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VERIFIED CONTENTAuthor: lek. Tomasz Nęcki

Bipolar disorder is characterized by the occurrence of episodes of both low and high mood in patients. The problem should be considered serious because people with it experience difficulties in virtually every aspect of life. What conditions might indicate bipolar disorder and what are the treatment options for this individual?

Bipolar disorder (bipolar disorder in short, also known as bipolar disorder , English bipolar disorder) belongs to the group of affective disorders (mood disorders). In the past, the individual was also referred to by other terms, such as cyclophrenia or manic-depression psychosis.

CurrentlyBDis one of the most common mental disorders. It is estimated that this disease affects 1-3% of people in the world. Men and women suffer from it with similar frequency. The disease typically occurs in early adulthood, usually before the age of 35.

Bipolar Affective Disorder - Causes

Unlike other mental disorders, the etiopathogenesis ofof bipolar disorderis relatively well understood. In the case of this individual, a lot of attention is paid to genetic determinants.

Genetic factors

The risk of developing this disease is much greater in people with family members who struggled with bipolar disorder.

Research conducted among twins also brings interesting information. It turns out that among identical twins, the incidence of bipolar disorder in both children may occur even in 40% of cases (where, for comparison, in fraternal twins this situation is sometimes found in 5% of them).

Work on the search for genes related to the occurrence of bipolar disorder is ongoing. However, some irregularities that may be related to this unit are already mentioned.

The attention is paid, inter alia, to that in bipolar patients there may be a decreased expression of enzymes responsible for DNA repair processes.

Environmental factors

As in the case of other psychiatric entities, also in the case of bipolar disorder, the impact on the onset of the disease as well as itsmileage may have various environmental factors.

The first episode of an affective disorder may result from the susceptibility of some people to this type of disorder , e.g. due to:

  • genetic load,
  • difficult life events, such as the death of a loved one, loss of job or experiencing violence.

The same may happen in those patients who have already been diagnosed with bipolar disorder. The period of remission may be interrupted by their experience of some difficult experiences.

Bipolar Affective Disorder - Symptoms

Symptoms from three different groups are associated with bipolar disorder - depressive, manic and hypomanic symptoms.They can appear both separately and simultaneously - then an episode is diagnosed mixed.

Depressive episodes

Patients with bipolar disorder may experience full-blown depressive episodes. In their case, the following symptoms may occur:

  • depressed mood,
  • anhedonia (loss of happiness),
  • no motivation to act,
  • energy drop,
  • feeling tired,
  • sleep disturbance (usually in the form of excessive sleepiness),
  • appetite disorders
  • or concentration disorders.

Thinking slowdown, memory disorders, and in some people even a significant degree of psychomotor inhibition are also encountered.

In the course of particularly severe depressive episodes, it is possible for patients to develop psychotic symptoms. They usually take the form of depressive delusions, which may be delusions of guilt or delusions of the impending catastrophe.

Sometimes patients may also experience hallucinations (e.g. auditory hallucinations, where voices will accuse the patient of various false things).

Suicidal thoughts and even suicide intentions are a serious threat. Patients can see the world in uniquely black colors. They may feel that nothing good will happen to them in their life and for this reason they may end up trying to take their own lives.

Manic episodes

Manic episodes are the complete opposite of depressive episodes. During them, the patient:

  • has an elevated mood and accelerated thinking,
  • he is bursting with energy,
  • he is talkative.

During a manic episode, patients may also be irritable, but also labile - there are not uncommon situations where, suddenly, from a state of euphoria, they suddenly become angry or even aggressive.

Patientshave a reduced need for sleep, are energized and ready for action. Quite often they get the impression that they are capable of anything and that nothing will prevent them from implementing their boldest plans.

These symptoms, however, can be troublesome for the patient's surroundings. The patient may become superior. He can also expect others to act as he wishes.

There is also a high degree of impulsiveness associated with manic episodes. Accidental sexual contacts are not uncommon, as are the immediate making of very important life decisions, such as taking out a large loan for an investment that the patient first thought of a few moments earlier.

As in the course of a depressive episode, psychotic symptoms may also occur in the case of manic episodes. They are, for example, delusions of magnitude, which consist in the fact that the patient is absolutely convinced of his great value.

Hypomanic episodes

The hypomanic episode is actually a milder version of the mania. Symptoms similar to those occurring in the course of a manic episode appear.

They are, however, much less intense. Additionally - in contrast to mania - patients tend to be partially critical of their ailments.

Mixed episodes

In the course of bipolar disorder, not only bright depressive and manic episodes are possible, but also mixed episodes, in which one patient has symptoms of mania and depression at the same time.

The patient may struggle with psychomotor slowing down at the same time, and also feel the racing of thoughts.

You may experience increased activity at the same time with depressed mood and thoughts of suicide. Quite often - instead of a clearly elevated or depressed mood - in the course of mixed episodes, clearly irritable is observed in patients.

Bipolar Affective Disorder - Types

There are two main types of bipolar disorder. In the case ofof bipolar disorder type 1 , the patient experiences manic and depressive episodes.In type 2this disease leads to depression and hypomania.

In the course of bipolar disorder, there may be periods when the patient struggles with various ailments, as well as periods that are even completely asymptomatic (referred to as remission).

It is impossible to predict what the order of the individual episodes will be, nor how long they will bedurable.

However, due to how often the patient develops bipolar symptoms, there is a form of the disease with a rapid and very rapid phase change.

Rapid phase change bipolar disorderis characterized by recurrence of symptoms more than 4 times a year. Then, when the patient's mood changes dramatically over the course of a few days or even many times a day, the diagnosis isbipolar disorderwith a very rapid phase change.

It is worth mentioning a kind of novelty here, which is the so-calledbipolar disorder spectrum . This problem is discussed in the case of those patients who have some symptoms of bipolar disorder, but they are not so severe that it is possible to clearly diagnose the typical form of the disease in them.

Bipolar Affective Disorder - Recognizing

The diagnosis of bipolar disorder is definitely not easy. It often happens that the patient receives the correct diagnosis many years after the first symptoms of the disease appear.

The situation is rather simple when a person has a manic episode. The situation is different, however, when depressive episodes predominate in the initial stage of the disease.

In this case, for many years, the patient may be treated with a diagnosis of recurrent depressive disorders or dysthymia. This is not a mistake - to be able to diagnose bipolar disorder, the patient must be diagnosed with a manic or hypomanic episode.

When the patient comes to a psychiatrist's office, it is necessary to undergo differential diagnosis. If bipolar disorder is suspected, the following should be excluded:

  • schizoaffective disorder,
  • schizophrenia,
  • ADHD
  • and personality disorders.

There are also certain problems, other than mental he alth problems, that may lead to the patient developing manic symptoms.

Examples include :

  • brain tumors,
  • hyperthyroidism
  • or poisoning with various psychoactive substances.

The use of certain medications, such as glucocorticoids, may lead to the appearance of mania symptoms.

Bipolar Affective Disorder - Comorbidity

Accurate diagnosis in suspected bipolar disorder is necessary not only because of the need to differentiate it from other individuals. Other conditions may also coexist with affective disorder, such as:

  • disordersanxiety,
  • eating disorder
  • Is substance abuse.

Bipolar Affective Disorder - Treatment

Pharmacotherapy is used in the treatment of bipolar disorder. Currently, two groups of drugs are used:

  • mood stabilizers (mood stabilizers)
  • and modern antipsychotic drugs, which also have a mood-stabilizing effect.

Normotymic drugs

The mood-stabilizing drugs that are used in patients with bipolar disorder include:

  • lithium s alts,
  • valproic acid,
  • carbamazepine
  • or lamotrigine.

Antipsychotics

Examples of antipsychotic drugs that are recommended to patients withbipolar disorderinclude :

  • olanzapine,
  • quetiapine
  • and aripiprazole.

Side effects

Treatment is usually long-term, so it is essential to pay attention to possible side effects of pharmacotherapy.

They vary depending on what medications the patient is taking. For example, in the case of lithium s alts, thyroid and kidney disorders may occur.

In turn, chronic use of olanzapine may carry the risk of metabolic syndrome.

Antidepressants

Depressive episodes may occur in the course of bipolar disorder.

Depressive medications are used in the treatment of affective disorder, but to a limited extent. All because taking this type of drugs by patients with bipolar disorder alone may be counterproductive and induce mania.

Antidepressants are sometimes prescribed to people suffering from bipolar disorder, however, as part of treatment combined with mood stabilizers or antipsychotic drugs.

Psychotherapy

Pharmacotherapy itself is not everything. Psychotherapy is also recommended for patients withbipolar disorder(especially in periods of remission).

Psychoeducation, which should cover both the patient and his relatives, is also extremely important. This term is used to provide information about the disease itself, its course, and treatment methods.

It is also very important that the patient and his relatives are informed about the symptoms that may suggest that the patient's mental state is deteriorating and that gradually - after a period of remission - it reappears indepression or mania.

Bipolar Affective Disorder - Hospital Treatment

Patients who are not life-threatening can be treated on an outpatient basis. However, when they show suicidal tendencies or are extremely mania, hospital treatment may become necessary.

Psychiatric hospitalization is also indicated in those patients in whom pharmacological treatment has not allowed to achieve sufficient results. In such situations, electroconvulsive therapy may be indicated.

Bipolar disorder - reluctance of patients to be treated

In the case of mental disorders, many patients are unwilling to start treatment. Patients withbipolar disorder , particularly those who experience mania, are also quite often reluctant to take medications recommended by a psychiatrist.

This may be because when the patient stops experiencing manic episodes, everyday life may be simply unattractive for him. In this case, he may feel that he has developed a depressive episode.

On the other hand, given what the consequences of a manic episode may be (e.g., taking out a substantially unpayable loan), treatment for bipolar disorder is of course necessary.

Psychoeducation becomes the key here. The patient should be informed whether the treatment is to protect him, what the normal condition looks like and what suggests a depressive or manic episode.

Bipolar disorder - prognosis

Bipolar disordermay be completely different in different patients. One person experiences only a few symptomatic episodes throughout their life, while others struggle with very rapid phase changes.

Overall, statistics show that one patient experiences an average of four episodes of depression, mania, or both in the first ten years after getting sick.

Bipolar disorder cannot be cured, but it is possible - thanks to effective pharmacotherapy - to maintain a long-term remission period. It is for this reason that some patients continue to take medication for the rest of their lives.

In people with bipolar disorder, the prophylaxis of manic and depressive episodes is of key importance. According to American data,up to 17% of patients suffering from bipolar disorder commit suicide . This usually happens because bipolar disorder has not been treated.

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Psychiatry