Bipolar affective disorder is a complex psychiatric disorder. Its most striking characteristic is the alternation, sometimes sudden, of episodes of depression with those of euphoria (mania and hypomania) and asymptomatic periods in between. The crises can vary in intensity (mild, moderate and severe), frequency and duration.
Mood swings have negative repercussions on the behavior and attitudes of patients, and the reaction they provoke is always disproportionate to the events that served as triggers or even independent of them.
In general, this mood disorder manifests itself in both men and women, between the ages of 15 and 25, but it can also affect children and older people.
Bipolar disorder can be classified into the following types:
Bipolar Disorder Type I
The person with the disorder has periods of mania, which last at least seven days, and phases of depressed mood, which last from two weeks to several months. In both mania and depression, the symptoms are intense and cause profound behavioral and conduct changes, which can compromise not only family, emotional and social relationships, but also the professional performance, economic position and safety of the patient and the people who live with him/her. The condition can be so serious that it requires hospitalization because of the increased risk of suicide and the incidence of psychiatric complications.
Bipolar disorder Type II
There is an alternation between episodes of depression and hypomania (a milder state of euphoria, excitement, optimism and, sometimes, aggression), without major impairment to the behavior and activities of the sufferer.
Unspecified or mixed bipolar disorder
The symptoms suggest the diagnosis of bipolar disorder, but they are not sufficient in number or duration to classify the illness into one of the two previous types.
Cyclothymic disorder
This is the mildest form of bipolar disorder, marked by chronic mood swings, which can occur even on the same day. The patient alternates between symptoms of hypomania and mild depression, which are often understood as characteristic of an unstable or irresponsible temperament.
Causes
The actual cause of bipolar disorder has not yet been determined, but it is already known that genetic factors, changes in certain areas of the brain and in the levels of various neurotransmitters are involved.
Likewise, it has been demonstrated that some events can precipitate the manifestation of this mood disorder in genetically predisposed individuals. Among these, the following stand out: frequent episodes of depression or early onset of these crises, puerperium, prolonged stress, appetite suppressant medications (anorectics and amphetamines), and thyroid dysfunctions, such as hyperthyroidism and hypothyroidism.
Diagnosis
The diagnosis of bipolar disorder is clinical, based on the history and the report of symptoms by the patient himself or by a friend or family member. In general, it takes more than ten years to be completed, because the signs can be confused with those of diseases such as schizophrenia, major depression, panic syndrome, and anxiety disorders. Hence the importance of establishing the differential diagnosis before proposing any therapeutic measure.
Symptoms
The main symptoms in each phase of bipolar disorder include:
Depression: depressed mood, deep sadness, apathy, lack of interest in activities that used to be pleasurable, social isolation, changes in sleep and appetite, significant reduction in libido, difficulty concentrating, fatigue, recurring feelings of worthlessness, excessive guilt, frustration and lack of meaning in life, forgetfulness, suicidal thoughts.
Mania: state of exuberant euphoria, with increased self-esteem and self-confidence, little need for sleep, psychomotor agitation, lack of control when coordinating ideas, distraction, compulsion to talk, increased libido, increasing irritability and impatience, aggressive behavior, delusions of grandeur. In this phase, the patient may take actions that will result in harm to themselves and those close to them, such as quitting their job, spending money uncontrollably, hasty emotional involvements, increased sexual activity and, in more severe cases, delusions and hallucinations.
Hypomania: symptoms are similar to those of mania, but much milder and have less impact on the patient's activities and relationships, who appears more euphoric, talkative, sociable and active than usual. In general, the crisis is brief, lasting only a few days. For diagnosis purposes, it is necessary to ensure that the reaction was not induced by the use of antidepressants.
Treatment
Bipolar disorder has no cure, but it can be controlled. Treatment includes the use of medication, psychotherapy and lifestyle changes, such as stopping the use of psychoactive substances (caffeine, amphetamines, alcohol and cocaine, for example), developing healthy eating and sleeping habits and reducing stress levels.
References:
Mayo Clinic
Cleveland Clinic
World Health Organization
https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder#:~:text=Family%20psychoeducation%20can%20also%20help,of%20people%20with%20bipolar%20disorder. Assessed and Endorsed by the MedReport Medical Review Board