What is bipolar disorder?
Bipolar disorder, also known as manic depression, is a mental disorder characterized by intense mood swings. It is a condition that is prolonged over time with alternating manic and depressive episodes either chronically or occasionally.
In the manic episode the individual feels extremely happy, euphoric, energetic or even irritable. On the other hand, in the depressive episode he may feel sad, hopeless, indifferent, depressed or with very low energy levels. Also, you may have both manic and depressive symptoms simultaneously, also known as a mixed episode.
It also causes changes in thinking, sleep, behavior, energy and the ability to perform activities of daily living.
Types of bipolar disorder
There is no clear consensus on the number of bipolar disorders. In this article we will focus on the three basic types of bipolar disorders.
Bipolar I disorder
Defined by manic episodes of at least seven days duration or symptomatology so severe that it requires inpatient care. It also frequently includes depressive episodes lasting no less than two weeks. This typology may involve mixed episodes.
Bipolar II disorder
It includes depressive episodes and hypomanic episodes, of less severity than manic episodes. Of greater complexity in the diagnosis, since hypomania is usually confused and is less reportable. Psychotic symptoms may appear during depressive episodes.
Cyclothymic disorder
Also known as cyclothymia, it is defined, as in bipolar II disorder, by depressive and hypomanic symptoms but with the exception that they have less intensity or duration than the episodes mentioned. There are differences in its duration depending on age, being at least two years in adults and one year in adolescents and children.
Unspecified bipolar disorder
This refers to those bipolar disorders that do not coincide with any of the diagnosed categories.
Regardless of typology, the presence of numerous manic or depressive episodes over the course of a year is known as “rapid cycling”.
What causes bipolar disorder?
There is no single cause of bipolar disorder. Numerous factors influence this disorder, such as genetics, neurological conditions or the environment.
Genetics
No specific genetic connection to bipolar disorder has been determined, although several studies show that there is a link between having bipolar disorder and the presence of bipolar disorder or depression in a relative.
Research suggests that people with certain genes are more likely to have the illness than others, and indicates that the disorder is caused by a combination of multiple genes.
However, some studies show that if one twin has the disorder, the other has only a 40% chance of having it.
Environment
Environmental factors play a major role in the development of the disorder. The occurrence and frequency of manic or depressive episodes are probably partly caused by life events or even interpersonal relationships, as is the case with common depression.
Around 50% of diagnosed adults have experienced traumatic situations during childhood, which results in an early onset of the disease, more concurrent disorders and a higher suicide rate. Additionally, lack of sleep in people with bipolar disorder induces manic episodes in 30% of cases.
Neurological condition
Bipolar disorder is rarely caused by a neurological condition or occurs in a person who has suffered a stroke, traumatic brain injury, or multiple sclerosis, among others.
Symptoms of bipolar disorder
Symptomatology may vary, involving manic, depressive or mixed episodes, known as mood episodes. These mood swings have consequences that usually last for one to two weeks, sometimes longer. When the subject is going through an episode, the symptoms remain throughout practically the whole day, every day, and are evident to those who observe them.
Intensity is inherent in the episodes, with strong emotions, abrupt changes in behavior, or energy levels. The severity of the symptoms varies from person to person, and it may be the case that the symptoms are milder in some sufferers than in others. For example, when a person is in a hypomanic episode, he or she tends to feel exhilarated and therefore may not be aware of what is happening. However, there is a possibility that those around him or her may be aware of these mood swings. After hypomania, the subject is likely to experience severe depression.
Manic phase
This phase includes high doses of energy, optimism or euphoria in large quantities, increased irritability, reduced need for sleep, increased distractions, lack of self-control and recklessness, verbosity, false beliefs or hallucinations, poor reasoning ability, disproportionate engagement in certain activities, decreased social skills, high self-esteem, irresponsible behavior or weight gain.
Depressive phase
Symptoms of a depressive episode include sadness or hopelessness, loneliness, loss of self-esteem, suicidal thoughts, too much or too little sleep, lack of concentration, eating problems, lack of energy, feelings of guilt, worthlessness and anger, anxiety, loss of interest in ordinary activities, weight loss or weight gain, inordinate slowness, chronic pain whether caused or not, lack of clarity in decision making, lack of motivation or apathy.
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Mixed phase
Involves manic and depressive symptoms. For example, sadness or hopelessness combined with hyperactivity. It is the most volatile as changes occur rapidly. Suicidal attempts or the abuse of substances harmful to health usually take place in this episode.
Hypomania
This episode contains symptoms of the manic episode but of lesser intensity or number. In addition, its duration is usually shorter and it is characterized by more inventive thinking, more energy, more ideas and disorder.
On the other hand, there are a number of features that accompany bipolar disorder but are not part of its diagnosis such as cognitive impairment and suicidality.
How is bipolar disorder diagnosed?
The diagnosis of bipolar disorder is made by a mental health professional by means of:
- Physical examinations
- Medical history
- Medical tests
- A mental health assessment
The professional relies on the symptoms, life and family history, and experiences of the subject.
In some cases, bipolar disorder may not be diagnosed until years after its onset due to symptomatology similar to other disorders such as schizophrenia, lack of awareness of the existence of a problem by the individual and those around them, or other confounding health problems.
Treatment of bipolar disorder
Although bipolar disorder is chronic, treatment is essential to control symptoms and achieve a better life regardless of the severity of the disorder. The main treatments include:
- Medications, such as mood stabilizers like lithium or atypical antipsychotics.
- Psychotherapy or talk therapy, which aims to identify and modify harmful emotions, behaviors or ways of thinking and provide support and coping strategies.
- A combination of both.
On the other hand, there are other treatments such as electroconvulsive therapy (brain stimulation procedure), regular exercise or maintaining a vital chart, which can help reduce and alleviate symptoms.
As we have seen above, not all individuals with bipolar disorder have cognitive deficits, but in those who do, deterioration occurs from the very beginning and worsens as the episodes continue. The main areas affected are concentration, attention, verbal learning, executive functions, activities of daily living and memory.
In these specific cases it is necessary to carry out cognitive therapy that focuses on cognitive stimulation as a means to improve the affected areas and thus slow cognitive deterioration.
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