Description and important aspects of bipolar disorder. The clinical picture of episodes of the disease and the main directions in the treatment of this pathology. Bipolar affective disorder (BAD) is a severe, recurrent mental illness that manifests itself as episodic phase changes in mood in the form of depression and mania. The frequency of manifestation of this disease ranges from 0.5 to 1.5%, depending on the method of statistical research. This is a fairly high figure, which indicates the widespread prevalence of the disease and the urgency of this problem today. Usually the disorder develops from the age of 15 to 50. Young people are most often affected, and this requires the appointment of optimal therapy to maintain a stable remission.
Causes of Bipolar Affective Disorder
It is generally accepted that bipolar disorder is an endogenous disorder. That is, its etiology is hidden inside the psyche of the person himself. Over time, there are still facts about the possible provocation of the development of the disorder by external circumstances. Environmental conditions may be the factor that triggers the cascade of episodes of bipolar disorder. Simply put, the disease does not arise due to trauma or external influence, a tendency to it accompanies a person throughout his life, and only certain circumstances can accelerate the manifestation of bipolar disorder. The main cause of bipolar disorder is related to a person's genetic material. People, among whose blood relatives there are suffering from this pathology, are almost 7 times more likely to get sick with it. In addition, these genes are associated not only with this disease, but also with diseases of the schizophrenic spectrum. More detailed DNA studies have made it possible to identify specific changes in chromosome regions that, if mutated, can cause similar symptoms. The main factors in the development of bipolar disorder are:
- Stress … The shocks suffered in life, serious events that abruptly turned the human world upside down, can also affect the likelihood of the manifestation of genes. Most often it is the death of a loved one, moving, the birth of a child. Postpartum depression can be the starting point for bipolar disorder. Sometimes even treatment with psychotropic drugs stimulates gene penetration and the appearance of symptoms of the disease.
- Trauma … A history of traumatic brain injury and brain injury of any severity can also be a risk factor for the development of bipolar disorder. In addition, it should include various bruises that cause organic changes in the structure of the brain.
- Intoxication and somatic diseases … Poisoning with strong toxic substances in acute or chronic form causes an imbalance in neurotransmitter systems. This, in turn, is accompanied by changes in the emotional background. The imbalance between dopamine, norepinephrine and serotonin is accompanied by various mental symptoms. In addition, hormonal imbalances can be caused by various somatic pathologies.
- Personality traits … Some people have a special character composition that determines their behavior and reaction to external factors. This refers to both accentuations and other special features. Melancholic and schizoid features are seen in the majority of patients with bipolar disorder.
Key features of bipolar disorder
Bipolar disorder manifests itself in episodes of mania and depression that alternate in a specific order. The duration of one phase is determined individually. Starting from a few weeks, an episode can drag on for years. In this case, the duration of the light gaps is also different. Almost most of the symptoms of bipolar disorder fit into the syndromic phases of mania and depression.
Mania
All the symptoms of this phase of bipolar disorder are described in a triad of features that each episode corresponds to. These are a kind of criteria for the diagnosis of this mental illness:
- Elevated mood … Hyperthymia manifests itself as a constant feeling of carelessness, causeless happiness and optimism. At the same time, there are no factors that would explain it. A person exhibits such behavior that does not meet the conditions. For example, if there is a misfortune or misfortune, he will not be able to bring himself to grieve for a second. The mood will be heightened regardless of those around.
- Motor activation … Simply put, in such a state it is difficult to sit still. A person is constantly moving, fussing, regardless of the reason. Anxiety manifests itself in the form of uncontrolled wandering around the room. The patient constantly tries to perform meaningless movements with his hands, rearranges things, fiddles with his fingers.
- Mental arousal … The cognitive function of a person with mania is greatly accelerated. He thinks faster, thinks, remembers. In such a state, any mental work is given easier than in an ordinary state. A person feels a surge of strength and energy. It seems that he will certainly be lucky in any business that he would not undertake. It also manifests itself in an increase in sexual libido. People in mania are confident in their own impeccability, ideality, often lose their sense of tact and politeness, rarely think about tomorrow and live in the moment. In this state, they make important purchases or sales that can harm themselves or their family.
The development of mania does not occur at once. Symptoms appear slowly and many do not notice the change in behavior. That is why patients with the last stages of mania come to the attention of doctors. Sometimes the clinical course of an episode may omit one of them, but in the classic version, the symptoms develop in this order.
Also, depending on the severity of the manic phase, two types of bipolar disorder are distinguished. In the first variant, classic mania is observed, and in the second, the symptoms remain only at the level of the first stage. The episode consists of 5 stages of development:
- Hypomania … This is the initial stage of mania, which is characterized by an increased mood, a surge of vivacity and strength. A person begins to sleep for a shorter period of time per day, and efficiency increases. At the same time, absent-mindedness, a decrease in concentration of attention is observed. Speech loses its semantic load, mechanical associations prevail.
- Severe mania … The symptoms of the disease are increasing, there is an elevated mood throughout the day. A person laughs, jokes even when it is inappropriate. Sometimes this is replaced by outbursts of aggression. In this state, behavior remains challenging, regardless of the polarity of mood. At this stage, patients sleep only a couple of hours a day, almost all the time they are busy with any business that comes to hand. At this time, there is a tendency to make unrealistic plans, to make serious rash deals. Sometimes delusions of grandeur arise.
- Heat stage … This phase is the shortest, but at the same time the most serious. During this stage, the greatest severity of all symptoms is observed. Motor activity is erratic and not appropriate for the circumstances. Speech loses all meaning and consists only of fragments of individual phrases. Despite this, a person is always trying to say or show something, and attracts a lot of attention.
- Motor sedation … In this phase, there is a relative regression of some of the symptoms. In particular, the intensity of movements decreases, and the person looks much calmer outwardly. At the same time, heightened mood and acceleration of mental processes persist. Speech gradually develops into semantic segments, but remains accelerated.
- Reactive period … This stage is characterized by complete regression of the symptoms of mania. Inhibition is observed in speech, thinking, and motor activity. The person is in an asthenic state, exhausted and requires a long rest. Sometimes in this state it is difficult to remember the previous stages. During the reactive period, there is a high risk of developing a depressive state immediately after the mania, the so-called inversion. Also, when you exit this episode, the likelihood of suicidal thoughts increases.
Depression
This phase of the disease is observed much more often than manic. Depression has similar criteria for diagnosing bipolar disorder as for mania. They are known as the Kraepelin triad. The latter says that with depression there is a depressed mood, lethargy in motor reactions and thinking. In addition, these symptoms lend themselves to daily cycles. Usually, patients get much worse in the morning, and by the evening, the manifestations of bipolar disorder diminish. In addition to these main criteria, there are other signs that are observed in depression. Almost every patient has a decrease in appetite, and they gradually lose weight during this episode. In women, against the background of a somatic psychological state during depression, there may be amenorrhea - the absence of menstruation. After leaving this state, the hormonal background normalizes the cycle. All the symptoms of this episode develop in several successive stages:
- Initial symptoms … The clinic of depression unfolds with signs of a slight decrease in mood, apathy, and increased fatigue. A person loses the desire to do any work, even the most interesting for him. Appetite decreases slightly, difficulty falling asleep appears.
- Increasing depression … At this stage, clinical symptoms are manifested by a large number of symptoms. Speech inhibition appears. The person is laconic, speaks quietly and to the point. Motor reactions are stingy. The ability to do any light work is lost. A person gets tired even from a long conversation, mental exhaustion is observed. Sleep and appetite problems are much more serious than in the first stage of depression.
- Heat stage … Anxiety gradually increases, melancholy, motor and mental retardation reach their possible maximum in bipolar affective disorder. Movements are reduced to a minimum, a person can stay in one position for hours without feeling discomfort. At the height of the peak, delusional ideas of self-accusation, hypochondria appear. Thoughts often come to commit suicide, but due to motor retardation at this stage, they are almost never realized. The danger is the time it takes to get in and out of depression.
- Reactive period … Similar to a manic episode, at this stage, there is a regression of the main symptoms of the disease. Almost all signs disappear. In most cases, asthenia is observed for some time. Sometimes, after depression, motor and speech disinhibition develops.
Treatments for bipolar disorder
It is generally accepted that bipolar disorder is incurable. With the help of therapy, you can achieve long-term remission for decades. In this case, it is necessary to take supportive treatment. Without appropriate therapy, episodes of mania and depression will alternate and will certainly lead to a deterioration in the person's mental state. Treatment for bipolar disorder consists of pharmacotherapy and psychotherapy.
Drug treatment
Pharmacological treatment is the foundation for managing the symptoms of bipolar disorder. Only with the help of psychotropic drugs can you carry out therapy for severe episodes of mania or depression, so you can not self-medicate. Only qualified medical care is able to stop the symptoms of bipolar disorder. In practice, several groups of drugs are used:
- Atypical antipsychotics … Olanzapine and Quetiapine are most commonly used. These agents are recommended for use during episodes of mania and depression, both as monotherapy and in combination with other drugs. Moreover, the effectiveness of treatment is higher if drugs are prescribed after the first case of bipolar disorder. In addition, antipsychotics can be used in the heat of mania as a means of dealing with mental arousal. Also, with their help, possible psychotic manifestations of this disease are stopped.
- Lithium preparations … These drugs represent a new word in the treatment of such disorders. Studies show that a decrease in the concentration of this element in the blood causes impulsivity, aggression and other symptoms. Long-term use of lithium preparations as a maintenance treatment for bipolar affective disorder is highly effective in preventing the development of subsequent episodes.
- Antiepileptic drugs … These include Carbamazepine, Lamotrigine, and Valproate. These drugs are also called mood stabilizers. With the help of such pharmacological preparations, the normalization of the background mood is achieved with minimization of its fluctuations throughout the day. The funds reduce general anxiety and are able to improve the patient's well-being with prolonged use. They are also used as maintenance treatment in remission.
- Antidepressants … This group of drugs is used for depressive episodes of bipolar disorder. The choice of a specific representative should be carried out by the attending physician, since a wide range of drugs allows you to influence various areas of mental activity. In addition, the appointment of antidepressant therapy requires a gradual increase in the daily dosage, which can only be done by the attending physician.
Psychotherapy
It is often difficult to cope with the condition after an episode of mania or depression on your own. A change in human behavior that he cannot control is unsettling and can leave an imprint of inferiority or self-inferiority for a long time. That is why it is necessary to take into account the influence that this disease has on the human psyche indirectly. For this, several directions have been developed in the psychotherapy of bipolar affective disorder:
- Cognitive Behavioral Therapy … This direction in psychotherapy is considered one of the most widespread. The psychotherapist helps the patient to identify the most important problem situations in his life, to formulate unspoken feelings. Then a certain model of behavior is developed, which becomes the correct template for actions in various life situations. The personal relationships in the patient's environment, which he considers unfavorable or tense, are sorted out. An experienced specialist helps to direct a person to a new level of life together with the disorder, teaches us to coexist without conflict situations.
- Family psychotherapy … People with bipolar disorder have a hard time being different from healthy people. The presence of episodes of mania or depression significantly complicates life, provokes interpersonal conflicts, internal psychological complexes. A person has a hard time accepting the fact that for a certain period of time he becomes not quite himself. That is why family psychotherapy was created to integrate such a patient into the circle of relatives and friends. With the help of various techniques, the specialist adapts a person to ordinary life conditions, tries to develop mechanisms of behavior that will allow him to socialize in real conditions.
- Group psychotherapy … Support for people with bipolar disorder also plays an important role in the treatment of bipolar disorder. To date, many groups have been created whose members suffer from such disorders. Understanding and supporting those whose problems are identical, restore a favorable background, eliminate the feeling of loneliness in their trouble. A person understands that the disease has affected not only him, sees examples of various adaptation options and chooses a suitable one for himself.
How to treat bipolar disorder - watch the video:
Bipolar disorder is considered one of the most common mental illnesses. Along with this, people have learned to perceive their illness correctly, they adapt, work and are quite happy, and modern methods of treatment allow them to achieve stable remissions. It is very important to take the prescribed medications for bipolar disorder, even in a state of complete well-being. This is a kind of guarantee that the state of health will not deteriorate.
