Bipolar affective disorder is a disease included in the list of mental disorders. Previously, the medical term “manic-depressive psychosis” was used, which more clearly reflects the condition of a sick person for ordinary people. But be that as it may, the disease exists and it is necessary to recognize the symptoms in time in order to undertake adequate treatment.

Surely most of the readers have encountered a person whose mood, ability to work, and intelligence often change. For example, an excellent employee suddenly loses the basic skills of his favorite activity, and a capable student completely loses knowledge of his favorite subject. Often the condition creates a lot of moral problems for those around the patient, whose condition can lead to suicide. This is bipolar affective disorder - manic depressive psychosis. There is an opportunity to influence the patient, and there are also preventive measures that minimize the risk of developing a mental disorder. The risk group includes children at puberty, high school students, and people in the pension category.

Bipolar affective disorder was formerly called manic-depressive psychosis

Determining this disease is very problematic. In sick individuals, there is a disruption of the emotional state in completely opposite poles. Most of us, or to be more precise, everyone, experiences a sharp change in mood, a change from performance to fatigue, and without any good reason. But there is nothing unnatural about this. As for people suffering from bipolar disorder, their condition when the emotional factor is disturbed can last for months, years, and severe depression and mania occur.

How to determine BAR

To know the “enemy” by sight, you need to study the term “bipolar affective disorder”, what kind of condition it is, leading to dangerous consequences. This disease affects approximately one and a half percent of the world's population. The problem in diagnosis arises from poorly manifested signs. Patients turn to doctors, and often, they are taken to a specialist by relatives only a few years after the first symptoms. In some patients they can appear maximum 1-2 times a year, in others almost every day. And most of those who suffer from the disease bipolar affective disorder (BAD) do not understand that they have been overtaken by a serious illness. The disease is characterized by manic and depressive states, and they often accompany a person at the same time.

Bipolar personality disorder: causes

This disease is endogenous in nature. The development of the condition is influenced by both external stimuli and the following points:

1. Genetic predisposition. When diagnosing a mental illness, experts note that the pathology was present or observed in the patient’s relatives. According to medical statistics, the disease is transmitted from parents in approximately 50% of cases. In addition to this illness, children may develop other mental pathologies.
2. Has a great influence on the human psyche environment. External stimuli can play the role of a trigger for the development of mental pathology. These include:
3. Head injury. A concussion can cause disruption of intercellular ligaments and necrosis of entire sections of brain tissue.
4. Infectious diseases. Meningitis, encephalitis and other diseases destroy brain cells and disrupt the balance of hormones.
5. Poisoning. When intoxicated, toxic substances and decay products from the death of healthy and pathogenic cells enter the human bloodstream, causing oxygen starvation and a lack of optimal blood supply.
6. Stress, psychological trauma. After traumatization of the psyche, not only the illness we describe often arises, but also other, serious mental disorders.

Important: one cannot assume that these factors directly cause bipolar affective disorder ICD 10; they only provoke the disease if it is genetic.

Stress may cause bipolar disorder

Bipolar affective disorders: how they manifest themselves

Manic-depressive psychosis, the second name for bipolar disorder, manifests itself either in the form of depression or mania, and sometimes in a combination of two forms at the same time.

For example, a person can be cheerful, overly talkative, optimistic, talk with enthusiasm about his plans, but usually it does not come to true action. A short period passes, and he becomes gloomy, whiny, and incapacitated. Moreover, he loses not only moral, but also physical strength, the ability to remember and think. This person sees the future only in black, gloomy colors, thoughts of suicide arise. For those who do not know what bipolar affective disorder is, this is a clear example. To understand the details, you need to understand each type of psychosis.

Depressive phase of bipolar affective disorder

Depressive episodes are characterized by the following manifestations:

• depressed mood;
• inhibition of thinking;
• fatigue, delay in movements.

The main symptom is a depressed mood. The condition is not affected by any positive news or events, be it the birth of a child, a wedding, a meeting with a loved one, etc. When talking with a doctor, such patients express their condition with words: sad, sad, “sick” at heart.

Inhibited thinking is manifested by difficulty in assimilating information and reproducing it. Previously beloved, mental work has now become a real test, the patient is not able to concentrate, plan, or make decisions.

Important: depression worsens in the morning; it is at this time that the risk of suicide is high. Therefore, it is necessary to be near the patient before waking up or immediately after it.

Depressive phase- bipolar affective disorder, the symptoms of which are supplemented by a complete loss or excessively increased appetite, increased sexual desire. When an illness occurs, the patient’s self-esteem drops, self-confidence, and faith in one’s strengths and capabilities are lost.

Affective personality disorder: manic episodes

This type of pathology is the complete opposite of the depressive phase of the disease. Unlike patients suffering from depression who understand the seriousness of their situation, representatives of the second type rarely consult a doctor on time. They are not able to be critical of the failure in their own psyche, they do not understand what consequences bipolar personality disorder and the symptoms of a dangerous illness can lead to.

A manic state manifests itself in this way:

• a person’s mood sharply increases;
• the pace of thinking increases;
• psychomotor activity is excited.

Increased sex drive in bipolar disorder

During the next phase of the disease, people become overly optimistic, their own self-esteem is inflated, they are not afraid of anything or anyone. You can recognize a sick person if you pay attention to the following points:

1. he becomes overly talkative and sociable;
2. anxiety and excessive activity appear;
3. unable to concentrate on one thing, constantly distracted;
4. the patient sleeps little;
5. Sexual desire increases, while intelligibility in sex partners decreases;
6. behavior becomes reckless and irresponsible.

Before making a diagnosis, it is necessary to exclude such persons from taking psychotropic medications, drugs, after which the clinical picture is similar to bipolar pathology.

BAD - bipolar affective disorder: diagnosis

An experienced doctor must examine psychotic signs, an important factor in the successful treatment of the condition. The following symptoms may occur with BA:

• delusions of grandeur, delusional hallucinations of an erotic nature, delusions of persecution;
• delusions of a nihilistic nature - denial of the obvious, delusions of guilt, hypochondria, etc.

For an accurate diagnosis, a complete anamnesis is required, taking into account all the details of the disease, including information about the mental state of the patient’s relatives.

It is important for a specialist to establish the form and course of the disease, to find out whether manic or depressive states have been observed before. If so, how long did the mania or depression last, and did remissions occur? Based on information and criteria indicating the patient’s condition and the severity of signs of the disease, the doctor makes a diagnosis.

Depending on what symptoms appeared earlier and how the attacks (phases) proceeded, the specialist distinguishes two types of bipolar disorder:

1. 1st type The disease is diagnosed if the patient has already had previous episodes (manic). This does not take into account depressive phases. Type 1 symptoms are more common in men.
2. 2nd type manifested by a predominance of depressive phases combined with rare episodes of mania. Females are more susceptible to this type.

Bipolar disorder: complications

Patients with bipolar disorder are primarily a danger to themselves. In advanced stages, without proper treatment, they make repeated suicide attempts.

• The depressive phase is a constant self-flagellation, a state of grief, melancholy, sadness. Many of us have heard the expression “Cats scratch your soul.” So, in patients with bipolar disorder, this condition lasts from several days to many years. Agree, it is impossible to live with this without adequate therapy.
• The manic phase also causes anxiety. Inflated optimism, high self-esteem, promiscuity in sexual intercourse leads to sexually transmitted diseases, intractable diseases, HIV, AIDS, etc. Don't forget about the financial side of the issue. Excessive activity and the desire to conquer business heights can lead to serious expenses, and as a result - loans, debts, unfulfilled obligations to serious people.

Bipolar affective disorder: treatment

At the first signs of a mental disorder, you should consult a doctor. You should not postpone a visit to a specialist if your relatives exhibit symptoms. As we already know, advanced phases can lead to life-threatening consequences for the patient and those around him.

Important: bipolar affective disorder is a mental disorder that cannot be treated independently at home, or with the help of dubious representatives of alternative medicine.

The methods of influencing types and phases are radically different. Treatment of bipolar personality disorder should be comprehensive: medication and psychotherapy.

Bipolar affective disorder should be treated by a psychotherapist

Medical pharmaceuticals used to eliminate the symptoms of bipolar disorder include:

• Neuroleptics: eliminate dangerous symptoms, anxiety, hallucinations, delusional states. Doctors often prescribe haloperidol, rispaxol, and quetiapine.
• Antidepressants: prescribed both to prevent and relieve a depressive mood. The number of items is huge, they are prescribed according to symptoms, effectiveness in effect, taking into account side effects. Popular drugs: amitriptyline, fluoxetine, fluvomaxin, sertraline, etc.
• Timostabilizers: regulate a person’s mood, reduce the severity of opposite vibrations. Previously, drugs of this type were used to eliminate seizures during epileptic seizures and other conditions. During research, experts discovered the ability of thymostabilizers to normalize the course of bipolar disorder. Among the effective agents are carbamazepine, lithium salt, valproate, which are used not only as treatment, but also as prevention of personality disorder.

Bipolar affective disorder: psychotherapy

In recent years, psychotherapy has been widely used; it can be both individual and general. It all depends on what symptoms bother the patient and what brings maximum discomfort in life.

Important: many people think about the question of whether bipolar disorder can be treated only with psychotherapy. Sessions with a psychotherapist are an additional type of treatment; without the use of medications there will be no successful effect.

When communicating with a patient, the doctor can make an accurate diagnosis, identify the main problems, and make it possible to realize the dangerous consequences of the actions taken. Thus, the patient can reevaluate and rethink his life and actions.

As for the patients' relatives, the doctor helps them understand the diagnosis of bipolar affective disorder, what happens to patients, improve the situation in the family, resolve conflict situations and concentrate on the most important thing - helping a loved one suffering from bipolar disorder.

Bipolar affective personality disorder: treatment methods

Psychotherapists most often use the cognitive-behavioral method of influence. During treatment, the specialist teaches the patient to identify problems that aggravate the condition, destructive behavior, and replace a negative perception of reality with a positive one. Thanks to such changes, the patient learns a new approach to life, overcomes difficult circumstances with minimal harm to his own psyche. Manic-depressive psychosis (bipolar affective disorder) requires careful study by the patient. He must understand the nature of the disease, the significance of the prescribed drugs and sessions.

Bipolar disorder: how to move on

Do not be upset or panic if you are diagnosed with bipolar disorder. This disease has a favorable prognosis. Most, with adequate therapy, feel stable remission - symptoms are absent or appear in a mild form, which no one notices, including the patient himself.

The prognosis for a diagnosis of bipolar disorder can be quite favorable.

Unlike schizophrenia and other mental disorders that cause changes in character and personality - indifference, lack of emotions, initiative - with bipolar disorder everything is more favorable. Only during acute phases do inadequate mental states arise; during remission, nothing betrays the disease. If you strictly follow your doctor’s recommendations, take medications on time, and attend psychotherapy sessions, the number of attacks will be reduced to a minimum, and stable remission will persist for years.

Causes of bipolar disorder

Most experts agree that there is no one global reason why a patient develops bipolar disorder. Rather, it is the result of several factors that influence the occurrence of this mental illness. Psychiatrists identify several reasons why bipolar disorder develops:

• genetic factors;
• biological factors;
• chemical imbalance in the brain;
• external factors.

As for the genetic factors that influence the development of bipolar disorder, scientists have made certain conclusions. They conducted several small studies using the personality psychology method on twins. According to doctors, heredity plays an important role in the development of manic-depressive psychosis. People who have a blood relative with bipolar disorder are more likely to develop the disease in the future.

When it comes to biological factors that can lead to bipolar disorder, experts say that brain abnormalities are often observed when examining patients diagnosed with bipolar disorder. But so far doctors cannot explain why these changes lead to the development of serious mental illness.

Chemical imbalances in the brain, especially with regard to neurotransmitters, play a key role in the occurrence of various disorders, including bipolar disorder. Neurotransmitters are biologically active substances in the brain. Among them are, in particular, the most famous neurotransmitters:

• dopamine;
• norepinephrine.

Hormonal imbalance can also trigger the development of bipolar disorder.

External or environmental factors sometimes lead to the formation of bipolar disorder. Among environmental factors, psychiatrists distinguish the following circumstances:

• excessive alcohol consumption;
• traumatic situations.

Symptoms of Bipolar Disorder

Symptoms during the manic stage include the following:

• a person feels like the ruler of the world, feels euphoric and is too excited;
• the patient is self-confident, he has an excessive sense of self-importance and increased self-esteem prevails;
• doctors note a distorted perception in the patient;
• a person is distinguished by fast speech and an excess of phrases;
• thoughts come and go at high speed (so-called racing thoughts), eccentric statements are made; patients sometimes even begin to embody some strange thoughts in reality;
• during the manic stage, a person is sociable and sometimes aggressive;
• the patient is capable of committing risky actions, has promiscuous sex life, alcoholism, he can use drugs and participate in dangerous activities;
• the individual may be careless with money and spend it excessively.

Symptoms during the depressive stage of bipolar include the following:

• the patient feels despondency, despair, hopelessness, sadness, and his thoughts are gloomy;
• in severe cases, the patient is visited and he can even take certain actions to carry out what is planned;
• doctors note insomnia and sleep disorders;
• the patient often experiences anxiety over trifles;
• the personality is often overwhelmed by a feeling of guilt about all events;
• the depressive phase of bipolar disorder is reflected in food intake - a person eats either too much or too little;
• patients note weight loss or, conversely, weight gain;
• the patient complains of fatigue, weakness, apathy;
• the person has attention problems;
• the patient is easily susceptible to irritants: noise, light, smells, reacts to tight clothing;
• some patients are unable to go to work or study;
• a person notices that he has lost the ability to enjoy activities that previously brought joy.

Psychosis

During both the manic and depressive stages of bipolar disorder, the patient may experience psychosis, when a person cannot understand where the fantasies are and where the reality in which he is located.

Symptoms of psychosis in bipolar disorder are as follows:

• illusions;
• hallucinations.

Clinical depression or major depressive disorder

Clinical depression is often a seasonal phenomenon. It used to be called seasonal affective disorder. There are mood swings depending on the time of year.

Symptoms of bipolar disorder in children and adolescents:

• sudden change of mood;
• attacks of anger;
• outbursts of aggression;
• reckless behavior.

It is important to remember that manic depression is treatable and exists. The symptoms of this mental illness can be reduced with the right approach, and thus the person can return to normal life.

Diagnosis of bipolar disorder

When diagnosing bipolar disorder, a psychiatrist or psychologist is guided by his previous work experience, his observations, conversations with family members, colleagues, close friends, teachers, as well as knowledge of secondary signs of this mental illness.

First, it is necessary to study the physiological state of the patient, do a blood and urine test.

Experts distinguish three common types:

1) The first type of bipolar disorder, the so-called expression of emotions in the mirror

There must be at least one episode of the manic phase of bipolar disorder or a mixed phase (with a previous depressive phase). Most patients experienced at least one depressive episode.

In addition, in this case it is important to exclude clinical affective disorders that are not associated with manic-depressive psychosis, for example:

• schizophrenia;
• delusional disorder;
• other mental disorders.

2) The second type of bipolar disorder

The patient has experienced one or more episodes of depression and at least one episode of hypomanic behavior associated with manic depression.

Hypomanic states are not as severe as manic states. During the hypomanic stage, the patient sleeps little, he is assertive, easy-going, very energetic, but at the same time is able to perform all his duties normally.

Unlike the manic stage of bipolar disorder, during the hypomanic stage, doctors do not observe symptoms of psychosis or delusions of grandeur.

3) Cyclothymia

Cyclothymia is a mental affective disorder in which the patient experiences mood swings, ranging from vague depression to hyperthymia (sometimes even episodes of hypomania occur). Hyperthymia is a persistent elevated mood.

In general, such mood swings with cyclothymia are a mild form of manic-depressive psychosis. Moderate depressive mood is often observed.

In general, a patient with symptoms of cyclothymia feels that his condition is quite stable. At the same time, other people notice his mood swings, ranging from hypomania to a manic-like state; then depression may occur, but this can hardly be called major depressive disorder (clinical depression).

Treatment for Bipolar Disorder

The goal of treatment for bipolar disorder is to reduce the frequency of manic and depressive episodes as much as possible, and to significantly reduce the symptoms of the disease so that the patient can return to normal life.

If the patient does not undergo treatment and symptoms of the disease remain, this can last for one year. If a patient is being treated for manic-depressive psychosis, improvement usually occurs in the first 3-4 months.

At the same time, mood swings still remain a hallmark of patients diagnosed with bipolar disorder who are undergoing treatment. If a patient regularly communicates with his doctor and goes to an appointment, then such treatment is always more effective.

Treatment for bipolar disorder usually involves a combination of several therapies, including medications, exercise, and work with a psychologist.

Nowadays, a patient is rarely hospitalized with symptoms of manic-depressive psychosis. This is only done if he might cause harm to himself or others. Then patients are in the hospital until improvement occurs.

Lithium carbonate is most often prescribed long-term to reduce mania and hypomania. Patients take lithium for at least six months. You must strictly adhere to the psychiatrist's instructions.

Other types of therapy for bipolar disorder include the following:

• anticonvulsants;
• neuroleptics;
• valproate and lithium;
• psychotherapy;

Anticonvulsants are sometimes prescribed to help a person in the manic stages of bipolar disorder.

Antipsychotics are aripiprazole, olanzapine and risperidone. They are prescribed if a person behaves too restlessly and the symptoms of the disease are severe.

In what cases are valproate and lithium carbonate prescribed? Doctors use this combination of drugs in rapid cycling.

Rapid cycling is a form of bipolar disorder where the patient experiences 4 or more episodes of mania or depression per year. This condition is more difficult to treat than varieties of the disease with less frequent attacks, and requires special selection of medications. According to some studies, more than half of patients suffer from this form of the disease.

In general, a sign of rapid cyclicality is unbalanced behavior in a person diagnosed with “manic-depressive psychosis” all the time, and there is no norm in his behavior for a long time. In such cases, psychiatrists prescribe valproate in combination with lithium. If this does not bring the expected effect, the doctor recommends lithium carbonate, valproate and lamotrigine.

The goal of psychotherapy is to:

• relieve the main symptoms of bipolar disorder;
• help the patient understand the main provoking factors that lead to the disease;
• minimize the impact of the disease on relationships;
• identify the first symptoms that indicate a new round of the disease;
• look for those factors that help you stay normal the rest of the time.

Cognitive behavioral therapy is training the patient in psychological self-help techniques and a type of family therapy. Psychiatrists talk to the patient and his family about how to avoid exacerbation of bipolar disorder.

Interpersonal (or interpersonal therapy) also helps patients with symptoms of depression. Interpersonal psychotherapy is a type of short-term, highly structured, specifically focused psychotherapy. It is based on the working principle of “here and now” and is aimed at resolving the problems of the current interpersonal relationships of patients who suffer.

2012-07-03 | Updated: 2018-01-05© Stylebody

Manic-depressive psychosis (MDP) or, in a new way, bipolar disorder is a mental illness in which alternating manic and depressive phases with healthy periods (intermissions) occur. During the latter, the patient, as a rule, feels well both physically and mentally. Another important feature of this disease is the absence of increasing personality changes even with a long course of the disease and frequent changes in phases.

As for the age at which the characteristic symptoms of manic-depressive psychosis and the progression of the disease are most often observed, it falls between 30 and 50 years.

Risk factors and causes of bipolar disorder

The exact causes and mechanisms of development of TIR have not yet been established. However, a number of studies have allowed scientists to identify risk factors for this disease. These include:

1. Genetic predisposition. There is evidence that the transmission of some forms of MDP is associated with the X chromosome.
2. Characteristic personality traits. The most susceptible to the disease are people with cyclical mood changes (with a cycloid type of psyche), melancholic people, psychasthenics (suspicious, impressionable, insecure individuals).
3. Diseases of the endocrine system.
4. Hormonal changes in the body during puberty, after menopause, including.
5. Postpartum depression.
6. Brain injuries and diseases.

Features of the course of the disease

Manic-depressive psychosis has several course options:

Unipolar In which the patient has only one thing - either depression or manic phases, followed by periods of mental health (intermission). Bipolar correct This disease has a clear sequence of phase changes (for example, mania, intermission, depression, intermission, mania, etc.) Bipolar incorrect With this variant of the course, manic-depressive psychosis is characterized by the following pattern: after depression and a healthy period, depression may develop again , and only then mania. Circular type With this type there are no healthy gaps. This form of the disease is considered the most severe.

The duration of one phase varies from 3 months to 2 years (manic phases are always shorter), while the healthy period is usually longer - on average 3-5 years, but can be lifelong.

Symptoms of the depressive phase

If bipolar personality disorder occurs classically, the depressive phase is characterized by the following symptoms:

1. Depressed mood.
2. Retardation of thinking and speech.
3. Motor slowness.

This phase of manic-depressive psychosis is characterized by a gradual increase in symptoms to a certain peak and the same gradual extinction of all signs of the disease.

Everything around is perceived in gloomy colors. Patients say that they have “neither present nor future”; they are indifferent to the successes and joyful events of loved ones. They do not come into contact with others, remain secluded, and suffering is usually expressed on their face. They answer questions slowly, their voice is monotonous. During the day, patients are not busy with anything; they can sit in bed for hours without changing positions. Sometimes ideas of self-blame appear; they believe that they are of no use to anyone and do not benefit others. Patients, considering themselves a burden to the family, express thoughts of death.

In addition, patients experience mood swings throughout the day: in the morning - worst, in the evening - much better. In the depressive phase of MDP, patients lose their appetite and noticeably lose weight. However, the most dangerous complications in this period of the disease are suicide attempts.

Symptoms of the manic phase

The manic phase also has its own triad of symptoms of bipolar disorder:

1. Elevated mood.
2. Mental excitement.
3. Excessive physical activity.

At the beginning of the phase, patients are cheerful, joyful, sociable, perceive everything in a “rosy light”, easily make acquaintances, are flirtatious, strive to attract attention with bright, unusual clothes, talk about their merits, exaggerate personal successes and merits. They are verbose, easily distracted, and their speech rate is sharply accelerated. The hasty switching of patients from one topic to another leads to the fact that it is sometimes very difficult to follow the development of their thoughts (in such cases, the thinking of patients is referred to as “jumps of ideas”).

They actively strive for activities that are usually fruitless in nature and manifest themselves, for example, in hasty copying of pages from various books, in constant rearrangement of furniture in the apartment, in repeated rubbing of the floor during the day, etc. They do this at night, without feeling the need for sleep. A manic state is accompanied by uncritical judgment, which often leads to the commission of socially dangerous actions. Patients commit theft of money, with which they purchase unnecessary things, sign illegal documents, commit forgery, fraud, and commit criminal negligence in work, which entails serious consequences.

In addition, the patient may experience aggression and fits of anger. In the acute period of the manic phase, a person sleeps only 3-4 hours a day. However, after some time the patient begins to calm down and return to a normal mental state.

Diagnosis, treatment and prognosis

Considering all the described symptoms of manic-depressive psychosis, the following cases can be identified in which you should consult a doctor:

• The appearance of causeless sudden changes in mood and behavior.
• Unmotivated and significant change in appetite and.

To make a diagnosis, the patient must have at least two episodes, one of which must be manic. In addition, the doctor pays attention to heredity and events preceding the occurrence of episodes of the disease. In unclear cases, doctors need long-term observation of the patient in order to accurately determine the diagnosis.

Treatment of manic-depressive psychosis is a very difficult task, since depression and mania are completely opposite conditions that require different treatments. The doctor has to very carefully select drugs and doses in order to gently bring the patient out of the attack and not transfer him immediately from the manic phase to depression or vice versa.

For bipolar disorder in the depressive phase, the patient is prescribed antidepressants and mood stabilizers (mood stabilizers). In the manic phase, antipsychotics and, again, mood stabilizers are indicated. During periods of mental health, patients are necessarily prescribed supportive treatment - mainly lithium and carbamazepine. These medications stabilize the patient’s mood and prevent exacerbations of the disease.

The prognosis for manic-depressive psychosis depends on the frequency and duration of the phases of the disease. If the pathology has a circular type of course, the patient may be given the first group of disability. If attacks occur very rarely and periods of intermission last for years, a person may well work and simultaneously undergo outpatient courses of treatment (preventive therapy).

Also, for patients with symptoms of bipolar disorder, qualified psychological assistance and participation in self-help groups for patients suffering from the same disease are very important, since the positive experience of other people has a beneficial effect on health.

Antidepressants

• Afobazol 10 mg No. 60 tablets, Pharmstandard-Leksredstva OJSC (Russia)
• Amitriptyline 25 mg No. 50 tablets, Zentiva a.s. (Slovakia)
• Bodrin No. 30 capsules, Adifarm Ltd. (Bulgaria)
• Valdoxan 25 mg No. 28 tablets, Les Laboratoires Servier Industrie (France)
• Venlaxor 37.5 mg; 75 mg No. 30 tablets, Grindeks (Latvia)
• Misol 50 mg; 100 mg No. 14 tablets,
• Mirtel 30 mg No. 30 tablets, G.L.Pharma GmbH (Austria)
• Fluoxetine 20 mg No. 20 capsules, G.L.Pharma GmbH (Austria)
• Fevarin 100 mg No. 15 tablets, Abbott Healthcare SAS (France)
• Cytol 20 mg; 40 mg No. 28 tablets, Abdi Ibrahim (Türkiye)
• Escita 10 mg; 20 mg No. 14 tablets, Nobel Ilach Sanai ve tijaret A.Sh. (Türkiye)

Neuroleptics

• Aminazin-N.S. 25 mg; 50 mg; 100 mg No. 10 tablets, Valenta Pharmaceuticals OJSC (Russia)
• Betamax 50 mg; 100 mg No. 30 tablets, Grindeks (Latvia)
• Vertinex 5 mg No. 10 tablets, Kusum Healthcare (India)
• Sonapax 10 mg; 25 mg No. 60 tablets, Jelfa Farmzavod A.O. (Poland)
• Tizercin 25 mg No. 50 tablets, Egis Pharmaceutical Plant OJSC (Hungary)
• Chlorprothixene 15 mg; 50 mg No. 30 tablets, Zentiva a.s. (Czech Republic)

Video: psychologist about bipolar affective disorder

Bipolar disorder (bipolar affective disorder, manic-depressive psychosis) is a mental disorder that is clinically manifested by mood disorders (affective disorders). Patients experience alternating episodes of mania (or hypomania) and depression. Periodically, only mania or only depression occurs. Intermediate, mixed states can also be observed.

The disease was first described in 1854 by French psychiatrists Falret and Baillarger. But it was recognized as an independent nosological unit only in 1896, after Kraepelin’s works devoted to a detailed study of this pathology were published.

The disease was originally called manic-depressive psychosis. But in 1993 it was included in the ICD-10 under the name bipolar affective disorder. This was due to the fact that psychosis does not always occur with this pathology.

There are no exact data on the prevalence of bipolar disorder. This is due to the fact that researchers of this pathology use different evaluation criteria. In the 90s of the 20th century, Russian psychiatrists believed that 0.45% of the population suffered from the disease. The assessment of foreign experts was different - 0.8% of the population. It is currently believed that symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease takes on a severe psychotic form. There are no data on the incidence of bipolar disorder in children, which is due to certain difficulties in using standard diagnostic criteria in pediatric practice. Psychiatrists believe that in childhood episodes of the disease often go undiagnosed.

In approximately half of patients, the onset of bipolar disorder occurs between 25 and 45 years of age. In middle-aged people, unipolar forms of the disease predominate, and in young people, bipolar forms predominate. In approximately 20% of patients, their first episode of bipolar disorder occurs after age 50. In this case, the frequency of depressive phases increases significantly.

Bipolar disorder is 1.5 times more common in women than in men. At the same time, bipolar forms of the disease are more often observed in men, and monopolar forms in women.

Repeated attacks of bipolar disorder occur in 90% of patients, and over time, 30–50% of them permanently lose their ability to work and become disabled.

Causes and risk factors

Diagnosis of such a serious disease must be trusted by professionals; experienced specialists at the Alliance clinic (https://cmzmedical.ru/) will analyze your situation as accurately as possible and make the correct diagnosis.

The exact causes of bipolar disorder are not known. Hereditary (internal) and environmental (external) factors play a certain role. In this case, the greatest importance is given to hereditary predisposition.

Factors that increase the risk of developing bipolar disorder include:

• schizoid personality type (preference for solitary activities, tendency to rationalize, emotional coldness and monotony);
• Statothymic personality type (increased need for orderliness, responsibility, pedantry);
• melancholic personality type (increased fatigue, restraint in expressing emotions combined with high sensitivity);
• increased suspiciousness, anxiety;
• emotional instability.

The risk of developing bipolar disorder in women increases significantly during periods of unstable hormonal levels (menstrual bleeding, pregnancy, postpartum or menopause). The risk is especially high for women with a history of psychosis suffered during the postpartum period.

Forms of the disease

Clinicians use a classification of bipolar disorders based on the predominance of depression or mania in the clinical picture, as well as the nature of their alternation.

Bipolar disorder can occur in a bipolar (there are two types of affective disorders) or unipolar (there is one affective disorder) form. Unipolar forms of pathology include periodic mania (hypomania) and periodic depression.

The bipolar form occurs in several variants:

• regularly interspersed– a clear alternation of mania and depression, which are separated by a light interval;
• irregularly intermittent– the alternation of mania and depression occurs chaotically. For example, several episodes of depression may occur in a row, separated by a light interval, and then manic episodes;
• double– two affective disorders immediately replace each other without a clear interval;
• circular– there is a constant change of mania and depression without clear intervals.

The number of phases of mania and depression in bipolar disorder varies among patients. Some people experience dozens of affective episodes throughout their lives, while for others such an episode may be the only one.

The average duration of the bipolar disorder phase is several months. At the same time, episodes of mania occur less frequently than episodes of depression, and their duration is three times shorter.

The disease was originally called manic-depressive psychosis. But in 1993 it was included in the ICD-10 under the name bipolar affective disorder. This was due to the fact that psychosis does not always occur with this pathology.

Some patients with bipolar disorder experience mixed episodes, which are characterized by rapid alternation between mania and depression.

The average duration of the clear interval in bipolar disorder is 3–7 years.

Symptoms of Bipolar Disorder

The main symptoms of bipolar disorder depend on the phase of the disease. So, the manic stage is characterized by:

• accelerated thinking;
• uplifting mood;
• motor excitement.

There are three degrees of severity of mania:

1. Mild (hypomania). There is an elevated mood, an increase in physical and mental performance, and social activity. The patient becomes somewhat absent-minded, talkative, active and energetic. The need for rest and sleep decreases, and the need for sex, on the contrary, increases. Some patients experience not euphoria, but dysphoria, which is characterized by the appearance of irritability and hostility towards others. The duration of an episode of hypomania is several days.
2. Moderate (mania without psychotic symptoms). There is a significant increase in physical and mental activity, and a significant increase in mood. The need for sleep almost completely disappears. The patient is constantly distracted, cannot concentrate, as a result, his social contacts and interactions are difficult, and he loses his ability to work. Ideas of greatness arise. An episode of moderate mania lasts at least a week.
3. Severe (mania with psychotic symptoms). There is pronounced psychomotor agitation and a tendency to violence. Jumps of thoughts appear, the logical connection between facts is lost. Hallucinations and delusions develop, similar to the hallucinatory syndrome in schizophrenia. Patients become confident that their ancestors belonged to a noble and famous family (delusion of high origin) or consider themselves a famous person (delusion of grandeur). Not only the ability to work is lost, but also the ability to self-care. Severe mania lasts over several weeks.

Depression in bipolar disorder occurs with symptoms opposite to those of mania. These include:

• slow thinking;
• low mood;
• motor retardation;
• decreased appetite, up to its complete absence;
• progressive loss of body weight;
• decreased libido;
• Women stop menstruating and men may develop erectile dysfunction.

With mild depression due to bipolar disorder, patients' mood fluctuates throughout the day. It usually improves in the evening, and in the morning the symptoms of depression reach their maximum.

The following forms of depression may develop in bipolar disorder:

• simple– the clinical picture is represented by a depressive triad (depressed mood, inhibition of intellectual processes, impoverishment and weakening of impulses to action);
• hypochondriacal– the patient is confident that he has a serious, deadly and incurable disease, or a disease unknown to modern medicine;
• delusional– the depressive triad is combined with delusions of accusation. Patients agree and share it;
• agitated– with depression of this form there is no motor retardation;
• anesthetic– the prevailing symptom in the clinical picture is a feeling of painful insensibility. The patient believes that all his feelings have disappeared, and in their place an emptiness has formed, which causes him severe suffering.

Diagnostics

To be diagnosed with bipolar disorder, a patient must have had at least two episodes of mood disorders. Moreover, at least one of them must be either manic or mixed. To make a correct diagnosis, the psychiatrist must take into account the patient’s medical history and information received from his relatives.

Currently, it is believed that symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease takes on a severe psychotic form.

The severity of depression is determined using special scales.

The manic phase of bipolar disorder must be differentiated from agitation caused by taking psychoactive substances, lack of sleep or other reasons, and the depressive phase from psychogenic depression. Psychopathy, neuroses, schizophrenia, as well as affective disorders and other psychoses caused by somatic or nervous diseases should be excluded.

Treatment for Bipolar Disorder

The main goal of treating bipolar disorder is to normalize the patient’s mental state and mood and achieve long-term remission. In severe cases of the disease, patients are hospitalized in the psychiatry department. Mild forms of the disorder can be treated on an outpatient basis.

Antidepressants are used to relieve a depressive episode. The choice of a specific drug, its dosage and frequency of administration in each specific case is determined by a psychiatrist, taking into account the patient’s age, the severity of depression, and the possibility of its transition to mania. If necessary, the prescription of antidepressants is supplemented with mood stabilizers or antipsychotics.

Drug treatment of bipolar disorder in the stage of mania is carried out with mood stabilizers, and in severe cases of the disease, antipsychotics are additionally prescribed.

In the remission stage, psychotherapy (group, family and individual) is indicated.

Possible consequences and complications

If left untreated, bipolar disorder can progress. In a severe depressive phase, the patient is capable of making suicidal attempts, and during a manic phase he poses a danger both to himself (accidents due to negligence) and to the people around him.

Bipolar disorder is 1.5 times more common in women than in men. At the same time, bipolar forms of the disease are more often observed in men, and monopolar forms in women.

Forecast

In the interictal period, in patients suffering from bipolar disorder, mental functions are almost completely restored. Despite this, the prognosis is unfavorable. Repeated attacks of bipolar disorder occur in 90% of patients, and over time, 30–50% of them permanently lose their ability to work and become disabled. In approximately every third patient, bipolar disorder occurs continuously, with minimal duration of light intervals or even their complete absence.

Bipolar disorder is often combined with other mental disorders, drug addiction, and alcoholism. In this case, the course of the disease and the prognosis become more severe.

Prevention

Measures for the primary prevention of the development of bipolar disorder have not been developed, since the mechanism and causes of the development of this pathology have not been precisely established.

Secondary prevention is aimed at maintaining stable remission and preventing repeated episodes of affective disorders. To do this, it is necessary that the patient does not voluntarily stop the treatment prescribed to him. In addition, factors that contribute to the development of exacerbation of bipolar disorder should be eliminated or minimized. These include:

• sudden changes in hormonal levels, endocrine system disorders;
• brain diseases;
• injuries;
• infectious and somatic diseases;
• stress, overwork, conflict situations in the family and/or at work;
• violations of the daily routine (insufficient sleep, busy work schedule).

Many experts associate the development of exacerbations of bipolar disorder with a person’s annual biorhythms, since exacerbations occur more often in spring and autumn. Therefore, at this time of year, patients should especially carefully adhere to a healthy, measured lifestyle and the recommendations of their doctor.

Video from YouTube on the topic of the article:

Among mental illnesses of the individual, manic-depressive psychosis, otherwise called bipolar disorder, or MDP for short, occupies a special place. As the name suggests, the disease consists of alternating two phases - depressive and manic, which can sometimes take on a mixed character.

General picture of the disease

The state of manic-depressive disorder is a series of successive phases (episodes) - depression and mania, between which there is often a picture of mental health (also called interphase), when the psyche and personality of the patient completely return to normal. The phases have different durations: from a couple of weeks to several years (an average has been identified - 4-7 months, but it is very arbitrary). The period of intermission is also different: it can be completely absent, or it can last for many years.

Since the disease is often accompanied by only one of two phases (unipolar form), its well-known name is now considered not entirely accurate. Therefore, in official science it is customary to call MDP bipolar affective disorder.

If the symptoms are less pronounced, then this disease is called cyclotomy.

History of the study of psychosis

Almost simultaneously, but independently of each other, TIR was described by two French researchers at once:

• Jean Pierre Falret(called the disease circular psychosis);
• Jules Gabriel Baillarger(titled “madness in two forms”).

Despite this, MDP was not identified as a separate unit of psychiatry for a long time. This happened only at the end of the 19th century thanks to the works of the German psychiatrist Emil Kraepelin, who first began to use the current name.

Types of TIR

The disease itself is very heterogeneous, which greatly complicates its clinical and symptomatic study. For convenience, the following very conditional classification is used:

Moreover, the number of phases itself may be different; there have been cases when there was only one phase. Manic-depressive disorder can consist only of a manic (hypomanic) or depressive phase.

Causes of the disease

There is not yet an exhaustive list of reasons that could cause this type of personality disorder. However, several main ones can be noted:

The disease can be triggered by stress and difficulties in building relationships with others.

Manic phase: key symptoms

The following set of signs will help you recognize this phase:

The patient feels unprecedented vigor, a surge of strength, and energy. He has an optimistic outlook on life, and his memories become pleasant. The world around us is perceived as surprising and interesting, and sensations become more intense: smells are perceived more clearly, sounds and visual images are perceived more clearly. Fatigue disappears, speech becomes loud and expressive.

The manic phase itself, in its classical version, consists of five alternating stages:

1. Hypomanic stage of psychosis. A person feels cheerful in body and spirit, his mood is excellent, his speech is accelerated and verbose, his appetite gradually increases, and the need for sleep decreases.
2. Second stage of psychosis- severe symptoms of mania. Motor and speech activity, constant jokes, high spirits, patients constantly jump from topic to topic, which makes communication with them very difficult. A person often overestimates his own strengths and begins to feel his greatness. A person can begin to implement previously failed plans and bring absurd ideas to life. Sleep duration decreases.
3. Manic Fury. Speech and movements are disordered and incoherent. In normal communication it is impossible to understand such a person, but analysis of speech helps to reveal that it is built on associations.
4. Motor sedation. The patient's movements become less abrupt, while unintelligible speech and high spirits remain.
5. Reactive stage of psychosis. All symptoms are reduced to normal, slight inhibition appears.

Depressive phase: key symptoms

A patient in this stage of psychosis is characterized by low mobility, and in especially severe cases, depressive stupor. Interestingly, improvements in the patient’s mood and well-being are observed in the late afternoon.

The phase consists of 4 stages.

The depressive stage is longer (it can last from several months to a year, with a manic stage - no more than 4 months), therefore it is considered more dangerous in psychiatry. Depression may be accompanied by hypochondriacal delirium and loss of sensitivity.

Diagnostics

The difficulty in diagnosing this psychosis is that the symptoms of the disease can be confused with seasonal mood swings. In order to exclude brain injuries, the patient is referred for an EMR of the brain and X-ray is prescribed.

Treatment method

The choice of method for treating psychosis in a patient is influenced by the nature of the disease, the severity of the symptoms, and the clinical course. That is why you should not self-medicate; there is only a risk of causing harm. Only a doctor can make a diagnosis.

If the psychosis phase is depressive, then antidepressants are prescribed; if the psychosis phase is manic, antipsychotics with a sedative effect (aminazine) or antimanic (haloperidol) and lithium therapy are used. To avoid suicide attempts, it is advisable to place the patient in a medical facility during periods of exacerbation. At the same time, with interphases the patient is fully able to work and is ready for normal life activities, but if one or another phase is repeated regularly or is protracted, manic-depressive disorder can be recognized as a chronic mental illness.

It should be remembered that people suffering from such psychosis for a long time may not give themselves away, seem completely normal. However, stress or any unpleasant event in life can cause an exacerbation of the disease. That is why such patients should be protected from stressful situations, unnecessary worries and nerves.

In the most difficult cases, electroconvulsive therapy in combination with diets and antidepressants can be used to treat psychosis. Fasting and sleep deprivation for several days also help.