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Bipolar disorders (manic depression) Causes, Symptoms and Treatment

What is bipolar disorder?

The bipolar disorder is a severe mood disorder characterized by alternating phases of ‘exaltation of mood “with an increase in energy and hyperactivity, and mood downturns (depression ).
These “manic” episodes are interspersed with periods during which the mood is normal and stable, for varying periods.

During “manic” episodes, the person is irritable, overactive, has little need for sleep, speaks a lot, and often has an exaggerated self-esteem or even a feeling of omnipotence. Conversely, during depressive episodes, his energy level is abnormally low, his mood is gloomy, sad, with a loss of interest in various activities and projects.

It is one of the most common psychiatric illnesses, affecting 1 to 2.5% of the population. The disease usually appears in young adults (under 25 years) and becomes recurrent. The first episode is followed by other episodes of mood disorders in 90% of cases.

It is a disorder that causes many social, occupational and emotional impairments and can frequently lead to suicide attempts. It has been recognized by the World Health Organization (WHO) as the seventh leading cause of disability per year of life among 15 to 44 year olds, among all diseases.

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Evolution of bipolar disorder

Bipolar disorders are characterized by a succession of episodes and frequent relapses, even under treatment.

The risk of suicide remains the main fear associated with this disease. Moreover, for biological reasons still poorly understood, bipolar disorders are frequently associated with an increase in cardiovascular risk, metabolic and hormonal diseases.

Studies show that, for all these reasons, the life expectancy of patients with bipolarity is on average 10 to 11 years lower than the life expectancy of the rest of the population 2 .

What are the symptoms of bipolar disorder? 

This disease, formerly known as  manic-depressive psychosis or  manic depression , comes in many forms. Thus, bipolar disorder may or may not be accompanied by psychotic symptoms (such as hallucinations, delusions). They can be, according to HAS:

  • hypomanic (similar symptoms but less intense than during an episode called “manic”);
  • maniacs without psychotic symptoms;
  • maniacs with psychotic symptoms;
  • mild or moderate depressive;
  • severe depressive without psychotic symptoms;
  • severe depressive with psychotic symptoms
  • mixed (mania and depression combined) without psychotic symptoms;
  • mixed with psychotic symptoms.

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders,  DSM-V , published in 2014, proposes categorizing the different types of bipolar disorder as follows:

  • Bipolar I disorder, characterized by the presence of at least one manic or mixed episode.
  • bipolar disorder type II, characterized by the occurrence of one or more major depressive episodes and at least one episode of hypomania.
  • bipolar disorder not specified.

If the course of the disease is quite characteristic, the individual symptoms vary from person to person. In some, the symptoms of depression will prevail over everything else, while in others agitation, excess energy or even aggression dominate.

The manic phase is characterized by an expansive mood, an increase in self-esteem, and ideas of greatness.

Generally, the person in the manic phase feels the need to speak constantly, to expose his innumerable ideas, to be full of energy and to lead several projects or activities at the same time. Her sleep needs are reduced (she feels rested after 3 or 4 hours of sleep) and she is easily irascible. This period lasts at least a week, is present throughout the day almost every day.

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Hypomania is manifested by the same type of symptoms, with persistent high but more “normal” energy.

During periods of depression, there is a decrease in interest or pleasure for almost all daily activities, a psychomotor slowing (or, sometimes, agitation), significant fatigue, and possibly excessive guilt or devaluation, decreased ability to concentrate. Suicidal thoughts can occur. According to some studies, the percentage of suicide attempts varies between 20 and 50% (HAS June 2014).

These symptoms are not necessarily all present, but the diagnostic criteria are based on the presence of a significant combination of several of them. With nearly three quarters of bipolar people, there are other conditions such as anxiety, addiction to alcohol or other substances, etc.

It is important to note that bipolar disorder is of variable severity, and that manifestations may be more or less obvious to the surrounding. Too often there is a delay in diagnosis, or confusion between “classic” depression and manic depression.

 

Who can be affected by bipolar disorder?

The causes of bipolar disorder are still unknown. They are probably multifactorial, involving genetic and environmental factors.

From a biological point of view, we know that there are abnormalities in the neurotransmitters in the brains of those affected. Thus, episodes of mania are associated with an abnormally high level of norepinephrine.

Genetic factors are also implicated: the risk of developing bipolar disorder is greater when someone in the family has already reached.

Finally, external elements can promote or trigger the disease. This is the case of traumatic events that occur early in life, as well as many other stressors or changes (seasons, pregnancies, hormonal fluctuations).

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Medical treatment of bipolar disorder (manic depression)

It is not possible to prevent the onset of this disease. On the other hand, several habits and lifestyle measures can limit the severity of symptoms, to a certain extent, and help stabilize mood.

For example, it is important:

  • to have a regular rhythm of sleep and sufficiently long nights
  • to practice regular physical activity
  • to avoid the use of tobacco, cannabis, alcohol and other drugs
  • to surround yourself and try to avoid stress situations (or prepare for them)

Medical treatments

The treatment of bipolar disorder has a twofold objective: to reduce the symptoms of an acute episode (whether manic or depressive), and to prevent relapses, stabilizing the mood in the long term.

Treatment recommendations vary somewhat from country to country , 3 , and 6 but generally recommend the same drug strategy.

The care of the patient should be based, as far as possible, on a multidisciplinary team, combining attending physician, psychiatrist, and psychologist. Support is also recommended for the immediate entourage of the patient, for whom the disease is trying and destabilizing.

Hospitalization

In severe cases of manic or depressive access, especially when suicidal thoughts are present or the “unbridled” behavior may endanger the patient, his entourage or his property, hospitalization is necessary.

Psychological care

Psychological support is recommended in addition to pharmacological treatment. Be it cognitive and behavioral, interpersonal or group therapy, this type of intervention has been beneficial, especially to treat acute episodes of depression but also as a basic treatment to stabilize the mood and limit the symptoms. long-term relapses.

Cognitive and behavioral therapy is a brief therapy focused on the elimination (or correction) of erroneous or negative behaviors and thoughts. Interpersonal therapy, meanwhile, is also brief (12 to 16 sessions). Initially developed to treat depression, it focuses on the life events precipitating the illness, and the patient’s relationships with those around him (interpersonal relationships).

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