Psychiatrist Ahmedabad

Bipolar mood disorder


INTRODUCTION

It is normal to experience ups and downs in life, but when the mood changes between an extreme high (mania) and an extreme low (depression), it is a clear sign of bipolar disorder. It has been observed that such patients may feel well between these times.
About 2.6 percent of the adult population in any given year, have bipolar disorder. It generally develops in late adolescence or early childhood. The symptoms of bipolar disorder can hurt school/job performance, damage relationships and disrupt daily life. It is often not recognized and patients suffer for a long time before diagnosis and treatment. Patients experiencing mania believe they are not ill and hence, do not favor seeking treatment. However, treatment is very important, considering the fact that the lifetime risk of suicide among patients suffering from bipolar disorder is at least 15 times that of the general population.
Technically, bipolar disorder is a mood disorder characterized by swings in a person’s mood from high(euphoric) to low(depressed).
Manic phase may lead to a patient to decide impulsively: sudden quitting of a job, excessive unplanned shopping or feeling of adequate rest, after only two hours of sleep.
On the other hand, in a depressive state, the patient may feel too tired to get out of bed and experience a feeling of hopelessness over being unemployed and in debt.

SYMPTOMS
As the symptoms can vary widely in their pattern, severity and frequency, bipolar disorder can appear differently in different people. Some patients could be prone to either mania or depression, while others could alternate equally between the two.
Symptoms of mania can include:
·         feeling happy or positive even if things are not going well for you,
·         feeling more active, energetic or restless,
·         being more irritable than normal,
·         feeling much better about yourself than usual,
·         talking very quickly, jumping from one idea to another, racing thoughts,
·         being easily distracted and struggling to focus on one topic,
·         not needing much sleep,
·         thinking you can do much more than you actually can,
·         making bad decisions,
·         doing things you normally wouldn’t which can cause problems, such as going on spending sprees, being sexually promiscuous, using drugs or alcohol, gambling or making unwise business decisions,
·         being much more social than usual, and
·         being argumentative, pushy or aggressive.
The symptoms of depression can include:
·         low mood,
·         having less energy, feeling tired or "slowed down",
·         feeling hopeless or negative,
·         feeling guilty, worthless or helpless,
·         being less interested in things you normally like doing or enjoying them less,
·         difficulty concentrating, remembering or making decisions,
·         feeling restless or irritable,
·         sleeping too much or not being able to sleep,
·         feeling more or less hungry than usual and/or losing or gaining weight, when you do not mean to, and
·         thoughts of death or suicide, or suicide attempts.


Sometimes one can have psychotic symptoms during a severe episode of mania or depression. Symptoms of psychosis can be:

·         Hallucinations - hearing, seeing, or feeling things that are not there,
·         Delusions – believing things that are not true and that other people find unusual.

TYPES OF BIPOLAR
Bipolar disorder has been classified into four basic types, depending on the changes in mood, energy and activity levels. Moods range from extremely “up”, elated and energized behavior(manic episodes) to very sad, ”down” or hopeless periods(depressive episodes).
1)      BIPOLAR I : In this condition, patient experiences severe manic symptoms which lasts longer than a week. Generally, such patients also face depressive episodes typically lasting at least 2 weeks. Hospitalization maybe required for bipolar I patients.
2)      BIPOLAR II : In this condition, the patient experiences more than one episode of severe depression. However, instead of full blown manic episodes, only a mild form(hypomania) is observed.
3)      RAPID CYCLING : In this condition, a patient has four or more depressive, manic, mixed, mixed or hypomanic episodes in a 12 month period.It affects 1 in 10 people with bipolar disorder and can happen with both type I and II.
4)      CYCLOTHYMIA : In this condition, a patient experiences cyclical mood swings, where the symptoms are less severe than hypomanic and depressive episodes. It lasts for at least 2 years, thus affecting day to day life and has the potential to develop into full bipolar disorder.

How common is Bipolar Disorder?
Statistics reveal that bipolar disorder is more common than many realize. World Health Organization(WHO) indicates that bipolar disorder is the 6th leading cause of disability in the world. (Source: bipolar-lives.com)

What causes Bipolar Disorder?
According to scientists, there is no single cause for bipolar disorder. It is the combination of different factors(biological, psychological and social) that contribute to the illness or increase its’ risk. 
GENETIC FACTORS:
A person whose immediate family member has a bipolar disorder, is five to ten times more likely to develop the illness as compared to someone who has no family history.
However, researchers have not found any exact genes that cause bipolar disorder. Different genes have been linked to the development of bipolar disorder.
It maybe noted that studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always follow suit, despite the fact that identical twins share all of the same genes. Thus, it can be concluded that genes are not the only risk factor for bipolar disorder.

BRAIN CHEMICALS:
Patients suffering from bipolar disorder have uneven levels of particular brain chemicals; as shown by various brain imaging studies.
There is a possibility that the illness can be triggered by external factors such as psychological stress and social circumstances which can have an impact on certain neurotransmitters or chemical messengers in the brain. As research evolves, scientists would be able to clearly explain the finer details.

ENVIRONMENTAL & SOCIAL FACTORS:
Certain life events can trigger symptoms of bipolar disorder. Stressful events like childbirth, money problems, relationship breakdown, childhood abuse,etc. can contribute to the development of depressive episodes.

TREATMENT

If the symptoms of bipolar disorder are spotted, one should not ignore the problem and seek professional help right away. The untreated bipolar disorder can create havoc in a patients’ career, relationships and general health; therefore, there should not be a delay or hesitation in approaching a mental health professional. As the illness is highly treatable, it is advisable to start treatment as early as possible, once the problem has been diagnosed, in order to prevent complications.
Generally, an episode of mania or hypomania is treated by antipsychotic medications; while psychological therapy combined with medications is the general method of treating depression in people with bipolar disorder.
MEDICATIONS:
Patients diagnosed with bipolar disorder need medication to prevent new episodes and stay symptom – free. It is important to continue treatment even when the patient feels better as this is a chronic illness and has the potential to relapse.
The medications used to treat this disorder are often called “MOOD STABILISERS”. Medication is used to treat symptoms of mania (ANTIMANIC) and to prevent symptoms of mania and keep the patient stable (PROPHYLACTIC). Doctors generally use different dosages and combinations.
Commonly prescribed medications are:
1)      LITHIUM: is the most common and very effective medication in controlling mania and preventing recurrence of both manic and depressive episodes. It is approved by the U.S. Food and Drug Administration (FDA). The right dosage of lithium is a very important aspect of recovery (low dosage is ineffective and high dosage is toxic). Regular blood tests in the first few weeks, is a method to ensure if the medication has been administered correctly.
2)      ANTI CONVULSANT DRUGS: like valproate or carbamazepine also have mood-stabilizing effects and are especially useful for ‘difficult to treat’ bipolar episodes.
3)      ANTI PSYCHOTIC DRUGS: like olanzapine and quetiapine are very effective in treating acute mania and help relieve psychotic depression.


PSYCHOTHERAPIES:
Cognitive Behavioural Therapy (CBT) is a talking therapy that can help a patient manage his problems by changing the way s/he thinks and behaves. It is based on the concept that a person’s thoughts, feelings, physical sensations and actions are interconnected and that negative thoughts and feelings can trap him/her in a vicious cycle.
It is mainly recommended for depressive episodes of bipolar disorder. This treatment helps patients learn to change inappropriate or negative thought patterns and behaviors associated with the illness.

PEER SUPPORT AND SELF MANAGEMENT
As bipolar disorder can be an isolating illness, support is a very important aspect of recovery. When a patient receives informal support from someone with similar experiences, such a contact can bring hope and understanding. People who have experienced mental health problems are potentially well placed to support others in similar situations. Peers can bring experiential knowledge to help them support others in overcoming certain barriers and contribute to culture change within mental health services.

Self-management techniques are things that one can do at home to help manage bipolar symptoms, in addition to therapy and/or medication.
1)      EXERCISE: can help boost mood, gets the blood pumping and can increase social interaction.
2)      HOBBIES: keep the mind busy by providing something else to focus on, help connect to other people with similar interests and can improve one’s self-esteem by mastering a new skill.
3)      SLEEP: A consistent sleep schedule can greatly benefit bipolar patients. Blackout curtains, sleep masks, ear plugs are some devices that can be used to ensure sound sleep.
4)      NUTRITION: One’s diet can affect one’s mood. The body utilizes food as fuel for different functions, including producing neurotransmitters. Generally, eating better helps one feel better.