For most people, mood swings are related to events in their environment. They last for as long as the event lasts and are not very long. In contrast, people with bipolar disorder experience extreme mood swings that are not related to external events. Their emotions are particularly intense and can last for very long periods of time. Living with intense and changing moods impairs their daily functioning and can affect, among other things, sleep patterns, energy levels, judgment, memory, and relationships with loved ones.
Manic-depressive psychosis is a fairly common disease. It is diagnosed in approximately one person out of 100. But given that many people do not seek medical help, considering mood swings a character trait, the disease statistics may be much higher.
The disease can develop gradually or appear suddenly at any age, but most often it begins to manifest itself in a young age (18-24 years).
Bipolar Disorder: Phases and Symptoms
BAR is characterized by alternating extreme states: from euphoria to suicidal thoughts. A great mood is always replaced by a depressed one. Such phases are called manic and depressive. These extremes constantly alternate with different durations. While some people may suffer from 2-3 attacks throughout their life and lead a normal life, others may have attacks very often: from several days to several months.
The most noticeable symptoms of bipolar disorder are behavioral, but the disease also affects cognitive function, metabolism, and even the cardiovascular system.
Depressive phase
The depressive phase is characterized by a very low mood, during which people may experience feelings of depression, worthlessness, and even suicidal thoughts. Since in many cases, a period of depression first appears long before the manic phase that would allow a diagnosis of bipolar disorder develops, such people are initially diagnosed with clinical depression.
Typical symptoms for a period of depression:Feeling sad and hopeless most of the day, nearly every day for at least two weeks. This mood is not related to life circumstances and is at a level that is not typical of normal behavior;
- Unreasonable anxiety;
- Lack of energy and fatigue;
- Difficulty concentrating and making decisions, problems remembering;
- Loss of pleasure or interest in everyday activities or things that brought joy or pleasure in the past;
- Feeling empty and tearful;
- Unjustified feelings of guilt;
- Pessimism, feeling of worthlessness;
- Hallucinations, illogical thinking;
- Changes in appetite accompanied by weight loss or gain;
- Sleep disturbances, including difficulty falling asleep, waking up in the middle of the night, or waking up very early in the morning without reason;
- Chronic pain of unknown origin;
Irritability that is present most of the time.
Manic period
The manic period is expressed in an excessive feeling of enthusiasm and elation. At this time, people experience great joy, express ambitious and exaggerated plans, ideas, feel creative. They can, for example, spend a lot of money on things they do not need. Such actions give them pleasure, but in practice have destructive consequences.
Mania can last for weeks or longer. Severe episodes of the disease can interfere with daily functioning and worsen relationships with family and friends. Most often, the manic phase of bipolar disorder occurs after 2-4 episodes of depression and is characterized by the following symptoms:
- A feeling of great joy and superiority without logical reason (a feeling of euphoria);
- Tendency to be easily upset;
- Very fast and confused speech;
- Feeling full of energy;
- High physical activity;
- Motivation to achieve results;
- A sense of self-importance and inflated self-esteem;
- Excessive optimism;
- Difficulty concentrating and increased sensitivity to distractions;
- Disturbed and illogical thinking;
- Aggressive behavior and risk-taking;
- Increased interest in sex, drug and alcohol use;
- Decreased need for sleep and food.
Lack of self-control during these periods leads to destructive results, worsening relationships with people around them. Patients are often unaware of the manic period of their illness and will be shocked by their behavior after this phase.
Diagnosis of bipolar disorder
There is no single test that provides a definitive diagnosis of bipolar disorder. To make this serious diagnosis, it is necessary to collect comprehensive medical information about the patient's family history of nervous system diseases and assess his or her overall health.
When a family doctor or primary care physician suspects bipolar disorder, they refer the patient to a psychiatrist or psychologist for evaluation. During evaluation, the psychiatrist performs a physical examination and orders laboratory tests to rule out other medical causes of the disorder. The doctor asks about symptoms of anxiety, history of drug use, hallucinations or delusions, and personality and behavioral disorders. Because some of the signs of bipolar disorder can occur with other mental illnesses, the psychiatrist also examines symptoms of panic disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), schizophrenia, and attention deficit hyperactivity disorder (ADHD). The psychiatrist may also ask to talk to family and close friends to better understand the situation, after obtaining the consent of the adult patient.
Any disorder that involves sudden changes in behavior and extreme changes in mood or thinking is diagnosed as bipolar disorder.
Many mental health professionals believe that some patients are misdiagnosed or not diagnosed at all and therefore do not receive appropriate treatment. Misdiagnosis may be due to the fact that current diagnostic criteria for bipolar disorder do not take into account certain symptoms that, although not severe, still impair patients’ daily functioning and quality of life. Some types of bipolar disorder are sometimes misdiagnosed as clinical depression.
Treatment for bipolar disorder
In many cases, bipolar disorder is treated throughout life, even during periods when the patient is in a balanced state. Effective therapy can significantly improve the condition within three months.
Statistics show that people with bipolar disorder experience 5-6 attacks over 20 years.
Medication Treatment for Bipolar Disorder
Drug therapy involves a complex algorithm of taking several types of drugs. It is conventionally divided into four components: therapy of manic and mixed states, therapy of bipolar depression, preventive therapy and therapy of bipolar disorder with rapid cycling.
Once the patient's mood has been stabilized, long-term pharmacological and other supportive treatment is prescribed. The choice of drugs depends on the characteristics of the disease, namely the predominant phase.
Lithium carbonate . A lithium-based drug intended for the treatment of mania, hypomania and depression. It is considered the most effective, but its mechanism of action is not entirely clear. Some researchers believe that lithium reduces inflammation during the manic period and thus alleviates some symptoms. It is usually prescribed for up to 6 months. Contraindicated with the simultaneous use of NSAIDs (ibuprofen, diclofenac).
Stopping medication on your own can lead to mania or deep depression.
Anticonvulsants: Used to stabilize mood swings in bipolar disorder. Like lithium, these drugs are used to stabilize mood and treat manic episodes. Although anticonvulsants are primarily used to treat epilepsy, studies have shown that they are also effective in treating neurological pain, migraines, and bipolar disorder.
Antidepressants (for depression) and antipsychotics (for mania) are often prescribed as adjunctive therapy for the treatment of bipolar disorder.
Antipsychotic drugs (neuroleptics). Prescribed to treat mania or hypomanic episodes.
Antidepressants. If a patient takes medication to treat bipolar disorder and develops clinical depression, antidepressants are added to the treatment. They are effective in about 70% of cases, but it will take at least 2-4 weeks before the first results are seen. Several types of antidepressants are used for bipolar disorder.
Psychological methods for bipolar disorder
Psychotherapeutic treatment is an integral part of the fight against bipolar disorder, because it is during the session that the doctor can find out the causes of the disease and influence them. The psychotherapist can provide the patient with tools to improve relationships during the illness. Cognitive behavioral therapy is carried out with an individual approach.
In addition to individual therapy, there is also group therapy, in which patients learn from each other how to cope with situations and problems, develop communication skills and ways to build relationships with other people.
We also note the importance of family therapy. Family therapy helps to identify and reduce crisis and stress situations in the family. Thanks to this, family members learn to communicate better with each other, resolve conflicts and problems.
Electric shock or transcranial magnetic stimulation (TMS)
Despite the rather scary reputation of electroconvulsive therapy, clinical data collected over the past 80 years show impressive effectiveness in treating patients with mood disorders – depression and bipolar disorder – as well as other psychiatric disorders that require immediate relief of acute conditions. Although the cerebral mechanism by which electroconvulsive therapy works is still unclear, there are very few interventions today that can produce such rapid results.
The main goal of this procedure is to provoke artificial cerebral epilepsy, which in turn will cure depression. By causing a neural shake-up, the brain reboots like a computer. The therapy is performed under anesthesia.
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