Among the disorders of the mental status of the individual, a separate place is given to bipolar affective disorder. The disease is characterized by the presence of frequent intermissions – the “bright” time of mental well-being, when there are no symptoms of the disorder.
People with bipolar disorder have a non-standard outlook – their state jumps between an extreme maximum and an extreme minimum. Often, patients are aware of the problem, but this does not help to cure without the help of doctors.
Definition of disorder
Bipolar disorder (BAD) has been referred to in the past as manic-depressive psychosis. Pathology includes recurrent episodes of mania or hypomania with phases of depression. It is a chronic affective mood disorder. The disease noticeably disrupts all spheres of the patient’s life – professional, social and others. Episodes of the current are sometimes found in a mixed form. There are periods of remission – at this moment, the person’s well-being improves, the symptoms disappear completely or weaken. The ICD code of the disorder is F31.
According to modern scientific data, bipolar disorder is a disabling pathology, the symptoms of which begin to appear in childhood or adolescence. A person suffering from bipolar disorder is at risk for suicidal behavior. Patients often suffer from disability and poor social adaptation.
According to the International Classification of Diseases, bipolar disorder is repeated episodes with impaired human activity. Deformation of mood is manifested in its sharp rises and sudden drops. In the phase of mania, excessive and unreasonably increased energy is observed. The depressive phase includes, on the contrary, a decline in activity.
The disease sometimes occurs in one phase for a long time. The predominance of either depressive or hypomanic phase is allowed. The frequency and duration of mania and depression varies from person to person.
With TIR, there are no hallucinations or other pronounced deformations of the personality, in contrast to other types of psychotic disorders.
According to the DSM (US Classification of Mental Disorders), there are two types of bipolar disorder. The first type – manic and depressive phases alternate, a mixed type of course is allowed. The second type is dominated by depressive phases, after which mild mania sets in.
Researchers point to the existence of two more varieties of BAR. With drug hypomania, recurrent depression is observed, followed by mild phases of hypomania. This disorder is induced, triggered by antidepressant therapy and is considered one of the stages in the treatment of depression. The second type is depressive disorder associated with hypertension. With such a pathology, the state of clinical depression is mixed with the hyperthymic personality temperament.
The following types of TIR are recognized in international psychiatry:
The bipolar nature of the disorder – in the structure of the symptom complex, phases of mania and depression are found with almost the same frequency. There are asymptomatic gaps between them.
Unipolar character – the structure of the disorder by the type of predominance in frequency of either a manic or a depressive phase.
Continuous character – there are no intermissions, both phases often replace one another.
The scientific validity of the described types of TIR is confirmed by multiple clinical and biological studies. Classic bipolar disorder is considered a more severe pathology.
Symptoms and signs of the manic phase
Manic manifestations are not difficult to confuse with attention deficit hyperactivity disorder. The hyperactive period is of varying severity. With a severe course, psychotic symptoms occur. The manifestations of the mania phase are as follows:
euphoria for no apparent reason;
excessive irritability or aggression is possible;
complete absence or decrease in the need for sleep – the duration of sleep is noticeably shortened;
the emotional background is unstable;
the patient’s speech is fast, illegible;
problems formulating thoughts;
impulsiveness – actions are first performed, and then their meaning is pondered;
excessive self-confidence in personal abilities;
acceleration of mental processes;
temporarily high self-esteem;
increased distraction – the patient “jumps” from one lesson to another, because of which the final result of the activity suffers;
the behavior is characterized by riskiness – rash expensive purchases, multiple promiscuous sexual relations, etc.
In this phase, a person is very superficial, but realizes the severity of his own condition. Problems with social adaptation are characteristic. Sometimes hypomania turns out to be productive for the patient’s life. But more often than not, it is dangerous.
Hypomanic state – increased motivation for activity, inconsistency of actions, general disorganization and spontaneity. The patient demonstrates rash behavior, performs extravagant actions. There is a disdainful attitude towards family, social, professional duties. Cognitive impairment:
“leaps of ideas”;
tendency to joke;
increased volume of the associative process.
Outwardly, a person has boastfulness, embellishment of his own personality, ideas of greatness. Delusional ideas, paranoia, hallucinations are not included in TIR symptoms.
Sensory disturbances are possible – colors are perceived brighter, tastes are sharper, vital tone increases, impressionability from events seen or heard.
The “manic triad” is described in psychiatry. These are three signs that accompany mania – high mood, accelerated thinking, increased speech and motor activity. A person in the mania phase feels a subjective, illusory surge of strength. He overestimates his own capabilities.
The patient starts several things at the same time, but does not finish one. The difficulty lies in the inability to focus on one thing. Outwardly, a person laughs loudly, screams, anger is abruptly replaced by fun. As thinking accelerates, many thoughts-associations arise, and they are all at the same time in the same second. As a result, a person’s speech cannot “catch up” with the thought process. Superficial judgments are noticeable.
In some patients, it is not an optimistic wave that dominates, but manifestations of pickiness, rudeness, and dysphoria.
Signs of a depressive phase
BAR begins in the majority of patients without noticeable, striking manifestations. In a typical TIR case, there are subtle fluctuations in the background mood with cycles of several days to weeks. Researchers of the problem emphasize that the unfavorable course of bipolar disorder is the onset of the disorder from the first depressive episode. During the depressive phase, 89% of suicides or suicidal attempts are committed.
Depression occurs when the high productivity of mental processes is abruptly replaced by its decline. Specific manifestations of the phase:
severely depressed mood;
slowing down the thought process;
slowing down of speech motor activity;
decreased or complete lack of appetite, perverted gustatory sensitivity;
in women – problems with menstruation;
mothers have problems with maternal instinct;
lack of sexual desires;
longing, which is felt physically as a heaviness in the chest area;
tachycardia attacks, constipation, mydriasis (dilated pupils of the eyes);
Depression sometimes takes on an endogenous form – due to the biological nature of the disorder, not only mental, but also somatic, endocrine disorders occur.
Sometimes the “atypical” nature of the course of depression is formed – increased appetite, hypersomnia. There is also a hypochondriacal type of disorder – in this case, obsessive hypochondriacal beliefs with affective coloration are noted. With a delusional type of flow, there is “Cotard’s syndrome” – in addition to anxiety, delusional beliefs of a fantastic nature are observed. With agitational depression, there is a noticeable nervous overexcitation. When asthenic variant flow in the patient notes the loss of ability to feel anything.
Patients experience unmotivated sadness and a feeling of hopelessness especially acutely – from several hours to several days without the opportunity to be distracted by something else. A person closes in on himself, stops contacting family members, friends. The interest in those activities and things that were previously interests is completely lost. Low ability to learn new things. Appetite may be uncontrollable or absent.
Fatigue, lack of energy is felt around the clock. Sleep is intermittent with frequent awakening episodes, especially in the early morning hours. After sleep, a person does not feel rested. There are problems with memory, poor concentration. Suicidal thoughts appear – a person experiences a clear conviction that life has no meaning and will never bring pleasure. In parasuicidal behavior, tunnel thinking syndrome is noted.
The depressive phase is very dangerous due to the high level of suicidal tendencies, parasuicides, and auto-aggressive acts. It is recommended to hospitalize a person for subsequent therapy in a hospital setting. Round-the-clock monitoring of the condition and parameters of the patient’s body is important.
Psychiatrists are involved in diagnostics. This is an important step before treating the disorder because the symptoms of many mental disorders are similar to each other. To exclude or confirm organic lesions, an MRI of the head, radiography, and electroencephalography are prescribed. The diagnosis is made according to the criteria for the ICD disorder by categorical separation of symptoms.
An episode of a mood disorder is a condition in which a mood disorder is expressed to a certain extent and for a certain time: depression – 2 weeks; mania – 1 week. According to researchers FK Goodwin, KR Jamison (in 1990), 65-70% of initially established psychiatric diagnoses are erroneous – other diseases are easily confused with bipolar disorder. Consequence – the appointment of the wrong drug treatment, aggravation of the course of TIR.
The diagnosis of the manic stage is established if the subject has at least three of the following symptoms:
delusional ideas of greatness;
excessively underestimated body need for sleep;
previously uncharacteristic incoherence of speech;
uncontrolled flow of ideas;
previously uncharacteristic strong distraction;
excitement of the psychomotor sphere;
interest in activities with an increased risk to life or health;
problems in the labor, educational, social functioning of the individual.
The psychiatrist determines the severity of the disorder: mild, moderate, or severe with psychotic symptoms. According to the studies of the authors RM Hirschfield et al., (2003), G. Perugi (2010), affective disorder is more often confused with depression (60%), anxiety disorder (26%), schizophrenia (18%), personality disorders (17%) , dependence on psychoactive substances (14%).
To establish the correct diagnosis, they pay attention to the following points:
with bipolar disorder, there is an unstable mental response to treatment with drugs of the antidepressant group;
with bipolar disorder, depression, anxiety is initially not combined with the use of surfactants;
psychotic symptoms develop with a previously normal level of social adaptation;
family history is likely to have mood disorders or other psychiatric pathologies.
The complexity of diagnosis is based on the fact that the symptom complex of bipolar disorder in its depressive phase is in many ways similar to clinical depression. Differences between bipolar depression and its other types: appetite disorder of the type of hyperphagia, the presence of hypersomnia, mild psychotic manifestations. BAD is also differentiated from classic depression in that its manifestations are noticeable during childhood and develop more rapidly.
Causes of the disease
The exact scientific evidence on the causes of TIR is currently not established. But there are confirmed factors that increase the risk of developing the disease:
autointoxication with psychoactive substances;
disturbed endocrine water balance, water-electrolyte metabolism;
Hormones are involved in the development of pathology: norepinephrine, serotonin, dopamine, acetylcholine, GABA. With bipolar disorder, there is an increased tone of the sympathetic nervous system, hyperfunction of the thyroid gland and the pituitary gland.
At risk are individuals with the following features:
traits of the psychasthenic personality type;
increased anxiety and suspiciousness;
instability of the emotional sphere.
The disorder occurs either for no apparent reason, or after provoking factors (stress, infections, psychological trauma, against the background of other mental pathologies).
The main role among the causes is assigned to the genetic factor. It was found that in the presence of mental pathologies in the closest relative, the risk of developing bipolar disorder is 14-15%. M.R. Post and SR Weiss in 1989 described the causes of bipolar disorder that were hidden in the effects of various stimulants and surfactants.
Differences between males and females
According to statistics, men get sick less often than women. Ratio: 3: 2. The female part of patients is characterized by a rapidly cyclic nature of the disorder. Women have low sensitivity to therapeutic techniques. They have a higher risk of suicidal behavior and a higher hospitalization rate. Symptoms of bipolar disorder in men are practically the same as in women.
Minor differences – in the male part of the patients, the phases of mania and hypomania predominate, and in the female, depressive states. The symptoms of depression in women are much more pronounced.
TIR in children
Bipolar disorder is most commonly diagnosed in individuals between the ages of 15 and 55. Symptoms are most pronounced between the ages of 16 and 20.
Very rarely, bipolar disorder occurs in childhood. Difficulty in diagnosis at this age stage – symptoms of affective disorder are often confused with ADHD. ADHD therapy involves taking stimulants. And if the child does have bipolar disorder, then stimulants intensify the symptoms in the mania phase.
The course of the disease in children differs from the pathology of adults. Children during manic periods show more irritability than adult patients. Symptoms of mania are usually more vivid, sometimes hallucinations are present.
Pediatric patients, going through a depressive phase, suffer from physical symptoms, pain syndrome. A noticeable difference in children’s BAR is hidden in the frequency of alternating cycles. The child’s cycles change very quickly, sometimes even within a day.
It is also difficult for adolescent children to make a diagnosis. The reason is that symptoms are difficult to differentiate from depression or mood swings that are natural for this age. In children with mental disorders, in addition to the classical treatment regimen, it is important to consult with parents to improve pedagogical education.
The therapy regimen is planned and carried out by a psychiatrist. Psychotherapy can be performed by a psychotherapist, but not by a clinical psychologist. Taking into account the clinical recommendations of the Russian community of psychiatrists, BAD therapy consists of the following stages:
the first – stopping methods of treatment aimed at smoothing out symptoms and minimizing side effects;
the second – methods of supportive therapy to preserve the effect obtained at the first stage;
the third is anti-relapse treatment.
At the first stages of therapy, the patient must take drugs of the group of antipsychotics, antidepressants, tranquilizers and / or antiepileptic drugs. The duration of therapy is from six months to several years.
An incorrectly established TIR diagnosis followed by an incorrectly prescribed therapy regimen is a dangerous situation. For example, diagnosing “clinical depression” instead of “bipolar disorder” and treating the patient with antidepressants is not only ineffective therapy, but also leads to suicidal attempts. Improperly prescribed drugs provoke a manic phase or lead to an increase in the change of manic-depressive episodes.
Any medications must be combined with a psychotherapeutic approach, otherwise the treatment will not be effective. During psychotherapy, it is possible to identify the alleged causes or provoking factors of bipolar disorder. The effectiveness of family counseling has been proven, but besides it, there are other areas:
cognitive-behavioral approach, which creates certain “models” that help the patient to adapt to stress, revise the feeling of psychological trauma, and develop a more reasonable position;
an interpersonal approach if there is tension in a relationship with another person / people;
social rhythm therapy, which allows you to normalize your daily routine.
Today, methods have been developed for the treatment of TIR, reducing intrapersonal conflict, “smoothing” the symptoms of the disorder.
Attention is paid to psychoeducational programs in order to raise a person’s awareness of bipolar disorder. To prevent relapse, both personal and group or family psychotherapy sessions are relevant.
The patient is offered to keep a map of self-observation of mood swings, self-control sheets. Such self-medication methods will help track changes in well-being, consult a doctor in time to correct the treatment regimen.
Acute psychosis is an acute onset illness with multiple psychotic symptoms. ICD code – F23. The diagnosis differs from bipolar disorder and includes the following manifestations:
illusion of perception;
severe deformation of the behavioral sphere;
mild disorientation in time and space;
complete, persistent lack of interest in the outside world and their own appearance.
The disease is designated as a gross violation of consciousness, the symptoms include a distorted perception of real events and their personality. A state of acute psychosis is a complete loss of control of one’s behavior.
Among the causes of the disorder are external (exogenous) and internal (endogenous) factors. External include: intoxication with alcohol or other drugs, traumatic circumstances. Internal causes – organic brain damage, hereditary predisposition.
Treatment differs from bipolar disorder – in acute psychosis, the patient is prescribed antipsychotics in combination with antidepressants or tranquilizers. If the disease is caused by surfactant intoxication, then medical detoxification is carried out first.
Paranoid psychosis is included in ICD-10 codes: F22.022.0 “delusional disorder” and F22.08 “other delusional disorders”. Symptoms include ideas of persecution, delusions of attitudes, accusations, or delusions of harm, poisoning, etc.
The disease is often combined with a depressive-paranoid or anxiety-paranoid syndrome. Among the causes of paranoid psychosis are:
the endogenous nature of the occurrence – against the background of other mental pathologies and due to a genetic predisposition;
exogenous organic causes – due to damage to brain tissue, trauma, neoplasms, intoxication;
reactive – the disorder occurs due to external provoking factors as a response to mental trauma.
Treatment is carried out with neuroleptics, neurometabolic methods and restorative therapy. It is important to keep the patient isolated from external disease-provoking events. Non-drug treatments are combined with cognitive psychotherapy, diet therapy and exercise therapy.
In the International Classification of Diseases, alcoholic psychosis is located under the code F10. The disease is a gross mental dysfunction caused by prolonged alcoholism. The developmental mechanism includes the effect of alcohol on the parts of the brain.
The described group of psychopathologies includes disorders with delusional ideas:
state of pathological intoxication;
paranoid psychosis of an alcoholic type;
delusions of persecution;
delirium of jealousy;
delusional ideas of poisoning or self-blame.
Patients with alcoholic psychosis show an inadequate response to real life situations. The emotional background is disturbed – there is a state of confusion, anxiety, fear. The patient poses a threat to himself and others – his behavior is based on impulsive reactions and is unpredictable.
With the disease, visual, auditory and tactile hallucinations are often noted. At risk of persons aged 37-45 years with prolonged alcohol abuse.
Treatment includes complete detoxification of the body from alcohol-containing substances and decay products. Next, a course of antipsychotics, psychotherapy is prescribed.
Consequences of TIR
TIR without treatment leads to disastrous consequences. It is not uncommon for patients with lingering mental illness to resort to chemical addiction. Death is possible due to the consequences of addiction or a high risk of suicide.
The medical and social consequences of affective disorder include disability, the inability to adapt to the external conditions of life. The result is a decrease in life expectancy and its quality. Outwardly noticeable consequences of a diagnosis without treatment:
maladjustment in family life, divorce;
a few years later – disability;
unemployment or frequent job changes, bankruptcy;
in the stage of mania – hypersexuality, leading to infectious diseases;
dependence on alcohol or other drugs.
The prognosis for bipolar disorder is better if you see your doctor on time. The prognosis depends on the type of course of the disease, the frequency of episodes, and the characteristics of the organism. Correctly prescribed medications and psychotherapeutic techniques will allow, if not cured, then enter the patient into long-term remission. After therapy, a person learns to adapt, improves in the social and professional spheres.