The Bipolar disorder it is a mental illness characterized by the tendency of a person to alternate between depressive episodes and manic episodes. In type 1 the person alternates depressive episodes with full manic episodes, and in type 2 the person alternates between depressive episodes and hypomanic episodes (less severe).
The symptoms of this disorder are severe, different from the normal ups and downs of mood. These symptoms can result in problems in personal relationships, work, school, financial, or even suicide..
During the phase of depression, the person may experience negative perception of life, inability to feel pleasure in life, lack of energy, crying, self-harm, and in extreme cases, suicide..
During the manic phase the person may experience denial that they have a problem, act energetic, happy or irritable, make irrational financial decisions, feel great enthusiasm, not think about the consequences of their actions or lack of sleep.
Although there are cases of onset in childhood, the normal age of onset for type 1 is 18 years of age, while for type 2 it is 22 years. About 10% of cases of bipolar 2 disorder develop and become type 1.
The causes are not clearly understood, but genetic and environmental factors (stress, childhood abuse) play a role. Treatment usually includes psychotherapy, medication, and in unresponsive cases, electroconvulsive therapy may be helpful..
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Signs and symptoms of the depressive phase of bipolar disorder include:
Mania can occur in different degrees:
It is the least severe degree of mania and lasts at least 4 days. It does not cause a marked decrease in the person's ability to work, socialize, or adapt. It also does not require hospitalization and lacks psychotic characteristics..
In fact, general functioning can improve during a hypomanic episode and is thought to be a natural anti-depression mechanism..
If a hypomanic event is not followed or preceded by depressive episodes, it is not considered a problem, unless that mood is uncontrollable. Symptoms can last from a few weeks to several months.
It is characterized by:
Mania is a period of euphoria and high mood of at least 7 days. If left untreated, a mania episode can last 3 to 6 months.
It is characterized by showing three or more of the following behaviors:
A person with mania may also experience a lack of need for sleep and poor judgment. On the other hand, maniacs can have problems with alcohol or other substance abuse..
In extreme cases, they may experience psychosis, breaking contact with reality while in high spirits. Something usual is that the person with mania feels unstoppable or indestructible and feels chosen to achieve a goal.
About 50% of people with bipolar disorder experience hallucinations or delusions, which can lead to violent behavior or psychiatric admission.
In bipolar disorder, a mixed episode is a state in which mania and depression occur at the same time. People who experience this state may have thoughts of greatness as well as depressive symptoms such as suicidal thoughts or guilt..
People who are in this state are at high risk of committing suicide, since depressive emotions are mixed with mood changes or difficulties in controlling impulses.
The exact causes of bipolar disorder are unclear, although it is believed to depend primarily on genetic and environmental causes..
It is believed that 60-70% of the risk of developing bipolarity depends on genetic factors.
Several studies have suggested that certain genes and regions of chromosomes are related to the susceptibility to developing the disorder, with each gene having a greater or lesser importance..
The risk of TB in people with family members with TB is up to 10 times higher compared to the general population. Research points to heterogeneity, meaning that different genes are involved in different families.
Research shows that environmental factors play an important role in the development of TB, and psychosocial variables can interact with genetic dispositions.
Recent life events and interpersonal relationships contribute to the likelihood of manic and depressive episodes.
It has been found that 30-50% of adults diagnosed with TB report abusive or traumatic experiences in childhood, which is related to an earlier onset of the disorder and greater suicide attempts.
From evolutionary theory, it could be thought that the negative consequences that bipolar disorder has on the ability to adapt, causes genes to not be selected by natural selection.
However, high rates of TB remain in many populations, so there may be some evolutionary benefit..
Proponents of evolutionary medicine propose that historically high rates of TB suggest that changes between depressive and manic states had some evolutionary advantage in ancient humans.
In people who have a high degree of stress, the depressed mood could serve as a defensive strategy with which to move away from the external stressor, reserve energy and increase the hours of sleep.
Mania could benefit from its relationship to creativity, confidence, high energy levels, and increased productivity.
States of hypomania and moderate depression may have certain advantages for people in a changing environment. The problem would be whether the genes responsible for these states are over-activated and lead to mania and major depression.
Evolutionary biologists have proposed that TB could be an adaptation of ancient humans to extreme northern climates during the Pleistocene. During hot summer, hypomania may allow you to do many activities in a short period of time.
On the contrary, during the long winter, excessive sleep, excessive eating and lack of interest could help survival. In the absence of extreme weather conditions, TB would be maladaptive.
One piece of evidence for this hypothesis is the correlation between seasonality and mood swings in people with TB and low rates of TB in African Americans..
Brain imaging studies have shown differences in the volume of various brain regions between TB patients and healthy patients. Increases in the volume of the lateral ventricles, globus pallus and an increase in the rate of white matter hyperintensities have been found..
Magnetic resonance studies have suggested that there is abnormal modulation between the ventral prefrontal area and the limbic regions, especially the amygdala. This would contribute to poor emotional regulation and mood-related symptoms..
On the other hand, there is evidence that supports the association between early stressful experiences and dysfunction of the hypothalamic-pituitary-adrenal axis, which leads to its overactivation.
Less common TB can occur as a result of a neurological injury or condition: brain trauma, stroke, HIV, multiple sclerosis, porphyria, and temporal lobe epilepsy..
A neurotransmitter responsible for regulating mood, dopamine, has been found to increase its transmission during the manic phase and decrease during the depressive phase..
Glutamate is increased in the left dorsolateral prefrontal cortex during the manic phase.
Bipolar disorder is not often recognized and is difficult to distinguish from unipolar depression.
Its diagnosis requires taking into account several factors: experiences of the person, behavioral abnormalities observed by other people and signs evaluated by psychiatrists or clinical psychologists.
The most widely used diagnostic criteria are the DSM and the WHO ICD-10.
Although there are no medical tests to confirm TB, it is advisable to do biological tests to ensure that there is no physical disease, such as hypothyroidism or hyperthyroidism, metabolic disorders, HIV or syphilis.
It is also advisable to rule out brain lesions and perform an EEG to rule out epilepsy. According to DSM-IV, there are the following types of disorders within bipolar disorders:
In this section, Bipolar II Disorder, the manic episode and the major depressive episode will be described..
A) Presence of one or more major depressive episodes.
B) Presence of at least one hypomanic episode.
C) The affective symptoms of criteria A and B are not better explained by the presence of a schizoaffective disorder and are not superimposed on a schizophrenia, a schizophreniform disorder, a delusional disorder or an unspecified psychotic disorder.
E) Symptoms cause clinically significant distress or impairment of the individual's social, occupational, or other important areas of activity.
Specify the current or most recent episode:
A) A distinct period of an abnormal and persistently elevated, expansive or irritable mood, lasting at least a week (or any duration if hospitalization is necessary).
B) During the period of mood alteration, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and there has been a significant degree:
C) Symptoms do not meet criteria for mixed episode.
D) The mood alteration is severe enough to cause impairment of work, habitual social activities, relationships with others, or to require hospitalization to prevent harm to oneself or others, or there are psychotic symptoms.
E) The symptoms are not due to the direct physiological effects of a substance or to a general medical condition..
A) Presence of five or more of the following symptoms during a period of 2 weeks, representing a change from previous activity; one of the symptoms must be 1. depressed mood, or 2. loss of interest or capacity for pleasure:
B) Symptoms do not meet criteria for a mixed episode.
C) Symptoms cause clinically significant distress or impairment of the individual's social, occupational, or other important areas of activity.
D) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
E) Symptoms are not better explained by the presence of grief, symptoms persist for more than two months or are characterized by marked functional disability, morbid worries of worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Some mental disorders co-occurring to TB can occur: obsessive compulsive disorder, attention deficit and hyperactivity disorder, substance abuse, premenstrual syndrome, social phobia or panic disorder.
Although TB cannot be cured, it can be controlled effectively in the long term with medication and psychotherapy..
Combined with medication, psychotherapy can be an effective treatment for TB.
Some psychotherapeutic treatments for TB are:
According to research, medication together with intensive psychotherapy (weekly cognitive behavioral therapy) has better results than just psychotherapy or psychoeducation.
The symptoms of TB can be controlled with different types of medication. Because not everyone responds in the same way to the same medication, different drugs may have to be tried before finding the right one.
Keeping notes of daily symptoms, treatments, sleep patterns, and other behaviors will help you make effective decisions. The drugs commonly used for TB are antidepressants, mood stabilizers, and atypical antipsychotics..
They are normally the first line of treatment for TB and are generally taken for years..
Lithium was the first stabilizer approved to treat manic and depressive episodes. There are anticonvulsants that are also used as mood stabilizers:
The use of valproic acid or lamotrigine can increase suicidal thoughts or behaviors, so caution must be exercised in its use and people who take it should be observed..
Additionally, valproic acid can increase testosterone levels in adolescent girls, which can lead to a condition called polycystic ovary syndrome, which has symptoms such as excessive body hair, obesity, or an irregular menstrual cycle..
The side effects of lithium can be: dry mouth, restlessness, indigestion, acne, discomfort at low temperatures, muscle or joint pain, brittle nails or hair.
When taking lithium, it is important to check your blood levels, as well as the functioning of the liver and thyroid gland..
In some people, taking lithium can lead to hypothyroidism.
Side effects of other mood stabilizers can be:
These drugs are often used together with antidepressants to treat TB. Atypical antipsychotics can be:
Side effects of atypical antipsychotics can be:
Due to changes in weight and metabolism, it can increase the risk of developing diabetes or high cholesterol, so it is important to control glucose levels, weight and lipids.
In rare cases, long-term use of atypical antipsychotics can lead to a condition called tardive dyskinesia, which causes uncontrollable muscle movements.
The antidepressants that are usually prescribed to treat the symptoms of bipolar depression are: paroxetine, fluoxetine, sertraline and bupropion.
Taking antidepressants alone can increase the risk of mania or hypomania. To prevent it, the use of mood stabilizers along with antidepressants is usually required..
Side effects of antidepressants can be:
Patients taking antidepressants should be watched carefully, as they can increase suicidal thoughts or behaviors..
If you are pregnant or have a newborn baby, consult your doctor about available treatments..
To properly treat TB, you need to make certain lifestyle changes:
Bipolar disorder is the sixth leading cause of disability in the world and has a prevalence of 3% of the general population.
Its incidence is the same in women and men, as well as across different cultures and ethnic groups. Late adolescence and early adulthood are the ages when TB appears most.
Risk factors that can increase the chance of developing TB are:
If left untreated, TB can result in several problems that affect all vital areas:
A healthy lifestyle is necessary to keep TB symptoms under control, reduce symptoms, and prevent relapses. Besides psychotherapy and medication there are other things you can do:
The mood swings and behaviors of a person with TB affect the people around.
They may have to face irresponsible decisions, exaggerated demands, explosive outbursts, or bombastic behavior. Once the mania ends, it will be necessary to face the lack of energy of the family member to continue with a normal life.
However, with correct treatment, most people can stabilize their mood. Here are some ways you can help:
And what experience do you have with bipolar disorder?
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