Bipolar disorder affects about 1% of the population, meaning that about 1 in 100 people will experience an episode that is likely to require ongoing care. The disease affects men and women equally, and usually begins around age 20.
Bipolar affective disorder, or manic depression, is a mood altering disorder characterized by experiencing extremely “high” moods, that is, having manic episodes in which you get extremely euphoric or excited, or experiencing extremely “low” moods, called depressive episodes, in which you feel sad most of the time, have reduced activity and find it difficult to experience pleasure.
It is worth remembering that there are different courses associated with bipolar affective disorder, or bipolar disorder for short CHAD. Depression in the course of CHAD and mania can range from mild to severe and affect how a person experiences the illness.
Symptoms of bipolar affective disorder CHAD
Manic episodes. Mania is an extreme mood state that is characterized by an inappropriately elevated, euphoric or irritable mood. A person in a state of mania may have little contact with reality, and may make risky decisions or transactions without considering the consequences.
Mania, hypomania – manic episode, hypomanic episode
A manic episode is characterized by an uncontrollable increase in mood, excessive excitement, feelings of euphoria or inappropriate irritability. The symptoms of CHAD themselves can vary in severity.The most common symptoms are:
Irrational ideas: people who are in mania may often experience delusions of grandeur. Psychotic symptoms may occur are associated with inadequate thoughts in relation to the world and to people. Individuals often feel that they have exceptional talents and have brilliant ideas.
Rapid flow of thoughts: people who fall into mania experience an increased rate of thinking. They move more quickly from one subject to another. Sometimes thoughts can become so fast that they begin to lose meaning, causing those closest to them to stop understanding.
Irritability: because of their rapid thought process, they easily become angry when people don’t seem to understand their ideas or share their enthusiasm for some new vision.
Reduced need for sleep: one of the most characteristic symptoms, a person in mania has a much lower need for sleep, the number of hours spent sleeping decreases dramatically, and sleepiness is not felt.
Increased sexual desire: people who fall into mania often experience an increased libido and may make less thoughtful, decisions about sexual partners.
Hypomania is a more moderate form of elevated mood, and does not significantly affect judgment of reality. There may be increased arousal, less need for the amount of sleep, however, some control mechanisms are maintained.
Depression – a depressive episode
Depression is characterized by a significantly lowered mood. To diagnose depression, the level of severity of major depression, its duration and the presence of characteristic symptoms are important to distinguish a major depressive episode from a milder depressive episode.
Symptoms of depression
Mood: the patient experiences persistent sadness, anxiety, feelings of emptiness. Individuals describe depression as overwhelming feelings of sadness and hopelessness. They may experience a loss of pleasure in activities of daily living from which they once derived much pleasure.
Poor or disturbed sleep: the sufferer often experiences sleep disturbances, which may be due to increased anxiety. It is then difficult to fall asleep or easy to wake up during the night. People struggling with insomnia worry about everyday events related to the future or return with thoughts to the past and their difficult events.
Decreased interest: a depressed person gradually loses interest in various activities, especially those related to social relationships and the sphere of pleasure.
Poor concentration: thinking may slow down and the person may have difficulty making decisions. Difficulty concentrating may even apply to everyday tasks such as shopping.
Suicidalthoughts or attempts: when a depressed person feels extremely overwhelmed by his negative feelings , he may have thoughts of ending his life or have plans to commit suicide.
How is CHAD diagnosed?
If you think you or any CHAD, consider a few key features.
- Manic episodes: A person with CHAD may manifest pronounced manic episodes, which are characterized by excessive excitement, excessive activity and high energy levels. They may be very talkative, have a sense of euphoria, overconfidence, scattered thoughts and a tendency to engage in risky activities.
- Depressive episodes. A person with CHAD also experiences depressive episodes, which are the opposite of mania. Depressive episodes are characterized by deep sadness, loss of interest, fatigue, loss of energy, difficulty concentrating, feelings of hopelessness and suicidal thoughts.
- Mood volatility. CHAD is manifested by frequent mood swings. A person with the disease may experience rapid changes between states of mania and depression. These changes can be unpredictable and occur at different times.
- Difficulties in social and occupational functioning. CHAD can significantly affect a person’s ability to function normally in daily life. It can lead to difficulties in maintaining social relationships, working, studying or other areas of life.
How to diagnose bipolar affective disorder – types of CHAD
Bipolar affective disorder CHAD type 1 – depressive episodes (higher periodicity) are separated by at least one or more episodes of mania. Many doctors describe bipolar affective disorder type I as a relapsing and remitting disorder, in which symptoms come and go. Therefore, it is important to ensure that treatment is continued, even if symptoms are no longer present, to prevent an episode from recurring.
Bipolar affective disorder CHAD type 2 – depressive episodes (usually even more frequent than in type II of this disorder) are separated by one or more episodes of hypomania. Type 2 bipolar disorder is characterized by full-blown episodes of depression and episodes of hypomania (i.e., with mild manic symptoms) that almost never develop into full-blown mania.
Cyclothymia is characterized by frequent short periods of mild depressive symptoms and hypomania, mixed with short periods of normal mood. Although a patient with cyclothymic disorder does not experience major depression or mania, there is a risk of developing bipolar I or II affective disorder.
Mixed episodes – an episode of the disorder is characterized by the presence of both depressive and manic symptoms almost every day for a period of time. The person experiences rapidly changing moods so-called phase change, e.g. irritability, euphoria, sadness, insomnia, agitation, hallucinations and delusions, suicidal thoughts, etc. may occur.
What is bipolar affective disorder ?
Bipolar affective disorder, also called bipolar affective disorder or simply bipolar affective disorder, is a chronic mental disorder characterized by manic episodes (periods of elevated mood) and depressive episodes (periods of depressed mood). It is one of the most serious affective disorders that can significantly affect a patient’s functioning in daily life. Bipolar affective disorder is considered a chronic condition and requires professional psychiatric diagnosis and treatment. Treatment may include drug therapy such as mood stabilizers (e.g., lithium, anticonvulsants), antidepressants, as well as psychological therapy such as cognitive-behavioral therapy, family therapy. Prevention is important, including stress management, healthy lifestyles, regular psychiatric care, and collaboration with medical professionals to manage symptoms and improve the patient’s quality of life.
Diagnosis of bipolar affective disorder
Proper diagnosis of the disease can help initiate the treatment process to begin to better manage the illness. Therefore, a proper and accurate diagnosis is essential. Remember a test for bipolar disorder taken on the Internet will not solve the case.
Remember, only a doctor can diagnose the first episode of mania or hypomania in a patient.When diagnosing the first episode of mania or hypomania, the doctor pays attention to the characteristic symptoms. Symptoms of hypomania may be similar to those of mania. For patients with symptoms similar to mania, it may be necessary to perform a diagnostic workup to determine a definitive diagnosis.
Diagnosis to exclude
As with all other mental disorders, do not confuse depression or mania, which are caused by a systemic condition, its treatment, or the side effects of substance abuse.
- Systemic conditions , which can cause similar effects to depression are: nervous system disease, Parkinson’s disease, strokes, vitamin deficiencies, hypothyroidism, hepatitis, cancer.
- Psychoactive substances that cause similar symptoms to mania are: alcohol, amphetamines, cocaine, opioids.
- Drugs that can affect the appearance of mania-like symptoms are antihypertensive drugs, cardiac medications, painkillers.
It is worth adding that there are cases of dual diagnosis, in which the affected person suffering from bipolar disorder additionally abuses psychoactive substances.
Diagnosis excluding
As with all other mental disorders, one should not confuse depression or mania, which are caused by a systemic condition, its treatment, or the side effects of psychoactive substance abuse.
- Systemic conditions that can cause similar effects to depression are: nervous system disease, Parkinson’s disease, strokes, vitamin deficiencies, hypothyroidism, hepatitis, cancer.
- Psychoactive substances that cause similar symptoms to mania are: alcohol, amphetamines, cocaine, opioids.
- Medications that can affect the appearance of mania-like symptoms are high blood pressure medications, heart medications, painkillers.
It is worth adding that there are cases of dual diagnosis, in which a person suffering from bipolar disorder additionally abuses psychoactive substances.
Borderline vs. bipolar affective disorder
Bipolar affective disorder (CHAD) and borderline personality disorder (BPD) are two separate and distinct categories. Here are some key differences between the two.
- Nature of the disorder. CHAD is a mood disorder, while BPD is a personality disorder. The diagnosis of CHAD focuses on manic and depressive episodes, while BPD addresses a wide range of emotional, interpersonal and behavioral symptoms.
- Mood volatility. The course of CHAD is characterized by manic and depressive episodes, which can occur in cycles. BPD, on the other hand, is characterized by sudden and intense mood swings, usually in response to external stimuli.
- Interpersonal relationships. People with BPD often have difficulty maintaining stable and healthy interpersonal relationships. They often feel a strong fear of rejection and have difficulty regulating emotions in relationships. In CHAD, interpersonal relationship difficulties may occur during manic or depressive episodes, but they are not a primary symptom of the disease.
- Self-injury and impulsivity. People with BPD often exhibit impulsive behavior, such as self-harm, suicide attempts, dangerous eating habits, substance abuse, etc. In CHAD, impulsivity can occur in manic episodes, but is not characteristic of the disease as a whole.
- Treatment. Treatment of bipolar affective disorder focuses mainly on pharmacotherapy, such as the use of mood stabilizers, antidepressants and antipsychotics. Cognitive-behavioral therapy is introduced in parallel in the treatment process. For BPD, schema therapy, dialectical-behavioral therapy (DBT) is often recommended as the main form of treatment, although pharmacotherapy can also be used to alleviate some symptoms.
Causes of bipolar disorder
No single specific factor has been identified as causing bipolar disorder. There are many factors that interact with each other that can contribute to the development of this disorder in some people. All of these factors interact to trigger the onset of this disease.
We will look at three key factors: genetic susceptibility, biological susceptibility and life stress.
Bipolar disorder is a disorder that tends to run in families. First-degree relatives of people with bipolar disorder have an increased risk of developing bipolar disorder. Children of patients with bipolar disorder have an 8% higher risk of the disease compared to the general population. Children of bipolar patients are also at increased risk (12%) of developing unipolar depression (i.e., depression only, no mania). Although these results indicate that to some extent the disorder is inherited, this is not necessarily a sufficient factor for the onset of the disease.
Stressful eventsor circumstances in a person’s life, such as family conflicts, employment difficulties, bereavement, or even milestone events (i.e., getting married, having children, moving house) can place additional demands on the person that alter the person’s life situation.
The occurrence of bipolar disorder spectrum disorder can therefore be explained as an interaction of the above three factors. A person who is genetically and/or biologically susceptible will not necessarily develop bipolar affective disorder. These vulnerabilities are influenced by how a person deals with stressors in his or her daily life. For example, a person with a family history of diabetes may not develop diabetes if he or she is careful in following his or her diet, limits sugar and gets enough exercise.
Treatment of bipolar affective disorder
Phases of treatment
Treatment for bipolar affective disorder usually involves three phases. The most important goal if experiencing a manic or hypomanic episode or severe depression is to try to take control of the symptoms and eventually eliminate the symptoms. Most importantly, the person suffering from ChAD should be able to return to a normal level of daily functioning. The duration of this acute phase of treatment can last from 6 weeks to 6 months. In follow-up treatment, the main goal is to maintain an asymptomatic state by preventing relapse.
The third phase is the maintenance phase is essential for all patients with bipolar affective disorder. The methods of CHAD maintenance treatment is to prevent relapse, that is, to prevent the occurrence of new depressive and manic episodes. For patients with bipolar affective disorder, as with other conditions such as diabetes or hypertension, systematic maintenance treatment can last five years, 10 years or a lifetime.
Pharmacotherapy
The recognized standard treatment for bipolar disorder is medication, which focuses on controlling or eliminating symptoms and then maintaining a symptom-free state.
Effective use of medications requires close cooperation with a doctor and appropriate selection of medications. The psychiatrist will properly select and medications and regularly monitor the patient’s condition. Some patients may respond well and experience few side effects with one type of medication, while others may do better with another. Therefore, when taking medications, it is important to regularly check their effects and consult your doctor.
Types of medications:
Mood stabilizers
A mood stabilizer is a medication used to reduce the likelihood of subsequent episodes of mania or depression. These are first-line agents in bipolar disorder. Depending on the symptoms accompanying the disorder, antidepressants or antipsychotics may also be used. A mood stabilizer is given to a person as a maintenance medication because it regulates mood swings, but does not remove the cause. Feeling good does not mean you can stop taking mood-stabilizing drugs.
Popular mood stabilizers are lithium carbonate, carbamazepine and sodium valproate.
Antidepressants
Antidepressants can also be used in combination with mood stabilizers in the acute, continuation and/or maintenance phases of medical treatment. There is no one particular antidepressant drug that is more effective than another in bipolar disorder.
Popular antidepressants are: selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline
- Tricyclics – imipramine, amitriptyline, desipramine,
- Monoamine oxidase inhibitors (MAOIs) – phenelzine
Antipsychotic drugs
Antipsychotic drugs can also be used both in the acute phase of the disease and sometimes as long-term treatment. Common antipsychotics include haloperidol, chlorpromazine, thioridazine, risperidone and olanzapine.
Another commonly used drug is clonazepam, classified as a benzodiazepine. It is used as an adjunct with other medications to help induce sleep, reduce psychomotor agitation and slow the chasing of thoughts
Cognitive-behavioral therapy
Research findings show that cognitive-behavioral therapy for bipolar disorder is effective in helping to manage and better control symptoms. Cognitive-behavioral therapy can play an important role in educating bipolar affective patients about their disorder (psychoeducation is a key task) and supports and coping with adaptive difficulties. Working in the cognitive stream promotes the development of skills, related to active problem solving, teaches patients to monitor and regulate their own thoughts, moods, behavior.
It is important to remember that in the case of patients suffering from bipolar affective disorder, therapy cannot be the only action and cannot replace pharmacotherapy
Bipolar affective disorder how to live with it ?
What can help prevent episodes of depression and mania?
Studies have shown that being aware of early warning signs, monitoring them, having an early intervention plan, and then acting on that plan when needed can be very helpful. If a patient detects an impending episode early, it can enable early intervention and prevent a wave of problems. To be able to detect an impending episode, one must learn to recognize the individual early signs and characteristic symptom of the disease. To recognize your early signs of mania or depression, it is helpful to ask yourself questions:
How am I when my mood is moderately elevated and moderately elevated?
What am I like when I’m mildly and moderately depressed?
What am I like when I experience hypomania or mania
What are my first symptoms of bipolar disorder
What situations, factors in the past have triggered my mood disorder?
Will I be able to recognize these symptoms the next time I experience them?
Protective and risk factors
It’s worth remembering your own protective factors and those that are potentially risky. Risk factors are those that increase a person’s chances of contracting the disease, meaning they can exacerbate symptoms and treatment. Examples of risk factors include poor or maladaptive coping strategies, alcohol or drug use, unstable relationships, unstable work, interpersonal conflicts, stressful events, etc. If risk factors outweigh protective factors, the risk of relapse increases, then remission can occur very quickly.
On the other hand, protective factors are those that help protect a person from getting sick and increase the period of remission of the disease. Protective factors include good coping strategies, a good social support network, effective communication and problem-solving skills, etc. Remember that online psychotherapy is an important protective factor, improving psychological well-being and mental health.
What else is worth keeping in mind?
- Stick to a balanced routine and lifestyle
A chaotic lifestyle can itself promote stress and fickleness, in view of this, it is worthwhile to ensure a structured routine and balanced lifestyle. Remember to maintain good eating habits, sleep, exercise, and social and fun activities.
- Create a good social support network
How do you help a person with depression? It’s a good idea to find people with whom you can sit down, talk honestly and hear words of support. We’re not talking about psychotherapy sessions, but rather an opportunity to talk about everything going on in your life and just listen to someone else. Living with an illness is a difficult experience. Often the problems seem bigger alone. Just the experience of talking can help put things into perspective. At social gatherings, there is often simply a pleasant and fun atmosphere, which can naturally improve your mood.
- Create good professional help for yourself
Find a doctor or psychotherapist you trust, talk to them about your needs and concerns. Learn as much as you can about your illness and take a proactive stance against the disease
- Expect stumbling blocks
Regressions, worse moments can happen at any time, try not to fall into the trap of believing that you will “go back to square one,” as this only makes you feel worse and does not serve to improve. Use your skills learned in therapy to help yourself in such situations. It can be useful to remind yourself that most people have “down days” or days when life’s problems are more difficult to overcome – after all, it’s part of our lives!
If you are experiencing this type of problem, make an appointment with our specialists – cognitive behavioral therapy
Literature:
Monica Ramirez Basco “Bipolar affective disorder. How to manage mood swings”.
Trisha Suppes, Elen B. Dennehy “Bipolar affective disorder”.
Monica Ramirez Basco , Rush John A “Bipolar affective disorder. Cognitive-behavioral therapy”.