Bipolar disorder is a mental disorder, the main manifestations of which are mood swings. The disease has two opposite poles - in people suffering from this disorder, differences are very strong.
General characteristics of the disease, study in medicine
Patients with bipolar disorder (BAR, or bipolar affective disorder) experience alternating episodes of mania and depression. For some periods, mania alone or depression can 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 the psychiatrists Falre and Bayard. However, as an independent nosological unit, it was recognized by the medical community only in 1896. Then Krepelin's scientific works devoted to the study of this violation were published. Initially, the disease was called manic-depressive psychosis.
However, in 1993 he was included in the ICD-10 under another name - "bipolar affective disorder." There is no exact data on how widespread it is. This is due to the fact that the researchers of this disease use various criteria for evaluating it. In the 90s of the last century, domestic psychiatrists believed that about 0.45% of the total population suffers from this ailment. However, the assessment of foreign experts was slightly different - 0.8%.
What is bipolar disorder in simple words? In the presence of this disease, differences in the emotional state go far beyond the norm, they are inadequate to real life circumstances. The mood of the patient varies from depression to mania.
Some statistics
Currently, scientists believe that symptoms of bipolar disorder can occur in approximately 1% of people, and in a third of them, the disease takes the form of psychosis. Data on how often the disease occurs among the child population are also missing. This is due to the difficulties of using standard diagnostics in pediatric practice. Psychiatrists believe that in children episodes of the disease often remain undiagnosed.
In approximately half of patients, signs of bipolar disorder first occur between 25 and 45 years of age. In middle-aged people, as a rule, the unipolar form of the disease predominates, and in young people, the bipolar form. At an older age, depressive phases become more frequent. The disease is 1.5 times more likely to occur among the female part of the population than among men.
Causes of the disease and risk factors
It is believed that the main causes of the disease are hereditary (genetic) factors, as well as environmental conditions. In this case, scientists give greater importance to factors of heredity.
The conditions that increase the risk of developing the disease include:
- Belonging to the schizoid type of personality (preference for solitary activity, emotional coldness, monotony).
- Increased need for an orderly life, responsibility, a tendency to pedantry.
- A high level of suspiciousness, anxiety.
- Instability of emotional background.
The risk of signs of bipolar disorder in women increases significantly during hormonal instability (menstruation, pregnancy, the postpartum period, menopause). Particularly high is the risk for women who have a history of postpartum psychoses.
Forms of the disease
Clinicians use a classification of disorders that is based on the criteria for the prevalence of depression or mania in the clinical picture.
The disease can occur in bipolar form (there are two types of affective disorders) or unipolar (in the case of one type of violation). To unipolar forms, psychiatrists include periodic mania (hypomania), as well as periodic depression.
The following forms of the course of bipolar personality disorder are also distinguished:
- Correctly intermittent. In this case, periods of mania and depression clearly alternate and are separated by a bright interval.
- Incorrectly intermittent. The alternation of episodes occurs randomly. For example, several episodes of depression can be observed, which are separated by a bright stage, and then manic episodes occur.
- Double. Affective disorders immediately succeed, without a bright gap.
- Circular. Mania is replaced by depression (and vice versa) constantly, without light gaps.
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 bright interval is from 3 to 7 years.
Bipolar Disorder: Symptoms
The main symptoms of the disorder are highly dependent on the phase of the disease. For example, for the manic period are characteristic:
- fast paced thinking;
- mood boost;
- motor excitement.
At the same time, three degrees of severity of mania are distinguished:
- Easy (otherwise called hypomania). Elevated mood, working capacity - increased (and this applies to both physical and mental). High social activity is noted . The need for sleep and rest is significantly reduced, and in sex it is increasing. The patient is quickly distracted by extraneous irritants, cannot concentrate for a long time. As a result, social contacts become difficult. The duration of an episode of hypomania, as a rule, is at least a week.
- Moderate (without psychotic symptoms). Significantly increased physical and mental performance. The mood rises. Almost completely, the need for sleep disappears. There is a megalomania. The duration of this episode is also at least a week.
- Severe mania (with the presence of psychotic symptoms). Pronounced psychomotor agitation may be observed , a tendency to violence appears. Jumps of thoughts arise, the patient loses the connection between the facts. Hallucinations appear, delirium. Many patients can gain confidence that their ancestors belonged to a certain noble family, or begin to consider themselves a famous person. Efficiency is lost, the patient also cannot service himself. 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. The presence of the latter can be said:
- slow pace of thinking;
- reduced emotional background;
- motor inhibition;
- decreased appetite until the complete rejection of food;
- decreased sex drive;
- in women, menstruation may be absent, and in men in some cases erectile dysfunction develops.
With a mild form of depression, the emotional background can fluctuate throughout the day. As a rule, in the evening the mood improves, and in the morning depressive symptoms reach a maximum.
Forms of depression
With bipolar mental disorder, the following forms of depression can occur:
- Simple. In this case, the clinical picture is represented by the classical depressive triad (depressed mood, low speed of thinking, depletion of the emotional-volitional sphere).
- Hypochondriac. The patient may believe that he has a fatal disease, which modern medicine knows nothing about.
- Crazy. Depressive symptoms in this type are combined with delusions of accusation.
- Agitated. With this form of depression, there is no motor block.
- Anesthetic The main symptom is painful insensibility. It seems to the patient that his feelings and feelings have disappeared. In their place - a continuous void, which gives him torment.
Therapy
Treatment for 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, complementing each other perfectly. Properly selected therapy gives good results and allows you to get rid of the unpleasant symptoms of BAR.
Psychotherapy
Attacks of the disease can be controlled not only with drugs. A good therapist can help here. However, it is necessary to attend receptions 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 the help of psychotherapy, the patient's attention should be focused on the following points:
- The realization that the patient is not behaving quite adequately.
- Development of action algorithms for episode recurrence.
- Strengthening progress in the repetition of depressive or manic moments, as well as increasing control over the emotional-volitional sphere.
- Sessions with BAR therapy can be group, individual, as well as family.
Drug treatment
Antidepressants are used to relieve symptoms of depression. The choice of the drug, as well as its dosage, is determined by the attending psychiatrist, taking into account the age of the patient, the severity of the depressive state, as well as the possibility of his transition to mania. If necessary, antidepressant therapy is combined with the use of normotimics and antipsychotics (which are treated at the stage of mania).
Self diagnosis
A bipolar disorder test is a good way to conduct an initial diagnosis. It will allow you to track alarming symptoms on time, and also to find out if you need to see a psychiatrist. The questionnaire includes several blocks:
- Have there been periods in your life when physical and mental activity was much higher than usual, and could be characterized by the following features:
- you felt absolute confidence in yourself;
- thoughts and ideas jumped uncontrollably one upon another;
- You managed to redo a large number of cases - much more than usual;
- you have experienced a great rise in sexual desire;
- difficulties arose when it was necessary to concentrate, to carry out painstaking work;
- You did unexpected things that others considered stupid and even dangerous;
- you felt an excess of words, spoke more than usual;
- There were episodes of rash spending of money that resulted in damage to you or your loved ones.
2. If there is a positive answer to two or more questions, did it happen that these symptoms appeared simultaneously?
3. How could you assess the difficulties that arise in connection with these symptoms - for example, irritation in communicating with family people, increased sociability, and the inability to concentrate? Is it possible to say that they have a significant impact on the quality of life, are problematic or not?
An affirmative answer to three (or more) questions from the first list, as well as a positive answer to the second and third questions of the bipolar disorder test, is a serious reason to think about your health. You must visit a psychiatrist or neurologist. It is also useful to consult a psychologist.
Types of Violation
Consider the main types of bipolar disorder. This violation is divided into two main types - types I and II. Most often, a manic-depressive form occurs, that is, a type I disorder. In order to make such a diagnosis, it is necessary that a person has an attack of mania at least once. Also, people with a similar disorder may experience depressive episodes. Signs:
- A person with the first type often feels invulnerable.
- It is difficult for him to work and communicate with others.
- Such people are suicidal.
- Often addicted to alcohol or drugs.
As for type II, there is often a significantly lower intensity of symptoms. A weakened version of hypomania may occur, but depression is at the heart of this disorder. A person with type II bipolar disorder may be given the wrong diagnosis - “depression”. Signs:
- Depression of this type is different from clinical, as it often causes symptoms of mania.
- The patient can be anxious, irritable. Thoughts are constantly replacing one another, there are sharp outbreaks of activity, creativity.
- Most often, this disorder occurs in women.
- High risk of suicide, alcoholism and drug addiction.
Features of the disorder during puberty
Bipolar disorder in adolescents may look a little different. As a rule, mood changes more often, and episodes of a mixed type more often occur. During mania, irritability displaces heightened mood. In the depressive phase, headache, fatigue may disturb. There is no desire to go to school, unexplained bouts of crying arise. With bipolar personality disorder, there is a high likelihood of substance abuse. To improve health, a teenager may resort to alcohol or drugs. Parents should closely 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 must be treated.
BAR: advice from psychiatrists
Many people ask a legitimate 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 medication and special therapy. However, this is the best protection against relapses of the disease. Consider a few recommendations for suffering from BAR:
- The correct selection of specialists, both a psychiatrist and a psychologist, is of great importance. The doctor should inspire confidence, the desire to work on his healing. Tensions are unacceptable in the treatment of BAD.
- It is equally important to eliminate the causes of stress in life - for example, it can be unpleasant people, money problems, a constant lack of time. It is useful to keep a diary about the actions that the patient takes in case he feels stress.
- Even with confirmation of the diagnosis, it is important to continue communicating with people. It’s good to find a supportive friend who you can turn to before stress leads to another breakdown.
- It is very important to adhere to the basic rules of mental and physical health - to monitor the quality and duration of sleep, engage in physical activity, eat quality food.
Bipolar disorder is not a sentence. With adequate therapy, the help of relatives and friends, you can cope with the disease and live an ordinary life. Patients with BAD work successfully, have families, are realized in creativity. It is also proven that they, as a rule, have various creative talents and are very interesting in communication.