Posted On: February 03, 2020
Bipolar disorder is a mental illness that has affected millions of people worldwide over the last couple of decades. The mental health, as an important element of every human health, is a state of well-being, the ability of the brain to function naturally and respond properly to environmental stimuli. But when we talk about bipolar disorder, when this state of well-being is traumatized by psychiatric conditions, the revise becomes the case. The affected person is then unable to adapt to challenging or even uncomfortable circumstances and maintain his mental balance.
Currently, these set of diseases classified as emotional disorders (emotional disturbance) has become a critical problem faced by many across the globe. These mental disorders can manifest themselves in many ways and at different ages, irrespective of gender. In the majority of cases, it is during adolescence, between 15 and 20 years of age, that these disorders manifest themselves, most often in an acute manner. Sometimes between 20 and 30 years old, when entering working life, a behavioral disorder appears, which most of the time turns the person’s life upside down.
According to the World Health Organization (WHO), 1 in 4 persons in the world will be affected by mental or neurological disorders at some time in their lives, while about 450 million people around the world are currently suffering from such condition, thereby place mental disorders among the leading causes of ill-health and disability worldwide. Some of these conditions such as depressive disorders, which exhibit a general mood of sadness or depression are already the fourth leading cause of the global disease burden.
Bipolar disorder, otherwise known as manic depression, is a mental illness in which the affected person has episodes of mania and depression. It causes drastic and severe mood changes, which include emotional highs (mania or hypomania), in which the person feels euphoric, irritable and energetic, and emotional lows (depression), in which he experiences a deep sadness and loses interest in performing some pleasant activities. These sudden changes in mood have a series of consequences for the person and can harm him in the different areas of his life, affecting, among other things, his energy, daily activities, sleep habits, personal relationships, behavior, and ability to think clearly, etc.
Although the exact causes of bipolar disorder are unknown, specialists have found that most people with this mental illness respond to two major factors: genetic factors and biological differences. In the case of genetic factors, the disease is observed more frequently in those who have a direct family member who presents it. While in the case of biological differences, observations show that people with bipolarity have physical changes in the brain, a biochemical imbalance, which may be caused by an irregular production of hormones or by problems with some neurotransmitters.
In addition to the above, several other risk factors can increase the likelihood of a person presenting bipolarity. Such risk factors range from alcohol or drug abuse to suffering from psychological trauma episodes of high stress, etc.
It is estimated that about 2 to 7 percent of people in America live with Bipolar disorder, while about 10 million people are likely to develop the same illness sometimes in their lives. In a health report, “Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year” (National Institute of Mental Health). Some researchers also estimated about 1,300,000 cases of bipolar disorder in France alone. This made this bipolar disorder one of the most leading causes of years lived with disability, worldwide.
The classic form of bipolar disorder is characterized by phases of depression and mania. Depending on the intensity of the symptoms, hence, there are two major types of bipolar disorder:
Phase/Type I Bipolar Disorder: This phase is characterized by intense manic phases and depressions. In manic phases, delusions may appear and auditory hallucinations (voices that give orders or insult). In the depressive phase of this type, there is sadness, slow movements, anxiety, apathy, insomnia, and loss of appetite.
Phase/Type II Bipolar Disorder: It is characterized by intense depressions and moderate euphoria phases that are called hypomania. Psychotic symptoms may appear, but they have to be associated with depressive phases. Moderate euphoria phases sometimes seem like a temperamental or character change. It is quite common for family members to detect more sociability in the patient, less shyness, more activity, etc.: the patient may not realize it.
Other minor types of bipolar disorders include;
Cyclothymic: Defined by numerous periods of hypomanic and depressive symptoms that last at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic criteria for a hypomanic and depressive episode.
Unspecified and Other Related Disorders: These would be bipolar symptoms that do not correspond to the categories described above. Sometimes there may be cases with mixed characteristics.
Genetic factors could be the main cause of the disease. This conclusion is reached after different studies that highlight the existence of several members diagnosed with this disease in the same family. On the other hand, genetic studies on different chromosomes support this possibility.
Genetic alterations probably involve dysfunction in the limbic system, which is a set of structures of the central nervous system whose function is the regulation of mood.
As a result of that, the limbic system would act as a thermostat for humor and if this state is avoided without proper management would become depressive and at the same time excessively euphoric.
The symptoms of bipolar disorder or manic depression include; mania, hypomania, and depression.
Mania, in these cases, is a manifestation of intense euphoria in which the need to sleep is lost and the affected person feels plethoric and full of energy and self-confidence. There is a frenzy of ideas, sexual dis-inhibition, compulsive purchases are made, unusual loquacity, bad decisions are made, among others. There can also be irritability and hostility if the opposite is taken. Besides, there may be psychotic symptoms such as delusions of grandeur and hallucinations.
People with hypomania are gentler in nature or behavior. Hypomania can be said to not being strong in action or effect than mania but occurs in less intense and dramatic ways in addition to not manifesting psychotic symptoms. There is a feeling of intense well-being and greater creativity and self-esteem in people living with the disease. There is acceleration in the characters of the victims, irritability and insomnia and alcohol consumption may increase and even drug use may appear. Hypomania can worsen and end in a frank mania or be the main factor that predisposes to the development of intense depression.
Depression is one of the two poles of bipolar disorder and is probably the most frequent manifestation. Its symptoms are totally indistinguishable from what is commonly known as depression. Therefore, many patients with bipolar disorder are not correctly diagnosed as such until an episode of mood elevation is detected, or it has previously appeared.
The depressive phase of this illness is characterized by:
It is not uncommon for the hopelessness that surrounds this situation, the patient has thoughts related to death and even tries to commit suicide.
The bipolar patient who has experienced previous depressive episodes may understand that this situation is temporary and, therefore, that he or she will leave it.
On many occasions, the patient does not recognize them as such, they think that their lives are meaningless and do not understand the need for treatment.
The treatment of a depressive phase always requires the use of a mood-stabilizing drug, and it is the psychiatrist who has determined the need for other treatments, such as taking antidepressants.
Recognizing a bipolar person and diagnosing bipolar disorder is not a simple matter due to the great complexity and variety of emotional states that anyone experiences throughout their day. According to the DSM-V, Diagnostic and Statistical Manual of Mental Disorders, to know if a person is bipolar, the following parameters must be considered.
In this case, there will be the presence of 3 or more of the following symptoms in a minimum period of one week and for most of the day:
Such alteration of mood involves a very significant deterioration in the social or work performance of the patient and requires hospitalization to prevent damage to himself or others.
Here, there is the presence of 3 or more of the symptoms mentioned above in the “Diagnosis of the manic episode” for a minimum period of 4 consecutive days and most of the day.
Unlike the manic episode, in this case, this alteration of mood does not cause significant changes in the person’s social or work performance and hospitalization is not necessary. Mood changes are usually observable by other people.
Here, there is a presence of at least 5 or more of the following symptoms for two weeks and without these symptoms being due to other conditions or diseases:
The treatment is mainly supported by taking regulatory drugs: thermoregulator such as lithium salts. This basic treatment is prescribed for the long term, even for life. They significantly improve the quality of life of patients by reducing the frequency and amplitude of the phases. They involve medical supervision to avoid any recurrence.
In the event of a severe depressive phase, antidepressants may be prescribed, in particular, serotonin reuptake inhibitors (IRS), with care so as not to lead to a manic phase. In the case of severe bipolar disorder, mesotherapy (electroshock) is possible.
Management is generally associated with psychotherapy or psychoeducation. Psychoeducation consists of explaining the disease and its treatments to the patient and his relatives. It is offered individually or in a group.
The medical monitoring is essential to prevent recurrence and to ensure that the treatment (medication and psychotherapy) is followed. It is also recommended to avoid stressful situations, to adopt a regular rhythm of life, to avoid the consumption of alcohol, drugs or tobacco.
The treatment can be reassessed and adapted for women with bipolar disorder who wish to have a child.
Bipolar disorder also called manic depression is a mental illness that causes episodes of mania and depression. It causes drastic and severe mood changes and has no specific cure. It is often experienced as a result of genetic factors.