Bipolar Affective Disorder

What is bipolar Affective Disorder?

Bipolar affective disorder (previously, manic-depressive psychosis) is a disorder characterized by repeated (at least two) episodes in which mood and level of activity are significantly impaired. In some cases, there is a rise in mood, increased mental and physical activity (mania or hypomania), in others a decrease in mood, decreased energy and activity (depression), as well as mixed states in which the patient has symptoms of depression and mania (for example, , longing for excitement, anxiety, or euphoria with lethargy – the so-called unproductive mania), or a quick change of symptoms of (hypo) mania and (sub) depression.

There is no exact data on the prevalence of bipolar affective disorder in the population. Due to the different understanding of the boundaries of this mental disorder, its prevalence figures fluctuate, averaging about 1%.

Causes of Bipolar Affective Disorder

The etiology of bipolar affective disorder is still not clear. A significant role in this process is given to heredity, since the probability of the disease is higher if it is present in other family members. Genetic studies indicate a connection between these disorders and several genes, allegedly located on chromosomes 18 and 4. In addition to hereditary causes, the development of the disease is explained by autointoxication (endocrine imbalance, impaired water and electrolyte metabolism).

Stressful situations can trigger an episode of mania or depression in people exposed to this condition. At the same time, stress is not the cause of the disease.

Pathogenesis during Bipolar Affective Disorder

The first episode most often occurs at a young age – 20-30 years, however, cases of occurrence of the disease at any age, from childhood to old age, are not excluded. Subsequent episodes occur periodically, in the form of phases, either directly or through “light” gaps (so-called interphases, or intermissions).

The frequency of episodes and the nature of remissions and exacerbations are very diverse. The disorder can manifest itself only as manic, only hypomaniacal, or only depressive phases, or alternating them with correct or incorrect alternation. Remissions tend to shorten with age, and depressions become more frequent and longer after middle age.

Options for the course of bipolar affective disorder:

  • periodic mania – only manic phases alternate;
  • periodic depression – only depressive phases alternate;
  • correctly alternating type of flow – through the “light” gaps the manic phase replaces the depressive, depressive – manic phase;
  • wrong-intermittent type of flow – through the “light” gaps, the manic and depressive phases alternate without a strict sequence (after the manic phase, the manic can begin again and vice versa);
  • double form – direct change of two opposite phases, followed by a “bright” gap;
  • circular type of flow – there are no “light” gaps.

The most common types of flow: irregular-intermittent type and periodic depression.

Manic episodes usually begin suddenly and last from 2 weeks to 4-5 months (the average duration of an episode is about 4 months). Depression has a tendency to a longer course (the average duration is about 6 months), although there is also a duration of more than a year (excluding elderly patients). Both episodes often follow stressful situations or mental trauma, although their presence is not necessary for a diagnosis.

The duration of the phases varies from several weeks to 1.5–2 years (on average 3–7 months), the duration of “light” gaps (intermissions or interphases) between phases can be from 3 to 7 years; The “light” gap may be completely absent.

Symptoms of Bipolar Affective Disorder

The manic phase is represented by a triad of the main symptoms: elevated mood, motor agitation, ideational-psychic agitation. During the manic phase, five stages are distinguished:

  • The hypomania stage is characterized by elevated mood, the emergence of a sense of spiritual uplift, physical and mental vigor. Speech is verbose, accelerated. Characteristically moderate motor agitation. Attention characterized by increased distractibility. Moderately reduced sleep duration.
  • The stage of severe mania is characterized by a further increase in the severity of the main symptoms of the phase. Patients are constantly joking, laughing, against the background of which short-term flashes of anger are possible. Speech, motor excitation pronounced. Severe distractibility leads to the inability to conduct a consistent conversation with the patient. Against the background of self-reassessment, delusions of grandeur appear. At work, patients build bright prospects, invest in unpromising unrealistic projects. Sleep duration is reduced to 3-4 hours per day.
  • The stage of manic fury is characterized by the maximum severity of the main symptoms. Sharply motor arousal is disorderly in nature, speech is seemingly incoherent, consists of passages of phrases, individual words or even syllables.
  • The stage of motor calm is characterized by the reduction of motor arousal against the background of continuing elevated mood and speech arousal. The intensity of the last two symptoms also gradually decreases.
  • The reactive stage is characterized by the return of all components of the symptoms of mania to normal, some decrease in mood, mild motor and ideatory retardation, asthenia.

The depressive phase is represented by the opposite manic stage of the triad of symptoms: depressed mood, slow thinking and motor retardation. During the depressive phase, four stages are distinguished:

  • The initial stage of depression is manifested by an unsharp weakening of the general mental tone, a decrease in mood, mental and physical performance. Characterized by the emergence of moderate sleep disorders in the form of difficulty falling asleep and its superficiality. For all stages of the course of the depressive phase, an improvement in mood and general well-being in the evening hours is characteristic.
  • The stage of increasing depression is already characterized by a clear decrease in mood with the advent of an alarming component, a sharp decrease in physical and mental performance, and motor inhibition. Speech is slow, laconic, quiet. Sleep disturbances result in insomnia. Characteristically marked decrease in appetite.
  • Stage of severe depression – all symptoms reach maximum development. The affects of anguish and anxiety are painfully experienced by the sick. The speech is sharply slow, quiet or whisper, the answers to the questions are monosyllabic, with a long delay. Patients can sit for a long time or lie in one position (the so-called “depressive stupor”). Anorexia is characteristic. At this stage, depressive delusions appear (self-incrimination, self-deprecation, self-depravity, hypochondria). Also characterized by the emergence of suicidal thoughts, actions and attempts. Suicidal attempts are most frequent and dangerous at the beginning of the stage and at the exit from it, when there is no marked motor retardation against the background of severe hypothymia. Illusions and hallucinations are rare, but they can be, more often in the form of voices, reporting on the hopelessness of the state, the meaninglessness of being, recommending suicide.
  • The reactive stage is characterized by a gradual reduction of all symptoms, asthenia persists for some time, but sometimes, on the contrary, there is some hyperthymia, lethargy, increased physical activity.

Diagnosis of Bipolar Affective Disorder

Diagnosis is based on the identification of repeated episodes of changes in mood and level of motor activity. When diagnosing, a directly observed episode of affective disorder is noted, for example, hypomanic, manic without psychotic disorders or with psychotic disorders, moderate or mild depression, severe depression with psychosis or without it. If there are no disorders, a diagnosis of remission is indicated, which is often associated with prophylactic therapy.

Differential diagnosis. Bipolar affective disorder is often differentiated from schizoaffective disorder, but other types of mental disorders are not excluded: neurosis, infectious, psychogenic, toxic, traumatic psychosis, oligophrenia, psychopathy.

Treatment of Bipolar Affective Disorder

The treatment of depression, mania and prophylactic therapy of seizures is divided. Features of therapy are determined by the depth of affective disorders and the presence of other productive symptoms. In depressive episodes, antidepressants, electroconvulsive therapy, sleep deprivation treatment, disinhibition with nitrous oxide are often used. When treating a depressive phase with antidepressants, it is necessary to consider the risk of phase inversion, that is, the patient’s transition from a depressive state to a manic, and what is more likely to be mixed, which can worsen the patient’s condition and, more importantly, mixed states are very dangerous in terms of suicide. Antidepressant treatment should be combined with mood stabilizers – mood stabilizers, and even better with atypical antipsychotics.

When manic episodes of a combination of lithium carbonate and neuroleptics.

Prevention of Bipolar Affective Disorder

In order to prevent exacerbations, they apply mood stabilizers such as carbamazepine, sodium valproate or lithium carbonate.

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