Bipolar Disorder - Causes, Symptoms, Types, and Treatment

What Is Bipolar Disorder?

Bipolar disorder, commonly known as manic depression, is a common psychiatric issue. Its presentation is usually chameleon-like, therefore it is difficult to diagnose. It comprises of mania, hypomania, and depression.

1. Mania - Mania is a period of abnormally and persistently elevated irritable mood. This episode should last for at least one week or less if the patient is hospitalized. This condition is so severe that it impairs the patient’s occupational and social functioning.

2. Hypomania - Hypomania is a relatively less severe form of mania that lasts at least for four days. It is not as severe as mania to compromise occupational and social functioning. However, it is visibly distinguished from the patient’s actual mood.

3. Depression - Depression is a state of inability to experience normal positive emotions, a sense of hopelessness along with negative thoughts.

The above three things may present with a little gap in the same patient or it may take months to switch between one form to another. Due to this reason, it is called chameleon-like. In more simpler forms, the mood of the patient changes abruptly.

What Causes Bipolar Disorder?

Causes may be genetic, hormonal, or environmental.

• Genetic Family history of neuronal illness or first degree relatives affected with such conditions may give a strong predisposition of bipolar disorder.

• Hormonal - Hormonal imbalance due to certain situations or due to a long-standing brain illness may cause bipolar disorder.

• Environmental - When there is an existing history of brain trauma, undesired circumstances, or drug misuse, these all affect neurotransmitters in brain so causes this.

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder varies from patient to patient and from one episode to next episode within the same patient. Thus variety of presentations make it more difficult condition to diagnose. There are a number of cases that left undiagnosed or diagnosed at a very later stage.

Symptoms of Mania:

• Decreases need for sleep.

• Irritability.

• Pressured speech.

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• Increase sexual desire.

• Aggressiveness.

• Behavior without regard for consequences.

• Overactivity.

Symptoms of Hypomania:

• Mildly elevated or mildly aggressive mood.

• Increased activity.

• Talk activeness.

• Increase sex drive.

• Reduced need for sleep.

• Difficulty in focusing on one task alone, that is, the task is often started but not finished.

Symptoms of Depressive State:

• Feeling of unhappiness.

• Sense of hopelessness.

• Negative thoughts.

• The sensation of “weight” on the head and body.

• Decrease in sleeping or no sleeping.

Sometimes, in severe conditions along with above symptoms of mania or depression, there are severe thoughts of disturbance even psychiatric symptoms while there is a period of full remission between these highs and lows, which the patient usually experienced.

Types of Bipolar Disorder:

There are various types, a few of them are as follows:

1. Cyclothymia - Sometimes there is a subclinical condition called cyclothymia in which the patient has a high or low mood without typical depressive or manic episodes.

2. Bipolar Disorder I - It is characterized by a single episode of mania, which is followed with hypomania, depression or mixed state.

3. Bipolar Disorder II - Bipolar disorder II has no episode of mania. It only consists of hypomania and depression. Sometimes cyclothymic disorder also occurs.

Risk Factors:

1. Genetics (first-degree relatives).

2. Alcohol.

3. Smoking.

4. Drug abuse (cocaine).

5. Caffeine.

6. Stress.

7. Trauma.

How Is Bipolar Disorder Treated?

There is no complete cure for bipolar disorder. The aim of treatment is to decrease frequency, severity, and psychosocial consequences of episodes and to improve it. Treatment includes medicinal and psychotherapy.

Drugs Used in Treatment:

One of the important drugs used in treatment is Lithium. Studies show that if lithium discontinues abruptly then chances of relapse increased. Therefore tapering of the dose is advised.

Licensed treatment includes treatment with Lithium, Carbamazepine, Aripiprazole, Quetiapine. Unlicensed treatment includes Valproic acid, Lamotrigine, Olanzapine, Risperidone, etc.

Psychotherapy:

As bipolar disorder progresses, the patient faces issues in their day to day social life including emotional disturbances, fear of recurrence of illness, interpersonal difficulties, issues related to marriage, family, child-bearing and parenting, academics. or occupational problems. To overcome these problems, psychotherapy is required along with proper medication. Psychotherapy includes:

• Psychoeducation

• CBT (Cognitive Behavioural Therapy).

• IPT/SRT (Interpersonal therapy/Social rhythm therapy).

• FFT (Family-focused therapy).

• Different support groups.

1) Psychoeducation - It includes the delivery of information. Thus with the help of psychoeducation, recurrence, and relapse can be minimized.

2) CBT - In CBT, patients are taught about cognitive-behavioral skills for coping with different stressors and the problems related to stressors.

3) IPT/SRT - The aim of IPT/SRT is to improve and maintain a regular pattern of daily activities. For example sleeping, eating, physical activities, and emotions.

4) FFT - It involves psychoeducation of patients as well as other family members.

5) Different Support Groups - The purpose of these groups is to remind the patient that he or she is not alone.

Prophylaxis:

The primary aim of prophylaxis is to prevent recurrent episodes of depression, hypomania, and mania. These patients are at high risk of suicide, different studies show that long term Lithium therapy reduces the risk of suicide.

Ensure that the patient consumes the correct dose as prescribed by doctor and withdrawal should be gradual of any of these drugs to decrease chances of remission. Continuous monitoring of drug side effects, blood level, physical checkups as protocol. Long term antidepressants should be avoided and prophylaxis should be done with antipsychotics and mood stabilizers.

How to Distinguish Bipolar Disorder From Extreme Clinical Depression, Schizophrenia and Substance Misuse?

Extreme Clinical Depression - The main difference between these two are episode of mania. Manic episodes are absent in extreme clinical depression while present in bipolar disorder.

Schizophrenia - Schizophrenic patients show characteristic qualities like hallucinations and delusions. Hallucinations are fake perceptions without an object. Delusion are pathological wrong believes.

Substance Misuse - There are traces of substances that can be detected medically by lab investigations. Moreover, patients also show signs and symptoms that are related to that substance.

Famous People and Bipolar Disorder:

Some famous people who had bipolar disorder are:

• Napoleon Bonaparte.

• Winston Churchill.

• Abraham Lincoln.

• Marilyn Monroe.

• Isaac Newton.

Take a good diet, exercise regularly, prevent triggers like stress, alcohol, smoking, drug abuse, and caffeine. Do not be afraid of this illness, do not need to isolate such patients. Despite isolation, provide a healthy environment for the patient. If you are the patient, try not to take stress, join different community groups that involve you to keep you busy and active. Do not consider yourself alone, as there are many diseases that have any permanent cure, but with treatment and lifestyle modification, the person can live a healthy life and keep him or herself in a joyful life.

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