How to treat bipolar mental disorder. Bipolar personality disorder

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Bipolar disorder is primarily a mental disorder, which is also called manic-depressive psychosis. Patients suffering from this disease are subject to frequent mood swings, which in some cases leads to bad consequences. A person alternately falls into two extremes - causeless euphoria and severe depression. These conditions usually change quickly, which interferes with full-time work or study. If severe depression develops, it can lead to suicide. The good news is that the disease is treatable, you just have to follow doctors’ recommendations.

The main risk group is teenagers and high school students. As you know, this is the age of personality formation, and a young body receives a large amount of hormones. As a result, if you do not cope with your condition, bipolar personality disorder may develop. The disease also occurs in people of retirement age. When the manic stage of the disease sets in, a person’s activity increases, causeless joy appears for any reason, and the level of energy is at its limit. When the condition enters the depressive stage, the opposite situation is observed, which in some cases provokes unpleasant consequences.

Mental disorder negatively affects performance and work in general, destroys relationships between people if there is no understanding, and has a bad effect on learning ability.

Symptoms

Bipolar disorder and symptoms are divided into two groups, since the disease has three stages of the condition: agitation, normal mood and depression. Let us consider them separately, with the exception of the normal state, which is intermediate and familiar to everyone.

Bipolar disorder and symptoms of mania (excitement):

Euphoric mood, incredible excitement;
Restlessness, increased energy and activity;
Inadequate assessment of the situation;
Fast pace of conversation, confusion of thoughts, jumping from one topic to another;
Increased irritability;
Unreasonable confidence in one's abilities and strengths;
Low need for sleep;
It is very difficult to focus on one topic;
Over a long period of time, the condition is strikingly different from normal;
Denial of the fact that this mood is abnormal;
Extravagance;
Aggressive behavior, provocations and importunity;
Increased sexual activity;
Use of harmful substances, smoking and alcohol, as well as medications for insomnia.

Doctors make a diagnosis if a person has at least three of the above symptoms that last for a week or a month. These symptoms, as a rule, are observed most of the day, after which they change to a normal state or go into a depressive stage.

Signs of bipolar disorder depressive episode:

Feelings of worthlessness, guilt, helplessness;
A prolonged state of emptiness, sadness and anxiety;
Insomnia or, conversely, severe drowsiness;
Pessimism and hopelessness;
Severe irritability and anxiety for any reason;
Lost interest in activities that previously brought great pleasure;
Difficulty remembering information, making any decisions, problems concentrating;
Feeling lethargic, low energy levels and constant fatigue;
Attempts and thoughts of suicide;
Unintentional weight gain, change in appetite;
Psychosomatic pain.

To be diagnosed with a depressive episode, a person must have five or more symptoms that also last most of the day, for two weeks or more. In this state, nothing pleases the patient, there are no favorite activities anymore, good news does not bring relief. Patients characterize their condition as depression, melancholy and sadness, which do not allow them to enjoy life. Slow thinking is observed, the perception of new information is complex, and patients often look at one point.

The most difficult time period is morning. At this time, most people suffering from a depressive phase feel unwell, and by the evening they return to normal. It has been observed that suicide attempts are most often made in the morning. At this stage, there is also poor appetite, self-confidence decreases, and self-esteem is low.

The phases of bipolar manic-depressive disorder are also divided into two corresponding groups. The manic phase consists of five stages.

Hypomanic. There is an elevated mood that lasts quite a long time. As a rule, during this period speech is very fast and intermittent. A person cannot stay on one topic for long and “jumps” from one to another.
Severe mania. In this phase, symptoms increase and the disease acquires pronounced features. Speech becomes more incoherent, louder, and attention wanders. Delusions of grandeur begin to appear, the patient thinks that he can “cross the sea up to his knees” or “move mountains.”
Manic frenzy. In the third phase, the person becomes practically uncontrollable, phrases consist of fragments of words, and chaotic movements are observed.
In the fourth phase, body movements return to normal, but the euphoric mood does not disappear.
Transition to normal.

The depressive phase of the disease consists of 4 states.

In the first phase, there is a decrease in physical activity, vitality weakens, mood disappears, and it is difficult to fall asleep.
Depression gradually increases, movements are inhibited, appetite decreases, and performance decreases even more.
In the third phase, the peak of the depressive state is observed. The patient becomes taciturn, quiet, remains motionless for a long time, his eyes look at one point. Thoughts of your own uselessness may appear.
At the fourth stage, the condition returns to normal.

Causes

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Modern scientists are trying to figure out how bipolar disorder develops and the main causes. The only thing that can be said with certainty is that the disease develops based on several factors. There is no single reason why a person develops manic-depressive syndrome. But numerous factors that negatively affect the psyche can develop bipolar disorder. It is known that the disease most often develops in the family, i.e. If someone has previously suffered from this mental disorder, there is a high probability of repetition in the family. Therefore, scientists are actively studying human DNA and trying to find specific genes that increase the chances of developing the disease.

Identical twins also took part in the studies. An interesting fact is that if one of them suffers from bipolar disorder, this does not mean that the second will develop the disease in the future. However, the chances of such an outcome are still higher than if they were not twins. It was possible to find out that the reason lies not only in one gene, but most likely in a combination of numerous genes. Research is being carried out using positron emission tomography and magnetic resonance imaging, which show the functioning of the brain in real time.

As a result, we can distinguish two main factors that influence the development of manic-depressive syndrome. The disease can develop along a hereditary line or due to external factors.

Heredity

As mentioned above, bipolar mental disorder can develop in cases where this disease has already been noticed in the family. Therefore, if you have been diagnosed with this, check your ancestral line. The best option is if you know that someone has had the disorder, so you can prevent the risk of development. According to scientific studies, if one of the parents had ARB, there is a 50% chance of developing the disease in their children. There is a risk of developing schizoaffective disorder.

External factors

Unfortunately, the world around us is sometimes very cruel and not all people are able to cope with difficult situations. As a result, they can hit the psyche hard and become a trigger for the development of bipolar mental disorder. In addition to psychological trauma, manic-depressive syndrome can develop after traumatic brain injury, intoxication and diseases of internal organs. It is worth noting that all these situations only trigger the process of disease development, which is already embedded in the genes. That is why scientists are trying to find them in order to create a more effective and faster way to treat bipolar disorder.

Treatment

First of all, it is worth understanding that bipolar affective personality disorder is not a runny nose, cold or other mild illness that can be treated very simply. In this regard, the help of a psychotherapist or other specialist who is well versed in bipolar disorder is necessary. Treatment, as a rule, comes down to taking thymostabilizers, antidepressants and antipsychotics. They are prescribed exclusively by prescription from the attending physician, as is the dosage, which must be strictly observed. The number and types of medications taken are also prescribed by the treating specialist, since each person needs a different dosage, according to the stage of the disease. Treatment for bipolar affective disorder varies at different stages of the disease.

Antidepressants. This category of drugs is prescribed when the patient is experiencing the depressive stage of the disease. They are also prescribed as a preventive measure. Among other things, it is necessary to visit a psychologist or psychotherapist who will motivate the person to recover and prevent accidents;
Thimostabilizers. Interestingly, drugs in this group are used for bipolar mental disorder and treatment of seizure disorders such as epilepsy. Over time, it was discovered that they also have a positive effect in the treatment of manic-depressive syndrome. They help eliminate fluctuations in mood, and the patient becomes more balanced. Among other things, thymostabilizers are prescribed as prophylaxis and to prevent the development of the disease;
Antipsychotics also help the patient. This group of drugs treats more serious consequences of the disease. They are prescribed when it is necessary to eliminate hallucinations, delusions, excessive anxiety and other mental disorders;
Do not forget that psychotherapy is mandatory, regardless of the stage of the disease and the type of medications taken. It is impossible to say for sure what type of psychotherapy will be useful for the patient: family, individual or group. Each situation is special and requires detailed study. The main thing is that the patient feels comfortable and relaxed.

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

The disease was first described in 1854 by French psychiatrists Falret and Baillarger. But it was recognized as an independent nosological unit only in 1896, after Kraepelin’s works devoted to a detailed study of this pathology were published.

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

There are no exact data on the prevalence 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 suffered from the disease. The assessment of foreign experts was different - 0.8% of the population. Currently, it is believed that 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 incidence 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 go undiagnosed.

In approximately half of patients, the onset of bipolar disorder occurs between 25 and 45 years of age. In middle-aged people, unipolar forms of the disease predominate, and in young people, bipolar forms predominate. In approximately 20% of patients, their first episode of bipolar disorder occurs after age 50. In this case, the frequency of depressive phases increases significantly.

Bipolar disorder is 1.5 times more common in women than in men. At the same time, bipolar forms of the disease are more often observed in men, and monopolar forms in women.

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

Causes and risk factors

Diagnosis of such a serious illness must be trusted to professionals; experienced specialists at 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. Hereditary (internal) and environmental (external) factors play a certain role. In this case, the greatest importance is given to hereditary predisposition.

Factors that increase the risk of developing bipolar disorder include:

schizoid personality type (preference for solitary activities, tendency to rationalize, emotional coldness and monotony);
Statothymic personality type (increased need for orderliness, responsibility, pedantry);
melancholic personality type (increased fatigue, restraint in expressing emotions combined with high sensitivity);
increased suspiciousness, anxiety;
emotional instability.

The risk of developing bipolar disorder in women increases significantly during periods of unstable hormonal levels (menstrual bleeding, pregnancy, postpartum or menopause). The risk is especially high for women with a history of psychosis suffered during the postpartum period.

Forms of the disease

Clinicians use a classification of bipolar disorders based on the predominance of depression or mania in the clinical picture, as well as 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. Unipolar forms of pathology include periodic mania (hypomania) and periodic depression.

The bipolar form occurs in several variants:

regularly interspersed– a clear alternation of mania and depression, which are separated by a light interval;
irregularly intermittent– the alternation of mania and depression occurs chaotically. For example, several episodes of depression may occur in a row, separated by a light interval, and then manic episodes;
double– two affective disorders immediately replace each other without a clear interval;
circular– there is a constant change of mania and depression without clear intervals.

The number of phases of mania and depression in bipolar disorder varies among patients. Some people experience dozens of affective episodes throughout their lives, while for others such an episode may be the only one.

The average duration of the bipolar disorder phase 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 the ICD-10 under the name bipolar affective disorder. This was due to the fact that psychosis does not always occur with this pathology.

Some patients with bipolar disorder experience mixed episodes, which are characterized by rapid alternation between mania and depression.

The average duration of the clear interval 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, the manic stage is characterized by:

accelerated thinking;
uplifting mood;
motor excitement.

There are three degrees of severity of mania:

Mild (hypomania). There is an elevated mood, an increase in physical and mental performance, and social activity. The patient becomes somewhat absent-minded, talkative, active and energetic. The need for rest and sleep decreases, and the need for sex, on the contrary, increases. Some patients experience not euphoria, but dysphoria, which is characterized by the appearance of irritability and hostility towards others. The duration of an episode of hypomania is several days.
Moderate (mania without psychotic symptoms). There is a significant increase in physical and mental activity, and a significant increase in mood. The need for sleep almost completely disappears. The patient is constantly distracted, cannot concentrate, as a result, his social contacts and interactions are difficult, and he loses his ability to work. Ideas of greatness arise. An episode of moderate mania lasts at least a week.
Severe (mania with psychotic symptoms). There is pronounced psychomotor agitation and a tendency to violence. Jumps of thoughts appear, the logical connection between facts is lost. Hallucinations and delusions develop, similar to the hallucinatory syndrome in schizophrenia. Patients become confident that their ancestors belonged to a noble and famous family (delusion of high origin) or consider themselves a famous person (delusion of grandeur). Not only the ability to work is lost, but also the ability to self-care. Severe mania lasts over several weeks.

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

slow thinking;
low mood;
motor retardation;
decreased appetite, up to its complete absence;
progressive loss of body weight;
decreased libido;
Women stop menstruating and men may develop erectile dysfunction.

With mild depression due to bipolar disorder, patients' mood fluctuates throughout the day. It usually improves in the evening, and in the morning the symptoms of depression reach their maximum.

The following forms of depression may develop in bipolar disorder:

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

Diagnostics

To be diagnosed with bipolar disorder, a patient must have had at least two episodes of mood disorders. Moreover, at least one of them must be either manic or mixed. To make a correct diagnosis, the psychiatrist must take into account the patient’s medical history and information received from his relatives.

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

The severity of depression is determined using special scales.

The manic phase of bipolar disorder must be differentiated from agitation caused by taking psychoactive substances, lack of sleep or other reasons, and the depressive phase – from psychogenic depression. Psychopathy, neuroses, schizophrenia, as well as affective disorders and other psychoses caused by somatic or nervous diseases should be excluded.

Treatment for Bipolar Disorder

The main goal of treating bipolar disorder is to normalize the patient’s mental state and mood and achieve long-term remission. In severe cases of the disease, patients are hospitalized in the psychiatry department. Mild forms of the disorder can be treated on an outpatient basis.

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

Drug treatment of bipolar disorder in the stage of mania is carried out with mood stabilizers, and in severe cases of the disease, antipsychotics are additionally prescribed.

In the remission stage, psychotherapy (group, family and individual) is indicated.

Possible consequences and complications

If left untreated, bipolar disorder can progress. In a severe depressive phase, the patient is capable of making suicidal attempts, and during a manic phase he poses a danger both to himself (accidents due to negligence) and to the people around him.

Bipolar disorder is 1.5 times more common in women than in men. At the same time, bipolar forms of the disease are more often observed in men, and monopolar forms in women.

Forecast

In the interictal period, in patients suffering from bipolar disorder, mental functions are almost completely restored. Despite this, the prognosis is unfavorable. Repeated attacks of bipolar disorder occur in 90% of patients, and over time, 30–50% of them permanently lose their ability to work and become disabled. In approximately every third patient, bipolar disorder occurs continuously, with minimal duration of light intervals or even their complete absence.

Bipolar disorder is often combined with other mental disorders, drug addiction, and alcoholism. In this case, the course of the disease and the prognosis become more severe.

Prevention

Measures for the primary prevention of 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 stable remission and preventing repeated episodes of affective disorders. To do this, it is necessary that the patient does not voluntarily 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:

sudden changes in hormonal levels, endocrine system disorders;
brain diseases;
injuries;
infectious and somatic diseases;
stress, overwork, conflict situations in the family and/or at work;
violations of the daily routine (insufficient sleep, busy work schedule).

Many experts associate the development of exacerbations of bipolar disorder with a person’s annual biorhythms, since exacerbations occur more often in spring and autumn. Therefore, at this time of year, patients should especially carefully adhere to a healthy, measured lifestyle and the recommendations of their doctor.

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Causes of bipolar disorder

Most experts agree that there is no one global reason why a patient develops bipolar disorder. Rather, it is the result of several factors that influence the occurrence of this mental illness. Psychiatrists identify several reasons why bipolar disorder develops:

genetic factors;
biological factors;
chemical imbalance in the brain;
external factors.

As for the genetic factors that influence the development of bipolar disorder, scientists have made certain conclusions. They conducted several small studies using the personality psychology method on twins. According to doctors, heredity plays an important role in the development of manic-depressive psychosis. People who have a blood relative with bipolar disorder are more likely to develop the disease in the future.

When it comes to biological factors that can lead to bipolar disorder, experts say that brain abnormalities are often observed when examining patients diagnosed with bipolar disorder. But so far doctors cannot explain why these changes lead to the development of serious mental illness.

Chemical imbalances in the brain, especially with regard to neurotransmitters, play a key role in the occurrence of various disorders, including bipolar disorder. Neurotransmitters are biologically active substances in the brain. Among them are, in particular, the most famous neurotransmitters:

dopamine;
norepinephrine.

Hormonal imbalance can also trigger the development of bipolar disorder.

External or environmental factors sometimes lead to the formation of bipolar disorder. Among environmental factors, psychiatrists distinguish the following circumstances:

excessive alcohol consumption;
traumatic situations.

Symptoms of Bipolar Disorder

Symptoms during the manic stage include the following:

a person feels like the ruler of the world, feels euphoric and is too excited;
the patient is self-confident, he has an excessive sense of self-importance and increased self-esteem prevails;
doctors note a distorted perception in the patient;
a person is distinguished by fast speech and an excess of phrases;
thoughts come and go at high speed (so-called racing thoughts), eccentric statements are made; patients sometimes even begin to embody some strange thoughts in reality;
during the manic stage, a person is sociable and sometimes aggressive;
the patient is capable of committing risky actions, has promiscuous sex life, alcoholism, he can use drugs and participate in dangerous activities;
the individual may be careless with money and spend it excessively.

Symptoms during the depressive stage of bipolar include the following:

the patient feels despondency, despair, hopelessness, sadness, and his thoughts are gloomy;
in severe cases, the patient is visited and he can even take certain actions to carry out what is planned;
doctors note insomnia and sleep disorders;
the patient often experiences anxiety over trifles;
the personality is often overwhelmed by a feeling of guilt about all events;
the depressive phase of bipolar disorder is reflected in food intake - a person eats either too much or too little;
patients note weight loss or, conversely, weight gain;
the patient complains of fatigue, weakness, apathy;
the person has attention problems;
the patient is easily susceptible to irritants: noise, light, smells, reacts to tight clothing;
some patients are unable to go to work or study;
a person notices that he has lost the ability to enjoy activities that previously brought joy.

Psychosis

During both the manic and depressive stages of bipolar disorder, the patient may experience psychosis, when a person cannot understand where the fantasies are and where the reality in which he is located.

Symptoms of psychosis in bipolar disorder are as follows:

illusions;
hallucinations.

Clinical depression or major depressive disorder

Clinical depression is often a seasonal phenomenon. It used to be called seasonal affective disorder. There are mood swings depending on the time of year.

Symptoms of bipolar disorder in children and adolescents:

sudden change of mood;
attacks of anger;
outbursts of aggression;
reckless behavior.

It is important to remember that manic depression is treatable and exists. The symptoms of this mental illness can be reduced with the right approach, and thus the person can return to normal life.

Diagnosis of bipolar disorder

When diagnosing bipolar disorder, a psychiatrist or psychologist is guided by his previous work experience, his observations, conversations with family members, colleagues, close friends, teachers, as well as knowledge of secondary signs of this mental illness.

First, it is necessary to study the physiological state of the patient, do a blood and urine test.

Experts distinguish three common types:

1) The first type of bipolar disorder, the so-called expression of emotions in the mirror

There must be at least one episode of the manic phase of bipolar disorder or a mixed phase (with a previous depressive phase). Most patients experienced at least one depressive episode.

In addition, in this case it is important to exclude clinical affective disorders that are not associated with manic-depressive psychosis, for example:

schizophrenia;
delusional disorder;
other mental disorders.

2) The second type of bipolar disorder

The patient has experienced one or more episodes of depression and at least one episode of hypomanic behavior associated with manic depression.

Hypomanic states are not as severe as manic states. During the hypomanic stage, the patient sleeps little, he is assertive, easy-going, very energetic, but at the same time is able to perform all his duties normally.

Unlike the manic stage of bipolar disorder, during the hypomanic stage, doctors do not observe symptoms of psychosis or delusions of grandeur.

3) Cyclothymia

Cyclothymia is a mental affective disorder in which the patient experiences mood swings, ranging from vague depression to hyperthymia (sometimes even episodes of hypomania occur). Hyperthymia is a persistent elevated mood.

In general, such mood swings with cyclothymia are a mild form of manic-depressive psychosis. Moderate depressive mood is often observed.

In general, a patient with symptoms of cyclothymia feels that his condition is quite stable. At the same time, other people notice his mood swings, ranging from hypomania to a manic-like state; then depression may occur, but this can hardly be called major depressive disorder (clinical depression).

Treatment for Bipolar Disorder

The goal of treatment for bipolar disorder is to reduce the frequency of manic and depressive episodes as much as possible, and to significantly reduce the symptoms of the disease so that the patient can return to normal life.

If the patient does not undergo treatment and symptoms of the disease remain, this can last for one year. If a patient is being treated for manic-depressive psychosis, improvement usually occurs in the first 3-4 months.

At the same time, mood swings still remain a hallmark of patients diagnosed with bipolar disorder who are undergoing treatment. If a patient regularly communicates with his doctor and goes to an appointment, then such treatment is always more effective.

Treatment for bipolar disorder usually involves a combination of several therapies, including medications, exercise, and work with a psychologist.

Nowadays, a patient is rarely hospitalized with symptoms of manic-depressive psychosis. This is only done if he might cause harm to himself or others. Then patients are in the hospital until improvement occurs.

Lithium carbonate is most often prescribed long-term to reduce mania and hypomania. Patients take lithium for at least six months. You must strictly adhere to the psychiatrist's instructions.

Other types of therapy for bipolar disorder include the following:

anticonvulsants;
neuroleptics;
valproate and lithium;
psychotherapy;

Anticonvulsants are sometimes prescribed to help a person in the manic stage of bipolar disorder.

Antipsychotics are aripiprazole, olanzapine and risperidone. They are prescribed if a person behaves too restlessly and the symptoms of the disease are severe.

In what cases are valproate and lithium carbonate prescribed? Doctors use this combination of drugs in rapid cycling.

Rapid cycling is a form of bipolar disorder in which the patient experiences 4 or more episodes of mania or depression per year. This condition is more difficult to treat than varieties of the disease with less frequent attacks, and requires special selection of medications. According to some studies, more than half of patients suffer from this form of the disease.

In general, a sign of rapid cyclicality is unbalanced behavior in a person diagnosed with “manic-depressive psychosis” all the time, and there is no norm in his behavior for a long time. In such cases, psychiatrists prescribe valproate in combination with lithium. If this does not bring the expected effect, the doctor recommends lithium carbonate, valproate and lamotrigine.

The goal of psychotherapy is to:

relieve the main symptoms of bipolar disorder;
help the patient understand the main provoking factors that lead to the disease;
minimize the impact of the disease on relationships;
identify the first symptoms that indicate a new round of the disease;
look for those factors that help you stay normal the rest of the time.

Cognitive behavioral therapy is training the patient in psychological self-help techniques and a type of family therapy. Psychiatrists talk to the patient and his family about how to avoid exacerbation of bipolar disorder.

Interpersonal (or interpersonal therapy) also helps patients with symptoms of depression. Interpersonal psychotherapy is a type of short-term, highly structured, specifically focused psychotherapy. It is based on the working principle of “here and now” and is aimed at resolving the problems of the current interpersonal relationships of patients who suffer.

Bipolar disorder is a complex mental illness characterized by frequent mood swings and a lack or excess of energy and vitality. It leads to loss of productivity in school or professional activities.

In bipolar disorder, there are alternating phases of depression, mania and hypermania. In this case, there are no changes in the human psyche.

This disease is mainly diagnosed in men and women aged 20 to 30 years, with an advantage in the fairer sex. Once the disorder appears, it begins to actively develop and can become chronic. If it is not noticed in time and treatment is not started, then it will be possible to state that a person simply has a change of phases without periods of normal condition. The consequences of chronic deep illness can be irreversible.

Bipolar disorder can occur in older people, as well as in children and adolescents.

Among the causes of the disorder, it is customary to distinguish biological and psychosocial.

Biological reasons

Biological causes include forms of hereditary predisposition. Bipolar disorder occurs in people with a certain set of genes. Also, the possibility of imbalance of neurotransmitters (dopamine, serotonin, norepinephrine) is inherited. These conclusions are based on studies documenting an increase in neurotransmitters during episodes of the disorder. Another factor influencing the occurrence of bipolar disorder is the disruption of the proper functioning of systems including the interaction: hypothalamus - pituitary gland - thyroid gland - adrenal glands.

It must be admitted that the true causes of bipolar disorder are not fully understood. Recently, scientists have made several discoveries regarding the genetics and inheritance of the disease:

- in families where there have been cases of bipolar disorder, there is an increase in cases of psychosis and disorders;

- the closer the relationship to the patient, the higher the risk of disease in a family member;

- unipolar disorders do not turn into bipolar and vice versa;

— the presence of a bipolar relative does not indicate the inevitability of the disease in other family members;

— the risk of developing a disease in a child often depends on the age of the parents: the father’s advanced age at the time of conception increases the likelihood of gene mutations in the child.

Effects and medications

The peculiarities of the effects of medications and substances on nerve cell receptors are also revealed. Doctors note the occurrence of bipolar disorder in cases of treatment of other mental disorders.

Physiological features of the body's vital functions

The causes of bipolar disorder may also be related to disturbances in the metabolism of biogenic amines, endocrine systems, and water-salt balance. The problem is that identifying these features in a person in order to understand the cause of the disorder and begin treatment is quite difficult. And sometimes it’s simply impossible.

Psychosocial (environmental) reasons

Psychosocial causes include manic depressive disorders, which are a manifestation of protective forces in severe stressful situations. A person’s activity can be explained by the body’s attempt to isolate a traumatic event from life. When the defensive forces of mania begin to be lost and disintegrate, depression begins to appear. In the future, defensive forces may be activated again, indicating the need to protect against one’s own inferiority. It is important to know that stress can activate the initial stage of the disease. And if immediate treatment is not started, the disease may begin to progress on its own, regardless of the presence or absence of stress.

Life events, especially childhood traumas, can cause genetic disorders. In addition, negative events that happen to a person who has had it in the past can cause relapses of the disease with increased symptoms.

In children, bipolar disorder can be caused by disturbances in interpersonal relationships or incidents of violence.

In the vast majority of people, the disease begins with an episode of depression (70%), and only 30% of patients report an episode of mania as the onset of the disease. However, before depression itself there are frequent mood swings.

Bipolar disorder is characterized by three phases:

Phase 1: manic. During this period, a person is overwhelmed by a large number of thoughts and actions that replace each other at a fast pace. At the same time, clear thoughts can be replaced by confused ones, and logical actions can be completely inexplicable. Due to a series of events, the patient becomes angry, fearful, and irritable.

People often have mood swings. Usually this is influenced by some events. But for some individuals such changes can be observed for no apparent reason. A mental disorder that clinically manifests itself as affective mood disorders is called bipolar disorder. Symptoms of the disease may vary depending on the stages.

History of discovery

French psychiatrists J. Falret and J. Baillarger first described bipolarity in 1854. The disorder was recognized as an independent nosological unit only in 1896, when the works of Kraepelin, who studied this pathology in detail, were published.

At first this disease was given the name “manic-depressive psychosis.” It has been called bipolar affective disorder since 1993, when it was included in the ICD-10. This is due to the fact that psychosis did not always occur during illness.

Researchers using different criteria for assessing the signs of bipolar disorder, so there is no precise data on the prevalence of the disease. In the 90s of the 20th century, Russian researchers in the field of psychology argued that about 0.45% of the planet's population suffers from pathology. Foreign psychiatrists tended to favor other data and believed that 0.8% of people were susceptible to the disease. Today, experts are inclined to believe that the disorder is observed in 1% of the population, while every third patient suffers from a severe psychotic form of the disorder.

Bipolar mental disorder manifests itself mainly in people 25-45 years old. Middle-aged patients most often suffer from the unipolar form of the disease, and young people most often suffer from the bipolar form. The first episode of pathology is observed in 20% of patients over the age of 50 years. Depressive phases appear more often in this case. Repeated attacks occur in 85% of people, and after some time, about 40% of them cease to be able to work and become disabled.

Description of the disease

Bipolar disorder is characterized by frequent mood swings, and the patient's condition does not change from bad to good. Depression and despondency are replaced by euphoria and the feeling that the patient is capable of performing courageous actions. Strong mood swings are always noticeable to others.

Mental disorder is most often observed among the fair sex. In men, this disease occurs 1.5 times less frequently.

Treating the pathology is not difficult if you choose the right therapy. With the help of medications and psychotherapeutic techniques, a person can keep his emotions under control. The problem lies in the correct diagnosis, since mood swings can be a symptom of various diseases. In addition, women's emotional state is more unstable than men, and during the period of premenstrual syndrome they experience influxes of emotions and loss of strength, which imperceptibly replace each other.

Because of this, bipolar affective disorder is often diagnosed in a patient only several years after the first symptoms appear. When a person and the people around him understand that something is wrong with him, and the manifestation of signs can no longer be attributed to a bad character, it is necessary to seek help from a specialist.

Reasons for appearance

Anyone can get bipolar. While doctors cannot name the exact causes of the disease. But there are factors that increase the risk of developing this disease:

Some people have a predisposition to the disease, since every person can have mental disorders. But usually this factor is combined with another, for example, heredity.

Types of disorder

Bipolarity is characterized by two types. The first type is characterized by severe symptoms. In this case, the diagnosis of mental illness is made with complete confidence. If a person with this type of disorder does not take treatment seriously, then they may end up in the intensive care unit. He will not be able to cope with the disease on his own.

The second type of disorder is more common than the first. With it, the symptoms are not yet so pronounced, so even the patient may find it difficult to understand that he needs the help of a doctor. If you do not go to the hospital in time, then the symptoms will progress, and the person will become depressed or euphoric and begin to behave inappropriately.

Besides, There are several types of mental disorder:

Unipolar. Mania or depression alternate with “light” intervals - euthymia. This form is called periodic mania or periodic depression.
Correctly intermittent. Manic and depressive phases replace each other at certain intervals.
Irregularly intermittent. After a depressive period, depression may occur again. The same thing happens if there is mania.
Double. This form is characterized by an alternation of depression and mania, after which there is an interphase (rest). When changing between depressive and manic forms, there are no “bright” intervals.

During the manic phase, the patient feels like a great person. His self-esteem is too high. He is constantly euphoric and has a lot of energy.

During depression, the world seems gray and boring to a person. Nothing makes him happy because he cannot find anything good in it. The patient considers himself unnecessary, in addition, he is sure that he is a problem for others. During the depressive period, the internal problems of the person suffering from the disorder worsen. This condition is often mistakenly considered schizophrenia.

Characteristic symptoms

Episodes of depression and mania can last for different lengths of time. On average, one phase lasts 6-12 months. But sometimes the episode does not even exceed two weeks, and in some cases it can last several years. Even “light” intervals (euthymia) are sometimes measured in tens of years.

Symptoms of Bipolar Affective Disorder at different phases:

The mixed condition, which predominates in 50% of patients, combines signs of both phases. It usually affects people who are treated with psychoactive drugs, as well as those who have diseases of the nervous system. The disease is severe.

Some of the main symptoms of bipolar personality disorder during the depressive period are slowness of thinking, retardation of movements, and decreased libido. With a mild form, patients' mood fluctuates throughout the day. It gets better in the evening, and in the morning the symptoms reach their maximum severity.

In bipolar disorder, depression can come in several forms. Simple depression is characterized by depressed mood, lack of motivation to act, and decreased intellectual function. In the hypochondriacal form, the patient believes that he has a serious, deadly and incurable disease or a disease unknown to modern doctors.

Delusional depression with rapid cycling is associated with delusions of blame, which patients agree with and share. The agitated form is characterized by speech motor excitation. With the anesthetic type of depression, the patient seems to have lost the ability to feel.

Diagnosis of the disease

First, the patient needs to contact a psychotherapist, with whom he will have to undergo a conversation, testing and examination. The doctor will order blood tests and a brain examination to rule out severe damage that could be caused by hemorrhage or a tumor.

The psychiatrist finds out not only the medical history of the patient himself, but also his relatives. This is necessary so as not to confuse bipolarity with major depression. With the second illness there is no mania, so the specialist needs to talk with the patient’s relatives.

In order for the doctor to make an accurate diagnosis, the patient is observed for at least two weeks. If during this period of time he has at least two episodes of affective disorders, one of which must be manic or hypomanic, then he is diagnosed with bipolar disorder.

When diagnosing, mania can easily be confused with agitation that occurs after taking psychoactive drugs. The depressive phase is often mistaken for psychogenic depression. It is very important to distinguish affective disorder from neuroses, schizophrenia and other diseases of the nervous system.

Treatment options

If you start treating the disorder immediately after the first manic episode, you can expect better results than with treatment started later.

Treatment of the disease is not easy. Its main task is to interrupt the phase of mania or depression at least for some time. Aggressive psychotherapy is not used in this case, since the patient’s psyche may stop responding to treatment procedures. Initially, the patient is prescribed small doses of medications, which are gradually increased until they are effective.

Under the influence of medications, phase inversion can occur, that is, it changes to the exact opposite. This is a rather alarming sign, so during treatment it is necessary to monitor the patient’s condition.

Started therapy should not be interrupted. Every day the doctor monitors changes in the patient’s psyche and mood. If side effects are observed after some medications, then change the dosage of the medications or replace them with others. People suffering from affective disorders The following drugs are prescribed:

Electroconvulsive therapy is prescribed only as a last resort, when other means have not had the desired effect. Therapy is carried out under light anesthesia. Before the procedure, the patient is given a muscle relaxant, so he will not feel pain or discomfort. The pulse is applied for 30-60 seconds. This technique normalizes the patient’s condition in an average of 10-15 minutes. He can leave the hospital on the same day.

Since electroconvulsive therapy has many contraindications, it is rarely prescribed. After the procedure, a person may experience temporary problems with consciousness, memory and spatial orientation, but they will quickly pass.

Pregnancy and lactation period

A woman planning children should first consult with her doctor about the possibility of conceiving if she has manic-depressive psychosis. She definitely needs to visit a psychiatrist, therapist and gynecologist.

If a woman becomes pregnant, then it is necessary to discontinue all psychotropic medications, since they negatively affect the development of the fetus. A doctor develops a gradual withdrawal plan for medications. If you immediately stop taking the medications, the patient’s mental condition will greatly deteriorate.

During pregnancy, a relapse of the disease may occur. In this situation, aggressive treatment methods using normometics are used. Therapy is carried out only in the hospital.

If necessary, the patient is prescribed lithium preparations, but with great caution, since they negatively affect the formation of the cardiovascular system in the fetus. If a woman is prescribed these medications during lactation, then she should not breastfeed her baby. After childbirth, the patient's condition is characterized by a severe return of the disorder.

Medical forecasts

Doctors cannot give one hundred percent predictions about the treatment of a mental disorder. If you seek help at the initial stage of development of the disease, then the person will be able to get out of this state.

When the causes of the disorder were mental illness and heredity, then it will not be possible to get rid of bipolarity completely. Everything will depend on the patient, who must deal with his treatment. People with manic and depressive states do not withdraw from society, although their work and personal relationships suffer.

Only mentally ill individuals can be limited in their legal capacity. Some of them are kept in psychiatric hospitals. The disorder is often combined with drug addiction or alcoholism, which makes the course of the disease and prognosis worse.

Help yourself

If a person neglects the disease and does not seek help from doctors, he will have many family and financial problems in life. The patient will not be able to study or work normally. He will begin to abuse alcohol or drugs. In the later stages of the disease, many patients isolate themselves from society. Some of them may try to commit suicide.

To avoid sad consequences, a person suffering from manic-depressive psychosis needs to lead a healthy lifestyle. In this way, the symptoms of the disease are controlled and reduced.

Psychotherapy and medications do the main work, but a person should make efforts to heal himself. He needs to learn more about his illness in order to make the necessary decisions. The patient must be patient and take medications in accordance with the regimen proposed by the doctor. He needs to identify which situations trigger his manic or depressive episodes. You should get rid of bad habits. Yoga and other relaxation methods will help you avoid stress.

Social support is important for a person with a mental disorder. He needs to establish relationships with family and friends, who should support him in difficult times and help him through difficult periods.