From Sorrow to Joy: Types of Bipolar Disorder, Why…

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Where does it come from

BAD (old name: manic-depressive psychosis, MDP) is a group of chronic mental illnesses in which pathological mood changes occupy a central place in the clinic: both upward (mania, hypomania) and downward (depression and subdepression) , mixed states are also possible.

The disease has a hereditary nature, but has no predetermination: in pairs of identical twins, both are sick in 70 – 80% of cases. And approximately 7% of patients do not have any burdened heredity. Therefore, this disease is formed due to a combination of hereditary and environmental factors, with a greater role of genetic ones.

One of the important features: bipolar disorder does not lead to personality deformation, and patients retain their cognitive functions, emotional range and energy level (we are talking about interictal periods).

Many variants of the course of bipolar disorder and its forms have been described. Many genes have been found that increase the likelihood of the disease. So we are talking about a heterogeneous group of diseases. The boundaries of this diagnosis depend mainly on the diagnostic classifiers used: for example, what is called “recurrent depression” in accordance with the ICD-10, will be coded as bipolar disorder in the DSM-V.

The prevalence of bipolar disorder is significantly higher in countries where DSM is used. According to Russian data, this is one of the rarest mental disorders (about 0.05% of the population has this diagnosis); according to American – an extremely common disease (up to 7% of the population fall under this code). It is believed that women get sick a little more often, although we are talking more about certain forms of the disease (unipolar depression).

How can the disease progress?

There is a unipolar type of bipolar disorder, when there are only one manic or hypomanic states, or only depressive states, and a bipolar type, when hypomanic (or manic) states alternate in different ways.

A decrease in mood can be of different severity: from mild sadness to a complete feeling of hopelessness and despair, and often does not have a direct conscious connection with current external and internal events, that is, it resumes automatically.

Daily mood fluctuations are often characteristic (more often the condition worsens in the morning). With expanded forms, people complain of a feeling of “vital longing”: a feeling of heaviness or pain in the chest area.

With depression, the pace of movement, the pace of thinking, and the pace of physiological processes slow down. A decrease in activity is manifested in fatigue, difficulty in motivation, a decrease or absence of sexual desire and appetite.

In the most severe forms, psychotic symptoms may appear, and are mostly delusional ideas of self-blame and self-destruction.

The course of the disease can be very different, that is, phases can pass one into another.

As a rule, depressions last longer than hypomania/mania.

Is there a cure for bipolar disorder?

BAD is treated quite successfully. Almost all classes of psychotropic drugs are used, but the central place in pharmacotherapy is played by normotimics, both the first generation: lithium preparations, carbamazepine, valproates, and the second generation: lamotrigine and some atypical antipsychotics. Other drugs (antidepressants, antipsychotics) are prescribed symptomatically.

Medicines are taken for a long time, almost for life. The decision to reduce the doses of drugs or cancel them with a long intermission is made only by a specialist.

How should relatives of people who have been diagnosed with bipolar disorder behave?

Relatives of patients undergo psychoeducational training. Their role is to support medication intake, encourage treatment when “first signs” appear: changes in activity, sleep duration/appetite level, speech rate, and help maintain a stable daily routine for the patient.


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