BIPOLAR DISORDER : A NOT SO UNCOMMON MENTAL ILLNESS

 BIPOLAR DISORDER 

A NOT SO UNCOMMON MENTAL ILLNESS

- DR. Avinash Bhondwe

  

 The birth anniversary of distinguished painter Vincent van Gogh is celebrated as World Bipolar Day on March 30. The mental disorder is not as talked about as other issues like depression, anxiety, and PTSD. 

          Bipolar disorder can be described as a mental condition when the brain suffers from extreme mood and energy changes, hampering the ability to function normally. These mood episodes can also result in depression and stress, and the condition is also known as manic-depressive disorder.

          Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

          The person suffering from bipolar disorder feels sad or hopeless and loses interest or pleasure in most activities. His mood shifts to mania or hypomania (less extreme than mania), he may feel euphoric, full of energy, or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior, and the ability to think clearly.

          Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

          Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

Symptoms

          There are several types of bipolar and related disorders. They may include mania or hypomania and depression. The symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

          Bipolar I disorder. The patient has one manic episode that may be preceded or followed by Hypomaniac or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).

          Bipolar II disorder. The patient has a history of at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.

          Cyclothymic disorder: The patient has at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

          Other types:  These include, for example, bipolar and related disorders induced by certain drugs or alcohol, or due to a medical condition, such as Cushing's disease, multiple sclerosis, or stroke.

          Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for long periods, which can cause significant impairment.

          Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

          Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

          Both a manic and a hypomanic episode include three or more of these symptoms:

·        Abnormally upbeat, jumpy, or wired

·        Increased activity, energy, or agitation

·        Exaggerated sense of well-being and self-confidence (euphoria)

·        Decreased need for sleep

·        Unusual talkativeness

·        Racing thoughts

·        Distractibility

·        Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

          A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

·        Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

·        Marked loss of interest or feeling no pleasure in all — or almost all — activities

·        Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

·        Either insomnia or sleeping too much

·        Either restlessness or slowed behavior

·        Fatigue or loss of energy

·        Feelings of worthlessness or excessive or inappropriate guilt

·        Decreased ability to think or concentrate, or indecisiveness

·        Thinking about, planning or attempting suicide

·        Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and adolescents

          Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

          Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

          The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

          Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.

          Some patients may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave him depressed, worn out — and perhaps in financial, legal or relationship trouble.

When treatment is necessary?

          If a person has any symptoms of depression or mania, he must see his family doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

Emergency help

          Suicidal thoughts and behavior are common among people with bipolar disorder. If the person has thoughts of hurting himself, a family doctor must call the local emergency number immediately, send him to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number.

    If anybody is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. The reference to a hospital with an emergency treatment setup is a must.  

Causes

The exact cause of the bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences: People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.

Genetics:  Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

·        Having a first-degree relative, such as a parent or sibling, with bipolar disorder

·        Periods of high stress, such as the death of a loved one or other traumatic event

·        Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of a person's life, such as:

·        Problems related to drug and alcohol use

·        Suicide or suicide attempts

·        Legal or financial problems

·        Damaged relationships

·        Poor work or school performance

Co-occurring conditions

          If a person has bipolar disorder, he may also have another health condition that needs to be treated along with the bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

·        Anxiety disorders

·        Eating disorders

·        Attention-deficit/hyperactivity disorder (ADHD)

·        Alcohol or drug problems

·        Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Prevention

          There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

          If someone has been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

·        Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. The person may have identified a pattern to your bipolar episodes and what triggers them. Advise him to call his family doctor if he feels he is falling into an episode of depression or mania.

·         Involve family members or friends in watching for warning signs.

·        Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.

·        Advise taking medications exactly as directed. A patient may be tempted to stop treatment — but advise he should not.  Stopping the medication or reducing the dosages on his own, should be strictly avoided. It may cause withdrawal effects or the symptoms may worsen or return.