a social environment. Moreover, the typical symptoms in autism may mask or distort the psychopathological manifestations of other disorders and thus make their diagnosis difficult.

It has been shown that autistic people are extremely sensitive to small environmental changes and often react with more sudden mood swings. And these fluctuations in the emotional state of the autistic person can mimic or mask the existence of a bipolar disorder.

Due to the difficulty in modulating and controlling the state of arousal, any change in routine or a new social situation can become a factor which provokes a series of symptoms such as irritation, emotional hyperactivity, psychomotor agitation and insomnia, which are easily misinterpreted as an affective episode.

Most studies describing the coexistence of autism with other disorders are based on demonstrating the presence of symptoms typical for the disorder studied without attempting to refer them to the course of an Autism Spectrum Disorder. An example of this can be the attempt to diagnose Bipolar Disorder based on the finding of the presence of manic and hypomanic episodes, which are difficult to define and confirm in autistic people. Such an approach, therefore, forces us to consider whether traditional assessment provides reliable results, and whether the diagnostic criteria and diagnostic tools derived from them should not be re-evaluated and adapted to the needs of the autistic people group.

An additional problem is the differences in the clinical picture and course of Bipolar Disorder in children and adolescents. It is thought that due to the lack of a uniform definition of this disorder for the age group of children, the number of people identified is probably higher than the number of people correctly diagnosed. Furthermore, during childhood and early adolescence Bipolar Disorder is expressed by clinical symptoms of a Unipolar Affective Disorder, acute psychosis or Oppositional Disorders, and mania symptoms are apparently observed later in development. In the group of adolescents with co-occurring Bipolar Disorder and Autism Spectrum Disorder, ruminative thoughts, distractibility, depressed mood, social avoidance and low reactivity to negative mood states are frequently observed.

In autistic people, mania presents an unusual picture due to the dominance of increased irritation, emotional instability and dysphoria in this period. Hostile, aggressive and violent behaviour, anxiety and consternation are also found, although the typical features of mania such as euphoric mood are less common.

In many cases, making a correct diagnosis is additionally hampered by a particular severity of the presence of psychotic symptoms. In this group of people, bizarre thoughts are often interpreted as delusions, and are also found during manic episodes, but must be differentiated with the specific way of thinking of autistic people, and which also occur in people with the ability to withstand very large temperature differences.

It is also a challenge to determine the occurrence of depressive episodes in autistic people, not least because their symptoms may be more subtle and are usually long-lasting. Due to their image, as well as the social consequences, there is a risk of misinterpretation. As well as interpersonal difficulties or poor emotional expression typical in autistic people. However, autistic people, often as in the case of other people, the typical symptoms for depression, such as anhedonia, depressed mood, suicidal thoughts, difficulty in concentration and decision-making, and somatic symptoms occur with due frequency.

Similarly as in the case of mania, depressive episodes in autistic people may be accompanied by symptoms of irritation, rapid emotional incapacitation, self-injury, aggression against the environment, and excitability, which requires careful assessment of the person for a correct diagnosis. In autistic people, it is particularly difficult to differentiate between an episode of mood swings and responses to deviations from daily routines, negative life events, or changes in the environment. Therefore, it is problematic to confirm the existence of the affective episode by oneself, especially in the early phase of the disorder. It has also been observed that the symptoms in Bipolar Disorder can directly influence the very course of the autism picture, worsening the impairment of social and cognitive functioning, especially in adolescents with disorders of this spectrum.

Songs have always represented me, he says. Like my ups and downs, my lyrics also describe these experiences. And people have got to know me that way, he continues. There have always been, and still are, moments when I can't write a lyric or create a song. Fortunately there are fewer of them, he says. The medication has helped a lot. Music has done the rest, he concludes.

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