More detailed description about bipolar disorder

In the modern world, approximately 1% of people over the age of 18 suffer from bipolar disorder. Some patients exhibit symptoms already in their childhood years; most often, however, the disease starts to appear during puberty or in the 2nd decade of life. Sometimes the disease can also appear very late in life. Women are affected more often than men.

The exact cause for the appearance and development of this disease remains unknown. However, many factors that increase the risk for bipolar disorders are known. Hereditary factors and genetics play a very important role. It is well-established that the disease appears more often in family members than in random individuals in the general population. In addition to hereditary factors, the environment and specific events in the patient's live also play an important role. Thus, people who have suffered longer periods of a stressful life and the consumers of illicit drugs are more prone to developing the disease. It has also been found that one-time stressful events such as the death of a loved one can increase the possibility of developing the disease.

Disease groups and its phases

The disease can be subdivided into the following groups:

• Bipolar I disorder (a single manic episode without previous depressive episodes),
• Bipolar II disorder (at least one depressive episode and at least one manic episode),
• Cyclothymia (a milder form of the bipolar disorder with less severe symptoms than in a full-blown bipolar disorder).

The manic phase is characterized by euphoria, extreme optimism, accelerated speech, "racing thoughts", decreased ability to concentrate and make rational decisions, decreased need for sleep, increased physical activity, increased sexual drive and irritability. The depressive phase is characterized by depression, sadness, despair, guilt feelings, anxiety (unfounded fear), lethargy, fatigue, troubles associated with the lack of sleep and appetite, and suicidal thoughts.

Disease diagnosis

A specialist psychiatrist makes the diagnosis; a thyroid disorder which can mimic the bipolar disorder must absolutely be ruled out. Psychological tests and questionnaires enquiring about the patient's emotions, feelings, thoughts and behavioural patterns enable a faster diagnosis. In order to make the final diagnosis, however, all criteria specified by the American Psychiatric Association (APA) must be met.

Prevention

Bipolar disorder appears due to many reasons that in essence lead to an instability in the neurotransmitter system of the brain; thus, specific prevention of this disease is yet unknown. As in any mood disorder and other psychiatric conditions, some general rules apply including primarily avoidance of stressful events and unhealthy lifestyles, as well as abundant physical activity, socializing and rest with adequate sleep.

The best prevention

A thorough knowledge of the disease as well as of the treatment options and measures to be taken in times of mood swings is the best prevention against relapses of periods of depressive mood or the shift into an excited, exuberant and angry behaviour that is associated with a loss of self-control.

It is important for the patients and their relatives to learn to recognize the signs of disease and report them to the physician who shall decide when antidepressants should be instituted as part of the therapy and when they should be terminated. Equally important, patients should be taught relaxation techniques, and encouraged to follow their disease by keeping a diary of personal descriptions of their moods, sleep patterns, nutritional habits as well as a schedule of daily activities.

Regular outpatient follow-up visits with your preferred provider are a requirement for they contribute, along with other preventive measures, to a decreased chance of a relapse of this disease.

Therapy

The therapy of the bipolar affective disorder (BAD) consists of two periods. First comes the period of acute treatment which typically requires hospitalization, followed by the prevention-maintenance treatment. The latter includes an adequate lifestyle change to a healthy lifestyle and due compliance with medications while being highly aware of their effects and the course of therapy.

The use of medications

The first line of treatment for BAD are mood stabilizers, used continuously throughout the course of this disease. These medications include lithium, valproate, lamotrigine, and carbamazepine. During a period of symptom exacerbation, either in the depressive or manic direction, therapy must additionally include antipsychotic medications. In the presence of severe depressive symptoms of disease, antidepressants must be added in a limited time period. Antidepressants such as sertaline, cipramil or paroxetine are primarily used. Sedatives such as diazepam, alprazolam, lorazepam used to be prescribed a lot in the past; the current opinion, however, is that they should be avoided for BAD patients usually require a life-long therapy. Their long-term use could lead to dependence that would additionally burden the patients and complicate their primary mental disorder.

Other therapies

Although it is very effective in the treatment of BAD, electroconvulsive therapy (ECT) is forbidden in Slovenia. Sleep deprivation, effective in seasonal mood disorders, is generally not used. Besides medications, individual or group psychotherapy is effective, especially in the sense of relaxation and establishment of social interactions, as well as acquiring the problem-solving abilities, self-control, self-respect and communication skills.

Back to basic description