What is it?
Bipolar disorder (manic-depressive psychosis) is a type of mental disorder in which the patient may have manic, depressive, and / or mixed symptoms that quickly change each other.
There is no Single sequence scheme for affective States. they can not only replace each other, but also combine to create a variety of complex symptoms. Manic-depressive psychosis is an old name for bipolar mental disorder, which was abandoned in 1993 due to the lack of clear presence of both conditions in all patients and possible variants of monopolar changes, as well as the greater political correctness of the new name, which does not put stamps in the eyes of society and the patient.
This disorder is still not fully understood and due to the large clinical diversity observed in it, there is still no single definition. Bipolar disorder in the classical sense has two phases (episodes) — mania and depression-succeeding each other through a state of interphase, in which the patient returns to his usual, "normal" state of mind.
Causes and risk factors
Most experts agree that there is no single global reason why a patient develops bipolar disorder. Rather, it is the result of several factors that influence the appearance of this mental illness. Psychiatrists have identified a number of reasons why developing bipolar disorder:
- genetic factors;
- biological factors;
- chemical imbalance in the brain;
- hormonal imbalance;
- external factors.
As for the genetic factors that influence the development of bipolar disorder, scientists have made certain conclusions. They conducted several small studies using the method of studying personality psychology on twins. According to doctors, heredity plays an important role in the development of manic-depressive psychosis. People who have a blood relative who suffers from bipolar disorder are more likely to discover this disease in the future.
If we talk about the biological factors that can lead to bipolar disorder, experts say that often when examining patients who are diagnosed with bipolar disorder, there are violations in the work of the brain. But for now, doctors can't explain why these changes lead to the development of serious mental illness.
Chemical imbalance in the brain, especially in terms of neurotransmitters, plays a key role in the occurrence of various mental diseases, including bipolar disorder. Neurotransmitters are biologically active substances in the brain. Among them are distinguished, in particular, the most famous neurotransmitters:
Hormonal imbalance can also trigger the development of bipolar disorder with a high probability.
External or environmental factors sometimes lead to the formation of bipolar disorder. Among the environmental factors psychiatrists distinguish the following circumstances:
- excessive alcohol consumption;
- nervous tension;
- traumatic situations.
Symptoms and first signs
The main signs of bipolar personality disorder depend on the phase of the disease. Thus, the manic stage is characterized by:
- accelerated thinking;
- mood boost;
- motor excitation.
There are three degrees of mania severity:
- Light (hypomania). There is an upbeat mood, an increase in physical and mental performance, and social activity. The patient becomes somewhat absent-minded, talkative, active and energetic. The need for rest and sleep decreases, and the need for sex, on the contrary, increases. In some patients, there is no euphoria, but dysphoria, which is characterized by the appearance of irritability, hostility to others. The duration of the hypomania episode is several days.
- Moderate (mania without psychotic symptoms). There is a significant increase in physical and mental activity, a significant rise in mood. Almost completely disappears the need for sleep. The patient is constantly distracted, unable to concentrate, as a result, his social contacts and interactions are hindered, and his ability to work is lost. There are ideas of grandeur. The duration of an episode of moderate mania is at least a week.
- Severe (mania with psychotic symptoms). There is a pronounced psychomotor agitation, a tendency to violence. There are jumps of thoughts, the logical connection between facts is lost. Hallucinations and delusions develop, similar to the hallucinatory syndrome in schizophrenia. Patients become confident that their ancestors belonged to a noble and famous family (delusions of high origin) or consider themselves a famous person (delusions of greatness). Not only is the ability to work lost, but also the ability to self-serve. A severe form of mania lasts for more than a few weeks.
Depression in bipolar disorder occurs with symptoms that are the opposite of those of mania. These include:
- slow thinking;
- low mood;
- motor inhibition;
- reduction of appetite, up to its complete absence;
- progressive weight loss;
- decreased libido;
- women stop menstruating, and men may develop erectile dysfunction.
In patients with mild depression and bipolar disorder, the mood fluctuates during the day. In the evening, it usually improves, and in the morning, the symptoms of depression reach their maximum.
In bipolar disorders, the following forms of depression may develop:
- simple-the clinical picture is represented by a depressive triad (mood depression, inhibition of intellectual processes, impoverishment and weakening of the motives for action);
- hypochondriac – the patient is sure of the existence of a serious, deadly and incurable disease, or a disease unknown to modern medicine;
- the delusional-depressive triad is combined with the delusional accusation. Patients agree with it and share it;
- agitated-in this form of depression, there is no motor inhibition;
- anaesthetic-the prevailing symptom in the clinical picture is a feeling of painful insensibility. The patient believes that all his feelings have disappeared, and in their place a void has formed, which causes him severe suffering.
Like other mental disorders, BAR is difficult to diagnose using instrumental or laboratory tests. The disease is confirmed by a psychiatrist on the basis of:
- personal conversation with the patient; the
- medical history;
- complaints from relatives.
It Often takes several months or decades for a doctor to determine bipolar affective disorder. The following criteria are taken into account when making a diagnosis:
- episodes of depression and manic behavior that last at least 1 week;
- affective symptoms are not due to medication, concomitant diseases, or schizophrenia;
- signs of BAR affect the patient's quality of life and impair their social and professional skills.
- episodes of decline and recovery of mood are periodically repeated.
To exclude head injuries and epilepsy, an electroencephalogram is performed. To check and exclude HIV, metabolic disorders, and hormonal imbalances, a blood test is prescribed.
Differential diagnosis of bipolar disorder is very difficult, because affective episodes can be observed in people who do not suffer from this disorder, simply against the background of oligophrenia, lack of sleep, infectious or toxic effects of various substances, various other somatic disorders, or as a reaction to difficult life situations.
In addition, BAR symptoms can often mimic most other psychiatric pathologies (schizophrenia, affective disorders, unipolar recurrent depression, etc.), and incorrect diagnosis of bipolar affective disorder with a different diagnosis leads to the appointment of the wrong drugs. As a result, inverted States are formed, various symptoms of brain disorders, etc., which further complicates and delays the correct diagnosis, and sometimes leads to disability.
It is Important to remember that although hallucinatory manifestations are possible in bipolar disorder, they are more common in various types of schizophrenia, and even in other mental disorders. It is important to check the therapist and other cross-specialists to exclude thyroid pathology and other diseases that may masquerade as symptoms of bipolar affective disorder. Sometimes a trial treatment of a non-psychiatric disorder may be the right solution, and if symptoms are reduced, the patient is redirected to another target specialist.
Treatment of bipolar disorder
The most important thing in the treatment of bipolar disorder is to choose the right scheme and clearly adhere to it. Thus, the change of mood and accompanying symptoms of the disease are stabilized.
Treatment of bipolar disorder must be carried out in a complex: medical and psychological, which is the best option for controlling the course of the disease. Treatment should proceed without interruption of the course prescribed by the doctor. If a change of mood occurs again during treatment, you should contact your doctor to change the prescribed medications and treatment plan. The more detailed and Frank the discussion with the psychiatrist of the problems that arise, the more effective the healing process will be.
If the disease is not started, you can contact a therapist. But it is best to be under the supervision of a psychiatrist, preferably a certified specialist with extensive practice in this area. First of all, a psychiatrist prescribes such a drug as Lithium. This drug stabilizes the mood. Lithium is an effective treatment for bipolar affective disorder and prevents the development of symptoms of manic and depressive disorders.
Along with the main drugs, additional ones are prescribed, such as Valproate, Carbamazepine, which are anticonvulsants. Another drug prescribed for the treatment of bipolar disorder is Aripiprazole (Buy Abilify). It is available in tablets, in liquid form or in the form of injections. When problems with insomnia are prescribed drugs such as Clonazepam, Lorazepam, but they are prescribed at the first stage of the disease, so as not to cause addiction.
Psychotherapy is recommended in conjunction with medical treatment. It is very important that the family and friends of a patient with bipolar disorder understand the severity of the disease and help him quickly adapt to normal life.
It is Impossible to carry out targeted prevention of the disease, since the disease largely depends on uncontrolled factors (hereditary, psychotraumatic). However, you can monitor the course of the disease by knowing the bipolar warning signs.
Bipolar affective disorder (manic-depressive psychosis) with timely treatment has a favorable prognosis. Bar therapy includes three main directions:
- Relief of acute conditions — medical treatment on an outpatient or inpatient basis, if there are indications for hospitalization.
- Supporting therapy of the patient for the purpose of rehabilitation and prevention of relapses-includes psychotherapy, drug therapy, additional General therapeutic procedures according to indications (physiotherapy, massage, physical therapy).
- Work with the patient's relatives and friends to rehabilitate them and raise awareness about the features of the disease.
The Effectiveness of treatment is determined by the accuracy of diagnosis of the disease, which is often difficult due to long intermissions (periods of "calm" between attacks). As a result, the disease phases are mistaken for individual disorders or for the onset of another mental illness (for example, schizophrenia). A reliable differential diagnosis can only be performed by a specialist psychiatrist.
In the absence of treatment, the duration of "light" intervals decreases, and affective phases, on the contrary, increases, while the affect can become monopolar. Affective disorder in this case takes on the character of prolonged depression or mania.
List of used literature:
- Demily, C., P. Jacquet, and M. Marie-Cardine. «[How to differentiate schizophrenia from bipolar disorder using cognitive assessment?]» L’Encephale 35.2 (2009): 139-145.
- Ketter, Terence A., et al. «Psychotic bipolar disorders: dimensionally similar to or categorically different from schizophrenia?» Journal of Psychiatric Research 38.1 (2004): 47-61.
- Tondo, L., et al. «Comparison of psychotic bipolar disorder, schizoaffective disorder, and schizophrenia: an international, multisite study» Acta Psychiatrica Scandinavica 133.1 (2016): 34-43.