The concept of bilateral (bipolar) affective disorder combines several similar chronic mental pathologies. Their distinctive feature is cyclically alternating periods of depressive and excited states of patients. The early name of the pathology, manic-depressive syndrome, clearly reflected this symptom.
What is bipolar disorder
People suffering from bipolar disorder tend to periodically or regularly fall into an uncontrollable depressed or emotional state. People are unable to regulate such mood swings on their own. They do not give in to volitional efforts. In addition, patients are not always able to critically assess their situation. A bad mood is often attributed to life circumstances, and during periods of euphoria, many lose control over their behavior.
The depression stage of bipolar disorder has classic symptoms:
- low mood;
- apathy;
- asthenia;
- lack of motivation in study and work;
- inability to feel pleasure;
- tendency to long-term worries, a sense of one’s own insignificance.
In severe cases, thoughts appear about the complete hopelessness of existence and the desire to commit suicide. A person in the depressive stage of the disorder may seem depressed about something or simply appear melancholic. The duration of depression of consciousness varies from several days to several months.
The manic period develops immediately after depression or against the background of emotional stability. It is characterized by a euphoric, excited state. In some patients, aggression and extreme anxiety predominate in behavior. Almost everyone loses the ability to adequately assess reality. To those around them, patients at this stage appear eccentric, intoxicated, unreasonably happy, irresponsible, or embittered. Often the behavior of patients is devoid of any logic and resembles madness. Psychosis can last for several hours, days or weeks. During this period, auditory and visual hallucinations and delusional ideas may appear.
The stage of hypomania has similar symptoms to mania, but is less pronounced. In this type of disorder, the ability to control behavior is partially preserved. Patients easily take on several tasks at the same time, are extremely energetic, react violently to what is happening around them, and amaze with activity and efficiency. It can be difficult to determine the inadequacy of such behavior from the outside, since the actions of patients are often outwardly logical and effective.
Epidemiology
The prevalence rates of MDP according to clinical and epidemiological researchers vary from 0.11 to 12 per thousand population. Differences in disease prevalence rates obtained in different studies are primarily due to the lack of uniform formalized diagnostic criteria.
The prevalence of recurrent depression (RD) in the population is from 3 to 6%, bipolar affective disorder (BAD) – 0.5 – 2%. The risk of developing recurrent depression throughout life reaches 20%, bipolar affective disorder – 5%, and taking into account subclinical forms – 12%.
Among patients with MDP, females predominate. Women make up 60 to 70% of patients with circular psychosis. The ratio of females to males in bipolar affective disorder is 3:2, in recurrent depression it is 2:1.
Types of bipolar disorder
Depending on the characteristics of polarizations of the psyche and the duration of their manifestation, several types of bipolar disorder are distinguished, which are independent pathologies.
- Bipolar disorder type 1. In the patient's life there was at least 1 acute manic period, which occurred after a long depression. The disease is usually accompanied by psychosis.
- Bipolar disorder type 2. Depression in this disease is replaced by hypomania, acute psychotic states are absent.
- The cyclothymic course of bipolar disorder is characterized by frequent alternations between depressed and manic states. They are more common in teenagers and people under 40 years of age.
- Mixed bipolar disorder manifests itself with simultaneous depression and manic periods. The most painful pathology in which feelings of anxiety and emotional outbursts are accompanied by despair.
Various types of bipolar disorder affect men and women of all ages. The severity of symptoms varies among most people. The stages of depression are often long-term, and occur gradually, signaling only a persistent decrease in mood. During rare or short-term manic episodes, such people appear to be completely adequate. In young people, as a rule, the disorder is more pronounced.
1% of the population has some type of bipolar disorder. About a third of all cases are severe. However, this mental pathology almost never leads to a decrease in mental abilities. During periods of remission, patients do not differ from other people, they reason sensibly and are aware of their actions. Negative emotions often push those suffering from bipolar disorder to abuse alcohol and potent substances, which provoke the progression of the disorder.
Manic depressive psychosis in men
In the manic stage, in the first stages it is often perceived positively by the patient himself and his environment. Business activity and self-confidence increase, and ideas on the verge of genius arise. This behavior, in the minds of the masses, is typical of business and successful people and is perceived not as a disease, but as success. As the diagnosis progresses, activity turns into increased irritability, aggression occurs, and the man may attack others.
A severe course is also distinguished by a depressive state in men. They often begin to try to rethink their actions throughout life, to negatively perceive what only a few hours ago seemed to be an outstanding success. Apparently, in approximately the same state, Gogol decided to burn the second volume of Dead Souls.
As the depressive state progresses, the desire to completely isolate oneself from the world develops, the patient tries to move minimally, refuses food, sexual desire disappears, and family ties disappear. Many patients talk about ending their lives or attempt suicide.
Manic psychosis in a person has every right to be called a silent killer. Diagnosis of pathology is complicated by frequent refusals by patients of any gender to seek help from a psychiatrist, citing a changeable character or slight natural hysteria. For this reason, pathology is often detected already at the stage of a serious attack, which requires immediate hospitalization.
Diagnosis of bipolar disorder
Reasons to suspect bipolar disorder:
- causeless mood changes: transition from a gloomy state to a cheerful and cheerful one;
- sudden keen interest in travel, unfamiliar people, new activities, just as suddenly replaced by new ideas;
- periods of insomnia and lack of appetite, accompanied by acute anxiety or euphoria;
- long-lasting despondency, after which the desire to quickly redo everything is overwhelming, embitterment and irritability appear.
If such symptoms occur regularly, you should take mental health seriously.
Among the reasons causing the development of bipolar disorder are:
- genetic predisposition;
- social spectrum;
- dysfunction, organic brain damage;
- psychological and traumatic brain injuries.
Psychiatrists differentiate bipolar disorders from schizophrenia, neuroses, endogenous depression, anxiety and other types of affective disorders. During conversations with patients and their relatives, doctors find out whether manic, hypomanic, mixed episodes occurred, and what preceded them. Anamnesis, possible triggers and injuries that provoked the onset of the disease are also important. The severity of the pathology is determined using special scales.
Etiology and pathogenesis
MDP has a complex etiology and pathogenesis. Hereditary predisposing factors interact with external biological and psychosocial influences.
Data from clinical genetic studies indicate the hereditary familial nature of the disease. It has been established that in families of patients with MDP, there is an accumulation of cases of affective spectrum disorders (MDP, cyclothymia, schizoaffective psychosis). Moreover, the risk of developing the disease increases as family members become more closely related.
Data have been obtained indicating the genetic heterogeneity of MDP. The hereditary burden in the bipolar variant is several times higher than that in the monopolar variant of the disease.
The results of twin studies confirm the contribution of genetic factors to the development of the disease. The concordance of monozygotic twins is 3-5 times higher than that of dizygotic twins.
Available data on the role of genetic predisposition do not exclude the influence of external “environmental” factors on the likelihood of developing the disease. The risk of developing the disease does not reach 100% even in monozygotic twins with both monopolar and bipolar variants of the disease.
The pathogenesis of MDP is associated with disruption of central noradrenergic and serotonergic neurotransmission. It is believed that the development of affective disorders is based on an imbalance of the serotonergic-noradrenergic system of the brain, which determines a deficiency or excess of biogenic amines in neuronal synapses. At the same time, the development of depression is associated with a deficiency, and mania – with an excess of catecholamines.
However, this hypothesis reflects only one link in the pathogenesis of affective disorders. Dysfunction of the hypothalamic-pituitary-adrenal and thyroid systems plays a certain role in the genesis of the disease.
There is evidence of a connection between affective disorders and desynchronization of biological rhythms, in particular with a disorder in the regulation of the sleep-wake cycle, due to impaired production of the pineal gland hormone melatonin.
Recent studies have established that with MDP, morphological changes (atrophy and hypertrophy) are observed in the hippocampus and amygdala - areas of the brain that play a key role in the regulation of emotions.
Treatment
Treatment for manic-depressive psychosis is gradual. First, the current exacerbation is stopped, normalizing the psychophysical state of the person. Next, maintenance and anti-relapse treatment regimens are individually prescribed.
A suicidal condition is an indication for emergency hospitalization. In some cases, electroconvulsive therapy (ECT) is justified to overcome drug resistance. ECT is relatively safe, as it is performed under anesthesia with the use of muscle relaxants, but there are a number of contraindications.
Medication
The choice of pharmaceuticals depends not only on the severity of symptoms. Relief from an acute condition is possible with the help of rationally prescribed drugs in adequate dosage. Often during treatment it is necessary to change medications, taking into account individual tolerance.
The following groups of pharmaceutical drugs can be used in the treatment of bipolar disorders:
- mood stabilizers - eliminate psychomotor agitation, normalize mood - Valproate, lithium preparations, benzodiazepines;
- neuroleptics - auxiliary drugs in the presence of severe psychotic symptoms, eliminate delusions and hallucinations;
- antidepressants from the group of selective serotonin reuptake inhibitors;
- combinations of psychotropic drugs in individually tolerable doses;
- symptomatic treatment of concomitant disorders.
Quickly bringing aggression and psychomotor agitation under control prevents the exacerbation episode from prolonging. The preventive effect of the drugs develops gradually, so maintenance therapy is prescribed for a long period. Timely relief of depression is necessary to prevent suicidal behavior.
Psychotherapy and rehabilitation
Pharmacotherapy is carried out against the background of psychosocial support. Rehabilitation measures significantly help in managing people with a depressive phase, reducing the frequency of relapse. Particular attention is paid to the following areas:
- increasing awareness of the patient and his caregivers about the nature of the disease, features of the course, methods of therapy and prognosis;
- formation of motivation to improve the quality of life;
- explaining the need to comply with the prescribed regimen;
- training to recognize early signs of developing relapse;
- methods of dealing with stress, exacerbation triggers, risk factors;
- psychotherapy – individual (cognitive-behavioral, rational), family, group (interpersonal).
A scheduled consultation with your doctor is a key point in treatment, so you need to openly discuss all issues with a specialist. The psychiatrist must regularly monitor not only the effectiveness of the measures taken, but also monitor changes in the person’s status. If necessary, the therapeutic course is modified.
