Irritability, anxiety, depressed mood can be not just the consequences of a hard working week or any setbacks in your personal life. These may not be just nerve problems, as many prefer to think. If a person for a long time without significant reason feels spiritual discomfort and notices strange changes in behavior, then you should seek the help of a qualified psychologist. Perhaps this is a manic-depressive psychosis.
Two concepts - one essence
In different sources and various medical literature devoted to mental disorders, you can find two concepts that at first glance may seem completely opposite in meaning. This is manic-depressive psychosis (MDP) and bipolar affective disorder (BAR). Despite the difference in definitions, they express the same thing, they speak of the same mental illness.
The fact is that from 1896 to 1993, a mental illness expressed in a regular change in the manic and depressive phases was called manic-depressive disorder. In 1993, in connection with the revision by the world medical community of the international classification of diseases (ICD), TIR was replaced by another abbreviation - BAR, which is currently used in psychiatry. This was done for two reasons. First, bipolar disorder is not always accompanied by psychosis. Secondly, the definition of TIR did not only scare the patients themselves, but also repelled other people from them.
Statistical data
Manic-depressive psychosis is a mental disorder found in approximately 1.5% of the world's inhabitants. Moreover, the bipolar variety of the disease is more common in women, and monopolar in men. About 15% of patients undergoing treatment in psychiatric hospitals suffer precisely from manic-depressive psychosis.
In half the cases, the disease is diagnosed in patients aged 25 to 44 years, in a third of cases in patients older than 45 years, and in older people there is a shift towards the depressive phase. Rarely, the diagnosis of MDP is confirmed in people under 20 years of age, since during this period of life a quick change of mood with a predominance of pessimistic tendencies is normal, since the psyche of a teenager is in the process of formation.
TIR characteristic
Manic-depressive psychosis is a mental illness in which two phases - manic and depressive - alternate with each other. During the manic phase of the disorder, the patient experiences a huge surge of strength, he feels excellent, he seeks to channel excess energy into the channel of new hobbies and hobbies.
The manic phase, which lasts for a relatively short time (about 3 times shorter than the depressive one), is followed by a “bright” period (intermission) - a period of mental stability. During the period of intermission, the patient is no different from a mentally healthy person. However, the inevitable subsequent formation of the depressive phase of manic-depressive psychosis, which is characterized by a depressed mood, a decrease in interest in everything that seemed attractive, a detachment from the outside world, the emergence of suicidal thoughts.
Causes of the disease
As in the case of many other mental illnesses, the causes of the onset and development of MDP are not fully established. There are a number of studies proving that this disease is transmitted from mother to child. Therefore, for the debut of the disease, the factor of the presence of certain genes and a hereditary predisposition is important. Disruptions in the endocrine system, namely, an imbalance in the amount of hormones, also play a significant role in the development of MDP.
Often a similar imbalance occurs in women during menstruation, after childbirth, during menopause. That is why manic-depressive psychosis in women is observed more often than in men. Medical statistics also suggest that women who have been diagnosed with depression after childbirth are more prone to the onset and development of MDP.
Among the possible causes of the development of a mental disorder is the patient’s personality itself, its key features. More than others, people belonging to the melancholic or statotymic type of personality are prone to the onset of TIR. Their distinguishing feature is a moving psyche, which is expressed in hypersensitivity, anxiety, suspiciousness, fatigue, unhealthy desire for orderliness, as well as solitude.
Diagnosis of the disorder
In most cases, bipolar manic-depressive psychosis is extremely easy to confuse with other mental disorders, for example, anxiety disorder or some types of depression. Therefore, to confidently diagnose MDP, the psychiatrist needs some time. Observations and examinations continue at least until the manic and depressive phase, mixed conditions are clearly identified in the patient.
Anamnesis is collected using tests for emotionality, anxiety and questionnaires. The conversation is conducted not only with the patient, but also with his relatives. The purpose of the conversation is to review the clinical picture and course of the disease. Differential diagnosis allows the patient to exclude mental illnesses that have symptoms and signs similar to manic-depressive psychosis (schizophrenia, neurosis and psychosis, other affective disorders).
Diagnosis also includes such examinations as ultrasound, MRI, tomography, all kinds of blood tests. They are necessary to exclude physical pathologies and other biological changes in the body that could provoke the occurrence of mental abnormalities. This, for example, the malfunction of the endocrine system, cancerous tumors, various infections.
Depressive TIR phase
The depressive phase usually lasts longer than the manic, and is characterized primarily by a triad of symptoms: depressed and pessimistic mood, slowed thinking and inhibition of movement, speech. During the depressive phase, mood swings are often observed, from depressed in the morning to positive in the evening.
One of the main signs of manic-depressive psychosis within this phase is a sharp weight loss (up to 15 kg) due to a lack of appetite - the food seems to the patient fresh and tasteless. Sleep is also disturbed - it becomes intermittent, superficial. A person may be disturbed by insomnia.
With an increase in depressive moods, the symptoms and negative manifestations of the disease intensify. In women, even a temporary cessation of menstruation may be a sign of manic-depressive psychosis during this phase. However, the intensification of symptoms, rather, is to slow down the patient's speech and thought process. Words are hardly selected and connected with each other. A man closes in himself, detaches himself from the outside world and any contacts.
At the same time, the state of loneliness leads to the emergence of such a dangerous complex of symptoms of manic-depressive psychosis as apathy, melancholy, and extremely depressed mood. It can cause suicidal thoughts in the patient to form in the head. During the depressive phase, a person diagnosed with TIR needs professional medical assistance and support from loved ones.
Manic TIR phase
Unlike the depressive phase, the triad of symptoms of the manic phase is directly opposite in nature. This is an elevated mood, violent mental activity and speed of movement, speech.
The manic phase begins with the patient's sensation of a surge of strength and energy, a desire to do something as soon as possible, to realize himself in something. At the same time, a person has new interests, hobbies, and the circle of acquaintances is expanding. One of the symptoms of manic-depressive psychosis in this phase is a feeling of an excess of energy. The patient is endlessly cheerful and cheerful, does not need sleep (sleep can last 3-4 hours), makes optimistic plans for the future. During the manic phase, the patient temporarily forgets past grievances and failures, but recalls the names of films and books lost in memory, addresses and names, phone numbers. During the manic phase, the effectiveness of short-term memory increases - a person remembers almost everything that happens to him at a given moment in time.
Despite the seemingly at first glance productivity of the manifestations of the manic phase, they do not play into the patient's hand at all. So, for example, a violent desire to realize oneself in something new and an unbridled desire for active work usually does not end with something good. Patients during the manic phase rarely bring any business to the end. Moreover, hypertrophied self-confidence and good luck from outside in a given period can push a person to rash and dangerous actions for him. These are large stakes in gambling, uncontrolled spending of financial resources, promiscuous sexual intercourse and even the commission of a crime for the sake of gaining new sensations and emotions.
Negative manifestations of the manic phase are usually visible immediately to the naked eye. The symptoms and signs of manic-depressive psychosis in this phase also include extremely fast speech with swallowing words, energetic facial expressions and sweeping movements. Even preferences in clothes can change - it becomes more catchy, bright colors. During the culmination stage of the manic phase, the patient becomes unstable, excess energy turns into extreme aggressiveness and irritability. He is not able to contact with other people, his speech may resemble the so-called verbal okroshka, as in schizophrenia, when sentences are divided into several parts that are not logically connected with each other.
Treatment of manic-depressive psychosis
The main goal of a psychiatrist in the treatment of patients with a diagnosis of MDP is to achieve a period of stable remission. It is characterized by a partial or almost complete alleviation of the symptoms of an existing disorder. To achieve this goal, it is necessary both the use of special drugs (pharmacotherapy), and the appeal to special systems of psychological impact on the patient (psychotherapy). Depending on the severity of the disease, the treatment itself can take place both on an outpatient basis and in a hospital setting.
Since manic-depressive psychosis is a rather serious mental disorder, its treatment is not possible without taking medication. The main and most frequently used group of drugs during treatment of patients with BAD is a group of normotimics, the main task of which is to stabilize the patient's mood. Normotimics are divided into several subgroups, among which lithium preparations, used mainly in the form of salts, are especially distinguished.
In addition to lithium preparations, the psychiatrist may prescribe antiepileptic drugs with a sedative effect, depending on the symptoms observed in the patient. These are valproic acid, Carbamazepine, Lamotrigine. In the case of bipolar disorder, the administration of normotimics is always accompanied by antipsychotics, which have an antipsychotic effect. They inhibit the transmission of nerve impulses in those brain systems where dopamine serves as a neurotransmitter. Antipsychotics are used mainly during the manic phase.
It is rather problematic to treat patients in MDP without taking antidepressants in combination with normotimics. They are used to alleviate the patient's condition during the depressive phase of manic-depressive psychosis in men and women. These psychotropic drugs, affecting the amount of serotonin and dopamine in the body, relieve emotional stress, preventing the development of melancholy and apathy.
This type of psychological assistance, such as psychotherapy, consists in regular meetings with the attending physician, during which the patient learns to live with his illness as an ordinary person. Various trainings, group meetings with other patients suffering from a similar disorder help an individual not only better understand his illness, but also learn about the special skills to control and stop the negative symptoms of the disorder.
A principle role in the process of psychotherapy is played by the principle of “family intervention”, which consists in the leading role of the family in achieving the psychological comfort of the patient. During treatment it is extremely important to establish an atmosphere of comfort and tranquility at home, to avoid any quarrels and conflicts, as they harm the psyche of the patient. His family and he himself must get used to the idea of the inevitability of the manifestations of the disorder in the future and the inevitability of taking medications.
Forecast and life with TIR
Unfortunately, the prognosis of the disease in most cases is not favorable. In 90% of patients after an outbreak of the first manifestations of MDP, affective episodes are repeated again. Moreover, almost half of people suffering from this diagnosis for a long time, goes to disability. In almost a third of patients, the disorder is characterized by a transition from the manic to the depressive phase, while there are no “bright gaps”.
Despite the apparent hopelessness of the future with a diagnosis of TIR, a person is given the opportunity to live a normal normal life with him. The systematic use of normotimics and other psychotropic drugs allows you to delay the onset of the negative phase, increasing the duration of the "bright gap". The patient is able to work, to learn new things, to get involved in something, to lead an active lifestyle, undergoing outpatient treatment from time to time.
The diagnosis of TIR was made by many famous personalities, actors, musicians and just people, one way or another connected with creativity. These are famous singers and actors of our time: Demi Lovato, Britney Spears, Linda Hamilton, Jim Carrey, Jean-Claude Van Damme. Moreover, these are outstanding and world-famous artists, musicians, historical figures: Vincent Van Gogh, Ludwig van Beethoven and, possibly, even Napoleon Bonaparte himself. Thus, the diagnosis of TIR is not a sentence, it is quite realistic not only to exist, but to live with it.
General conclusion
Manic-depressive psychosis is a mental disorder in which the depressive and manic phases replace each other, alternating with the so-called bright period - the period of remission. The manic phase is characterized by an excess of strength and energy in the patient, an unreasonably elevated mood and an uncontrolled desire for action. For the depressive phase, on the contrary, it is characterized by depressed mood, apathy, melancholy, inhibition of speech and movements.
Women suffer from TIR more often than men. This is due to malfunctions in the endocrine system and to a change in the amount of hormones in the body during menstruation, menopause, after childbirth. So, for example, one of the symptoms of manic-depressive psychosis in women is a temporary cessation of menstruation. The treatment of the disease is carried out in two ways: by taking psychotropic drugs and psychotherapy. Unfortunately, the prognosis of the disorder is poor: in almost all patients after treatment, new affective seizures may occur. However, with due attention to the problem, you can live a full and active life.