This chapter is specifically intended to understand what bipolar disorder is from a medical perspective. I advise you to take a look, and I hope that neither you nor anyone dear to you recognizes themselves in the article. ❤️❤️❤️
Bipolar disorder is defined today as a mental condition with alternating depressive, manic, or hypomanic episodes. Two types of bipolar disorder are described: type I, described in the 19th century as manic-depressive disorder or depressive psychosis - specifically, the patient experiences manic and depressive episodes with or without psychotic elements, and type II, in which the patient is more often depressed, with hypomanic episodes and increased mood instability.
To better understand what depression or mania means, let's start by explaining what mood is:
Mood is a pervasive and persistent emotion that influences a person's behavior and colors the way they perceive the world.
Mood disorders represent an important category in psychiatric pathology, including depressive disorders, bipolar disorder, dysthymia (a mood disorder consisting of chronic depression), and cyclothymia (periods of hypomania and moderate depression).
Numerous adjectives are used to describe mood: depressive, sad, a sense of inner emptiness, irritable, euphoric, grieving, desolate, melancholic, manic, excited.
To identify mood, we need signs and symptoms: some are observed by the clinician (depressive facial expressions), while others can only be objectified through the patient's statements (feelings of helplessness).
Mood can be fluctuating or rapidly alternating between extremes; other signs accompany mood disorders: executive function disturbances, cognitive abilities, language, vegetative functions, impairment of interpersonal, social, and occupational relationships.
Now let's make the connection between mood, depressive episodes, and manic episodes. You may have heard discussions or expressions like, "I don't understand you anymore! You go from one state to another!" or "You seem manic! You don't stop!" However, in order to talk about psychiatric pathology, diagnostic criteria must be met. A manic episode represents a clearly defined period with a persistent expansive, euphoric, or irritable mood, exaggerated self-esteem or grandiosity, decreased need for sleep without feeling tired, increased physical and mental activity (racing thoughts), distractibility, excessive involvement in activities that produce pleasure but with unpleasant consequences (very costly distractions, inappropriate sexual behavior), severe impairment in daily functioning that may lead to hospitalization in a psychiatric ward, and psychotic symptoms (delusions of grandeur, invulnerability, paranoia).
The hypomanic episode is similar to the manic episode, but the patient exhibits moderate impairment in social and professional functioning and does not require hospitalization.
Manic episodes occur more frequently in men, while depressive episodes are more common in women. In women, compared to men, when manic episodes occur, they are more likely to be mixed (manic/depressive) and have a faster cycle (four or more episodes per year).
The depressive episode includes symptoms such as loss of interest and involvement in daily activities or new projects, depressive mood, lack of energy, sleep disturbances with frequent awakenings due to worry, agitation or psychomotor retardation, asthenia or loss of energy, excessive feelings of worthlessness or excessive guilt, changes in body weight and appetite, as well as other vegetative complaints: menstrual disorders, interest and performance in sexual activity.
The age of onset for bipolar disorder has a wide range: it can occur during childhood (from 5-6 years old) until around the age of 50, with a median age of 30.
As for the causes of bipolar disorder, biological factors are mentioned: neurotransmitters (with serotonin and norepinephrine being the most involved), hormonal imbalances (thyroid hormones, growth hormone, prolactin), sleep neurophysiology disorders, immune system disorders, structural and functional changes in the brain detectable through CT/ MRI imaging (abnormal hyperintensities in the periventricular region, basal ganglia, thalamus). All of these will be taken into consideration and analyzed during consultations by a specialized psychiatrist.
From a genetic point of view, the question arises: is the rate of disease occurrence among the patient's family members higher than in the general population? If one parent has an affective disorder, the child will have a 10-25% risk of developing the disease; if both parents are affected, then the risk doubles. Regarding bipolar disorder, the annual incidence is less than 1% and the general prevalence rate is between 0.3 and 4%.
Behavioral changes, inability to feed and protect oneself, severe symptoms with increased cyclicality, loss of the support system within the family.
The choice of initial treatment depends on the chronicity of the condition, the progression and severity of symptoms, concomitant somatic conditions, and the patient's previous response to treatment.
In the case of a patient with an acute manic episode, treatment compliance is an issue due to a low level of understanding, with the patient refusing medication and hospitalization in the context of symptoms such as aggression, impulsivity, and impaired judgment.
Preventing recurrences is the greatest challenge. Treatment not only needs to maintain well-being but also avoid unpleasant side effects such as sedation, tremors, and weight gain.
The response to treatment in bipolar disorder can be complicated by the presence of anxiety, abusive alcohol and psychostimulant substance use, and pathological gambling.
The course and prognosis of bipolar disorder. Positive prognostic factors include episodes of moderate intensity, absence of psychotic symptoms, absence or short duration of hospitalization in a psychiatric ward. Psychosocial factors indicating a good prognosis include strong friendships during adolescence, a stable and functional family, absence of personality disorders and other psychiatric illnesses.
Negative prognostic elements include alcohol consumption, frequent hospitalizations, psychotic features, and precarious psychosocial status.
The course tends to be chronic with relapses, with men being more predisposed to a chronic course compared to women.
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Life As A Bipolar Person
Non-FictionPersonal experience with a relatively unknown illness in my country, treated with too much nonchalance and indifference: bipolar disorder. A wake-up call, amusing and not so amusing stories, advice, case studies, consequences, and acceptance. But al...
