• Bipolar Disorder

    Bipolar Disorder

    Bipolar disorder, formerly known as manic-depressive disorder, is a quiet commonly used term these days. Many famous people declared to suffer from it; such as Robin Williams, Mel Gibson, Catherine Zeta-Jones, Amy Winehouse, Sinéad O’Connor, Britney Spears, Jean-Claude Van Damme, Axl Rose, Russell Brand, Richard Dreyfuss and many more. Moreover, many historical personalities are believed to have suffered from bipolar disorder; such as Frank Sinatra, Ernest Hemingway, Vincent van Gogh, Friedrich Nietzsche, Florence Nightingale, Edvard Munch, Edgar Allan Poe and many more.

    Bipolar disorder seems to be a common disease that everybody knows somehow. But what are the facts? In this article we would like to give you an overview over the disease and answer the most common question.

    Definition

    As the name suggests, Bipolar Disorder is a mood disorder where patients can show both poles of the mood span alternating. Meaning patients could switch frequently from mania (“too happy”) to depression (“too sad”). But what is “too” happy or “too” sad? Who decides if it is a normal mood or a disease? The answer is clear. The suffering itself defines the disease. Meaning, the right question to ask should be: Is anybody suffering? The patient itself or the surrounding? If nobody is suffering it is absolute fine to be sad or happy sometimes. It belongs to life. The situation changes if somebody is suffering from its sadness or even is at the point to commit suicide because the suffering is so extreme that it appears like there is no way out. These people have the right and they should have an easy access to professional help. There should be no stigma holding them back. It’s not a weakness or failure in any kind. The same is applicable for the surrounding. If other people suffer from the behaviour of somebody else, they should have the possibility to express their suffering and search help; e.g. your spouse is so “happy” that he gambles away your whole savings because he continuously believes to be “lucky” the next time. Or a pilot who is so “happy” and over-confident that he believes that he doesn’t need sleep or any kind of safety measures anymore before flying you to your holiday destination. In these situations the patient himself won’t suffer but there is a possibility that others will.

    It is not a psychiatrist or any other doctor who decides in first place if somebody is mentally ill. It’s the patients themselfs and their surrounding.

    Facts

    Even though many successful people are suffering from bipolar disorders, it is a serious disease. Some facts: 11% to 15% of untreated patients are committing suicide. Up to 50% attempt suicide. More than 50% will develop drug or alcohol misuse. The divorce rate is increased three-fold. 50% will be unemployed 6 months after a manic episode. 800 out of 100,000 People living in the U.S. are suffering from it. Onset is most commonly between 15-24 years. Both sexes are equally affected. Bipolar disorders are more common in urban areas and in upper socioeconomic classes and higher educated people.

     

    Causes

    The causes of bipolar disorders are still unknown. Most probably there won’t be a single cause but a multifactorial genesis. The Stress-Vulnerability-Coping Model is a commonly used model to explain mental illnesses. Scientists could identify many different risk factors; like a positive family history of bipolar disorder. Patients whose father or mother suffered from bipolar disorder have a 20% higher risk to develop it as well. Moreover childbirth was discovered as a risk factor. 45% of women suffering from bipolar disorder had their first episode in the postpartum period. Stress – be it physical (eg physical illnesses) or psychological (eg work, relationship etc.) – seems to be a risk factor; as well as drug or alcohol abuse.

     

    Symptoms and signs

    Depression: The ICD-10 defines 3 major symptoms which are depressed mood, Loss of pleasure and interest in activities and Fatigue or loss of energy. Other symptoms could be lack of concentration and memory, hopelessness, feelings of guilt and unworthiness, suicidal tendencies, sleep disorders, loss of appetite and weight.

    Mania: The ICD-10 defines 2 major symptoms which are abnormally euphoric mood or irritated mood. Further symptoms could be lack of concentration and distractibility, racing thoughts, poor judgment, reckless behavior, increased impulsivity, inflated self-esteem, increased energy, increased activity, hyperactivity, rapid speech, reduced need for sleep, increased libido and hyper sexuality.

    Psychotic symptoms: in both episodes it is possible that psychotic symptoms occur.

    Forms

    Bipolar I disorder is described as the combination of 2 or more episodes of Mania and Depression or mixed episodes.

    Bipolar II disorder is described as the combination of 2 or more episodes of Hypomania and Depression or mixed episodes.

    Rapid cycling bipolar disorder is described as the combination of 4 or more episodes of Mania and Depression or mixed episodes in one year.

    Ultra rapid cycling bipolar disorder is described as the combination of 4 or more episodes of Mania and Depression or mixed episodes in one month.

     

    Diagnosis

    As in any mental illness first severe organic causes have to be ruled out. This should be done by a psychiatrist and include physical examination, blood tests and the MRI of the brain should not be older than 1 year. If medication should be used other diagnostic procedures may be applicable like EEG or ECG. In the second step the psychiatrist will do psychiatric examination and evaluate based on the ICD-10 or the DSM-IV the symptoms. Moreover there are neuropsychological tests available to evaluate the symptoms of manic or depressive episodes.

     

    Treatment

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    There are very effective treatment options for bipolar disorders. The priority is to protect the patient and his surrounding from any kind of risk. Be it the sufferer itself from risky behaviour or suicide; be it his surrounding from reckless behaviour or abuse. Without adequate treatment the average woman suffering from bipolar disorder will lose 9 years of life, 14 years of effective activity, and 12 years of normal health. This is due to the fact that bipolar disorder is a chronic disease. Over 90% of people who have an episode of mania will have another. The earlier the onset, the worse is the prognosis. With treatment 90% will improve, 50% will be symptom-free.

    But before going into detail, let’s have a look at the biggest obstacles on the way to get there.

    Therapy motivation. The most complicated step is always the first one. Searching professional help is a difficult step for most people. It seems that the stigma of mental illnesses is widely present. Moreover the inside that treatment could be necessary is particularly in manic episodes often not sufficient. Even if the surrounding is suffering from the behaviour of the patient, the patient in a manic episode could not be aware of it. It is a difficult task for caregivers to convince the patient that there might be something wrong. Often the patients realize the consequences of their behaviour only after the manic episode is over or if it has severe consequences like jail terms or health damages. While suffering from a depressive episode the drive is often reduced to the extent that patients are not able to search for help by them self’s. This shows the importance’s of the caregivers in bipolar disorders.

    The next obstacle is the maintenance of a successful therapy. Even if the patient discovered that treatment helped, it is common that they will stop medication at some point. One-third to one-half of bipolar patients stop medication against advice. As bipolar disorder is highly recurring, there is a high risk of relapse.

    Pharmacotherapy

    In Bipolar disorder different types of medication are used. The treatment is always individual and depends on many factors, such as experienced effects in the past, side effects, current episode, severity of symptoms etc. Commonly used medications are Mood Stabilizer, Antidepressants, Anticonvulsants and Benzodiazepines. An average treatment period could be 12 month in patients with a low risk of relapse and 5 years to indefinite in patients with high risk of relapse.

    Psychology

    Medication should always be combined with some kind of psychological support. It is important to establish a reliable relationship to your healthcare professional and to develop a realistic treatment plan. It could include Cognitive behavioral therapy, Family therapy or group therapy.

    Psychoeducation

    Particularly in bipolar disorder the knowledge about the disease is essential. For patients and caregivers as well. It’s important to identify individual risk factors and triggers and to develop strategies to avoid them. Moreover the patient has to learn to detect early symptoms of another episode.

    Lifestyle

    The goal is to eliminate all individual risk factors that could trigger a relapse. This could include sleep pattern, substance use, stress at work or in the family. It could be shown that a relapse is less likely if a good sleep pattern is maintained.

    Support groups

    To have a good psychiatrist and a professional health support is important. However, besides this it is big help to get help from other sufferers or caregivers as well. Here you can find more information about our free of charge support group.

    Video

    Descent into Madness

    What happens when life loses any semblance of stability and one is subject to waves of cosmic and sometimes terrifying hallucinations? For Kay Redfield Jamison, a clinically bipolar professor of psychiatry and a mental health expert, this uneasy cons

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