Bipolar affective disorder

In the past, it was believed that bipolar affective disorder is a manic depressive disorder or manic depression. To date, this disease is referred to as a serious mental illness that provokes the patient to life-threatening behavior, the destruction of personal relationships and career, and provokes suicidal thoughts - especially if the disease is not being treated.

What is bipolar affective disorder?

Bipolar affective disorder is characterized by a sharp change in mood - for example, an overly upbeat mood, a mania, drastically replaced by a deeply depressed, depressed. Moreover, between these bouts of mood swings, a person is quite normal and feels the corresponding mood situation.

The order of appearance of the depressive and manic phases does not have a clear pattern. If the cyclic nature of the disease is not recognized, then the diagnosis turns out to be wrong, and the treatment is seriously hampered. The correct choice of treatment depends also on whether cyclical mood changes occur quickly or slowly, whether there are episodes of mixed iodisporic mania.

"Mania" can be described as a condition in which the patient is extremely excited, full of energy, overly talkative, carefree, feels almighty, and be in a state of euphoria. In this state, the patient is prone to excessive spending money or casual sexual relations. And at one point this elated mood disappears, irritability, confusion, anger and a sense of despair appear.

And this other mood is called a state of depression, when the patient becomes sad, crying, feels worthless, experiencing a breakdown, loses interest in entertainment and has problems with sleep.

But, since the mood change in each case proceeds strictly individually, bipolar affective disorder is very difficult to diagnose as a disease. In some cases, the condition of mania or depression can last for weeks, months or even years. In other cases, bipolar disorder takes the form of frequent and sudden changes in mood phase.

"A whole range of symptoms and mood phases have been identified that determine the presence of bipolar affective disorder," says Michael Aronson, allopath doctor. "Disease is determined not only by a sudden change in mood, in fact, some patients feel great, the condition of mania can be quite productive." In this state, people are confident that things are going well for them. "

The trouble comes when this state grows into something more than just a good mood. "Such a change can have catastrophic consequences." People behave recklessly, spend a lot of money, lead a promiscuous sexual life, which can lead to serious illnesses. "

As for the depressive phase, it is also dangerous for the patient's life: It can cause frequent thoughts of suicide.

It is very difficult for the relatives of the patient to come to terms with this disease. This is the most complex mental illness that a patient's relatives can not understand, says Aronson. "Native people are much quicker to reconcile themselves with the diagnosis of schizophrenia, because they are more aware of this disease." In the case of bipolar disorder, they can not understand how a person, being productive, can become reckless and feeble-minded at one and the same time. It seems that this is just bad behavior and not a desire to pull yourself together. "

If it seemed to you that something like this is happening in your family or with your loved one, the first thing you should do is turn to a psychiatrist. No matter what diagnosis the doctor puts, bipolar disorder or other mood disorder, a number of effective treatments will be at your disposal. But the most important point in the treatment is your mindfulness and desire to be cured.

Bipolar disorders usually begin at a young age, in 20-30-year-olds. The incidence during life is about 1%. Prevalence among men and women is approximately the same.

Bipolar disorder, depending on the severity of the symptoms and the characteristics of the episodes, is classified into type I bipolar disorder, type II bipolar disorder, bipolar disorder, nowhere else classified. Forms associated with another disease or drug use are classified as bipolar disorder due to a general physical condition or drug-induced bipolar disorder.

The cause of bipolar affective disorder

To date, doctors have not fully understood the causes of bipolar affective disorder. But over the past 10 years, they have much better studied the wide range of mood swings, including a change in the excessively elevated mood of deep depression, as well as all the conditions that occur with the patient in between.

Experts believe that bipolar affective disorder is hereditary and a major role in its development is played by genetic predisposition. There is also undeniable evidence that the patient's environment and lifestyle affect the degree of difficulty in his illness. Stressful situations in life, alcohol or drug abuse, make bipolar affective disorder more resistant to treatment.

There is evidence of impaired regulation of serotonin and norepinephrine. Stressful life events are often the cause of the disease, although there is no clear relationship.

Bipolar disorder or symptoms of bipolar disorder can occur in a number of somatic diseases, as a side effect of many drugs or as part of other mental disorders.

Symptoms of bipolar affective disorder

Symptoms of bipolar affective disorder can be divided into two types:

• Bipolar depression, which manifests feelings such as sadness, hopelessness, helplessness and uselessness.
• Bipolar mania, in which a person experiences a state of euphoria and increased enthusiasm.

What are the symptoms of bipolar depression?

Symptoms of the depressive phase of bipolar affective disorder include:

• Depressive mood and low self-esteem
• Frequent attacks of sobbing
• The decline of energy and an indifferent view of life
• Sadness, loneliness, helplessness and guilt
• Slow manner of speaking, fatigue, low coordination of movements and inability to concentrate
• Insomnia or increased drowsiness
• Thoughts of suicide or death
• Change in appetite (overeating or lack of appetite altogether)
• Drug use: self-medication with drugs
• Constant pain, the origin of which can not be explained
• Loss of interest and indifference to once-loved pursuits

What are the symptoms of bipolar mania?

• A state of euphoria or irritability
• Excessive talkativeness, wandering thoughts
• Heightened self-esteem
• Unusual energy; reduced need for sleep
• The use of alcohol or illicit drugs - cocaine or methamphetamines
• Impulsiveness, restless desire for pleasure - the commission of meaningless purchases, impulsive travel, frequent and illegible sexual relations, investing money in risky projects, fast driving
• Hallucinations or illusions (in acute forms of the disease with psychotic biases)

Bipolar affective disorder - Symptoms

Diagnosis of bipolar affective disorder

Some patients in hypomania or mania do not talk about their condition unless they are specifically questioned. A detailed survey can reveal painful symptoms (for example, excessive spending, impulsive sexual acts, abuse of stimulant drugs). Such information is often provided by relatives. The diagnosis is based on the symptoms and signs described above. All patients need to gently, but directly ask about suicidal thoughts, plans or actions.

To exclude disorders caused by the use of drugs or somatic diseases, it is necessary to evaluate the use of pharmacological drugs (especially amphetamines, in particular methamphetamine), prescribed medications and a physical condition. Although there are no laboratory studies patagnognomichnyh for bipolar disorder, you need to make routine blood tests to eliminate somatic diseases; thyrotropic hormone (TSH) to exclude hyperthyroidism. Other somatic diseases (eg, pheochromocytoma) sometimes make diagnosis difficult. Anxiety disorders (such as social phobia, panic attacks, obsessive-compulsive disorder) should also be taken into account in differential diagnosis.

Before learning how to make an accurate diagnosis and recognize different moods with bipolar affective disorder, doctors took many years. More recently, physicians have combined bipolar affective disorder with schizophrenia, a mental illness in which incoherent speech, illusions, or hallucinations are observed. Now that doctors have learned much more about mental illness, they can easily distinguish between symptoms of bipolar depression, hypomania, or mania and prescribe a highly effective cure for bipolar affective disorder.

Many of us have got used, that for statement of the exact diagnosis it is necessary to pass numerical inspections and to hand over many analyzes, sometimes expensive. However, when diagnosing bipolar affective disorder, laboratory tests become unnecessary, because their results can not help the doctor. The only method of diagnosis, giving an excellent picture of the disease, is a frank conversation with the doctor about the mood, behavior and life habits of the patient.

While different tests will give the doctor a picture of your body's health, a frank conversation and a description of the symptoms of bipolar disorder will enable him to diagnose and prescribe an effective course of treatment.

• What does the doctor need to know in order to diagnose bipolar affective disorder?

Diagnosis of bipolar affective disorder is possible only if the doctor carefully listens to all the patient's symptoms, including their severity, duration and frequency. The most common symptom of bipolar affective disorder is sudden mood swings that can not be entered into any frame. The patient can be diagnosed by following the advice given in the Manual on Diagnosis and Mental Disorders, Vol. 4, which was published by the American Psychiatric Association.

When diagnosing the first question the doctor should ask, was it in the family of the patient a case of mental illness or bipolar affective disorder. Because bipolar affective disorder is a genetic disease, it is very important to tell the doctor truthfully about all the mental illnesses that have occurred in your family.

Also the doctor in detail will ask to describe your symptoms. He can also ask questions that will help him determine your ability to concentrate and think soberly, remember, the ability to clearly express your thoughts and the ability to maintain a relationship with your loved one.

• Can other mental illnesses have the same symptoms as bipolar disorder?

Some serious diseases, such as lupus, AIDS and syphilis, can have signs and symptoms that at first glance resemble bipolar disorder. This results in the formulation of the wrong and diagnosis and the appointment of an incorrect course of treatment.

In addition, scientists argue that with bipolar affective disorder symptoms of such diseases as anxiety syndrome, obsessive-compulsive disorder syndrome, panic disorder, social anxiety syndrome and post-traumatic anxiety syndrome are amplified. If these diseases are left without proper treatment, then soon they will provoke unnecessary suffering and deterioration.

Another problem that can coexist with bipolar disorder is the use of steroids, which help treat rheumatoid arthritis, asthma and allergies, ulcerative colitis, eczema and psoriasis. These drugs can cause attacks of mania or depression, which can be mistaken for bipolar disorder symptoms.

• What needs to be done before visiting a doctor regarding bipolar affective disorder.

Before visiting the doctor, write down all the symptoms of depression, mania or hypomania. Very often, a friend or close relative knows a lot more about the patient's unusual behavior and, thus, will be able to describe them in more detail. Before the visit, consider the following questions and write down the answers:

1. You are troubled by your mental and physical health
2. Symptoms that you notice
3. Unusual behavior
4. Past Illnesses
5. A history of your family's mental illness (bipolar affective disorder, mania, depression, seasonal affective disorder, or others)
6. Medications that you are taking now or in the past
7. Natural food supplements (if you take them then bring them to the doctor's office)
8. Lifestyle (sports, nutrition, smoking, alcohol or drug abuse)
9. Sleep
10. The causes of stress in life (marriage, work, relationships)
11. Any Questions About Bipolar Affective Disorder

• What tests will the doctor make when diagnosing bipolar affective disorder?

The doctor may ask you to fill out a questionnaire that will help you recognize symptoms and behaviors in bipolar depression, mania, or hypomania. In addition, the doctor can prescribe a blood and urine test to rule out the presence of other diseases. Also, a doctor can assign an analysis to determine the presence of narcotic drugs in the body. A blood test will help to eliminate the presence of thyroid dysfunction, since the condition of depression in a patient is often associated with this disease.

• Can brain echography or fluoroscopy detect the presence of bipolar affective disorder?

Despite the fact that doctors do not trust such tests in diagnosing bipolar affective disorder, some high-tech scanning drugs can help doctors in setting specific psychiatric diagnoses and also see how the patient's organism perceives the prescribed medicine. Many of these technological preparations are widely used in the study of the action of drugs and their susceptibility to the body, including lithium and anticonvulsants, and also help to better understand the neurotransmission processes that accompany repeated attacks of the disease.

According to the National Institute of Mental Health, recent studies prove that on the results of electroencephalograms and magnetic resonance imaging studies of the brain, one can see the difference between bipolar disorder and simple behavior changes that cause similar symptoms with bipolar disorder in children.

• If it seems to me that a loved one has bipolar affective disorder, how can I help him?

If you suspect that your beloved person develops bipolar disorder, talk with this person about your experiences. Ask if you can negotiate with the doctor about admission and accompany him / her at this appointment. We will show you how to do it better:

• Be sure to tell your doctor that you are treating this problem for the first time and that it may take longer to complete the survey.
• Try to write down all your experiences on paper, it will help you to tell the doctor everything, without forgetting anything.
• Try to clearly describe the essence of the problem, what exactly bothers you - bipolar depression, mania or hypomania.
• Describe clearly and in detail the physician's mood swings and his behavior.
• Describe any acute mood swings, especially anger, depression or aggressiveness.
• Describe changes in personality characteristics, especially if there is a state of excitement, paranoia, illusions or hallucinations.

[1], [2], [3], [4], [5], [6]

Prognosis and treatment of bipolar affective disorder

Most patients with hypomania can be treated on an outpatient basis. Acute mania usually requires in-patient treatment. Usually mood stabilizers are used to induce remission in patients with acute mania or hypomania. Lithium and certain anticonvulsants, especially valproate, carbamazepine, oxcarbazepine and lamotrigine, act as mood stabilizers (normotimics) and are approximately the same in effectiveness. The choice of the mood stabilizer depends on the medical history of the patient and the side effects of the particular drug.

Two-thirds of patients with uncomplicated bipolar disorder respond to lithium. A number of mechanisms of therapeutic action are proposed, but they are not proven. Predictors of a good therapeutic response to lithium are euphoric mania as part of a primary mood disorder, having less than 2 episodes a year, a personal or family anamnesis of a positive response to lithium therapy. Lithium is less effective in patients with mixed states, forms of bipolar disorder with rapid cycling, concomitant anxiety disorders, substance abuse or neurological diseases.

Lithium carbonate is prescribed from an initial dose of 300 mg orally 2 or 3 times a day and rises 7-10 days before reaching a blood concentration of 0.8-1.2 meq / L. The lithium level should be in the range of 0.8-1.0 meq / l, which is usually achieved by prescribing 450-900 mg of the prolonged form orally 2 times a day. Adolescents who have a good glomerular function need higher doses of lithium; Older patients need smaller doses. During the manic episode, the patient restrains lithium and excretes sodium; oral doses and blood lithium levels should be higher during acute treatment than during maintenance prophylactic therapy.

Since the onset of the action of lithium has a latent period of 4-10 days, at first it may be necessary to prescribe antipsychotics; they are appointed as necessary to achieve control of the manic state. Acute manic psychoses are increasingly treated with second-generation antipsychotics, such as risperidone (usually 4-6 mg orally once a day), olanzapine (usually 10-20 mg once a day), quetiapine (200-400 mg orally twice a day) , ziprasidone (40-80 mg 2 times a day) and aripiprazole (10-30 mg once a day), since they have a minimal risk of extrapyramidal side effects. For overly active psychotic patients with inadequate intake of food and water, antipsychotics are prescribed intramuscularly and supportive care for 1 week prior to initiation of lithium treatment. Non-cooperative, grumpy manic patients may have a depot of phenothiazine (eg, fluphenazine 12.5-25 mg intramuscularly every 3 to 4 weeks) instead of oral antipsychotics. Many patients with bipolar disorder and non-congruent moods with psychotic symptoms that go beyond the boundaries of pure mood disorder need periodic courses of depot antipsychotics. Lorazepam or clonazepam 2-4 mg intramuscularly or orally 3 times a day, prescribed at the beginning of acute phase therapy, can help reduce the required dose of antipsychotics.

Although lithium reduces bipolar mood swings, it does not affect normal mood. It is also believed that lithium has an anti-aggressive effect, but it is not clear whether this effect is present in people without bipolar disorder. Lithium can cause sedation and cognitive impairment directly or indirectly through the development of hypothyroidism. The most frequent acute, mild side effects are small tremor, fasciculations, nausea, diarrhea, polyuria, thirst, polydipsia and weight gain (partly due to the consumption of high-calorie drinks). These effects are usually transient and often occur after a small dose reduction, dose sharing (eg, 3 times a day) or when using slow-release forms. After stabilizing the dosage, the entire dose of the drug should be taken after supper. This mode of appointment can improve compliance, and it is believed that lowering the concentration of the drug in the blood protects the kidneys. Beta-blockers (for example, atenolol 25-50 mg orally once a day) help with severe tremor. Some beta-blockers can worsen depression.

Lithium intoxication is primarily manifested by large-scale tremor, increased deep tendon reflexes, constant headache, vomiting, confusion, and can subsequently progress to stupor, seizures and arrhythmias. Toxic effects are more common in the elderly and in patients with reduced creatinine clearance or with loss of sodium, which can occur as a result of fever, vomiting, diarrhea, or the use of diuretics. Non-steroidal anti-inflammatory drugs, other than aspirin, can contribute to the development of hyperlithia. It is necessary to measure the level of lithium in the blood, including during periods of dose changes and at least every 6 months. Lithium can provoke the development of hypothyroidism, especially with familial complications of hypothyroidism. Therefore, it is necessary to measure the level of the thyroid-stimulating hormone at the beginning of lithium administration and at least annually if there is a hereditary burden or symptoms indicate thyroid dysfunction or twice a year for all other patients.

Lithium therapy often leads to exacerbation and chronicity of acne and psoriasis, can cause nephrogenic diabetes insipidus, these phenomena can decrease with a reduced dose or a temporary interruption of lithium treatment. Patients with parenchymal diseases of the kidneys are at risk of structural damage to the distal tubules. Kidney function should be evaluated at the beginning of therapy, and then it is necessary to periodically check serum creatinine levels.

Anticonvulsants, acting as mood stabilizers, especially valproates, carbamazepine, oxcarbazepin, are often used in the treatment of acute mania and mixed states (mania and depression). Their exact therapeutic effect with bipolar disorder is not known, but it can include the mechanism of action through gamma-aminobutyric acid and, ultimately, through the G-protein signaling system. Their main advantages over lithium are wide therapeutic limits and the absence of renal toxicity. The loading dose for valproate is 20 mg / kg, then 250-500 mg orally 3 times a day. Carbamazepine is not prescribed in a loading dose, its dosage should be gradually increased to reduce the risk of toxic effects. Oxcarbazepine has fewer side effects and has a moderate effect.

For optimum results, a combination of mood stabilizers is often necessary, especially in severe manic or mixed states. Electroconvulsive therapy is sometimes used in cases of ineffective therapy by mood stabilizers.

Treatment of the primary manic or hypomanic episode mood stabilizers should be continued for at least 6 months, then they are gradually canceled. The appointment of mood stabilizers resumes with repeated episodes and goes into supportive therapy if isolated episodes are observed for less than 3 years. Supportive lithium therapy should begin after 2 classic manic episodes, isolated in less than 3 years.

Patients with recurrent depressive episodes should be treated with antidepressants and mood stabilizers (anticonvulsant lamotrigine can be particularly effective), since monotherapy with antidepressants (especially heterocyclic ones) can provoke hypomania.

Fast cycling warning

Antidepressants, even given in conjunction with mood stabilizers, can cause rapid cycling in some patients (eg, patients with type II bipolar disorder). You should not use prophylactic antidepressants, except when the previous episode of depression was severe, and if antidepressants are prescribed, then for a period of no more than 4-12 weeks. If there is severe psychomotor agitation or mixed states, the additional use of second-generation antipsychotics (for example, risperidone, olanzapine, quetiapine) can stabilize the patient's condition.

To establish the cause of rapid cyclicity, it is necessary to gradually stop the use of antidepressants, stimulants, caffeine, benzodiazepines and alcohol. Hospitalization may be required. Possible the appointment of lithium (or divalproex) with bupropion. Carbamazepine may also be useful. Some specialists combine anticonvulsants with lithium, trying to keep the dosages of both drugs at a level from 1/2 to 1/3 of their average dose, and the level of concentration in the blood in appropriate and safe limits. Given that latent hypothyroidism also predisposes to rapid cycling (especially in women), it is necessary to check the level of thyroid-stimulating hormone. It is necessary to carry out substitution therapy with thyroid hormones, if the level of thyroid-stimulating hormone is high.

[7], [8], [9], [10]

Phototherapy

Phototherapy is a relatively new approach in the treatment of seasonal bipolar disorder or bipolar II disorder (with autumn-winter depression and spring-summer hypomania). Probably, this method is most effective as an addition.

Is it possible to cure bipolar affective disorder?

Completely cure this disease is impossible, but with the help of sessions of psychotherapy, mood stabilizers and other medications, you can learn to live a normal and full life. It should also be noted that bipolar disorder is a lifelong mental illness, which carries the risk of recurrence of its seizures. In order to be able to control his condition and prevent serious attacks, the patient must constantly take medication and regularly visit the attending physician.

In addition to this, these people can visit support groups themselves or with their family members, where the former can speak frankly about their condition, while others can learn to support their native people. A patient who has just started treatment simply needs constant support. In addition, studies suggest that among patients receiving support from the outside, a greater number of working people than among those who are deprived of such support.

Bipolar affective disorder - Treatment

Precautions during pregnancy

Most drugs used to treat bipolar disorder need to be gradually canceled before pregnancy or in the early stages. Until lithium is abolished, women who want to have a child should undergo at least 2 years of effective maintenance therapy in the absence of episodes of the disease. The intake of lithium ceases during the first trimester to avoid the risk of developing Epstein's anomaly, heart disease. Carbamazepine and divalproex should be abolished during the first trimester of pregnancy, since they can cause malformations of the neural tube. Other mood stabilizers (such as lamotrigine, oxycarbazepine) may be prescribed at absolute indications during the II and III trimesters, but they must be canceled 1-2 weeks before the birth and resumed a few days after the birth. At the expressed exacerbations during I trimester of pregnancy it is safer to use electroconvulsive therapy. With early exacerbation of mania, powerful antipsychotics are relatively safe. Women who take mood stabilizers should not breast-feed, as these drugs enter the breast milk.

Education and Psychotherapy

Support from relatives is crucial in preventing large episodes. Group therapy is often recommended for patients and their spouses; they receive information about bipolar disorder, its social consequences and the main role in the treatment of mood stabilizers. Individual psychotherapy can help the patient better cope with the problems of daily life and adapt to the disease.

Patients, especially those with type II bipolar disorder, may not follow the regimen of mood stabilizers, as they feel that these drugs make them less vigorous and creative. The doctor should explain that the decline in creativity is not characteristic, since mood stabilizers usually provide the opportunity for more even behavior in interpersonal, educational, professional and artistic activities.

Patients should be advised about the need to avoid stimulant drugs and alcohol, the importance of full sleep and recognition of early signs of exacerbation. If the patient has a propensity for financial expenditure, then the money should be transferred to a trusted member of the family. Patients with a penchant for sexual excess should be informed about the consequences for the family (divorce) and infectious risks of promiscuity, especially AIDS.

To help patients with bipolar affective disorder apply different types of psychotherapy, for example:

• Individual psychotherapy: this is a therapy in which only the patient and a doctor specializing in bipolar disorder take part, during which attention is paid only to this patient. During the sessions the doctor will help the patient to reconcile with the diagnosis, learn more about the disease, teach him to recognize her symptoms and how to deal with stress.
• Family psychotherapy: Bipolar affective disorder affecting one of the family members and thus affects the life of all its members. During family psychotherapy sessions, family members learn more about the illness and learn to recognize the first signs of the phases of mania or depression.
• Group psychotherapy: This kind of psychotherapy allows people with the same problems to share them and together learn how to deal with stress. The method of mutual help, which is used during group therapy, can be the best method that will help you change your opinion about bipolar disorder and improve methods of fighting stress.

[11], [12], [13]

How to avoid bipolar affective disorder?

Bipolar affective disorder, also known as manic depression, is a mental illness that is characterized by a sharp change in an extremely upbeat mood oppressed depressive. Bipolar affective disorder affects people of different ages, gender and ethnicity. It is also known that genetics plays an important role in the development of this disease, since scientists have established that this disease is most often transmitted by inheritance within the framework of one family.

Since it is impossible to prevent bipolar affective disorder, it is necessary to know its first signs. Recognition of the first symptoms of the disease and regular visits to the doctor, will help you to control mood, ensure yourself an effective and safe intake of medications and help to avoid further deterioration of your condition.

Despite the fact that it is absolutely necessary to treat mood changes, scientific research claims that the initial and main goal of a doctor should be to prevent the first bouts of mood changes.