Bipolar psychosis of the manic and depressive type is a phenomenon that is recognized as a mental disorder and can be observed in people of different age categories. Next, we consider the main manifestations of this disorder, as well as the main causes of its formation and treatment methods.
Medical history
The study of the problem was begun in 1854. In any case, it is this year that dates the first reflection of the symptoms of this psychological disorder in the scientific literature. The first mention of it was made in the works of the great French psychiatrists Bayardzhe and Falre. A little later, this pathology was studied in more detail in the work of another specialist in this field - Kraepelin.
The original name for bipolar disorder is known to be manic-depressive psychosis. Since 1993, after its introduction into the ICD-10, the diagnosis has been renamed more appropriately. Psychiatrists justified this decision by the fact that with the pathology under consideration, the occurrence of psychoses is not always observed.
general characteristics
Bipolar disorder (manic-depressive psychosis) is a phenomenon that is quite common in modern psychiatry. The peculiarity of this disorder is that it manifests itself in the form of regular affect disorders, or, to put it more simply, unreasonable sudden changes in mood.
Psychiatrists note that patients with this type of disorder regularly experience a change in mania (in some cases hypomania) with depression and vice versa. At certain periods, the clinical picture of this problem manifests itself in the form of the onset of persistent depression or only mania. At some points, intermediate or mixed states may be observed.
Who is diagnosed
There is currently no accurate data on the age of patients with the disorder in question. Practice shows that most patients of psychiatrists are aged 25 to 45 years. Moreover, statistics show that people in the middle age category have a unipolar form of the disease, and those younger are bipolar.
As practice shows, if the disorders of the type in question were not previously observed, then the first crisis can happen after the age of 50 - this is what happens in 20% of psychiatrists suffering from bipolar deviation.
As for determining the propensity for bipolar disorder by gender, the symptoms of bipolar psychosis are observed more often in women than in men (1.5 times more cases).
Practice shows that the recurrence of outbreaks of symptoms characteristic of bipolar disorder is observed in almost all cases (about 90%). Speaking about the consequences of this phenomenon, it is worth noting their great seriousness, since on average about 30-50% of patients with persistent impairment lose their ability to work and get disability after a certain time.
Causes of symptoms
Currently, specialists in the field of psychiatry cannot indicate a specific list of exact causes that entail a guaranteed change in the psyche called bipolar manic psychosis. Instead, they note that the reasons lie in internal factors and environmental influences. Experts also note that the possibility of acquiring such a disease directly depends on a hereditary predisposition.
Today, there is a certain list of factors that, according to experts in the field of psychiatry, contribute to the emergence, strengthening and development of manic-depressive disorder of the bipolar type. These include:
- emotional lability (instability);
- the presence of signs of a schizoid personality type in a person (monotony, emotional coldness, desire for solitude, the presence of rationalization);
- anxiety;
- increased suspiciousness;
- a tendency to melancholy behavior (restraint in the manifestation of various emotions, the presence of high sensitivity, increased fatigue);
- the presence of signs of a statotymic type of personality (increased level of responsibility, a constant demand from others to observe a certain order, pedantry).
In addition to all of the above, according to psychiatrists, the risk of developing symptoms of bipolar psychosis increases significantly in women during a period of sharp fluctuations in hormonal levels. Vivid examples of such are moments of menstrual bleeding, as well as during menopause or in the postpartum period. In particular, the risk of developing such a disease is great for those women who have a history of the presence of short-term psychoses in the postpartum period.
Forms of the disease
It should be noted that the concept of bipolar affective psychosis provides for several forms of the disease in which it can be expressed. As for the classification of forms of disorders, it is based on the prevalence of what phenomena can be observed in the clinical picture of the patient: mania or depression, as well as in the order in which they alternate.
Speaking about the problem under consideration, it is worth noting that it can occur in two forms: bipolar and unipolar. In this case, a deviation will be recognized as bipolar disorder, during the course of which both types of disorders of an affective type are observed. As for unipolar disorder, its manifestation is the constant observation of an affective disorder of one type (or only depression, or only mania).
When considering the forms of the course of the type of disorder under consideration, special attention should be paid to its bipolar type. This is due to the fact that it tends to leak in various ways:
- correctly intermittent disorder (when there is a regular change in depression and mania, in between which clarifications of consciousness occur);
- incorrectly intermittent (when depression and mania alternate, but in a chaotic manner);
- circular disorder (when observing this type of deviation, there is a constant change in depression and mania, and between such states there is no place for enlightenment of consciousness);
- double (when observing this form of the disorder, two opposite episodes of the disorder are observed in a row; in between, there are no enlightenment of consciousness, the “bright” phase occurs after).
As for the number of phases of the disorder observed in psychiatric patients, it can be different: it happens that after a single manifestation of the disorder, the relapse no longer occurs, but in most cases they recur, and an unlimited number of times.
As for the duration of the phases of the disorder, it can be any, but, as practice shows, the average is 2-3 months. Statistics also show that episodes of depression occur much more often than bipolar psychoses with a predominance of manic conditions. It should also be noted that depressive disorders last much longer than manic (3 times).
Considering the features of the periods of enlightenment of consciousness between disorders, it is worth noting that such periods, as a rule, have a fairly stable duration of about 3-7 years, depending on the environment.
Symptoms of the disorder
Bipolar affective psychosis: what is it? Specialists in the field of psychiatry note a certain list of symptoms indicating that a person has deviations of the type in question. It is worth noting that they differ significantly depending on what phase the disorder itself is in: mania or depression. We consider them further in more detail, separately.
So, for bipolar psychosis with a predominance of depressive states, the following symptoms are characteristic:
- sudden or gradual weight loss;
- retardation of movements;
- constantly lowered mood;
- decreased appetite (in some cases, its complete absence);
- decreased libido;
- retardation of thinking.
In addition to all of the above, during the course of manic-depressive psychosis with bipolar disorder in men, erectile dysfunction can be observed, which is due to a decrease in libido and a constantly lowered mood level. As for women, their menstrual cycle may end.
Speaking of the symptoms characteristic of the manic stage of the disorder, it is worth highlighting the complete opposite of all those signs that are observed in people who are in the phase of depression, namely:
- motor excitement;
- excessive mood rises;
- accelerated thinking.
As for the types of mania, it can be mild, severe, and moderate. Consider their features in more detail.
With easy mania, you can observe a person's constant stay in high spirits. In his daily regimen, there is a significant decrease in the need for sleep, but the number of other desires is increasing: sex, food, physical activity, communication with others, etc. As practice shows, the period of mild mania (or, as it is called in psychiatry, hypomania) tends to not last long - only for several days.
Speaking of moderate mania, it is worth saying that this stage proceeds without observing any psychotic symptoms. At this time, a person has almost no need for sleep, he begins to be constantly distracted by something and cannot concentrate on any elements of activity, as a result of which he partially loses his working capacity. It is worth noting that with this form of the disorder, the patient's ability to contact with others is significantly impaired. Moreover, with such a deviation, people often develop megalomania. The duration of such an episode is usually not more than a week.
What is worth saying about the severe form of the disorder? First of all, it should be noted that this form is always accompanied by psychotic symptoms. As a rule, during its course, the patient has a tendency to violence, excessive excitement, as well as a continuous stream of thoughts with jumps from one to the other. During the course of this phase of the patient, hallucinations and delirium can torment, which is characteristic of the usual process of schizophrenia. Often a person begins to consider himself great and assure everyone that his ancestors belong to a well-known and very noble family. An essential sign that a manic disorder has a severe form is the fact that a person completely loses not only his ability to work, but also the opportunity to look after himself. This form of mania tends to last more than one week.
As for depression, they can also take various forms:
- simple (classic picture);
- hypochondriacal (confidence in the presence of a terrible disease);
- delusional (delusions of accusation);
- agitated (classic picture with the absence of motor inhibition);
- anesthetic (a feeling of painful insensibility).
Diagnostics
In order for the psychiatrist to be able to make an appropriate diagnosis, it is necessary to observe at least two episodes of affective disorders. In order to make a correct diagnosis, a specialist can study not only the patient’s history, but also the information that his relatives provide.
As for the process of determining the severity of the disease, it is carried out on a certain scale.
Treatment
What to do if a patient has been diagnosed with bipolar affective psychosis? The clinical recommendations for the treatment of this deviation provide for intervention by normalizing the patient's condition, as well as improving his mood. As a result of the correct actions, the patient will have a long period of remission.
As for the place where treatment should be carried out, in the case of a mild form of the disease, treatment is carried out on an outpatient basis, and in severe cases, in a psychiatric clinic.
Correctly selected antidepressants are used to relieve episodes of depression. As for the choice of funds, this can only be done by a specialist in the field of psychiatry after examining the patient, taking into account the severity of depression, the ability to switch into a state of mania, and the patient's age. For the treatment of particularly severe forms of depression, the psychiatrist may prescribe antipsychotics or normotimics in addition to antidepressants.
If the disorder occurs in the stage of mania, treatment is carried out exclusively by normotimics, but in the case of a severe form of the disease, by antipsychotics.
After completing the full course of treatment, the patient goes through the stage of remission. This period should occur in a family environment. At this time, different types of psychotherapy can also occur (family, individual, group).
About the complications of the disorder
Those people who have developed psychosis in bipolar disorder must be examined by a psychiatrist. And you also need qualified treatment that is fully consistent with the severity of the disease. Carrying out such actions is an urgent need, since when ignoring the problem in the vast majority of cases, the disease begins to progress.
If the disease progresses, the patient may experience manic seizures, during which the person is even able to make suicidal attempts. Also, such situations are fraught with committing by a person dangerous actions for society through negligence.
About forecasts
Special attention should be paid to what are the forecasts for the further development of mental illness.
It should be noted that modern psychiatrists note that the deviation in question is very often combined with abuse of bad habits (alcoholism, drug addiction, etc.). It is worth considering that in the presence of this factor, the severity of the disorder only intensifies, and the prognosis of treatment, as a rule, indicates a hopeless situation.
As for the general forecasts, the presence of the deviation in question often has not the most favorable forecasts. As treatment practice shows, about 90% of people suffering from it later again begin to experience complications, resulting in a relapse.
Statistics show that for every third patient, the disorder in question proceeds continuously, without the presence of intervals of awareness or with their minimum duration. However, it is known that when observing such a person can completely recover a complex of mental functions, but, as a rule, this is not for long.