Bipolar affective disorder (BAR) is a mental illness that manifests itself in depressive, manic and mixed conditions, which have their own specifics. The topic is complex and multifaceted, so we will now talk about several of its aspects. Namely, about the types of disorder, its symptoms, the causes of the appearance and much more.
Characteristic
Bipolar affective disorder manifests itself in constantly alternating periods of depression and euphoria. A quick change in symptoms cannot go unnoticed.
Mixed states often arise. They are also called phases. They periodically replace each other. They can occur in combination with longing and restlessness and over-agitation, or in the simultaneous manifestation of lethargy and euphoria.
Mixed states occur either in a row or through light gaps, which are also called interphases, or intermissions. In such periods, the personal qualities of a person and his psyche are fully restored. It should be noted that no matter what the state of the BAR appears, they always have a bright emotional color, and they proceed rapidly and rapidly.
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 exposed to him increases if one of his closest relatives suffered from the BAR.
According to studies, these disorders are associated with genes that are thought to be on the 4th and 18th chromosomes. But besides heredity, autointoxication can also play a role, manifested in a violation of water-electrolyte metabolism and endocrine balance.
The scientists who conducted the study and subsequent comparison of the brain of ordinary people and those who have BAR, came to the conclusion that their neural activity and brain structures are different, and significantly.
Of course, there are predisposing factors. They can cause bipolar affective disorder, but only with regular repetition. We are talking about constant stresses that a person is exposed to over a long time period.
Another practice known cases when this disease developed as a side effect of taking certain medications prescribed to people to treat other ailments. Often, BAR occurs in those who suffer from alcohol or drug addiction. Moreover, the disease can develop both in existing addicts and in long-established ones.
Unipolar BAR
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. The unipolar type includes two states:
- Periodic mania. It manifests itself in the alternation of only manic phases.
- Recurrent depression. It manifests itself in the alternation of only depressive phases.
In short, it is worth talking about each of them. Because each phase is directly related to bipolar affective disorder. In psychiatry, they are also considered in great detail.
Periodic mania
It is considered by some experts as a form of manic-depressive psychosis, but this position is not officially approved in the ICD-10 classification.
Manic lights appear in a painfully elevated mood, motor excitement and an accelerated flow of thoughts.
There is also affect, which is characterized by excellent health, contentment and a sense of happiness. Pleasant memories arise, perceptions and sensations intensify, 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 recovery from somatic diseases.
- The emergence of optimistic plans.
- Perception of the surrounding reality in rich colors.
- Exacerbation of olfactory and taste sensations.
- Memory enhancement.
- Liveliness, expressiveness of speech.
- Improving smarts, sense of humor.
- Expanding the circle of acquaintances, hobbies, interests.
- Increased motor activity.
But also a person makes unproductive and easy conclusions, overestimates his own personality. Often there are crazy ideas of greatness. Higher feelings weaken, disinhibition of drives arises. Attention switches easily, instability is manifested in everything. He willingly takes on new things, but does not complete what he started.
And at one point a critical phase sets in. A person becomes extremely excited, even maliciously aggressive. He ceases to cope with household and professional duties, loses the ability to adjust his behavior.
Depressive phase
It is characterized by a painfully lowered mood (lasts more than 2 weeks), loss of ability to experience positive emotions, and the appearance of depressing sensations (for example, heaviness in the soul).
It also becomes difficult for a person to select words and form phrases, he pauses long before answering, he thinks hard. Speech becomes poor and monosyllabic.
Motor inhibition can also occur - clumsiness, drowsiness, lethargic gait, depressive stupor. Even the outwardly depressive phase is manifested. Usually in mournful facial expressions, withering of facial tissues and a violation of tone.
In addition to the symptoms of bipolar affective disorder manifested in the depressive phase, the following include:
- Depressive thoughts.
- The diminution of self-worth, unreasonably low self-esteem. Such phrases often sound: “My life does not make sense”, “I am a jerk”, etc. To convince a person at the same time is unrealistic.
- Feeling of hopelessness and hopelessness.
- Thoughts of brutal suicide.
- Self flagellation. Comes to the point of absurdity. A person can seriously reason in this way: “If in the third grade I shared a sandwich with Misha when he asked, he would not be disappointed in people and would not addicted to drugs.”
- Insomnia or a very small amount of restless sleep (up to 4 hours) with early awakenings.
- Impaired appetite.
The depressive phase in bipolar affective disorder, the symptoms of which are now briefly listed, can also be accompanied by physical ailments - constipation, increased heart rate, dilated pupils, irregular blood pressure, pain in the muscles, joints, and heart.
Other varieties
The next type of bipolar affective disorder is a correctly intermittent course. It is characterized by a change in the manic phase of the depressive and vice versa. The notorious light gaps (intermissions) are.
An irregularly intermittent flow also occurs. In this case, there is no specific sequence of phase rotation. A depressive one, for example, may again be followed by a depressive one. And vice versa.
Cases of a double course of bipolar affective disorder (manic-depressive psychosis) are also familiar to practice. It is characterized by a direct change of two notorious phases, followed by intermission.
The latter type of flow is called circular. For him, the correct alternation of phases is characteristic, but the absence of intermission. That is, there are no bright gaps at all.
Type II bipolar disorder
It’s a little worth talking about him. All that was mentioned above was related to bipolar disorder of the first type. To the second, of course, this information is also directly related. However, type 2 bipolar affective disorder is something else. This is the name of the BAR form, which is characterized by the absence of a mixed history of manic episodes in a person’s history. In other words, only depressive and hypomanic phases are present.
Namely, type II BAR is most often diagnosed as depression. This is because the notorious hypomanic manifestations usually elude the attention of a specialist. Needless to say, even the patient may not notice them.
To identify type II BAR, the doctor must pay special attention to the examination of hypomania. Its most striking manifestations are insomnia, anxiety, and also a great mood, regularly replaced by irritability. This usually lasts at least 4 days.
Patients notice that the emotions they experience during such periods are radically different from those that arise during periods of depression. They are also characterized by increased talkativeness, an exorbitant sense of self-importance, a flight of thoughts and irresponsible behavior.
Many suffer from hypomania from irritability and anxiety. Doctors focus on 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 side effect is a sharp and dynamic cyclical mood.
In the end, everything ends with a strong emotional disorder. This is dangerous, since a person can begin to take actions that are dangerous both for him and for others. If this phase goes into a deep manic state, then hospitalization is required. Indeed, in this condition, 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 such a condition may be mistaken as a response to treatment. But in reality it will be only 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, cases of fixing this ailment in children from 7 years old are already becoming frequent. Why does he appear in such young children? The reasons are unknown, but experts refer to genetics. But the factors that provoke BAR in babies are highlighted. These include:
- Impaired thyroid function.
- Bad or inadequate sleep.
- Great shock.
In the case of modern adolescents, the abuse of drugs or alcohol 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 banned for them.
How to find out that a child is suffering from bipolar affective disorder? First, he begins 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 isolated and sad, began to regularly arrange tantrums, react sharply to any comments, and seemingly lost interest in life.
Yes, this is similar to a transitional age, but the following factors are also added to the above, the manifestation of which children usually complain about:
- Headache.
- Chronic fatigue.
- Muscle pain.
- Excessive drowsiness or insomnia.
Typically, depression is diagnosed in this phase. But then it gives way to the manic stage. Phases alternate, there is a lull. Then - again a series of depressive states.
The manic phase in children happens much less often, and it differs from its manifestation in adults. Its attack provokes a trigger - a strong shock. It is more acute than in adults. The child becomes very irritable, and a good mood is replaced by outbursts of anger. Teenagers still often demonstrate sexual activity and aggression. Their self-esteem rises and their need for sleep is significantly reduced.
So the combination of several of these factors should be an alarming signal for both the teenager and his parents.
Diagnostics
It is important to talk about how bipolar affective disorder is determined. The diagnosis is not easy to establish. Because the categories of bipolarity are characterized by polymorphism.
In simple terms, this is a disease characterized by a number of different disorders that are similar to manifestations of other mental illnesses. He can be confused with psychosis, deep depression, emotional shock, even with one form of schizophrenia.
In addition, specialists use different diagnostic approaches. According to statistics, more than 70% of people who suffer from bipolar affective disorder receive a wrong, erroneous diagnosis.
And this is very bad, because this is followed by unreasonable medical appointments. A person begins to take unnecessary drugs, which exacerbates the course of bipolar disorder. As a result, the correct diagnosis is established on average 10 years after the onset of the development 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 act on a person.
- The presence of depression, dependence on prohibited substances or alcohol, impulsivity, comorbid conditions (the simultaneous presence of several diseases in a person).
- The early development of psychosis, occurring, despite the developed sociality.
- Family history, the presence of addiction diseases and affective disorders in immediate families.
- The presence of an idiosyncratic reaction or induced mania for antidepressants, if a person takes them.
In addition, comorbidity is taken into account - the presence of several chronic diseases at once, which are connected by a pathogenetic mechanism. In general, the diagnosis of bipolar affective personality disorder presents a lot of difficulties. Unfortunately, it will not be possible to identify the disease through the study of tests submitted by a person.
Therapy
Now it’s worth talking about the treatment of bipolar affective disorder. 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 directed to stopping the main symptoms. It starts from the moment of the clinical response to spontaneous remission that occurs outside of treatment. Stabilizing therapy should prevent exacerbation of bipolar affective disorder. Treatment lasts from 4 months for manic episodes and from 6 for depressive ones.
- Prophylactic. It is necessary 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.
Basically, therapy is 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 must be considered in therapeutic interventions.
Most often, after the diagnosis of bipolar affective disorder, mood stabilizers (sodium valproate and lithium), antidepressants, and atypical antipsychotics are prescribed. Everything is sold by prescription. According to statistics, the body reacts most actively to "sodium valproate." In comparison with it, "Carbamazepine", "Aripiprazole", "Quetiapine", "Haloperidol" give a weak effect.
Disability
Is it given in diagnosed bipolar affective disorder? Disability is a complete or partial disability due to mental, sensory, mental or physical disabilities. As already explained earlier, BAR refers to the first of the listed. So disability can issue.
However, the disease must be diagnosed. A person will need to describe in detail everything that happens to him: is there dystonia and fever, is there a problem with sleep, what is accompanied by all the notorious phases, are voices heard sometimes, 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 commit suicide, engage in self-harm, etc. In such cases, they give the second group of disability, in which a person is considered inoperative. But serious long-term treatment is also prescribed in the clinic under the supervision of specialists.