Bipolar Mood Disorder
It is also known as Manic Depressive Psychosis or Bipolar Affective Disorder. It is characterised by periods of depression that occur from time to time, and at the other end periods of mood elevation. The depressive state displays the characteristics I explained in my article called Depression. Mania presents a picture of increased self-confidence, increased libido, accelerated associations, increased motor activities, excessive energy, lack of sleep without tiredness the next morning, lack of appetite, passion for shopping, excessive travelling, rejoicing without any reason.
The onset of mania is sudden. Although the person may sense something strange going on, he is not entirely aware that he is in an episode of the illness. In many cases insight into the illness is only gained after a few attacks.
Outside the episodes of mania and depression the person’s life unfolds almost normally. When the patient recognizes that the manic periods stem from his illness, he may experience great sadness or, to use a more correct word, shame, as the manic attack has probably resulted in serious damage to his social relationships and economic status. Being stigmatized is one of the greatest problems of persons with manic attacks.
The frequency of occurrence of bipolar-I is 1%. If we include bipolar-II, the frequency increases to a fairly large percentage of 5%. Bipolar I-I is defined as hypomania, the name given to the illness when the progression of the manic attacks is mild.
The illness is often seen in people with a high level of creativity. It has a hereditary aspect. An important fact that points to this is that in monozygotic twins the likelihood of occurrence in both twins is a lot higher. However, it is considered that genetic predisposition alone is not enough to establish the illness and certain stressors are required to as a genetic trigger.
Biochemical theories on mania tend to point to a possible pathology in the dopaminergic and cholinergic systems of the patient. Electrophysiological analyses on the other hand describe a state of neural hypersensitivity.
Various endocrinopathy, diseases that directly affect the central nervous system, and certain drugs like cortisone and narcotics may create a similar picture. In order to distinguish such pictures from the illness itself and to make a correct diagnosis, the diagnosis and follow-up should only be undertaken by a psychiatrist.
Like with other psychiatric occurrences, bipolar mood disorder is addressed and treated in two ways, which can be summed up as pharmacotherapy and psychotherapy. In pharmacotherapy mood regulating drugs like lithium play an important role. In order to avoid their toxic effects they have to be used long-term throughout the patient’s life. In addition, treatment agents with anti-manic qualities can be used on a periodical basis. During the depressive episode the short-term use of antidepressants is indicated but these have to be used carefully as they may trigger manic attacks.
In psychotherapy emphasize is placed on giving the patients an insight into their condition and supporting them in the process. Again there are signs that cognitive-behavioural therapy decreases the risk of a relapse.
Compliance with the doctor’s recommendations and treatment is very important. The quality of life of patients who are regularly followed up by their doctor, shows a marked improvement, with fewer and less severe attacks.