Bipolar disorder is a mental disorder whose main manifestations are mood swings. The disease has two opposite poles - in people suffering from this disorder, the swings are very pronounced.
General characteristics of the disease, study in medicine
Patients with bipolar disorder (BAD, or bipolar affective disorder) experience alternating episodes of mania and depression. During some periods, only manias or depressions may occur. In some cases, states of an intermediate, mixed nature may be observed. For the first time this disease was described in detail in 1854 by psychiatrists Falre and Bayarzhe. However, as an independent nosological unit, it was recognized by the medical community only in 1896. Then the scientific works of Kraepelin devoted to the study of this violation were published. The disease was originally called manic-depressive psychosis.
However, in 1993 it was included in the ICD-10 under a different name - "bipolar affective disorder". There is no exact data on how widespread it is. This is due to the fact that researchers of this disease use various evaluation criteria in its diagnosis. In the 90s of the last century, domestic psychiatrists believed that about 0.45% of the total population suffers from this disease. However, the assessment of foreign experts was somewhat different - 0.8%.
What is bipolar disorder in simple terms? In the presence of this disease, changes in the emotional state go far beyond the norm, they are inadequate to real life circumstances. The patient's mood changes from depression to mania.
Some statistics
Currently, scientists believe that the symptoms of bipolar disorder can be observed in approximately 1% of people, and in a third of them the disease takes the form of psychosis. Data on how common the disease occurs in the pediatric population is also lacking. This is due to the difficulties of using standard diagnostics in pediatric practice. Psychiatrists believe that episodes in children often go undiagnosed.
Approximately half of patients with bipolar disorder first develop between 25 and 45 years of age. In middle-aged people, as a rule, the unipolar form of the disease predominates, while in young people it is bipolar. In older age, depressive phases become more frequent. The disease is 1.5 times more common among the female population than among men.
Causes of disease and risk factors
It is believed that the mainthe causes of the disease are hereditary (genetic) factors, as well as environmental conditions. At the same time, scientists attach more importance to heredity factors.
Conditions that increase the risk of developing the disease include:
- Belonging to a schizoid personality type (preference for solitary activities, emotional coldness, monotony).
- Increased need for orderliness in life, responsibility, tendency to pedantry.
- High level of suspiciousness, anxiety.
- Instability of the emotional background.
The risk of signs of bipolar disorder in women increases significantly during hormonal instability (menstruation, pregnancy, postpartum period, menopause). The risk is especially high for women with a history of postpartum psychosis.
Disease forms
Clinicians use a classification of disorders that is based on the criteria for predominance of depression or mania in the clinical picture.
The disease can be bipolar (there are two types of affective disorders) or unipolar (in the case of one type of disorder). Psychiatrists refer to unipolar forms as periodic mania (hypomania), as well as periodic depression.
The following forms of bipolar personality disorder are also distinguished:
- Correctly interspersed. In this case, periods of mania and depression clearly alternate and are separated by a light interval.
- Improperly interleaved. The sequence of episodes is random. For example, there may be several episodes of depression, separated by a light phase, and then followed by manic episodes.
- Double. Affective disturbances follow each other immediately, without a bright gap.
- Circular. Mania replaces depression (and vice versa) constantly, without bright intervals.
The number of phases of bipolar disorder varies from patient to patient. One may have dozens of different episodes over several years, while others may have a single period of disturbance.
As a rule, the average duration of one phase is several months. Mania occurs less frequently than depression, and its duration is three times shorter. The average duration of the light period is from 3 to 7 years.
Bipolar Disorder: Symptoms
The main signs of the disorder are highly dependent on the phase of the disease. For example, a manic period is characterized by:
- fast paced thinking;
- lifting mood;
- motor excitement.
There are three degrees of severity of mania:
- Mild (otherwise called hypomania). The mood is upbeat, performance is increased (and this applies to both physical and mental). There is a high level of social activity. The need for sleep and rest is significantly reduced, and for sex it increases. The patient is quickly distracted by strangersirritants, cannot concentrate for a long time. As a result, social contacts become difficult. An episode of hypomania usually lasts at least a week.
- Moderate (no psychotic symptoms). Significantly increased physical and mental performance. The mood rises. The need for sleep almost completely disappears. Delusions of grandeur arise. This episode is also at least a week long.
- Severe mania (with psychotic symptoms). There may be pronounced psychomotor agitation, there is a tendency to violence. There are jumps of thoughts, the connection between the facts the patient loses. There are hallucinations, delusions. Many patients may gain confidence that their ancestors belonged to some noble family, or begin to consider themselves a famous person. Working capacity is lost, the patient also cannot serve himself. The severe form can last over several weeks.
Signs of a depressive phase
As for depression, it proceeds with the opposite symptoms. What is bipolar disorder in simple words? This is an alternation of episodes of mania and depression. They can talk about the presence of the latter:
- slow pace of thinking;
- reduced emotional background;
- motor retardation;
- decrease in appetite up to the complete refusal of food;
- reduced sex drive;
- Women may not have periods and men may develop erectile dysfunction in some cases.
With a mild form of depression, the emotional background can fluctuate during the day. As a rule, mood improves in the evening, and depressive symptoms reach a maximum in the morning.
Shapes of depression
The following forms of depression may occur in bipolar disorder:
- Simple. The clinical picture in this case is represented by the classic depressive triad (depressed mood, low speed of thinking, impoverishment of the emotional-volitional sphere).
- Hypochondriacal. The patient may believe that he has a fatal disease that modern medicine knows nothing about.
- Delusional. Depressive symptoms in this type are combined with delusions of accusation.
- Agitated. With this form of depression, there is no motor retardation.
- Anesthetic. The main symptom is painful insensitivity. It seems to the patient that his feelings and experiences have disappeared. In their place is a solid void that torments him.
Therapy
Treatment of bipolar disorder begins with overcoming the main symptoms of the disease - seizures. Depending on the clinical picture, the psychiatrist may prescribe either drug therapy or psychotherapy and hypnosis. However, most often in practice, these methods are combined, perfectly complementing each other. Properly selected therapy gives good results and allows you to get rid of the unpleasant symptoms of bipolar disorder.
Psychotherapy
Bouts of the disease can be controlled not only with the help of medicines. This is where a good therapist can help. However, attending appointments is necessary with some stability in the patient's mood, and this can often be achieved only with the help of drugs.
During the treatment of bipolar disorder with psychotherapy, the patient's attention should be directed to the following points:
- Awareness that the patient is not behaving quite adequately.
- Development of action algorithms for repetition of episodes.
- Strengthening progress when repeating depressive or manic moments, as well as increasing control over the emotional-volitional sphere.
- BAD therapy sessions can be group, individual or family.
Medicated treatment
Antidepressants are used to relieve symptoms of depression. The choice of the drug, as well as its dosage, are determined by the attending psychiatrist, taking into account the age of the patient, the severity of the depressive state, and the possibility of its transition to mania. If necessary, antidepressant therapy is combined with the use of mood stabilizers and antipsychotics (which are treated at the stage of mania).
Self-diagnosis
Testing for bipolar disorder is a good way to make an initial diagnosis. It will allow you to track alarming symptoms in time, as well as find out whether you need to contact a psychiatrist. The questionnaire includes several blocks:
Have there been periods in your life when physical andmental activity was much higher than usual and could be characterized by the following features:
- you felt absolutely self-confident;
- thoughts and ideas jumped uncontrollably from one to another;
- you managed to do a lot of things - much more than usual;
- you experienced a big boost in sex drive;
- difficulties arose when necessary to concentrate, do painstaking work;
- you did unexpected things that others thought were stupid and even dangerous;
- you felt an overabundance of words, spoke more than usual;
- there have been episodes of reckless spending of money, resulting in damage to you or your loved ones.
2. If two or more questions are answered yes, has it ever happened that these symptoms appeared at the same time?
3. How would you rate the difficulties that arise in connection with these symptoms - for example, irritation in communicating with loved ones, increased sociability, inability to concentrate? Can we say that they have a significant impact on the quality of life, are they problematic or not?
Accepting yes to three (or more) questions from the first list, as well as a positive answer to the second and third questions of the test for bipolar disorder, is a serious reason to think about your he alth. It is necessary to visit a psychiatrist or neurologist. It is also useful to consult a psychologist.
Types of violations
Let's look at the main types of bipolar disorder. This violation is divided into two main types - I and II types. The most common is the manic-depressive form, that is, a type I disorder. In order to make such a diagnosis, it is necessary that the person has at least once experienced an attack of mania. People with this disorder may also experience depressive episodes. Signs:
- A person with the first type often feels invulnerable.
- He finds it difficult to work and communicate with others.
- Such people are suicidal.
- Often addicted to alcohol or drugs.
As for type II, there is often a much lower intensity of symptoms. A milder version of hypomania may occur, but depression is the underlying disorder. A person with bipolar II disorder may be misdiagnosed with depression. Signs:
- This type of depression differs from clinical depression as it often causes symptoms of mania.
- The patient may be anxious, irritable. Thoughts constantly replace one another, there are sharp bursts of activity, creativity.
- Most often this disorder occurs in women.
- High risk of suicide, alcoholism and drug addiction.
Features of the disorder during puberty
Teen bipolar disorder may look a little different. Mood changes tend to be more frequent, and mixed episodes are also more common. During mania, irritability pushes aside elevated mood. In the depressive phase, headache, fatigue may disturb. No desire to go to school, there are inexplicable bouts of crying. With bipolar personality disorder, there is a high likelihood of substance abuse. To improve well-being, a teenager may resort to alcohol or drugs. Parents should carefully monitor the child, pay special attention to conversations and even hints of suicide, and take them seriously. Such thoughts may indicate the presence of a disease that needs to be treated.
BAR: advice from psychiatrists
Many people ask a natural question: How to live with bipolar disorder? The main thing here is to see a doctor in a timely manner. It takes time for the patient to adapt to medications, special therapy. However, this is the best protection against relapses of the disease. Let's consider a few recommendations for those suffering BAR:
- The right selection of specialists, both a psychiatrist and a psychologist, is of great importance. The doctor must inspire confidence, a desire to work on his cure. Tensions are unacceptable in bipolar therapy.
- It is equally important to eliminate the causes of stress in life - for example, unpleasant people, money problems, constant lack of time. It is helpful to keep a diary of the actions the patient takes when they feel stressed.
- Even when the diagnosis is confirmed, it is important to continue to communicate with people. It's good to find a supportera friend to turn to before stress leads to another relapse.
- It is very important to adhere to the basic rules of mental and physical he alth - monitor the quality and duration of sleep, engage in physical activity, eat quality food.
Bipolar disorder is not a death sentence. With adequate therapy, the help of relatives and friends, you can cope with the disease and live a normal life. Patients with bipolar disorder successfully work, start families, and are realized in creativity. It is also proven that they tend to have various creative talents and are very interesting in communication.
