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What is Bipolar Disorder?

Bipolar disorder is categorized as mood disorders. As the name indicates it has two types of mood variations depressed or ‘down’, elevated or ‘up’ mood (mania). During the depression, a person may feel unhappy or hopeless and interest is reduced in daily activities. Depression and mania appear in episodes.

When there is a shift to mania feeling of euphoria, heightened level of energy and sometimes feelings of irritability prevail. These mood changes can badly affect behavior, sleep, energy, activity, judgment, and thinking. Mania and depression episodes may have a rare or common occurrence. Bipolar disorder is classified into two types


Bipolar disorder is a long-lasting condition, but it can be managed by following a specific treatment plan. The mainstay of treatment for bipolar disorder is medication. However, family education, psychotherapy also helps in improving the prognosis

Symptoms of Bipolar Disorder

The first thing to remember is that this illness is episodic. After the episode, a patient returns to baseline functioning.

Three Major Mood Episodes of Bipolar illness


    Episodes in Bipolar Disorder

The above-mentioned episodes in mania are in a sequence of progression of symptoms and disorder. 

Manic Episode-Oops the Energy Blast

  • The manic episode appears like a blast of uncontrollable energy that shows up in the form of overactive behavior and disturbance in daily routine activities. 
  • An individual has inflated self-esteem (e.g. he or she may regard himself or herself as the owner of millions or may think of himself or herself as if to have a special connection with God or being blessed by prophethood).
  • A person has trouble sleeping, concentrating and thinking. 
  • An individual feels thoughts are moving fast forward and he has no control which is noticeable in his speech e.g. individual kept on switching from one topic to another or if anything is asked from him or her the answer would be vague)
  • An individual becomes talkative than usual. The volume of voice is loud and the rate of speech is also increased.  
  • He/she can be agitated and irritable. 
  • There is an increased inclination towards risk-taking behavior (e.g. driving the vehicle rashly) 
  • He may spend a lot of money e.g. making foolish investments and may indulge in careless sexual activities.

Hypomanic Episode

  • This is a milder form of mania. 
  • The patient is active but the activity level is more towards productive behavior which is observable from a decreased need for sleep (e.g. individual do not feel the need for sleep even after taking a 3hours sleep in a day) 
  • Individuals may feel more energetic, increased drive to do their daily work and carry out professional duties. 
  • Individuals may seem to be in a very jolly and friendly mood towards everyone (e.g. shaking a hand and sharing greetings even to unfamiliar beings.( Note. This overfamiliar behavior is different from usual considerable behavior towards others). This unusual behavior is easily noticeable by the family.

Major Depressive Episode-Or paying debts for the Over-energized behavior 

  • This episode is characterized by a sad mood, feelings of emptiness or hopelessness. Often excessive crying spells for no reason or on pity matters. 
  • Diminished interest in activities in which the individual previously actively participates.
  • Feelings of disappointment, worthlessness and undue guilt occupy an individual’s mind. 
  • An individual feels tired and slowed down. 
  • Changes in appetite and sleep are also prominent. 
  • Thoughts about ending one’s life, suicide ideation and suicide attempt in extreme cases are also present. 
  • For further details please see the blog for unipolar depression 

What is the pattern of episodes changing?


  • The illness may start with either manic episode or with depression
  • An individual episode may last from weeks to six months
  • After the episode, patients are improved enough to start normal functioning
  • If not treated the disorder progresses
  • With the passage of time duration of individual episode increased and in between symptoms free internal decreases

Three main types of bipolar disorder

The following figure gives the classification of types of Bipolar disorder in order to understand the episodic nature of the disorder. 


Who is at more risk to develop the disorder?

Genetics:

it is more or less a familial disorder. The risk of developing the disorder is more if you have a positive family history.

Environmental:

Just like other medical disorders environment has an important contribution to mental health issues. Extreme stress, traumatic experiences, and other medical illnesses can lead to increased risk of the disorder.

Brain structure:

Individual brain structure and chemical changes in the brain also add to the risk of disorder. These chemical changes are mostly related to neurotransmitters.

Treatment for Bipolar Disorder

Bipolar disorder is a long-standing disorder but treatment helps most people. Even persons facing the worst stages of mania and depression benefit from treatment. The main treatment options are medications and psychotherapy. 

Modules of Medical/Drug Treatment: 

Medical treatment is the mainstay for managing the disorder. Medical advice should be taken from a psychiatrist who can decide the need for psychotherapy on an individual patient basis.


For how long the drug treatment is required? 

It depends upon the duration and severity of illness. For the first episode, the minimum duration is one to two years after the improvement of symptoms. This long duration is required to decrease the chance of relapse.

Modules of Psychological Intervention


Psycho-education is aimed at providing insight into the nature of the disorder that helps the patient and family to have a better understanding of the illness so that effective strategies taught in the psychological sessions are also implemented not only by the patient but by the family also.

Cognitive-behavioral therapy in Bipolar; three phases

  • The first phase: Direct confrontation is avoided in the manic phase. The emphasis is on reducing stimuli.
  • The second phase: This is during the early phase of recovery. The intervention takes more cognitive focus. This includes identifying and modifying unhelpful thinking styles 
  • The final phase: The disorder is episodic and the next episode is likely to occur. The individual is also guided in this stage regarding the early warning signs of the disorder.

Four factors that increase the chances of a good recovery

In bipolar disorder, prevention is related to managing the disorder and early recognition and treatment of signs to avoid episodes of mania and major depression. Following tips can be helpful in this regard: 

  1. Tracking the symptom pattern; with the passage of time patient understands that disorder follows a pattern and there are some trigger factors. When you feel an episode of mania/depression is going to happen/worsening call your doctor. Involve friends and family to help you recognize the signs and symptoms. 
  2. Lifestyle modification; Adopt a healthy lifestyle. Keep regularity in eating and sleeping habits. Regular exercise helps to reduce depressive episodes.
  3. Say no to drugs and alcohol. Recreational drugs, caffeine, and alcohol can be the trigger factors for bipolar. These can also lead to the worsening of a preexisting episode so avoid them to the maximum. 
  4. Be compliant with your medication. Adherence to your medical treatment is key to a better lifestyle with bipolar disorder. Reducing dose or stopping medication can cause withdrawal effects and worsen the disorder.

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