Bipolar disorder is a fairly common emotional disorder, affecting 1% of the world’s population. This pathology is characterized by extreme emotional changes, including episodes of mania alternating with depression or may also occur at the same time.
Bipolar disorder affects about 1% of the world’s population
What is bipolar disorder?
Bipolar disorder is also known as bipolar affective disorder, bipolar illness, and manic-depressive disorder. This term refers to a form of mental disorder that causes extreme changes in emotions including low emotions (depression) and high emotions (mania). Episodes of depression and mania often occur alternately but sometimes occur in the same period and will often have one pole predominate over the other.
Bipolar disorder is classified as an emotional disorder. According to statistics, about 1% of the world’s population is facing this disease. The disease usually begins in adolescence and between the ages of 20 and 30. While depression is more common in women, the risk of bipolar disorder is equal in both sexes.
Similar to other mental disorders, bipolar disorder markedly impairs work performance, learning, and social interactions. It also increases the risk of suicide – especially during depressive episodes. To date, the cause of the disease is still unknown and the treatment process is quite limited. Therefore, about 1/3 of patients have to live with this disease for the rest of their lives.
Types of bipolar disorder
Bipolar disorder is divided into different types based on clinical symptoms. Currently, this disorder is divided into 3 categories including bipolar I, II disorder and cyclical mood disorder.
Manic-depressive illness is divided into 3 different types based on the characteristics of the disease cycle
- Bipolar I Disorder: Bipolar I disorder is defined in the full presence of a typical manic episode. Before or after manic episodes are depressive or hypomanic episodes. During a manic episode, the patient may experience psychotic symptoms.
- Bipolar II Disorder: Defined as having at least one major depressive episode and at least one hypomanic episode. At the same time, complete absence of manic episodes. Bipolar II disorder is more prone to depression, so it affects mainly women.
- Cyclical Mood Disorder: Cyclic mood disorder consists of episodes of hypomania and mild depression that occur alternately within one year (for children, adolescents) and two years (for adults). great).
Bipolar disorder is an emotional disorder with diverse symptoms. The symptoms are not the same for each person and there are also marked differences in each stage. In which, bipolar I disorder predominates in manic episodes and bipolar II disorder predominates in depression. Meanwhile, cyclic mood disorder (cyclic affective disorder) is usually milder, has a shorter duration of progression, and is less likely to cause serious consequences.
Manifestations of bipolar disorder
Bipolar disorder has a wide range of symptoms and may vary depending on the stage. Symptoms of the disease often appear acute, then repeat in cycles and gradually subside. After remission, patients can return to normal life, but there are also people who have to face residual symptoms and encounter many annoyances when studying and working.
After acute episodes, the disease may recur with separate episodes of greater severity, which may be manic, mild depressive, depressive, or mixed features. Phases can last from a few weeks to 3 to 6 months.
Not only the difference in manifestations, the cycle – the time from the onset of one stage to the next is also different in each disease. Some patients have rapid cycles (more than 4 periods per year) while others have only a few episodes throughout their lives. In most cycles, one pole will prevail over the other, with mania predominating in men and depression predominating in women.
Symptoms of bipolar disorder:
1. Mania and hypomania
Mania is a state of elevated mood characterized by excitement, optimism, joy, increased physical activity, and an increased body of energy despite a decrease in the need to eat and sleep. During manic episodes, the patient is very excitable and difficult to control himself. These features must be accompanied by more than 3 of the following symptoms:
During a manic episode, mood is elevated leading to mental happiness, optimism, increased energy, and physical activity.
- Reduced need for sleep
- Exaggerate about one’s abilities, appearance and increase self-esteem
- Fast-paced, scattered thinking is reflected in the appearance of continuous thought streams, talking a lot, quickly, reducing the ability to concentrate and being scattered.
- Talking constantly and talking more than usual
- Increased physical activity, even agitation and aggression if mood is excessive
- Having thoughtless, impulsive behavior that does not care about consequences such as risky investments, excessive shopping, racing, unsafe sex, gambling, etc.
It can be seen that the elevated mood during manic episodes causes the patient to behave instinctively and extravagantly without thinking about the consequences. These symptoms interfere with schoolwork, occupation, and activities of daily living. However, in the manic state, the patient believes that he is in the best mental state because the body is always full of energy and the spirit is happy and optimistic.
In addition to mania, patients with bipolar disorder may experience hypomanic episodes. This condition is less severe than mania. Hypomania usually lasts for at least 4 days or more and is characterized by symptoms such as:
- Bright mood creates a cheerful, optimistic spirit
- Reduced need for sleep
- Speak quickly but clearly and not as fast as a manic episode
- Increase confidence and creativity
Hypomania sometimes brings many benefits to life. During this stage, the patient is always energetic, confident, creative and has good communication skills. Because the mood is only moderately increased, the patient can still maintain normal working, studying and living activities.
However, some patients experience unpleasant symptoms during hypomanic episodes such as:
- Mood is unstable
- Irritability, anger
- Easily scattered, lack of concentration
2. Depressive episode
The opposite of mania is depression – a low emotional state. Typical depression often presents in bipolar II disorder. In the other two forms, the patient may develop a depressive state with milder manifestations known as mild depression.
Depression is an emotional state that is the exact opposite of mania
Typical depression is characterized by a low mood, loss of interest and interest in things. This condition lasts for at least 2 weeks and is accompanied by at least 5 of the following symptoms:
- The patient has a sad, depressed mood that takes up most of the day
- Significantly reduced interest, interest in everything around – including previous interests
- Decreased energy leads to fatigue and lethargy
- Insomnia (usually waking up in the middle of the night) or sleeping too much
- Decrease or increase in appetite leading to unintentional weight loss/gain
- Feelings of guilt and thinking that you are worthless even though this is not true
- Indecisiveness, inability to concentrate and slow thinking
- Constant thoughts of death, thoughts or plans to commit suicide
3. Mixed phase
In addition to depression, mania, and hypomania, patients with bipolar disorder may also experience mixed episodes. This phase is defined as a manic/hypomanic episode accompanied by at least 3 depressive symptoms that occur on most days of the episode.
Compared with manic or depressive episodes, mixed episodes are often associated with a higher risk of suicide because the patient is in constant cyclical state. In addition, because the symptom is a mixture of many emotional states, the diagnosis process also takes a long time.
4. Some accompanying symptoms
In addition to the characteristic features mentioned above, patients with bipolar disorder may also experience a number of accompanying symptoms, often psychotic, anxiety, and physical symptoms. In bipolar I and II disorder, patients are more likely to experience anxiety, melancholy, and stress as a result of the disease’s impact on life. In particular, severe cases may be accompanied by psychosis:
- Mania with psychotic symptoms is usually hallucinations, hallucinations and paranoia with conceited content, exaggerating self, etc. In addition, patients may also have hallucinations that they are being watched or paranoia with sexual content.
- In contrast, during depressive episodes, patients mainly have psychotic manifestations such as hallucinations, hallucinations and paranoia about being punished, criticizing and criticizing for mistakes made. Depression that accompanies psychosis causes deep suffering and sometimes leads to suicidal behavior.
Heredity is one of the factors that increase the risk of manic-depressive illness
Causes of bipolar disorder
The cause of bipolar disorder (manic-depressive illness) is unknown. However, several factors have been identified to be involved in the pathogenesis. Factors associated with manic-depressive illness include:
- Heredity: Most mental disorders are hereditary, and this goes for bipolar disorder as well. Experts found that the risk of the disease increased significantly if there was a first-degree relative with a history of the disease (including parents or siblings). However, experts have not yet found the genes involved in the genetic mechanism of this disease.
- Neurotransmitter Disorders: Neurotransmitters in the brain play a role in regulating emotions and the activities of many organs in the body. Most patients with mood disorders in general and bipolar disorder in particular have an imbalance of these substances, especially norepinephrine and serotonin.
- Risk factors: In addition to genetics and neurotransmitter imbalances, manic-depressive illness is also associated with factors such as alcohol abuse, substance abuse, and high stress (bereavement of a loved one) , terrible accident, default, chronic illness, incurable, …).
Currently, experts have not found the exact cause for most mental disorders. Therefore, the treatment process of these diseases still has many limitations and challenges.
What complications does bipolar disorder cause?
People around them can easily notice the emotional and behavioral abnormalities of a person with bipolar disorder. However, patients may not notice this condition and often dismiss it when others suggest examination and treatment. In particular, some patients feel at their best during a manic episode. With elevated mood, patients will easily make friends, increase creativity and study and work effectively.
However, excessive excitement comes with many risks such as aggression, breaking the law, financial problems and conflict in relationships. In addition, extravagant behaviors during this period also increase physical and health damages such as racing injuries, infection with social diseases due to unsafe sex, etc.
In addition, during depressive episodes and mixed episodes, patients may develop suicidal thoughts and behaviors. Some patients use alcohol and drugs to relieve deep sadness, pessimism, and guilt. If left untreated, patients will face many problems in life and may develop other psychological problems such as anxiety disorders, attention deficit hyperactivity disorder, eating disorders, etc.
Diagnosing bipolar disorder
Bipolar disorder has a variety of symptoms and sometimes a mixture of mania, hypomania, and depression. To diagnose this pathology, the doctor will use the following techniques:
- Diagnosis through clinical manifestations according to DSM-5 . criteria
- Measure TSH and Thyroxine (T4) levels to rule out hyperthyroidism
- Urinalysis to rule out the use of drugs and central nervous system stimulants
Bipolar disorder is only diagnosed when symptoms cause significant effects on social functioning, work performance, and learning. In addition, the patient may also need to have additional diagnostic tests to rule out schizoaffective disorder – a mental disorder that presents with mania, depression, and symptoms of schizophrenia. including psychosis). In addition, having multiple medical conditions at the same time makes it difficult to diagnose bipolar disorder.
Treatments for bipolar disorder
As mentioned, bipolar disorder usually develops in three phases. Initially, symptoms appear acute, then continue until remission. Eventually, the disease will go into complete remission. The goal of treatment is to keep the patient in remission so that he can stabilize his life and prevent the consequences of mania and depression.
People with cyclical mood disorders are usually treated on an outpatient basis. Meanwhile, bipolar I and II disorders may require inpatient treatment during acute episodes to avoid the risk of suicide and the serious consequences of reckless behaviour. Similar to other affective disorders, the mainstay of bipolar disorder is medication and psychotherapy.
1. Using drugs
Medication is the mainstay of treatment for manic-depressive illness. Depending on the stage of the disease and the severity of symptoms, the doctor will consider prescribing the appropriate medication. After symptoms have resolved, patients need maintenance medication to prevent recurrence.
Medications used during the manic phase:
- Mood stabilizers and anticonvulsants such as Carbamazepine, Valproic acid, etc.
- Neuroleptics/antipsychotics are used to reduce hallucinations, delusions, agitation, and abnormal behaviors. Commonly used drugs include Aripiprazole, Quetiapine, Risperidone, Olanzapine, etc.
- Benzodiazepines are used to control mania, improve sleep, and reduce restlessness and agitation. The most commonly used drug is Seduxen.
- The most commonly used mood-modifying drug is Lithium. The drug has a rapid effect in stabilizing mood and most symptoms are relieved quickly after 2 weeks of treatment.
Medications used in depressive episodes:
- Common types of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors, …
- May be used with antipsychotics if hallucinations and delusions are present.
- Antidepressants are only used for a short time and family members need to be closely monitored to promptly stop taking them as soon as the patient turns into a manic state.
Medications used to prevent relapse:
- Anticonvulsants (Carbamazepine, Gabapentin, Valproic acid, Topiramate, Lamotrigine, etc.)
- Mood stabilizers (Lithium)
- Antipsychotic / neuroleptic drugs
The goal of maintenance treatment is to stabilize mood and prevent disease recurrence. Because of the long-term use of drugs, patients need to check liver – kidney function regularly for timely adjustment. In addition, family members need to support the patient in taking medication to avoid forgetting to use the drug, taking an overdose and promptly detecting side effects.
2. Psychotherapy
Besides medication, psychotherapy is also an important method in the treatment of manic depression. Usually, the patient will receive individual therapy. However, bipolar disorder is chronic and is likely to develop throughout life. Therefore, group therapy will be considered so that partners and family members understand the feelings and troubles that the patient is facing.
The goal of psychotherapy is to psychologically help patients achieve better mental and physical health. Depending on the stage of the disease, the specialist will choose the appropriate therapy. For manic-depressive illness, psychotherapy is also provided with the aim of helping the patient understand the role of treatment – especially medication use. Because patients with bipolar disorder often do not want to take drugs during manic episodes because they believe that drugs reduce creativity and excitement and make patients unable to be happy and optimistic.
In addition to medication, psychotherapy is also an important method in the treatment of bipolar disorder
During depressive episodes, psychotherapy helps patients improve self-esteem and motivation to perform daily activities as well as maintain school and work performance. During manic episodes, the patient has almost no suicidal thoughts or behaviors. However, sufferers face many health problems due to unhealthy lifestyle, financial pressure and a series of consequences due to reckless and extravagant behaviour.
First, the specialist will help the patient to be aware of keeping a healthy lifestyle, avoiding alcohol, sleeping pills and ensuring adequate sleep even though there is no need. To limit financial consequences, it is necessary to have a family member to manage expenses for the patient. In addition, experts will help patients understand the consequences of having unprotected sex, racing, talking without thinking, etc.
Psychotherapeutic therapies used in patients with bipolar disorder:
- Cognitive behavioral therapy
- Educational psychotherapy
- Psychoanalytic therapy
In addition, families should encourage the patient to join groups specifically for patients with manic depression. Valuable experiences from other patients will help the patient learn to control and regulate his or her own emotions. At the same time, have the skills to deal with and overcome the troubles in life caused by this disease.
3. Other methods
Most patients with manic depression respond well to medication and psychotherapy. However, for severe cases, with suicidal thoughts and behaviors, your doctor will consider a number of other methods.
Methods that may be applied to patients with bipolar disorder:
- Electroconvulsive therapy: Electroconvulsive therapy (ECT) is used in major depressive episodes – especially treatment-resistant depression. In addition, some cases of mania are also considered for this therapy.
- Light therapy: Light therapy is used for bipolar I and II disorders that are seasonal (usually severe in the fall-winter and mild in the spring-summer). This therapy uses artificial light to replace sunlight because in autumn and winter, the intensity and duration of sunlight is significantly reduced. Light therapy increases vitamin D synthesis and decreases the hormone melatonin, which plays a role in regulating emotions and reducing drowsiness and loss of energy.
Care for patients with bipolar disorder
Currently, the etiology and pathogenesis of bipolar disorder are unknown. Therefore, it is very difficult to prevent recurrence of the disease. However, patients can prolong the stabilization period of the disease and minimize the effects of manic and depressive episodes through the following measures:
- Pay attention to the warning signs and tell your doctor right away. Early detection and intervention will help control symptoms quickly, while minimizing the health and financial consequences of manic and depressive episodes.
- Absolutely do not use alcohol and stimulants. Also, only use sedatives when prescribed by your doctor. Substance and drug abuse can increase the risk of relapse, worsen symptoms, and increase suicidal ideation.
- Use the drug as directed, do not adjust the dose on your own and absolutely do not stop the drug without the permission of the doctor because stopping suddenly can cause withdrawal syndrome.
- Share your health status with those around you to receive support when needed. In particular, patients need to be honest with their superiors to avoid troubles at work.
- Build a healthy lifestyle and equip yourself with stress-relieving skills.
Bipolar disorder is a chronic mental disorder and is likely to be lifelong. Although there is no optimal method, at present, appropriate treatment and care can control symptoms, help patients minimize damage in the disease stages and stabilize long life.
