Bipolar disorder (bipolar, manic-depressive psychosis)

Bipolar disorder (bipolar affective disorder, manic-depressive psychosis) is a mental disorder that is clinically manifested by mood disorders (affective disorders). Patients have alternating episodes of mania (or hypomania) and depression. Periodically there are only mania or only depression. Intermediate, mixed states can also be observed.

The disease was first described in 1854 by the French psychiatrists Falre and Bayarzhe. But as an independent nosological unit, it was recognized only in 1896, after the work of Kraepelin was published, devoted to a detailed study of this pathology.

Initially, the disease was called manic-depressive psychosis. But in 1993 it was included in ICD-10 under the name of bipolar affective disorder. This was due to the fact that with this pathology psychosis does not always occur.

There is no accurate data on the spread of bipolar disorder. This is due to the fact that researchers of this pathology use different evaluation criteria. In the 90s of the 20th century, Russian psychiatrists believed that 0.45% of the population suffers from the disease. The assessment of foreign experts was different - 0.8% of the population. Currently, it is believed that the symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease takes on a severe psychotic form. There are no data on the occurrence of bipolar disorder in children, which is due to certain difficulties in using standard diagnostic criteria in pediatric practice. Psychiatrists believe that in childhood episodes of the disease often remain not diagnosed.

In about half of the patients, manifestation of bipolar disorder occurs at the age of 25–45 years. Unipolar forms of the disease prevail in middle-aged people, and bipolar in the young. In approximately 20% of patients, the first episode of bipolar disorder occurs at an age over 50 years. In this case, the frequency of depressive phases increases significantly.

Bipolar disorder is 1.5 times more common in women than in men. In this case, men are more likely to have bipolar forms of the disease, and in women - monopolar.

Recurrent attacks of bipolar disorder occur in 90% of patients, and over time, 30–50% of them steadily lose their ability to work and become disabled.

Causes and risk factors

The diagnosis of such a serious disease should be trusted to professionals, experienced specialists of the Alliance Clinic (https://cmzmedical.ru/) will analyze your situation as accurately as possible and make the correct diagnosis.

The exact causes of bipolar disorder are not known. A certain role is played by hereditary (internal) and environmental (external) factors. In this case, the greatest value is given to hereditary predisposition.

Factors that increase the risk of developing bipolar disorder include:

  • schizoid personality type (preference for solitary activity, tendency to rationalization, emotional coldness and monotony),
  • static type of personality (increased need for orderliness, responsibility, pedantry),
  • melancholic personality type (fatigue, restraint in the expression of emotions in combination with high sensitivity),
  • hypersensitivity, anxiety,
  • emotional imbalance.

The risk of developing bipolar disorders in women increases significantly during periods of unstable hormonal background (menstrual bleeding period, pregnancy, postpartum or menopause). Especially high risk for women in the history of which there is an indication of psychosis, postponed in the postpartum period.

Forms of the disease

Clinicians use a classification of bipolar disorders based on the prevalence of depression or mania in the clinical picture, as well as on the nature of their alternation.

Bipolar disorder can occur in a bipolar (there are two types of affective disorders) or unipolar (there is one affective disorder) form. Periodic mania (hypomania) and periodic depression are unipolar forms of pathology.

The bipolar form proceeds in several versions:

  • correctly intermittent - a clear alternation of mania and depression, which are separated by a bright gap,
  • incorrectly intermittent - alternation of mania and depression occurs chaotically. For example, several episodes of depression can be observed in succession, separated by a light gap, and then manic episodes,
  • double - two affective disorders replace each other immediately without a bright gap,
  • circular - there is a constant change of mania and depression without bright intervals.

The number of phases of mania and depression in bipolar disorder varies with different patients. Some have dozens of affective episodes throughout their lives, while others may have a single episode.

The average duration of the phase of bipolar disorder is several months. At the same time, episodes of mania occur less frequently than episodes of depression, and their duration is three times shorter.

Initially, the disease was called manic-depressive psychosis. But in 1993 it was included in ICD-10 under the name of bipolar affective disorder. This was due to the fact that with this pathology psychosis does not always occur.

In some patients with bipolar disorder, mixed episodes occur, which are characterized by a rapid change of mania and depression.

The average duration of the light period in bipolar disorder is 3–7 years.

Symptoms of Bipolar Disorder

The main symptoms of bipolar disorder depend on the phase of the disease. So, for the manic stage are characteristic:

  • accelerated thinking
  • mood elevation
  • motor agitation.

There are three severity of mania:

  1. Light (hypomania). There is a high mood, an increase in physical and mental performance, social activity. The patient becomes somewhat distracted, talkative, active and energetic. The need for rest and sleep decreases, and the need for sex, on the contrary, increases. In some patients, there is not euphoria, but dysphoria, which is characterized by the appearance of irritability, hostility towards others. The duration of an episode of hypomania is several days.
  2. Moderate (mania without psychotic symptoms). There is a significant increase in physical and mental activity, a significant increase in mood. The need for sleep almost completely disappears. The patient is constantly distracted, unable to concentrate, as a result his social contacts and interactions are hampered, his ability to work is lost. There are ideas of greatness. The duration of an episode of moderate mania is at least a week.
  3. Heavy (mania with psychotic symptoms). There is a pronounced psychomotor agitation, a tendency to violence. There are jumps in thoughts, the logical connection between facts is lost. Hallucinations and delusions, similar to the hallucinatory syndrome in schizophrenia, develop. Patients gain confidence that their ancestors belonged to a noble and famous family (delirium of high origin) or consider themselves to be a well-known person (delusions of grandeur). Not only the ability to work is lost, but also the ability to self-service. Severe mania lasts over several weeks.

Depression in bipolar disorder proceeds with symptoms opposite to those of mania. These include:

  • slow thinking
  • low mood
  • motor lethargy
  • decrease in appetite, up to its complete absence,
  • progressive weight loss,
  • decreased libido
  • women stop menstruating, and men can develop erectile dysfunction.

With mild depression on the background of bipolar disorder in patients, the mood fluctuates during the day. In the evening, it usually improves, and in the morning manifestations of depression reach their maximum.

In bipolar disorders, the following forms of depression may develop:

  • simple - the clinical picture is represented by a depressive triad (depressed mood, inhibition of intellectual processes, impoverishment and weakening of the impulses to action),
  • hypochondriac - the patient is sure that he has a serious, deadly and incurable disease, or a disease unknown to modern medicine,
  • crazy - The depressive triad is combined with delusions of accusation. Patients agree with him and share it.
  • agitated - with depression of this form there is no motor lethargy,
  • anesthetic - the prevailing symptom in the clinical picture is a feeling of painful insensitivity. The patient believes that all his feelings have disappeared, and an emptiness has formed in their place, which causes him great suffering.

Diagnostics

To make a diagnosis of bipolar disorder, a patient must have at least two episodes of affective disorders. At the same time, at least one of them must be either manic or mixed. For a correct diagnosis, the psychiatrist must take into account the patient’s medical history, information received from his relatives.

Currently, it is believed that the symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease takes on a severe psychotic form.

Determination of the severity of depression is carried out using special scales.

The manic phase of bipolar disorder needs to be differentiated with arousal caused by psychoactive substances, lack of sleep or other causes, and depressive - with psychogenic depression. Psychopathy, neurosis, schizophrenia, as well as affective disorders and other psychosis due to somatic or nervous diseases should be excluded.

Treatment of bipolar disorder

The main objective of the treatment of bipolar disorder is the normalization of the mental state and mood of the patient, the achievement of long-term remission. In severe cases, patients are hospitalized in a psychiatric department. Treatment of mild forms of the disorder can be carried out on an outpatient basis.

Antidepressants are used to relieve a depressive episode. The choice of a particular drug, its dosage and the frequency of intake in each case is determined by the psychiatrist, taking into account the patient's age, the severity of depression, the possibility of its transition to mania. If necessary, the appointment of antidepressants supplemented by mood stabilizers or antipsychotics.

Drug treatment of bipolar disorder in the mania stage is performed by mood stabilizers, and in severe cases of the disease, antipsychotics are also prescribed.

In remission, psychotherapy is shown (group, family, and individual).

Possible consequences and complications

Left untreated, bipolar disorder may progress. In the difficult depressive phase, the patient is able to commit suicide attempts, and during the manic phase it is dangerous both for himself (accidents by negligence) and for people around him.

Bipolar disorder is 1.5 times more common in women than in men. In this case, men are more likely to have bipolar forms of the disease, and in women - monopolar.

In the interictal period, patients suffering from bipolar disorder, mental functions are almost completely restored. Despite this, the prognosis is poor. Recurrent attacks of bipolar disorder occur in 90% of patients, and over time, 30–50% of them steadily lose their ability to work and become disabled. Approximately every third patient has a bipolar disorder that goes on continuously, with a minimum duration of light intervals or even with their complete absence.

Often, bipolar disorder is combined with other mental disorders, drug addiction, and alcoholism. In this case, the course of the disease and the prognosis becomes heavier.

Prevention

Primary prevention measures for the development of bipolar disorder have not been developed, since the mechanism and causes of the development of this pathology have not been precisely established.

Secondary prevention is aimed at maintaining a stable remission, preventing repeated episodes of affective disorders. For this, it is necessary that the patient will not stop the treatment prescribed to him. In addition, factors that contribute to the development of exacerbation of bipolar disorder should be eliminated or minimized. These include:

  • drastic hormonal changes, endocrine disorders,
  • brain diseases
  • injuries
  • infectious and somatic diseases,
  • stress, overwork, conflict situations in the family and / or at work,
  • violations of the day (lack of sleep, busy schedule).

Many experts associate the development of exacerbations of bipolar disorder with annual human biorhythms, since exacerbations occur more frequently in spring and autumn. Therefore, at this time of year, patients should especially carefully follow a healthy, measured lifestyle and recommendations of the attending physician.

Symptomatology

Symptoms of bipolar disorder are represented by constantly alternating periods of euphoria and depression. Such periods can last for many years, and the relatives and friends of a person do not understand that unusual behavior is not a property of his psyche, but a violation that requires correction.

Most often, the diagnosis of such a pathology as bipolar disorder is possible in the depressive phase, when a person experiences such thrills of worthlessness and uselessness that sometimes he decides that suicide is the only way out for him, and even makes an attempt to reduce his counting with life.

Signs of bipolar disorder in the depression phase are manifested in four stages. At the initial stage, a person's mood decreases, nothing pleases him, the world seems hostile, the general vitality weakens. In the second stage, there is an increasing depression, characterized by a decrease in appetite, lethargy, despondency, and decreased performance.

The third stage is the most severe - the symptoms of the disease reach a critical level. A person feels that he is not needed by anyone, he speaks in monosyllables, almost in a whisper, stares at one point for a long time, he has thoughts about self-destruction.

The fourth stage is the stage of regression of symptoms, when a person's condition returns to normal, and he becomes adequate again, can lead a normal social life, work, etc.

Bipolar personality disorder in the manic phase is manifested by completely different symptoms. And in this phase the disease proceeds in five stages:

  • the first stage is characterized by elevation of mood and periods of physical vitality,
  • the second is the increase in symptoms (loud laughter, quick and sometimes incoherent speech, dispersal of attention, megalomania, the desire to "move mountains"),
  • the third stage of the manic phase is manifested by the fact that the symptoms of the disease reach a maximum when a person’s behavior becomes uncontrollable,
  • in the fourth stage, the euphoric state is preserved, but the movements become calmer,
  • in the fifth stage, the state of the person returns to normal, and he again feels and behaves adequately.

The duration of the manic phase and depressive may be different.

Bipolar mental disorder is also characterized by the fact that when a person has been ill for a long time and the symptoms of the disorder are increasing, he may experience sound and visual hallucinations, delusions may have occurred to him.

The patient may claim to be an emperor or another great person, or decide that the life of all people on the planet, etc., depends on him, that is, he develops delusions of grandeur.

Such symptoms occur during the manic stage of the disease, while in the depressive stage, mental disorders manifest as a denial of everything good around, a feeling of being useless and worthless. A person is sure that he is not economically protected, that he is a burden to others, etc. Very often, in this condition, the patient is diagnosed with schizophrenia, because this condition is very similar to the manifestations of this disease.

Varieties

To correctly identify the disease, it is necessary to understand that there are two types of pathologies such as bipolar disorder. Type 1 is less common and is characterized by severe symptoms. Diagnosis of this type of disease leaves no doubt. If a person with this type of pathology is not treated promptly, he can easily end up in the intensive care unit, since he cannot cope with the symptoms on his own.

Species 2 occurs several times more often than the first. With this type of disease, the symptoms are less serious, so it is more difficult for others to understand that a person needs medical help. If there is no help, the symptoms may progress, or the person falls into a prolonged depression or euphoric state characterized by inappropriate behavior.

Causes of Bipolar Disorder

The disease can occur at any age, but most often between 20-30 years.
Bipolar disorder is less common than unipolar. The risk of this disease ranges from 0.4% to 1.6%; for comparison, 21% of women and 13% of men suffer from ordinary depression (unipolar disorder).

There are biological and psychosocial causes of the disease.

Biological causes represent mainly the heredity of polygenic (diverse number of genes) character. Studies show that one of the main causes of the disease is an imbalance of the neurotransmitters serotonin, dopamine, norepinephrine biochemical factors. During an episode of mania, the amount of dopamine and norepinephrine increases significantly. Another biological factor underlying the formation of the disease is a violation of the proper functioning of the systems (hypothalamus-pituitary-adrenal, pituitary-hypothalamus-thyroid) and their biological rhythms.

Psychosocial causes - these include manic and depressive disorders, which are a manifestation of the body's defenses in connection with a severe stressful situation. Excessive activity can be expressed by attempts to isolate a traumatic event from life. The transition from mania to depression occurs at the time of the collapse of the defensive functions of mania, while the transformation of depression into mania is a defense against a sense of inferiority. Stressful experiences in the early stages of the disease may precipitate manic or depressive episodes. Further, the disease progresses independently with a low probability of dependence on stress.

What to do and which doctor to contact

Schedule an appointment with a psychiatrist or psychotherapist if you discharge any signs of illness from yourself or a person close to you. People with bipolar disorder are more likely to deny any problems, especially during manic episodes, but don't let them fool you.

Bipolar disorder, like any other serious illness, needs timely diagnosis and treatment. With the right therapy, bipolar disorder can be managed and the patient can live a full life.

Types of Bipolar Mood Disorder

Bipolar disorder is characterized by extreme mood swings from maximum to minimum. These episodes can last hours, days, weeks, or months. Mood swings can mix (crying and smiling). The most common types of bipolar disorder:

Bipolar 1: This is a classic form of the disease. Leaves no doubt about the diagnosis. If left untreated, the person may end up in the intensive care unit.
Bipolar 2: It is four times more common than bipolar 1. It is characterized by much less serious manic symptoms. It is harder to recognize when a person needs help. Without proper treatment, the sick person often becomes worse, and the patient can dive deep into manic or depressive episodes.

What should be discussed with your doctor if you are taking medication:

Ask your doctor what medications you need to take and what results to expect.
Find out how your medicine affects brain biochemistry.
If you take medicine, then sooner or later the patient will feel the desired effect. Mood should improve or stabilize.
With the wrong therapy, some people feel much worse than before taking medication. Report any problems to your doctor so that a specialist can get an accurate picture of how the drug affects you.
Discuss medication side effects with your doctor. Almost all medicines have side effects, but there comes a time when the side effect may exceed the benefits of the drug. When discussing this with a specialist, it is important to choose the most appropriate treatment for bipolar disorder.

Here are some side effects of commonly prescribed drugs:
- problems with weight, including (addition or loss),
- drowsiness,
- decrease in sexual desire,
- tremor,
- dry mouth,
- blurred vision,
- changes in appetite,
- thoughts of suicide.
If you have thoughts of suicide, contact your doctor immediately. These are signs that your medication and therapy are not working correctly; we need immediate advice from a specialist in this area.
- over time decreases the power of the drug.

Sometimes, after a period of time, the effect of the drug may decrease. Developing addiction and resistance (tolerance) to the drug.

Signs of addiction and addiction:

- the course of your illness has changed,
- there was another mental illness,
- despite your usual diet, you notice sharp fluctuations in body weight.

Herbal medicine for bipolar disorder:

It is used in addition to pharmacotherapy. Before use, you should consult with your doctor.

Well balance the mood of such a herbal collection:
willow bark, nettle leaves, lemon balm leaves, lavender flowers, burdock root, hop cones, chamomile flowers, St. John's wort. Dried herbs mix in the same proportion and brew in a water bath at the rate of 10g per 1 liter of water.

In order to eliminate psychotic symptoms, it is enough to add to the herbal collection 1-2 grams of common belladonna, lily of the valley in May, or ergot mace.

Psychotherapy for bipolar disorder:

Psychotherapy should begin after the mood has stabilized with the help of medications.
Along with mood stabilizers, psychotherapy is recommended in order to help the patient develop suitable and effective strategies for coping with everyday stressful situations.

Different psychological counseling options are available:

Individual psychotherapy - one-on-one with a professional psychotherapist with experience in the treatment of bipolar disorders. During the session, the doctor should help the patient to understand the structure of the disease, to learn to recognize the early symptoms of the disease, to develop ways to deal with stress.

Family Counseling - Families often participate in this kind of therapy in order to learn how to identify the early signs of an impending manic or depressive episode in a person close to them and promptly seek help.

Group counseling is considered the most productive way to change the patient's perception of bipolar disorder and improve skills in overcoming life difficulties. Sessions provide an opportunity to exchange information, patients in the group independently develop effective strategies for resolving problems.

Symptoms of bipolar psychosis

The biphasic course of the disease proceeds in constant shifts of depressive states to manic forms. Moreover, depression in its frequency prevail over mania. Symptoms of manic states are expressed in the unusual elevated mood, high self-esteem, increased efficiency and reduced need to sleep. Over time, insomnia comes. At the patient the feeling of a distance is lost, in a speech there is a pressure.

The state of mania for a person resembles an inexhaustible energy source, hence the unlimited reassessment of vitality and the presence of risk in behavior. Problems of readaptation may begin when a person tries to show his behavior with an unconventional look, but the expected sense of release in this case is not filled internally and aggravates the disease. The type of thinking changes - a person ascribes all his successes to himself, and blames others for his failures.

Symptoms of depression include the state of despondency, complete indifference, loss of interest in everyday things that have previously pleased a person. Obsessive thoughts appear, the future is drawn in black. Sleep disorders manifest differently, either early awakening or an increased need to sleep. The patient experiences the power of his mood over him and believes that these differences cannot be corrected from the outside. Phases of bipolar psychosis harass the patient and his close relatives.

Man loses control of the sense of time. Depression seems to him inevitable and eternal. There is a re-adaptation (meeting others' expectations in the process of socialization), the desire to please everyone, which takes the form of caricature behavior. The depressed model of thinking significantly distorts the perception of others and personal achievements, as a rule, the patient relates defeats to his account, and victories to others.

Causes of bipolar psychosis

The disease has its origins in hereditary constitutional factors, that is, it is inherited, but only to those who have suitable qualities related to the anatomical and physiological appearance, in other words, a suitable cyclotymic constitution. At this point in time, there is a direct link between psychosis and impaired transmission of nerve impulses in some parts of the brain. Nerve impulses are responsible for the process of forming the senses, which are the main reactions of the mental species. The bipolar-type psychosis in most cases develops among young people, while there are much more women among the diseased.

Treatment of bipolar psychosis

During treatment, the influence of mental, somatic and social factors is taken into account, so treatment is a comprehensive approach in the fight against psychosis. The therapist prescribes medications that work to eliminate physical ailments. A psychotherapist prescribes medication that regulates mental behavior. The main role is played by psychological rehabilitation, which is carried out by psychologists individually or in groups.

Psychological methods of treatment inspire the patient confidence in the positive outcome of the disease, return a sense of time, carry out adaptation to a normal state. The main task of treating both symptomatic and long-term psychological is to prevent the emergence of new grievances and help in experiencing old ones, as well as disclosing and directing the internal forces of the body for treatment, strengthening family relations, and developing sustainable social ties.

The treatment process should set up the patient's ability to regulate their actions themselves. Discussions in rehabilitation groups can become very effective, where more “experienced” patients participate and there is an opportunity to evaluate their behavior from the outside. The patient’s close relatives are necessarily involved in the psychological treatment of bipolar psychosis for the therapeutic benefit of the patient.

Expert Editor: Pavel Alexandrovich Mochalov | D.M.N. general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - “Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.

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What is bipolar psychosis?

Psychosis is the inability to recognize what is real in the world around you. This is different from what your thoughts and ideas tell you. People who experience psychosis often have hallucinations or illusions.

Most people associate psychosis with schizophrenia, but this can be a sign of other mental and physical conditions and disorders.

People with bipolar disorder may experience hallucinations or delusions. When this occurs, they have bipolar disorder with psychotic features (with additional specifications for bipolar I, bipolar II, phase depression, manic or “mixed” omens). Some call it bipolar psychosis.

Delusions

Fallacy is an unshakable belief in what is not real, true, or probable. People may have grand delusions. This means that they consider themselves invincible or have special abilities or talents. Grandiose delusions are common during the manic phases of bipolar disorder.

When experiencing the depressive phase of bipolar disorder, a person may have paranoid delusions. They may believe that some of them got them or that their money was taken, leaving them in poverty.

Mood-congruent psychosis

With customized congruent psychotic symptoms (sometimes called features), delusions or hallucinations reflect a person’s mood or beliefs. For example, a person may have a sense of guilt or inadequacy. They may also believe that they have a disease or they die. These are common beliefs of people suffering from depression.

Mood-inappropriate psychosis

In psychosocial mood symptoms, delusions or hallucinations are not associated with a person’s beliefs or feelings. Hearing your thoughts or believing that you are controlled by others is two examples. Mood-inappropriate psychosis may be more serious. The results of one study showed that people with psychosomatic disorders prone to strokes are more likely to require hospitalization.

Watch the video: Bipolar Disorder. Clinical Presentation (September 2019).