Bipolar disorder: Symptoms, causes, diagnosis and treatment

People with bipolar disorder continually see their lives switch between euphoria and depression. Bipolarity is the name we give today to manic depression. This mood disorder, which is diagnosed late, affects 1% of the population. Bipolar disorder, formerly called "manic depression" or wrongly bipolar, is a disease that affects mood regulation. The World Health Organization ranks it among the ten most disabling conditions. There are different types of bipolar illness, but it is generally characterized by the alternation of periods of depression and so-called “manic” or hypomanic periods, interspersed with free intervals (where the person is in a normal state).

Symptoms of bipolar disorder

- In the depressive phase, the patient shows all the symptoms of major depression.

- In the manic phase, he is in a euphoric, enthusiastic, and/or irritable state. His sleep needs are reduced. He is in physical, sexual, social hyperactivity. The individual is very confident; he is talkative and believes himself capable of succeeding in everything. When this last phase is less intense, we speak of hypomania.

Manic (or hypomanic) and depressive episodes follow one another in the course of life.

The disease most often begins at the end of adolescence, between 15 and 19 years of age. Some warning signs of bipolar disorder should lead to consultation.

What is the cause of this mood disorder?

This disorder caused by brain dysfunctions is said to have genetic origins. It is not necessarily hereditary, but there are family predispositions.

Painful life events, particularly the shock experienced in childhood, can trigger or worsen the disease in people who are predisposed.

What are the consequences of bipolar disorder?

- In the manic phase: the individual can be led to adopt behaviors dangerous for his physical integrity (speeding driving, hazardous and unprotected sexual relations.), and socially problematic. Also with aggressiveness at work with a risk of job loss; compulsive and reckless spending; risky financial investments; gambling addiction.

- In the depressive phase: we find all the symptoms of depressive suffering with a very marked risk of suicide. One in two patients will make at least one suicide attempt in their lifetime.

Finally, the disease is really trying for loved ones who must endure the phases of mania during which the individual refuses any advice of moderation (risks of over-indebtedness, etc.) Or even proves to be irritable or aggressive; then, the phases of depression are experienced in depression and inability to act on a daily basis.

Bipolar disorder is often associated with an anxiety disorder and sometimes leads to alcohol addiction (which can mask the disease and complicate the diagnosis).

How to recognize this disorder?

While one in two patients will attempt suicide in their lifetime, it is essential that doctors be helped to diagnose this delicate disorder.

Here is the advice of the High Authority for Health:

- You have to think about bipolar disorder in front of a depressive disorder and find out if there is mania that went unnoticed.

- In adolescents, we must be vigilant in the face of withdrawal, dropping out of school, risky behavior, taking psychoactive substances.

- Care should be taken if the patient has had more than three histories of depressive episodes if he has attempted suicide if he has reacted poorly to antidepressant treatment.

- The attending physician should not hesitate to consider hospitalization if he considers the manic episode or the risk of suicide high.

- Support by a psychiatrist for confirmation of the diagnosis is necessary, as is collaborative treatment with the attending physician.

How to diagnose bipolar disorder?

The diagnosis is often made late (after nine years on average) because it takes several months, even several years, before the succession of cycles is noticeable.

It is often an acute manic episode (which requires temporary hospitalization), which allows it to be posed. The diagnosis is more difficult when the hypomanic phases are just signaled by a slight state of euphoria. In this case, the patient may be wrongly perceived as depressed or an alcoholic.

The attending physician who sees the patient only occasionally (and rather in the depressed phase) is not necessarily in a position to observe the variations in mood. The patient himself, when he is in the euphoric phase, does not perceive himself absolutely as such: he feels in great shape!

It is often the entourage that sounds the alarm. Relatives must be particularly attentive to changes in the behavior of an adolescent or a young adult, withdrawal, dropping out of school, risky behavior, etc.).

How to treat bipolar disorder?

The hospitalization is often required in acute manic or depressive phase-in when the risk of suicide seems worrying. The purpose of these hospitalizations is to prevent the patient from being harmed, but also to allow the drugs to show their first effects.

The mood disorders should indeed be regulated by specific drugs, the mood stabilizers, the oldest known (and always very helpful) are the lithium salts. Other psychotropic drugs can be prescribed more punctually in case of manic phase or depressive phase.

Life-long thermoregulatory drugs thymoregulators must be taken for life (which is not always well accepted by patients who tend to stop treatment as soon as they feel better). They have a preventive effect that prevents relapses and, in many cases, this allows patients to return to normal life.

Psycho educational measures that allow patients to control the disease (by avoiding fatigue, by learning to limit disruptive events, etc.) remain essential.

Cognitive-behavioral therapy for bipolar disorder

Numerous studies have shown, in recent years, the effectiveness of Cognitive Behavioral Therapy combined with pharmacotherapy in the treatment of the bipolar disorder. Cognitive Behavioral Therapy is very effective in increasing compliance. In particular, the work on compliance is based on three key interventions:

1. Constantly develop and strengthen the therapeutic alliance throughout the psychotherapeutic process.

2. Develop problem-solving strategies that help the patient solve practical problems related to the use of drugs.

3. Develop strategies that help the patient to combat with dysfunctional beliefs underlying emotional stress and dysfunctional behaviors.

The main purposes of the treatment are the following:

• Provide information to the patient and their family members about Bipolar Disorder, drug treatment, and difficulties with treatment compliance.

• Early warning signs, teaching preventive coping skills that can reduce the severity and duration of symptoms.

• Recognize the dysfunctional beliefs typical of Bipolar Disorder, particularly with respect to drug therapy in order to improve treatment compliance.

• Promote problem-solving skills, emotional regulation, and adaptive response in order to cope with psycho-social stressors.

• Promote a sense of personal power by improving the quality of life, in particular, reducing hospitalization and the risk of suicide.

Author: Vicki Lezama