Bipolar Disorder

The disorder or bipolar disorder, which used to be called manic-depressive illness, is a mental disorder characterized by wide mood swings ranging from high (manic) to low (depressed).

Periods of high mood or irritable are called manic episodes. The person becomes very active, but in a decentralized manner and not productive, sometimes awkward and painful consequences. Examples include spending more money than is reasonable or engage in sexual adventures that would later come to regret. A person in a manic state is full of energy and is very irritable, can sleep less than normal and can engender great plans that could never realistically materialize. A person can develop thoughts that are not consistent with reality - psychotic symptoms - such as false beliefs (delusions) or false perceptions (hallucinations). During manic episodes, the person may have trouble with the authorities. If the person has milder symptoms of mania and psychotic symptoms not present, the situation is called "hypomania" or hypomanic episode.

At present, divided into two bipolar disorder subtypes: bipolar I and bipolar II.

• Bipolar disorder type I: classical form in which the person has at least one manic episode.

• Bipolar Type II: one never had a manic episode, but had at least one hypomanic episode and at least a period of severe depression. The bipolar II disorder may be more common than bipolar I.

There is another disorder that is classified separately but is closely related to bipolar disorder, cyclothymia called. People with this disorder fluctuate between hypomania and mild or moderate depression never develop true manic or major depressive episodes.

Some people with bipolar disorder alternate quickly or frequently between manic and depressive symptoms, a pattern that calls for "rapid cycling".

Most people who has manic episodes also goes through periods of depression. If the manic and depressive symptoms overlap for a certain period, the episode is called "mixed." In some people, there may be difficulties in saying what kind of mood - depression or mania - is prominent.

People who have had a manic episode are very likely to come forward with new episodes if not treated. The disease tends to follow a familiar pattern. Unlike depression, in which there is a predominance of women diagnosed, bipolar disorder occurs almost equally in men and women. The bipolar I and II disorders occur in up to about 4% of the population.

The biology of bipolar disorder is beginning to be better understood, although there is still much to learn. For example, people with bipolar disorder may have problems with your biological clock (or circadian rhythm). This finding fits in our knowledge of the effect of bipolar disorder on sleep - less sleep during manic episodes and sleep more than usual during depressive episodes.

By using advanced brain imaging techniques, the scientists also found that people with bipolar disorder have a distinct pattern of activation in several brain regions (compared with people without the disorder). Are being sought which genes that put people at increased risk of developing bipolar disorder. The findings in this area may help to distinguish between the different subtypes of the disorder.

The most important risk for this disease is the risk of suicide. People who have bipolar disorder are also more likely to drink excessive alcohol or abusing other substances.

Prevention

There is no way of preventing bipolar disorder but the treatment may prevent the emergence of manic, depressive or at least reduce their intensity, or frequency. By seeking medical help in milder forms of the disorder can be achieved to prevent the onset of more severe forms. Unfortunately, the fear of stigma often leads to people not mention your concerns to your family physician or other health care provider.

Treatment

It is very useful to use a combination of medication and psychotherapy. Often there is a need for more than one medication to keep the symptoms under control.

Mood stabilizers

The mood stabilizer best known and oldest is lithium carbonate, which can relieve the manic episodes and prevent re-appear. Lithium may reduce the risk of suicide.

People under therapy with lithium must perform periodic blood tests to ensure that the dose they are taking is adequate (not excessive or insufficient). Side effects include nausea, diarrhea, frequent urination (urinating often), tremors and decreased mental acuity. Lithium can cause small changes in tests that assess thyroid function, kidney and heart. Usually these changes are not serious, but it is important to do some tests before you start taking lithium, including an electrocardiogram (ECG) and blood tests to evaluate the function of the thyroid, kidney and count the leukocytes (white blood cells).

Since many years it has also been resorted to anti-convulsant drugs, which are primarily used to treat seizures, in order to treat bipolar disorder. Those that are most used include valproic acid, lamotrigine and carbamazepine.

Some people tolerate better than valproic acid lithium. When starting the intake of valproic acid is often the appearance of nausea, loss of appetite, diarrhea, tremor and sedation, but these side effects tend to fade with time. The medication may also cause weight gain. Liver damage and problems with blood platelets, which help the blood to clot, side effects are rare, but severe.

In recent years it has been used most frequently lamotrigine because some studies show that it is more effective than lithium in the prevention of depressive episodes of bipolar disorder (although lithium is more effective in preventing mania). The most troublesome side effect of lamotrigine a rash is intense - in rare cases, this rash can become dangerous. To minimize the risk, it is likely that the physician chooses to start with a low dose and gradually increase very slowly. Other common side effects include nausea and headache (headache).

Carbamazepine is another anti-convulsant used to treat bipolar disorder. Its most common side effects are drowsiness, dizziness, blurred vision, nausea and vomiting. These side effects can often be prevented with a gradual increase in dose. There are some serious side effects, but rare, which include liver inflammation, decrease in RBC (red blood cells) and leucocytes (white blood cells) and severe rashes.

Avoid taking lithium, carbamazepine and valproic acid during the first three months of pregnancy, for taking these drugs is demonstrated associated with an increased risk of birth defects. However, in certain instances the return of manic or depressive symptoms may present a risk to the fetus more significant than taking the medicines. Thus, it is important to discuss with your doctor the various treatment options and associated risks.

Antipsychotic Medications

In recent years, studies have shown that some of the new antipsychotics may be effective in controlling the manifestations of bipolar disorder. Often it is necessary to weigh the benefits against the side effects of these drugs:

• Olanzapine: drowsiness, dry mouth, dizziness and weight gain.

• Risperidone: drowsiness, restlessness and nausea.

• Quetiapine: dry mouth, drowsiness, weight gain and dizziness.

• Ziprasidone: sleepiness, dizziness, restlessness, nausea and tremors.

• Aripiprazole: nausea, stomach pain, drowsiness (or lack of sleep) or restlessness.

Some of these new antipsychotics, especially olanzapine may increase the risk of diabetes and change the values ​​of lipids in the blood. With risperidone and quetiapine risk is moderate. The ziprasidone and aripiprazole cause a minimal change in weight and lower risk of diabetes.

Anxiolytics

Sometimes, they use anti-anxiety medications (anxiolytics), such as lorazepam and clonazepam to reduce anxiety and agitation associated with a manic episode.

Anti-depressants

The use of antidepressants in bipolar disorder is controversial. Currently, many psychiatrists avoid prescribing anti-depressants due to evidence that may trigger a manic episode or induce a pattern of rapid cycling. Thus, from the moment it performs a diagnosis of bipolar disorder, many psychiatrists attempt to treat the disease using mood stabilizers. However, some studies continue to show the value of antidepressant treatment, usually when you are also prescribe a mood stabilizer or anti-psychotic medication.

There are many different forms of bipolar disorder that is impossible to establish a general rule. In some cases it may be justified if the isolated use of an anti-depressant. This is another area in which the pros and cons of treatment should be viewed carefully with the doctor.

Psychotherapy

Psychotherapy is important as it provides education and support and help the person to accept the disease. Recent research has shown that episodes of mania, psychotherapy helps people recognize the symptoms of mood changes at an early stage and help them to follow a treatment regimen more tightly. For depression, psychotherapy can help people develop coping strategies (learning to deal with the situation). The family education helps family members to communicate and solve problems. When families remain involved, patients adjust more easily and are more likely to make informed decisions about treatment and have a better quality of life, have fewer episodes of illness, fewer days with symptoms and fewer hospital visits.

Psychotherapy helps a person deal with the painful consequences, practical difficulties or shame associated with a manic behavior. The person may have suffered some losses either in personal or professional relationships. Several types of psychotherapy techniques may be useful depending on the origins of the problems. The cognitive-behavioral therapy helps you recognize the thought patterns that may prevent the person from treating the disease as well. Psychodynamic psychotherapy, insight oriented (discrimination) or interpersonal can help resolve conflicts in important relationships or explore the history behind the symptoms.