CONDITIONS
Bipolar Affective disorder
Bipolar Affective disorder
Bipolar Affective disorder, also known as bipolar disorder and formerly known as manic-depressive illness or manic depression – one of the top 10 leading causes of disability worldwide. It is brain disorder, a mental health condition characterized by extreme mood swings including emotional highs (mania or hypomania) and lows (depression). Bipolar disorder also causes unusual shifts in a person’s mood, energy, activity levels, concentration; that cumulatively makes it difficult for them to carry out daily activities. Bipolar disorder is typically diagnosed in the teenage years or early 20s, although it can occur at any age.
Bipolar disorders in India have later onset between 25 and 30 years of age, with only 15%–20% of the patients having an onset in less than 18 years and the known lifetime prevalence rates for bipolar disorders is 0.5%
What are the types of Bipolar Disorder and what are their symptoms?
Bipolar I Disorder: Experiencing a manic episode (either an extreme increase in energy and elevated mood is seen or uncomfortably irritable in mood). At least one manic episode may be preceded or followed by hypomanic or major depressive episodes, and in some cases, false beliefs, hallucinations may also be seen (psychosis).
Bipolar II disorder: The absence of a manic episode but presence of at least one major depressive episode and at least one hypomanic episode
Cyclothymic disorder: Multiple periods of hypomania and depressive symptoms (though less severe than major depression) for at least two years (one year in children and teenagers)
Known as two distinct types of episodes, mania and hypomania have the same symptoms but differ in severity with mania being more severe than hypomania and causing more noticeable problems at work, school, relationships and social activities. The behaviours are clearly different from a person’s normal behaviour and easily identified by friends and family and severe enough to commonly require hospital care for their safety. People experiencing manic episodes also sometimes experience false beliefs, and/or hallucinations, known as psychotic features. The symptoms in mania often last for a week while hypomanic symptoms can last for just 4 days in a row.
Symptoms of manic and hypomanic episodes:
At least three of the following behavioural changes are seen in any of the manic and hypomanic episode:
- Decreased sleep (high energy)
- Exaggerated sense of well-being and self-confidence (euphoria)
- Faster speech
- Volatile change of ideas, topics and uncontrollable thoughts
- Increased distraction
- Increased activity and restlessness
- Increased careless behaviour (e.g., reckless driving, spending sprees)
What is major Depressive Episode
Lasts for a period of at least two weeks and the person experiencing has at least five of the following symptoms (including at least one of the first two symptoms):
- Intense sadness or despair (feeling empty, hopeless, tearful)
- Loss of interest in some or almost all the activities once enjoyed by that person
- Significant weight loss
- Feelings of worthlessness or guilt
- Increased tiredness
- Increased or decreased sleep
- Increased or decreased appetite
- Restlessness (e.g., pacing) or slowed speech or movement
- Difficulty concentrating
- Frequent thoughts of death or suicide
What are the causes of bipolar disorder?
May be caused by several factors such as:
- Biological differences: Different structural changes are seen in people with bipolar disorder.
- Genetics: More common in people with first-degree relative (sibling or parent with similar condition)
What are the risk factors of bipolar disorder?
- Having a first-degree relative, such as a parent or sibling, with bipolar disorder
- Periods of high stress, such as the death of a loved one or another traumatic event
- Drug or alcohol abuse
What are the diagnostic parameters for bipolar disorder?
Physical exam: To assess medical problems causing the symptoms.
Psychiatric assessment: A psychological self-assessment or questionnaire might be requested to be filled by the patient and the doctor may refer you to a psychiatrist, who may speak to the patient about their thoughts, feels and behaviour.
Mood charting: A way to help with diagnosis and finding the right treatment, the patient may be asked to keep a daily record of the moods, sleep patterns.
Criteria for bipolar disorder: Comparing symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
What are the treatment options for bipolar disorders?
Bipolar disorder is a lifelong condition and treatment is directed at managing symptoms and may include:
Medications such as mood stabilizers, antipsychotics, antidepressants, a combination of antidepressant-antipsychotic and anti-anxiety medications may be prescribed. Depending on the type of symptoms, the doctor may prescribe different types and doses of medications. Often, medications are initiated immediately to balance the mood.
Continued treatment: Lifetime treatment with medications is required in patients with bipolar disorder, even during periods of better health. Skipping maintenance treatment increases the risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
Day treatment programs: Support and counselling are provided while symptoms get under control.
Substance abuse treatment: In case of problems with alcohol or drugs, a substance abuse treatment is required. This is vital in the management of bipolar disorder
Hospitalization: In case the patient is suicidal or detached from reality (psychotic), hospitalization may be recommended.
The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.
How can bipolar disorder be prevented?
Although there is no sure way to prevent bipolar disorder, early detection and treatment may help prevent conditions from worsening.
- Paying attention to warning signs and identifying a pattern to bipolar episodes and their triggers helps in the management of the disorder. Help of family members or friends may be enlisted in watching for warning signs.
- Avoiding drugs and alcohol
Taking medications exactly as directed is highly important. Any temptation to stoptreatment should curbed because stopping medication or reducing dose by self may result in withdrawal effects or your symptoms may worsen or return.
References
- Dhiman S, Subodh BN, Chakrabarti S. Course and outcome of bipolar I disorder among Indian patients: A retrospective life-chart study. Indian J Psychiatry. 2022 Sep-Oct;64(5):510-517.
- Howland M., Sehamy A E. What are Bipolar Disorders? (November 2023). https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
- Bipolar disorder. November 2023. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961
