Bipolar psychosis of the manic and depressive type is a phenomenon that is recognized as a mental disorder and can be observed in people of different age categories. Let us further consider the main manifestations of this disorder, as well as the main causes of its formation and methods of treatment.
Case history
The study of the problem under consideration was started in 1854. In any case, it is this year that the first reflection of the symptoms of this psychological disorder in the scientific literature dates back. The first mention of it was made in the works of the great French psychiatrists Bayarzhe and Falre. A little later, this pathology was studied in more detail in the work of another specialist in this field - Kraepelin.
It is known that the original name of bipolar disorder is manic-depressive psychosis. Since 1993, after its inclusion in the ICD-10, the diagnosis has been renamed more appropriately. Psychiatrists substantiated this decision by the fact that with the pathology under consideration, the occurrence of psychosis is by no means always observed.
General characteristics
Bipolar disorder(manic-depressive psychosis) is a phenomenon that is quite common in modern psychiatry. The peculiarity of this disorder is that it manifests itself in the form of regular affective disorders, or, in simpler terms, causeless abrupt mood swings.
Psychiatrists note that patients with this type of disorder regularly change from mania (in some cases, hypomania) to depression and vice versa. At certain periods, the clinical picture of this problem manifests itself in the form of the onset of a stable depression or only mania. At some points there may be intermediate or mixed states.
Who is diagnosed with
At present, there are no exact data regarding the age of patients with the disorder in question. Practice shows that the majority of psychiatric patients are between the ages of 25 and 45. Moreover, statistics show that people who are in the middle age category have a unipolar form of the disease, and those who are younger have a bipolar form.
As practice shows, if no disorders of the type in question were previously observed, then the first crisis can happen after the age of 50 - this is exactly what happens in 20% of psychiatric patients suffering from bipolar deviation.
With regard to the definition of predisposition to bipolar type disorder by gender, the symptoms of bipolar psychosis are observed in women more often than in men (1.5 times more cases).
Practiceshows that the recurrence of flare-ups of symptoms characteristic of bipolar disorder is observed in almost all cases (about 90%). Speaking about the consequences of such a phenomenon, it is worth noting their great seriousness, since on average about 30-50% of patients with persistent impairment lose their ability to work and become disabled after a certain time.
Reason for the development of symptoms
Currently, psychiatrists cannot provide a definitive list of exact causes that entail a guaranteed change in the psyche called bipolar manic psychosis. Instead, they note that the reasons lie in internal factors and the influence of the environment. Experts also note that the possibility of acquiring such a disease directly depends on hereditary predisposition.
Today, there is a certain list of factors that, according to experts in the field of psychiatry, contribute to the emergence, strengthening and development of bipolar manic-depressive disorder. These include:
- emotional lability (instability);
- the presence in a person of signs of a schizoid personality type (monotony, emotional coldness, desire for solitude, the presence of rationalization);
- anxiety;
- heavy suspiciousness;
- tendency to melancholic behavior (restraint in the manifestation of various emotions, the presence of high sensitivity, increased fatigue);
- presence of signs of statothymic personality type (increased levelresponsibility, constant demand from others to observe a certain order, pedantry).
In addition to all of the above, according to psychiatrists, the risk of developing symptoms of bipolar psychosis increases significantly in women during a period of sharp fluctuations in hormonal levels. Vivid examples of these are the moments of menstrual bleeding, as well as during menopause or in the postpartum period. In particular, the risk of developing such a disease is high for those women who have a history of short-term psychosis in the postpartum period.
Disease forms
It should be noted that the concept of bipolar affective psychosis provides for several forms of the disease in which it can be expressed. As for the classification of forms of disorders, it is made on the basis of the predominance of which phenomena can be observed in the patient's clinical picture: mania or depression, and also according to the order in which they alternate with each other.
Speaking about the problem under consideration, it is worth noting that it can occur in two forms: bipolar and unipolar. In this case, a deviation will be recognized as a bipolar disorder, during the course of which both types of affective disorders are observed. With regard to unipolar disorder, its manifestation is the constant observation of one type of affective disorder (either only depression, or only mania).
When considering the forms of the course of the type of disorder in question, a separateattention should be paid to its bipolar type. This is due to the fact that it tends to flow in various ways:
- correctly intermittent disorder (when there is a regular change of depression and mania, in between which there are clarifications of consciousness);
- incorrectly intermittent (when depression and mania alternate, but in a chaotic manner);
- circular disorder (when observing this type of deviation, there is a constant change of depression and mania, and between such states there is no place for enlightenment of consciousness);
- double (when observing this form of disorder, two opposite episodes of disorder are observed in a row; in the intervals between them there are no enlightenments of consciousness, the "light" phase comes after).
As for the number of phases of the disorder observed in psychiatric patients, it can be different: it happens that after a single manifestation of the disorder, relapses no longer occur, but in most cases they repeat, and an unlimited number of times.
As for the duration of the phases of the disorder, it can be any, but, as practice shows, the average is 2-3 months. Also, statistics show that episodes of depression occur much more often than bipolar psychoses with a predominance of manic states. It should also be noted that depressive disorders last much longer than manic ones (3 times longer).
Considering the features of the intervals of enlightenment of consciousness between disorders, it is worth noting that suchperiods tend to be fairly stable in duration, around 3-7 years depending on the environment.
Disorder symptoms
Bipolar affective psychosis: what is it? Specialists in the field of psychiatry note a certain list of symptoms indicating that a person has deviations of the type in question. It is worth noting that they differ significantly depending on what phase the disorder itself is in: in mania or in depression. Let's consider them further in more detail, separately.
So, for bipolar psychosis with a predominance of depressive states, the following symptoms are characteristic:
- sudden or gradual weight loss;
- inhibition of movements;
- constantly low mood;
- reduced appetite (in some cases - its complete absence);
- decrease in libido;
- slow thinking.
In addition to all of the above, during the course of manic-depressive psychosis with bipolar disorder in men, erectile dysfunction can be observed, which is due to a decrease in libido and a constantly lowered mood level. For women, their periods may stop.
Speaking of the symptoms characteristic of the manic stage of the disorder, it is worth highlighting the exact opposite of all the signs that are observed in people who are in the phase of depression, namely:
- motor excitement;
- excessive risesmood;
- accelerated thinking.
As for the types of mania, that it can be mild, severe and moderate. Let's consider their features in more detail.
With mild mania, one can observe the constant presence of a person in high spirits. In his daily routine, there is a significant decrease in the need for sleep, but the number of other desires increases: sex, food, physical activity, communication with others, etc. As practice shows, the period of mild mania (or, as it is called in psychiatry, hypomania) tends to last for a short time - only for a few days.
Speaking of moderate mania, it is worth saying that this stage occurs without the observation of any psychotic symptoms. At this time, a person almost completely lacks the need for sleep, he begins to constantly be distracted by something and cannot concentrate on any elements of activity, as a result of which he partially loses his working capacity. It is worth noting that with this form of the disorder, the patient's ability to contact with others is significantly impaired. Moreover, with such a deviation, people often develop delusions of grandeur. The duration of such an episode is usually no more than a week.
What should be said about the severe form of the disorder? First of all, it should be noted that this form is always accompanied by psychotic symptoms. As a rule, during its course, the patient has a tendency to violence, excessive excitement, as well as a continuous stream of thoughts with jumps from one to another. During the periodthe course of such a phase of the patient can be tormented by hallucinations and delusions, which is typical for the usual process of schizophrenia. Often a person begins to consider himself great and assure everyone that his ancestors belong to a famous and very noble family. An essential sign that a manic disorder has a severe form is the fact that a person completely loses not only working capacity, but also the ability to take care of himself on his own. This form of mania tends to last for weeks.
As for depression, they can also take on various forms:
- simple (classic pattern);
- hypochondriac (confidence in the presence of a terrible disease);
- delusional (nonsense accusations);
- agitated (classic picture with lack of motor inhibition);
- anesthetic (feeling painful insensibility).
Diagnosis
In order for a psychiatrist to be able to make an appropriate diagnosis, at least two episodes of affective-type disorders must be observed. To correctly diagnose, a specialist can study not only the patient's history, but also the information provided by his relatives.
As for the process of determining the severity of the disease, it is carried out according to a certain scale.
Treatment
What to do if a patient has been diagnosed with bipolar affective psychosis? The clinical guidelines for the treatment of this deviation provideintervention by normalizing the patient's condition, as well as improving his mood. As a result of the right actions, the patient will have a long period of remission.
With regard to the place where treatment should be carried out, in the case of a mild form of the disease, treatment is carried out on an outpatient basis, and in a severe case, in a psychiatric clinic.
Properly selected antidepressants are used to stop episodes of depression. As for the choice of means, this can only be done by a specialist in the field of psychiatry after examining the patient, taking into account the severity of depression, the ability of it to go into a state of mania, the age of the patient. For the treatment of especially severe forms of depression, a psychiatrist may prescribe antipsychotics or mood stabilizers in addition to antidepressants.
If the disorder proceeds in the stage of mania, treatment is carried out exclusively with mood stabilizers, but in the case of a severe form of the disease - antipsychotics.
After completing the full course of treatment, the patient goes into remission. This period should take place in a family environment. Various types of psychotherapy (family, individual, group) may also take place during this time.
On the complications of disorders
Those people who develop psychosis with bipolar disorder should definitely be examined by a psychiatrist. It also requires qualified treatment that fully corresponds to the severity of the disease. Carrying out such actions is an urgent need, because if the problem is ignored,in the vast majority of cases, the disease begins to progress.
In the case of progression of the disease, the patient may experience manic seizures, during which a person can even make suicidal attempts. Also, such situations are fraught with the commission by a person of actions dangerous to society through negligence.
About predictions
Special attention should be paid to what are the forecasts for the further development of mental illness.
It should be noted that modern psychiatrists note that the considered deviation is very often combined with the abuse of bad habits (alcoholism, drug addiction, etc.). It is worth considering that in the presence of this factor, the severity of the disorder only intensifies, and the prognosis of treatment, as a rule, indicates the hopelessness of the situation.
As for general forecasts, the presence of the considered deviation often has not the most favorable forecasts. As the practice of treatment shows, about 90% of people suffering from it later begin to experience complications again, resulting in a relapse.
Statistics show that in every third patient the disorder in question proceeds continuously, with no gaps of awareness or with their minimum duration. However, it is known that when observing such a person, a complex of mental functions can be completely restored, but, as a rule, this is not for long.
