Bipolar disorder is a mental illness and is one of the affect disorders. Hence, it is also known as bipolar affective disorder (BAS). Bipolar disorders are characterized by extreme mood swings that can hardly be controlled at will. Longer-lasting depressive phases usually alternate with shorter euphoric and/or aggressive states. In particularly severe attacks, the manic phases can lead to psychosis with delusions such as megalomania or paranoia.
Bipolar disorder is one of the rare affect disorders. The probability of a disease in the course of life (lifetime prevalence) is a maximum of 3 percent. Men and women are equally often affected. The frequency peak is in young adults between 18 and 25 years of age. Bipolar disorders are more often associated with other mental illnesses such as anxiety disorders and obsessive-compulsive disorders. The incidence is also significantly higher in addicts and attention deficit hyperactivity disorder (ADHD).
Characteristic symptoms of bipolar disorder are strong mood swings that go far beyond the normal range and beyond that cannot be controlled by those affected.
Psychologists and neurologists distinguish between two main patterns. In the so-called bipolar I disorder, those affected experience extremely strong manic and depressive phases. In bipolar II disorder, the mood swings are much less pronounced. This is especially true in the manic phase. Doctors also speak of hypomania here.
Symptoms Of Hypomania
A hypomanic episode of bipolar disorder usually lasts for about 4 days. Above all, it is characterized by an exceptionally high mood, which is not infrequently accompanied by increased irritability. Hypomania can resemble a healthy high mood. Hence there are other criteria for diagnosis. Accordingly, a hypomanic phase can be assumed if at least 3 of the following symptoms apply:
- increased activity and restlessness
- increased performance
- unusual wealth of ideas
- Conversation (torrent of speech, monologues)
- Difficulty concentrating
- decreased need for sleep
- increased libido
- reckless behavior
- unusual sociability
Symptoms of the manic phase
In a manic episode, the symptoms are significantly more severe. Euphoria and restlessness know no bounds. Those affected are often barely recognizable to family members or friends. In pronounced phases, manic people know no limits and sometimes lose all risk control. This leads to reckless behavior, even without any self-protection. In a manic phase, people sometimes jump off bridges, knowing that they can fly – or that they are invulnerable.
Symptoms of the depressive phase
After about 7 to 10 days of the manic episode, a normal state often occurs for a short time. Moods and feelings can be influenced again and can be controlled normally. Sometime later, people with bipolar disorder lapse into a depression that usually lasts for weeks or months. Symptoms of the depressive phase are, for example, extremely sad mood, greatly reduced interest in family, friends, and acquaintances, weight loss or weight gain, increased need for sleep (sometimes throughout the day), extreme exhaustion and lack of energy, and recurring suicidal thoughts.
The causes of bipolar disorder have not yet been clarified. Presumably, there is a hereditary component. But that is not clearly proven either. It is noticeable that bipolar disorders are often associated with other mental illnesses. These include anxiety and obsessive-compulsive disorders, attention deficit hyperactivity disorder (ADHD), and addictions (especially illegal drugs and alcohol).
- Bipolar disorder is usually treated with a combination of psychotherapy and drug therapy.
- Drug therapy for bipolar disorders
Antidepressants such as imipramine, clomipramine, or amitriptyline are sometimes used to lift mood and improve drive during periods of depression. However, there is a risk that those affected will slide into a manic phase more quickly. In the case of bipolar disorders, selective serotonin reuptake inhibitors have proven to be more effective in the depressive phase. These include citalopram, fluoxetine, paroxetine, and sertraline, among others.
In acute manic phases, it may be necessary to suppress the mania with mood modulators from the group of typical neuroleptics such as haloperidol and loxapine. Medicines from the group of atypical neuroleptics such as risperidone, olanzapine, quetiapine, and ziprasidone are another alternative.
However, this form of drug therapy is usually only used in the acute phase, when those affected are forcibly committed to inpatient accommodation because of behavior that is harmful to themselves or others.
Many sufferers benefit from oral lithium in the prevention of acute attacks. However, it often takes a while to find the right dosage for the individual. In addition, adherence to therapy must be strong. Irregularities in the intake quickly lead to a new episode. Other live prophylactic drugs are carbamazepine, valproic acid, and lamotrigine.
Psychotherapy for bipolar disorder
Bipolar disorder responds well to psychotherapeutic treatment. The prerequisite for this, however, is that those affected are ready for therapy at all. In addition, a framework must be created that is conducive to the psychological stability of those affected. At least at the beginning of psychotherapy, this is usually only possible in a specialized clinic. After a successful inpatient start, the therapy must be continued on an outpatient basis. In most cases, stable freedom from symptoms is only achieved after a longer treatment period of around 2 years.