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15.08.2020

BIPOLAR DISORDER

Bipolar disorder, also known as manic-depressive disorder or cyclophrenia, is a serious mental disorder with a heterogeneous clinical picture, which makes it difficult to diagnose. This disease has some common features with the more common depression. In this case, however, depression is only one of the elements (poles) of this disease, the other extreme is mania (hypomania) as a state diametrically different from depression.

Diagnose

To diagnose bipolar disorder, the patient should be diagnosed with (simultaneously) at least one manic episode and one depressive episode.

 

Being only depressed or just mania is not a valid basis for the diagnosis of bipolar disorder. 

 

At this point, it is worth presenting the meaning of such terms as: depression, mania, hypomania, mixed episode - characteristic in the course of bipolar disorder.

 

  • Depression - a state of depressed mood, decreased activity and concentration, sleep disturbances, appetite disorders, a sense of anxiety, tendency to irritability, decreased sex drive, suicidal thoughts

  • Mania - state of agitation, elevated mood, reduced criticism, chaotic and irrationality in action, expansive and auto-aggressive behavior, greater sexual drive, no feeling of fatigue, no appetite

  • Hypomania - a state of "milder" mania, elevated mood without apparent chaotic actions, disturbance in attention, less need for sleep, symptoms are less severe, appear less frequently and last less than in the case of mania

  • Mixed episode - a state combining elements of depression and mania, i.e. a state of agitation and energy in one moment, and suicidal thoughts in the other.

Types of BP

  • Type I -  has an alternating history of manic and depressive episodes.

  • Type II - with alternating episodes of depression and hypomania

  • Type III - in which repeated, alternating episodes of depression, manic and hypomanic states are the result of the action of strong antidepressants

  • Type III and hypomania - are the result of addiction to alcohol (or other substances such as drugs)

  • Bipolar affective disorder, seasonal type - episodes of depression in the autumn and winter months, episodes of mania or hypomania in the spring and summer months.

  • Cyclothymia - there are depressive states, neurosis, alternating with episodes of hypomania.

The most common / diagnosed disorders are types I and II.

Causes of BP

Genetic factors are recognized as one of the main reasons for the development of bipolar disorder. About half of people with bipolar disorder have a family member with an affective disorder (or depression).  Another cause may be somatic diseases or disorders of the neurotransmitters in the central nervous system (bipolar disorder may be caused by an excess or deficiency of one of the three neurotransmitters: noradrenaline, serotonin or dopamine).

Psychological, social and environmental factors also play an important role in the initial stage of the disease and later in its development. Depending on the type, they may aggravate or alleviate the course of bipolar disorder.

 

The risk of developing the disease is increased by: long-term stress, serious illness, inadequate sleep, lack of organization of the circadian rhythm, abuse of psychoactive substances.

Statistics

  • 40 % of patients were initially diagnosed with depression

  • 360 000  of people suffering from BP in Poland

  • risk of cardiac death in people with BP is twice as high as in the population

  • 15-18 year old – most common age for the disease first symptoms

  • 2-3% of population suffering from BP

Treatment

Research shows that proper diagnosis of bipolar disorder is difficult. It also requires long-term and comprehensive treatment, which should include pharmacological treatment, psychoeducation and psychotherapy. 

 

In pharmacological therapy, drugs are used to regulate the mood (so-called mood stabilizers) and atypical antipsychotics. Sometimes it is necessary to use antidepressants.

 

Psychoeducation - is based on teaching the patient the knowledge about his illness. This type of therapy is carried out by a qualified psychiatrist or therapist. It usually takes the form of an individual or group conversation. 

 

Psychotherapy - it is used most often in the case of periods of remission (a state in which the patient is free from symptoms). A variety of therapeutic activities are used here to help, including in acquiring the ability to control one's own behavior.

 

Electric shock - used in cases where the patient is a threat to himself and others, and when drug treatment is unsuccessful.

 

Therapies with intravenous ketamine may be a novelty in the treatment of bipolar disorders. Studies have shown a rapid antidepressant effect of ketamine infusion lasting for at least 2 weeks in a significant proportion of patients with bipolar depression receiving mood stabilizers, refractory to previous antidepressants.

Literature