Define: Bipolar Disorder

Bipolar disorder or manic-depressive illness causes abnormal shifts in mood and behavior. Due to its effect on concentration, energy level, and sleep, a person’s capacity to complete daily tasks can be severely affected. This illness is characterized by severe symptoms that can damage relationships, lead to poor performance in the job or school, and even increased risk for suicide.

Bipolar disorder is treatable. People suffering from it can lead a full and productive life.

Causes

• Genetics – Bipolar disorder is hereditary. People with certain genes have a greater tendency of developing it. Children who have a parent or a sibling suffering from bipolar disorder are more vulnerable to it than children who don’t have any such member in their immediate families. Still, majority of the children with a family history of bipolar disorder may never develop it.

• Brain structure and functioning – Researchers use certain brain imaging tools like functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) to take pictures of the living brain. These images help the doctors to study the human brain’s structure and activities to identify ‘multi-dimensional impairment’ in children, patterns of brain growth and development linking to the common causes of mood swings.

Symptoms

Manic episodes in bipolar disorder often last for at least a week during which serious mood disturbances are noted in the patient, including elation, irritability, or expansiveness. Apart fro mood, to meet dsm criteria any three of the following symptoms must be present at the same time:

• Grandiosity or narcissistic outlook
• Sleeplessness
• Excessive talking or pressured speech
• Racing thoughts or flight of ideas
• Distractibility
• Increased goal-directed activities at home, or at work
• Impulsivity and engagement in excessive pleasurable activities, including in those that may be risky

During hypomanic bipolar episodes, patients have an elevated, expansive, or irritable mood. These episodes may last for at least 4 consecutive days. Besides, following symptoms could be noted as well (at least any three):

• Grandiosity or inflated self-esteem (narcissistic outlook)
• Sleeplessness
• Pressured speech (taking a mile a minute)
• Racing thoughts or flight of ideas
• Distractibility
• Increased goal-directed activities at home, or at work
• Participating in activities with a high risk

People can also have depressive episodes on the other end of spectrum. To meet criteria for a major depressive episodes (MDE), a person has 5 or more of the following symptoms for about 2 weeks. Most important symptoms are pervasive depressed mood or loss of pleasure or interest in hobbies/pleasurable activities.

• Depressed mood
• Significant loss of pleasure or interest in almost all activities
• Marked loss of or increase in appetite
• Hypersomnia (excessive sleep) or insomnia (sleeplessness)
• Psychomotor retardation or agitation
• Loss of energy or fatigue
• Feelings of worthlessness or excessive guilt
• Poor concentration
• Preoccupation with wishing yourself dead or feeling suicidal (planning to attempt suicide)

These bipolar disorder symptoms can cause major disability and distress. They aren’t caused because of substance abuse or any other medical condition.

Treatment

Partial hospitalization can provide a huge relief to the mentally ill person, as this may provide crucial support and interpersonal relationships.

Pharmacologic Therapy

Various agents are available that can be used to treat bipolar disorder. The choice of agent depends on symptoms like agitation, aggression, psychosis, and sleep disturbance .

• Benzodiazepines (e.g., lorazepam, clonazepam)
• Antimanic agents (e.g., lithium)
• Anticonvulsants (e.g., carbamazepine, valproate sodium,)
• First-generation antipsychotics (e.g., inhaled loxapine, haloperidol)
• Second-generation antipsychotics (e.g., asenapine, ziprasidone,)
• Phenothiazine antipsychotics (e.g., chlorpromazine)

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is effective in instances where patients with bipolar disorder or manic-depressive illness (MDI) fulfill the following criteria:

• When fast, distinct psychiatric treatment is required.
• When there is low risk in treating with ECT as compared to other forms of treatment.
• When the bipolar disorder refracts to a sufficient number of trials with other treatment strategies.
• When the patient chooses this treatment modality.

Psychotherapy

• Cognitive behavioral therapy (CBT), can help people with bipolar disorder to alter their destructive or negative thought patterns and behaviors.
• Family-focused therapy involves family members. It helps to improve a family’s coping strategies. For example: identifying new depressive episodes early and helping the patient accordingly. This therapy promotes communication amongst the family members, as well as creates a problem-solving outlook in them.
• Interpersonal and social rhythm therapy may help people with bipolar disorder strengthen their relationships with others and manage their daily routines better. Regular daily routines and sleep schedules can assist in defending against new manic episodes.
• Psychoeducation can be used to teach people with bipolar disorder about their illness and the kind of treatment needed. Psychoeducation can help them to recognize signs of an approaching mood swing so that they can seek early treatment before a full-blown episode. Psychoeducation done in a group can be effective for family members and caregivers.

Dietary and Activity Measures

Patients are encouraged to exercise regularly. They must develop a regular daily schedule of major activities such as times of going to bed and waking up. Addition of certain supplements may help not only combat side effects of medication but also help improve mood.

Bipolar disorder FAQs