Jāņa Zālīša psihoterapijas klīnika

Follow Us :

Facebook Twitter Youtube
Get Appointment

Blog

Bipolar Mood Disorders – Article series “How to treat the soul?” Part 7!

/ Uncategorized / By

Series of articles "How to heal the soul?" Part 7 - Bipolar Mood Disorders!

Mood disorders are “21st century. disease of the century”. Depression is currently being discussed the most, although there is another fairly common disease based on pathological mood changes – bipolar affective disorder! It is sometimes difficult to distinguish between bipolar disorder and depression, although the treatment for each of these conditions is completely different. It may also be that bipolar disorder hides behind other mental disorders that manifest themselves more clearly and draw the most attention to themselves. Therefore, it is likely that when you go to the doctor, it will be difficult to establish a correct diagnosis right away, because other symptoms will be in the foreground. For example, up to 65% of people suffering from bipolar disorders have panic attacks, while up to 47% of patients have a diagnosis of social anxiety disorder, up to 40% – post-traumatic stress syndrome [2].
Bipolar affective disorder – sudden changes in mood. Unlike normal mood swings that any person experiences in his life, in the case of bipolar disorder, the mood does not change depending on good or bad events, but changes arbitrarily – a person goes from being overly excitable and/or easily irritated, or sometimes euphoric, to being passive after a while for no reason , hopeless, helpless, as if nothing special has happened in life. These fluctuations are called “manic-depressive” episodes. Changes in mood often lead to significant changes in behavior as well. Both states repeat and replace each other, so that there can also be periods of normal, balanced mood between them [1; 2; 5].
The cause of these disorders at the molecular level has not been precisely determined, but it is associated with disorders of the neurotransmitter systems – incorrectly released substances that transmit signals between nerve cells [2].
From the point of view of psychodynamic psychotherapy, the state of mania is, by its very nature, the denial of all factors causing depression. At the center of mania is prosperity in all spheres of life, in which a person values ​​himself wonderfully and heroically. It is a versatile defense mechanism against depression.
According to the personality structure theory, during mania the depressed Super-Ego is defeated, but the Ego takes the main role and controls the Super-Ego. But all this is largely a huge illusion (denial), because in reality everything is different. Lewin (1961) explains the elevated mood during mania as follows: during mania, the patient believes that everything he has wanted and dreamed about for a long time will soon happen. However, the maniacal enthusiasm is not real. This occurs because real possibilities are mistakenly confused with dreams and fantasies. The surrounding people are also involved in this, to whom the manic patient gives certain roles, and the belief of the surrounding people in him even exacerbates the manic phase of the illness. However, when fantasy and dream meet reality, depression begins – disappointment in oneself causes aggression and it is directed against oneself [7].

How to recognize bipolar mood disorder?

The main symptoms of a manic episode are a very high, excited, euphoric mood and/or increased irritability that also:
  • high energy, high activity, physical restlessness;
  • rambling, fast talking, jumping from one topic to another;
  • verbosity;
  • unstable attention, rapid change of plans, difficulty concentrating;
  • reduced need for sleep;
  • unjustified confidence in one’s abilities, increased self-worth, grandiose ideas;
  • reckless behavior, antisocial behavior: unreasonable spending of money, reckless business, reckless driving, use of drugs, alcohol, stimulant medications, provocative or aggressive behavior and self-criticism disappear – the fact that something is wrong is denied;
  • increased sexual activity, frequent change of sexual partners or lack of choice [1; 5].
In hypomania, the symptoms are less pronounced, but they are similar. However, accelerated thinking, racing thoughts, and reduced need for sleep are more typical of mania.

Symptoms of a depressive episode:

  • prolonged sad, anxious mood;
  • feelings of hopelessness and pessimistic thoughts;
  • feelings of guilt, helplessness, low self-esteem;
  • loss of interest, no longer interested in things that previously gave pleasure, including sex;
  • low energy, constant fatigue, “braking”;
  • concentration difficulties, memory impairment, difficulty making decisions;
  • restlessness, mild irritability;
  • drowsiness or insomnia;
  • changes in appetite and/or weight gain or loss;
  • chronic pain or other physical symptoms of discomfort that are not the result of physical illness or injury;
  • thoughts of death, suicide, suicide attempts [1; 5].
The time criterion and amount of symptoms required to establish a manic/hypomanic or depressive episode is quite debatable and depends on the classification used. Currently, the SSK-10 classification is officially used for diagnosis in Latvia. Accordingly, a diagnosis of bipolar disorder requires at least two distinct episodes in one’s lifetime – mania, hypomania, depression, and/or a mixed episode. Mania is a very marked manifestation of the disease that usually interferes with social functioning. Among them there is also hypomania, during which a person feels more euphoria, but manic symptoms are less pronounced than in true mania. In general, this condition could also be pleasant and not interfere with social life, but trouble is usually caused by a subsequent episode of depression. There is a feeling that something is not quite right. In order to establish a diagnosis of a hypomanic episode, it is necessary that at least three of the above symptoms exist for a period of at least four days. A manic episode, on the other hand, lasts at least one week and the symptoms are more vivid and intense. To establish a depressive episode, classic depressive symptoms must exist for at least two weeks, but the amount and intensity of symptoms determine the severity of depression (you can read more about depression here: https://www.panaceja.lv/raksti/9). Separately, there is a mixed affective episode. It is essentially a simultaneous manifestation of depressive and (hypo-)manic symptoms lasting at least one week. For example, a sad, pessimistic mood exists together with speeding up thinking, running thoughts, reckless actions, which patients tend to describe with the phrase: “thoughts run ahead, but I can’t express them, I feel restless, it’s hard to concentrate”, etc. An important point – all those symptoms did not appear due to alcohol, drug use or other illness. In the event that you suspect possible bipolar disorders for yourself or your loved ones, you should consult a psychiatrist for further clarification of the diagnosis and treatment or to rule out the diagnosis [1; 2; 5].
Cyclothymia should be mentioned as a separate diagnosis. These are mood swings that do not reach the intensity to be considered bipolar disorder, but persist for at least two years. Cyclothymia is not characterized by “bright” breaks with an even mood for more than two months. Cyclothymia usually does not require treatment as it is easy to live with. Such people are usually socially active, creative, but have a higher risk of using alcohol and other addictive substances [5].
Depending on the extent to which episodes of (hypo-)mania and depression occur in the course of life, two types of bipolar disorders are also distinguished – BAT I and BAT II. The first type is more characterized by mania, hypomania or mixed episodes, while the second type has more frequent depressions, less often hypomanias, but mania never develops in full [2; 5].

TEST – Bipolar Disorder Spectrum Diagnostic Scale: BSDS [3].

Please read all 19 statements below!
  • Some people experience sudden changes in mood/energy levels at times___.
  • These people notice that sometimes their mood and/or energy levels are very low, and other times they are markedly elevated___.
  • When energy levels drop, there is a need to stay in bed longer or a greater need for longer sleep, and there is a lack of motivation to carry out daily activities and responsibilities___.
  • During such periods, body weight often increases___.
  • During times of low mood and/or energy levels, these people are often sad or depressed__.
  • Sometimes feel hopeless and even want to die___.
  • That work capacity will also decrease and social functioning will deteriorate___.
  • These types of low mood/low energy levels usually last for several weeks, but can be as short as a few days___.
  • People with a similar pattern of mood swings may also have periods of “normal” mood when work and social functioning are not impaired, but the mood and energy level itself is perceived and assessed as “normal”___.
  • They may then experience a “jump” or “change” in feeling___ again.
  • Their energy is constantly increasing, they feel completely normal, and during these periods they are able to do so many different things that were not possible before___.
  • Sometimes these people feel as if there is too much energy during the “elevation”, they are “overflowing” with their energy___.
  • Some become irritable, even aggressive___.
  • Some people can start several things at the same time during their “highs”___.
  • During the “boom” some spend money recklessly, in a way that can lead to problems___.
  • They may become talkative and/or their sexuality increases___.
  • At times, this elevated mood seems strange or even annoying to those around___.
  • During a “rise” these people’s behavior can lead to problems at work or problems with the police___.
  • Sometimes, during the “high”, such people begin to abuse alcohol or use any drugs not prescribed by a doctor, or even narcotic substances___.
Now that you have read these statements, please choose how completely they describe your experience! Choose one of the following four statements:
  • ( ) These statements describe my own experience very well, almost perfectly;
  • ( ) These statements describe my experience quite well;
  • ( ) These statements describe to some extent what is happening to me now, but not fully;
  • ( ) These statements do not at all describe what is happening to me right now.
Now, please go back to the statements at the beginning of the test and put a tick next to each one that suits you!
Only one tick can be placed next to each statement.
Add up all the ticks (1 tick = 1 point) and add the ‘overall rating’ to the total: 6 points if the test ‘very accurately describes what happens’; 4 points if the test “pretty well describes your experience”; 2 points if the test “incompletely describes what is happening”; 0 points – if the test “does not describe what is happening to you at all” [3].
  • Total rating: = ___ (max=25)
  • Interpretation of results:
  • 19 or more points: bipolar spectrum disorder is highly probable;
  • 11-18 points: moderate probability of bipolar spectrum disorder;
  • 6-10 points: low probability of bipolar spectrum disorder;
  • Less than 6 points: Bipolar spectrum disorder is unlikely. [3]

Panacea for bipolar affective disorder!

The main treatment method for bipolar affective disorders is drug therapy and psychotherapy, as well as intervention in the patient’s psychosocial environment.
The choice of drug therapy depends on the predominant symptoms or episode. Usually, normothymics (mood stabilizers), neuroleptics (antipsychotics) and antidepressants are used for treatment. The use of antidepressants without normothymics in bipolar depression may not have an effect or may even, on the contrary, cause a manic episode. Therefore, the basic medications are normothymic drugs for adults, and neuroleptics for children [4; 6].
The effectiveness of psychotherapy has been proven in the treatment of depressive and hypomanic episodes and in supportive therapy. Acute mania or when accompanied by psychotic symptoms (hallucinations, nightmares) is the main treatment method, but psychotherapy is recommended only as supportive therapy. Psychotherapy prolongs remission and reduces the severity and intensity of subsequent disease exacerbations [2; 5].
Psychosocial intervention involves educating the patient and their loved ones on how to recognize an impending manic or depressive episode and how to deal with it. The principle is as follows: the patient signs a written contract with a relative describing how to deal with certain symptoms. For example, if sleep duration decreases, agitation increases (respectively, approaching mania), the patient’s relative blocks or takes away the patient’s credit cards (if the patient is characterized by reckless spending during mania) or takes away the keys from the car (if aggressive driving is characteristic), which also helps organize an appointment with a doctor and adjust therapy [2; 5]. On the other hand, the patient himself must fill in special mood diaries every day, which help to understand his feeling [8].
Authors of the article: resident doctor in psychiatry, Alina Kuznetsova doctor psychiatrist Pēteris Zālītis

Sources used in the article: