Bipolar affective disorder (BAD) is a mental illness that manifests itself in depressive, manic and mixed states, which have their own specifics. The topic is complex and multifaceted, so now we will talk about several of its aspects. Namely, about the types of the disorder, its symptoms, causes, and much more.
Characteristic
Bipolar affective disorder manifests itself in constantly alternating periods of depression and euphoria. The rapid change of symptoms cannot go unnoticed.
Mixed states often occur. They are also called phases. They periodically replace each other. They can manifest themselves in a combination of melancholy with anxiety and agitation, or in the simultaneous manifestation of lethargy and euphoria.
Mixed states go either in a row or through bright gaps, which are also called interphases or intermissions. During such periods, the personal qualities of a person and histhe psyche is fully restored. It should be noted that in whatever states BAD manifests itself, they always have a bright emotional coloring, and proceed rapidly and violently.
Causes and conditions of occurrence
For a long time the etiology of bipolar affective disorder remains unclear. However, heredity plays an important role in the development of this disease. The likelihood that a person will be affected increases if someone from his immediate family suffered from bipolar disorder.
According to research, these disorders are associated with genes that are supposedly located on the 4th and 18th chromosomes. But in addition to heredity, autointoxication can also play a role, manifested in violation of water-electrolyte metabolism and endocrine balance.
Scientists who have studied and then compared the brains of ordinary people and those with bipolar disorder have concluded that their neural activity and brain structures differ significantly.
Of course, there are predisposing factors. They can cause bipolar affective disorder, but only if repeated regularly. We are talking about constant stress that a person is exposed to over a long period of time.
In practice, there are cases when this disease developed as a side effect of taking certain medications prescribed to people for the treatment of other ailments. OftenBAD also occurs in those who suffer from alcohol or drug addiction. Moreover, the disease can develop both in current addicts and in long-term addicts.
Unipolar BAR flow
It should be noted that there are types of bipolar affective disorder. And to be more precise, the varieties of the course of this disease. Unipolar type includes two states:
- Periodic mania. It manifests itself in the alternation of only manic phases.
- Periodic depression. Manifested in the alternation of only depressive phases.
It's worth briefly talking about each of them. Since each phase is directly related to bipolar affective disorder. In psychiatry, moreover, they are considered in great detail.
Periodic Mania
Considered by some experts as a type of manic-depressive psychosis, but this provision is not officially approved in the ICD-10 classification.
Manic headlights appear in morbidly elevated mood, motor excitement and accelerated thought flow.
There is also affect, which is characterized by excellent he alth, contentment and a sense of happiness. Pleasant memories arise, perceptions and sensations are sharpened, logical memory is weakened and mechanical memory is strengthened.
In general, the manic stage is accompanied by manifestations that are sometimes difficult to call negative. These include:
- Spontaneous recoveryfrom somatic diseases.
- The appearance of optimistic plans.
- Perception of reality in rich colors.
- Intensification of olfactory and gustatory sensations.
- Memory enhancement.
- Liveness, expressiveness of speech.
- Improved intelligence, sense of humor.
- Expanding circle of acquaintances, hobbies, interests.
- Increased physical activity.
But also a person makes unproductive and easy conclusions, overestimates his own personality. Often there are delusional ideas of greatness. Higher feelings are weakened, there is a disinhibition of drives. Attention switches easily, instability is manifested in everything. He willingly takes on new cases, but does not complete what he started.
And at one moment the critical phase begins. The person becomes extremely agitated, even viciously aggressive. He ceases to cope with everyday and professional duties, loses the ability to correct his behavior.
Depressive phase
Characterized by a painfully depressed mood (lasting more than 2 weeks), loss of the ability to experience positive emotions, the appearance of oppressive sensations (for example, heaviness in the soul).
It also becomes difficult for a person to select words and form phrases, he makes long pauses before answering, he thinks hard. Speech becomes poor and monosyllabic.
Motor retardation may also appear - clumsiness, dullness, sluggish gait, depressive stupor. Even outwardly depressive phase manifests itself. Usually in mournful facial expressions,withering of facial tissues and violation of tone.
In addition to the above, the symptoms of bipolar affective disorder manifested in the depressive phase include the following:
- Depressive thoughts.
- Depreciation of self-importance, unreasonably low self-esteem. Such phrases are often heard: “My life does not make sense”, “I am a nonentity”, etc. It is unrealistic to convince a person.
- Feeling hopeless and hopeless.
- Thoughts of brutal suicide.
- Self-flagellation. Comes to the point of absurdity. A person can seriously think like this: “If in the third grade I shared a sandwich with Misha when he asked, then he would not be disappointed in people and would not get addicted to drugs.”
- Insomnia or very little restless sleep (up to 4 hours) with early awakenings.
- Appetite disorders.
The depressive phase in bipolar affective disorder, the symptoms of which have now been briefly listed, can also be accompanied by physical ailments - constipation, increased heart rate, dilated pupils, spikes in blood pressure, pain in muscles, joints and heart.
Other varieties
The next type of bipolar affective disorder is the right-intermittent course. It is characterized by a change from a manic phase to a depressive one and vice versa. There are notorious light gaps (intermissions).
There is also an irregular-intermittent flow. In this case, nocertain phase sequence. Depressive, for example, may again be followed by depressive. And vice versa.
Practice is also familiar with cases of a double form of bipolar affective disorder (manic-depressive psychosis). It is characterized by a direct change of two notorious phases, followed by an intermission.
The last type of flow is called circular. It is characterized by the correct phase sequence, but the absence of intermission. That is, there are no bright gaps at all.
Bipolar II disorder
It's worth telling a little about him. Everything that was said above concerned bipolar disorder of the first type. To the second, of course, this information is also directly related. However, bipolar affective disorder type 2 is something else. This is the name of the form of bipolar disorder, which is characterized by the absence of mixed and manic episodes in the anamnesis of a person. In other words, there are only depressive and hypomanic phases.
It is BAD type II that is most often diagnosed as depression. This is because the notorious hypomanic manifestations usually escape the attention of a specialist. Needless to say, even the patient may not notice them.
To identify BAD type II, the physician must pay special attention to the consideration of hypomania. Its most striking manifestations are insomnia, anxiety, as well as excellent mood, regularly replaced by irritability. It lasts, as a rule, at least 4 days.
Patients notice that the emotions they experience during such periods are radicallydifferent from those that occur during periods of depression. They are also characterized by increased talkativeness, an exorbitant sense of self-importance, flight of thoughts and irresponsible behavior.
Many suffer from hypomania from irritability and restlessness. Doctors emphasize this and diagnose anxiety disorder with depression. The result is an incorrectly prescribed treatment, due to which the patient's condition becomes manic. Often, a sharp and dynamic cyclical mood becomes a side effect.
In the end, everything ends with a strong emotional breakdown. This is dangerous, as a person may begin to take actions that are dangerous both for him and for others. If this phase goes into a deep manic state, then hospitalization will be required. Indeed, in such a state, a person can cause irreparable harm to himself and others.
In other, more rare cases, people with hypomania feel happy and capable of feats. But this only complicates the diagnosis. If a person uses antidepressants, then this condition can be mistakenly perceived as the body's response to treatment. But in reality, it will only be the calm before the storm.
Bipolar affective disorder in children and adolescents
It was previously believed that the earliest manifestation of BAD occurs in adolescence. However, now cases of fixation of this disease in children from 7 years old are becoming frequent. Why does it appear in such young children?The reasons are unknown, but experts refer to genetics. But the factors provoking BAD in babies are highlighted. These include:
- Impaired thyroid function.
- Bad or insufficient sleep.
- Strong shock.
In the case of today's teenagers, drug or alcohol abuse is added to this list. Unfortunately, in our time, it is not uncommon for many teenagers (who, as you know, have an already fragile psyche) to be addicted to substances prohibited for them.
How do you know if a child has bipolar affective disorder? First, he enters a depressive phase. Often, parents do not pay attention to her manifestations, attributing everything to a transitional age. They do not attach importance to the fact that their child became withdrawn and sad, began to regularly throw tantrums, react sharply to any remarks, and seemed to have lost interest in life.
Yes, it looks like a transitional age, but also the following factors are added to the above, which children usually complain about:
- Headache.
- Chronic fatigue.
- Muscle pain.
- Excessive sleepiness or insomnia.
Depression is usually diagnosed in this phase. But then it is replaced by a manic stage. Phases alternate, there is a lull. Then - again a series of depressive states.
The manic phase is much less common in children and is different from its manifestation in adults. Its offensive is provoked by a trigger - a strong shock. She goes fasterthan in adults. The child becomes very irritable, and the good mood is replaced by outbursts of anger. Adolescents still often demonstrate sexual activity and aggression. They have increased self-esteem and significantly reduced need for sleep.
So the combination of several of these factors should be a wake-up call for both the teenager himself and his parents.
Diagnosis
It is also important to talk about how bipolar affective disorder is defined. The diagnosis is not easy to establish. Because the category of bipolarity is characterized by polymorphism.
In simple terms, this is a disease characterized by a wide variety of disorders that are similar to manifestations of other mental illnesses. It can be confused with psychosis, deep depression, emotional distress, even a form of schizophrenia.
Plus, experts use different diagnostic approaches. According to statistics, more than 70% of people who suffer from bipolar affective disorder receive an incorrect, erroneous diagnosis.
And this is very bad, because this is followed by unreasonable prescriptions. A person begins to take unnecessary drugs, which aggravates the course of bipolar disorder. As a result, the correct diagnosis is established on average 10 years after the onset of the disease.
There are several key points that a doctor must pay attention to when talking with a patient. These include:
- Frequent depressive episodes, which are characterized by early manifestation (manifestation of typical symptoms after an erased or latent course). Also, antidepressants do not work on humans.
- Presence of depression, dependence on illegal substances or alcohol, impulsivity, comorbid conditions (simultaneous presence of several diseases in a person).
- Early onset of psychosis occurring despite advanced sociality.
- Family history, presence of addiction and affective disorders in immediate family.
- Having an idiosyncratic reaction or induced mania to antidepressants, if the person is taking them.
In addition, comorbidity is taken into account - the presence of several chronic diseases at once, which are interconnected by some pathogenetic mechanism. In general, the diagnosis of bipolar affective personality disorder presents many difficulties. Unfortunately, it will not be possible to identify the disease through the study of human tests.
Therapy
Now we should talk about the treatment of bipolar affective disorder. The therapy is divided into the following three stages:
- Active. The emphasis is on the treatment of acute conditions. Therapy begins from the moment the condition is detected and lasts until the clinical response. It usually takes 6 to 12 weeks.
- Stabilizing. Treatment is aimed at stopping the main symptoms. Begins with clinicalresponse to spontaneous remission occurring outside of treatment. Stabilization therapy should prevent exacerbation of bipolar affective disorder. Treatment lasts from 4 months for manic episodes and from 6 for depressive episodes.
- Prophylactic. It is needed in order to weaken or completely prevent the onset of the next phase. If we are talking about the first affective episode, then preventive treatment lasts 1 year. With repeated - from 5 and above.
Therapy is mainly aimed at eliminating mania and depression. However, comorbidity, mixed states, suicidal behavior, and affective instability also occur. They affect the outcome of the disorder and should be taken into account in therapeutic interventions.
Mood stabilizers (sodium valproate and lithium), antidepressants, and atypical antipsychotics are most commonly prescribed after a diagnosis of bipolar affective disorder. Everything is sold by prescription. According to statistics, the body reacts most actively to sodium valproate. In comparison with him, "Carbamazepine", "Aripiprazole", "Quetiapine", "Haloperidol" give a weak effect.
Disability
Is it given for a diagnosed bipolar affective disorder? Disability is a complete or partial loss of ability to work due to mental, sensory, mental or physical disabilities. As already clarified earlier, BAR belongs to the first of those listed. So thatdisability can be issued.
However, the disease must be diagnosed. A person will need to describe in detail everything that happens to him: is there dystonia and temperature, are there problems with sleep, what accompanies all the notorious phases, are sometimes voices heard, is there weakness, fear, a distorted perception of reality, etc.
You also need to be prepared for the need to go to the clinic. There are severe cases, accompanied by manifestations of schizophrenia or especially serious symptoms - some manage to make suicide attempts, engage in self-harm, etc. In such cases, they give a second disability group, in which a person is considered non-working. But serious long-term treatment is also prescribed in the clinic under the supervision of specialists.
