Bipolar disorder , formerly known as manic depression , is a mental disorder that causes periods of depression and periods of abnormal mood elevation. The increased atmosphere is significant and is known as mania or hypomania, depending on the severity, or whether the symptoms of psychosis are present. During mania, a person behaves or feels energetic, happy, or irritable abnormally. Individuals often make poorly thought-out decisions with little regard for the consequences. The need for sleep is usually reduced during the manic phase. During a period of depression, there may be weeping, negative views about life, and bad eye contact with others. The risk of suicide among those with illness is high at more than 6 percent for 20 years, while self-harm occurs in 30-40 percent. Other mental health problems such as anxiety disorders and substance use disorders are commonly associated.
The cause is not clearly understood, but environmental and genetic factors play a role. Many genes with small effects contribute to risk. Environmental risk factors include history of childhood abuse, and long-term stress. About 85% of the risk is associated with genetics. This condition is divided into bipolar I disorder if there has been at least one episode of mania, with or without depressive episodes, and bipolar II disorder if there is at least one hypomanic episode (but no episodes of manic) and one episode of major depression. In those with less severe symptoms of prolonged duration, a cyclothimic disorder condition may be diagnosed. If due to medication or medical problems, it is classified separately. Other conditions that may be present in the same way include attention deficit hyperactivity disorder, personality disorder, schizophrenia and substance use disorders as well as a number of medical conditions. Medical tests are not required for diagnosis, although blood or medical imaging tests may be performed to rule out other problems.
Treatments generally include psychotherapy as well as medications such as mood stabilizer and antipsychotics. Examples of commonly used mood stabilizers include lithium and various anticonvulsants. Involuntary care at the hospital may be necessary if someone is at risk for themselves or others but refuses care. Severe behavioral problems, such as anxiety or hostility, can be managed with short-term antipsychotics or benzodiazepines. In the period of mania, it is recommended that antidepressants be stopped. If antidepressants are used for periods of depression, they should be used with a mood stabilizer. Electroconvulsive therapy (ECT), although not well studied, can be tried for those who do not respond to other treatments. If treatment is stopped, it is recommended that this be done slowly. Many people have financial, social or work-related problems because of the disease. These difficulties occur one-quarter to one-third of the time, on average. The risk of death from natural causes such as heart disease is twice that of the general population. This is because of poor lifestyle choices and side effects from drugs.
Bipolar disorder affects about 1% of the global population. In the United States, about 3% is expected to be affected at some point in their lives. The most common age at which symptoms begin is 25 years. Prices look similar in women and men. The economic cost of the disturbance was estimated at $ 45 billion for the United States in 1991. Most of this is related to larger number of working days, estimated at 50 per year. People with bipolar disorder often face problems with social stigma.
Video Bipolar disorder
Signs and symptoms
Both mania and depression are characterized by disorders in normal mood, psychomotor activity, circadian rhythms, and cognition. Mania can present with different levels of mood disorders, ranging from euphoria associated with "classic mania" to dysphoria and irritability. The core symptoms of mania involve an increase in the energy of psychomotor activity. Mania can also come with increased self-esteem or splendor, quick speech, subjective feelings of quick thoughts, impeccable social behavior, or impulsivity. Mania is distinguished from hypomania by length, where hypomania takes four consecutive days, and mania takes more than a week. Unlike mania, hypomania is not always associated with impaired function. The biological mechanisms responsible for switching from a mania or hypomanic episode to an episode of depression, or vice versa, are poorly understood.
Bead episodes
Mania is a period different from at least one week of high mood or irritability, which can range from euphoria to delirium, and those with hypo or mania may show three or more of the following behaviors: quick talk, no interruptions, short ranges attention, racing thinking, increased goal-oriented activity, agitation, or they may exhibit behaviors characterized as impulsive or high-risk, such as hypersexuality or excessive spending. To meet the definition for episode mania, this behavior must interfere with the ability of individuals to socialize or work. If left untreated, episodes of mania usually last three to six months.
People with hypomania or mania may experience decreased need for sleep, impaired judgment, and over-talk and very quickly. Bead individuals often have a history of substance abuse developed over the years as a form of "self-medication". At a more extreme time, a person in a crowded maniac can experience psychosis; rest with reality, a state in which the mind is influenced along with mood. They may feel unstoppable, or as if they have been "chosen" and are on a "special mission", or have other grandiose or delusional ideas. This can lead to violent behavior and, occasionally, hospitalization in inpatient psychiatric hospitals. The severity of manic symptoms can be measured by assessment scales such as the Young Mania Rank Scale, although questions remain about the reliability of this scale.
The occurrence of manic episodes or depression is often overshadowed by sleep disorders. Changes in mood, psychomotor changes and appetite, and anxiety increase can also occur up to three weeks before the episode of developing mania.
Hypomanic episodes
Hypomania is a milder form of mania, defined as at least four days from the same criteria as mania, but it does not cause a significant decrease in individual ability to socialize or work, lacks psychotic features such as delusions or hallucinations, and does not require psychiatric hospitalization. The overall function may actually increase during episodes of hypomania and is thought to function as a defense mechanism against depression by some people. Hypomanic episodes rarely develop into episodes of crowded mania. Some people who experience hypomania show an increase in creativity while others get irritable or show poor judgment.
Hypomania may feel good for some people who experience it, although most people who experience hypomania claim that stress from the experience is very painful. Bipolar people who experience hypomania, however, tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings, individuals will often deny that something is wrong. What might be called a "hypomanic event", if not accompanied by depressive episodes, is often not considered problematic, unless mood swings are uncontrollable, fluid, or agile. Most commonly, symptoms persist for several weeks to several months.
Depressive episodes
Symptoms of the depressive phase of bipolar disorder include feeling sad, irritable or angry, losing interest in previously enjoyed activities, excessive or inappropriate guilt, discouragement, sleeping too much or not enough, appetite and/or weight changes, fatigue, concentration problems, self-hatred or feelings of worthlessness, and thoughts about death or suicide. In severe cases, an individual may develop symptoms of psychosis, a condition also known as severe bipolar disorder with psychotic features. These symptoms include delusions and hallucinations. The episodes of major depression persist for at least two weeks, and can lead to suicide if left untreated.
The earlier the age of onset, the more likely the first few episodes become depressive. Because the diagnosis of bipolar disorder requires a mania or hypomanic episode, many individuals initially affected were misdiagnosed with severe depression and then wrongly treated with a prescribed antidepressant.
Affective episode mix
In bipolar disorder, a mixed state is a condition in which symptoms of mania and depression occur together. Individuals experiencing mixed conditions may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or suicidal feelings. Mixed countries are considered at high risk for suicidal behavior because depressive emotions such as despair are often paired with mood swings or difficulties with impulse control. Anxiety disorders occur more frequently as comorbidities in mixed bipolar episodes than in mixed or non-mixed bipolar or mania. Substance abuse (including alcohol) also follows this trend, so appearing to describe bipolar symptoms is nothing more than a consequence of substance abuse.
Related features
Related features are the clinical symptoms that often accompany the disorder but are not part of the diagnostic criteria. In adults with these conditions, bipolar disorder is often accompanied by changes in process and cognitive abilities. This includes reducing attentional and executive ability and memory impairment. How the individual processes of the universe also depends on the phase of interference, with the differential characteristics between manic, hypomanic and depressive states. Several studies have found a significant association between bipolar disorder and creativity. Those with bipolar disorder may have difficulty maintaining the relationship. There are some common childhood precursors seen in children who later receive a diagnosis of bipolar disorder: mood disorders (including major depressive episodes) and attention deficit hyperactivity disorder (ADHD).
Comorbidity conditions
The diagnosis of bipolar disorder may be complicated by shared psychiatric conditions (including comorbids) including the following: obsessive-compulsive disorder, substance abuse, eating disorders, attention deficit hyperactivity disorders, social phobia, premenstrual syndrome (including premenstrual dysphoric disorder), or panic disorder.. Careful longitudinal analysis of symptoms and episodes, enriched where possible with discussions with friends and family members, is crucial to establishing a treatment plan in which this comorbidity exists.
Maps Bipolar disorder
Cause
The causes of bipolar disorder may vary between individuals and the exact mechanisms underlying the disorder remain unclear. Genetic influences are believed to be responsible for 60-80 percent of the risk of developing disorders that show a stronger offspring component. The overall heritability of the bipolar spectrum has been estimated at 0.71. Twin studies have been limited by relatively small sample sizes but have demonstrated substantial genetic contributions, as well as environmental influences. For type I bipolar disorder, the rate at which identical twins (same genes) would have type I (concordance) bipolar disorder is estimated at about 40 percent, compared with about 5 percent in fraternal twins. Combinations of bipolar I, II, and cyclothymia also produce levels of 42 percent and 11 percent (identical and fraternal twins, respectively), with a relatively lower ratio for bipolar II that may reflect heterogeneity. There is overlap with major (unipolar) depression and if this is also calculated in co-twins, concordances with bipolar disorder increase to 67 percent in identical twins and 19 percent in fraternal twins. The relatively low concordance between consolidated fraternal twins indicates that the influence of shared family environments is limited, although the ability to detect them is limited by small sample sizes.
Genetic
Behavioral genetic studies have shown that many areas of chromosome and candidate genes are associated with susceptibility to bipolar disorder with each gene exerting mild to moderate effects. The risk of bipolar disorder is nearly ten times higher in first-rate families than those affected by bipolar disorder when compared with the general population; similarly, the risk of major depressive disorder is three times higher in their families with bipolar disorder when compared with the general population.
Despite the findings of the first genetic relationship to mania in 1969, the study of association was inconsistent. The largest and latest genomic association study (GWAS) failed to find a particular locus that had a major effect reinforcing the notion that no single gene was responsible for bipolar disorder in many cases. Polymorphisms in BDNF, DRD4, DAO, and TPH1 have been frequently associated with bipolar disorder and initially successful in meta-analysis, but failed after correction for some tests. On the other hand, two polymorphisms in TPH1 were identified related to bipolar disorder.
Due to inconsistent findings in GWAS, several studies have taken an approach to analyzing SNPs in biological pathways. The signaling pathways traditionally associated with bipolar disorder supported by this study include CRH signaling, cardiac -adrenergic signaling, Phospholipase C signaling, glutamate receptor signaling, cardiac hypertrophy signaling, Wnt signaling, Notch signaling, and endothelin signaling 1. Of 16 genes identified in this pathway, three were found to be unregulated in the dorsolateral prefrontal cortex of the brain in post-mortem studies, CACNA1C, GNG2, and ITPR2.
The findings strongly lead to heterogeneity, with different genes involved in different families. Powerful and replicable genomic-strong associations exhibit several common single nucleotide polymorphisms, including variants in the CACNA1C, ODZ4, and NCAN genes.
The age of advanced fathers has been associated with an increased likelihood of bipolar disorder in heredity, consistent with the hypothesis of new genetic mutation increases.
Environment
Environmental factors play an important role in the development and bipolar disorder, and individual psychosocial variables can interact with genetic disposition. It is possible that recent life events and interpersonal relationships contribute to the onset and recurrence of bipolar mood episodes, as they do for unipolar depression. In the survey, 30-50 percent of adults diagnosed with bipolar disorder reported a childhood traumatic/harsh experience, attributed to average onset of early onset, higher suicide attempts, and more common disorders such as PTSD. The number of reported stress events in childhood was higher in those with an adult diagnosis of bipolar spectrum disorder compared with those who did not, especially those that came from a harsh environment rather than from the child's own behavior.
Neurological
Less commonly, bipolar disorder or bipolar disorder may occur as a result of or associated with neurological conditions or injury. Conditions like these and injuries include (but are not limited to) strokes, traumatic brain injury, HIV infection, multiple sclerosis, porphyria, and rare temporal lobe epilepsy.
Mechanism
Physiological
Abnormalities in the structure and/or function of certain brain circuits may underlie bipolar. Meta-analysis of structural MRI studies in reports of bipolar disorder decreases volume in the anterior rostral cingulate cortex (ACC), fronto-insular cortex, ventral prefrontal cortex, and claustrum. Increases have been reported in lateral ventricular volume, globus pallidus, anterior anterior cingulate, and the amygdala as well as deep levels of white matter hyperensity. Functional MRI findings suggest that abnormal modulation between the prefrontal and limbic ventral regions, especially the amygdala, may contribute to emotional regulation and poor mood symptoms. Pharmacologic therapy mania increases ventral prefrontal cortex activity (vPFC), normalizes relative to control, indicating that hypoactivity vPFC is an indicator of mood. On the other hand, hyperactivity pretreatment in the amygdala decreases post-treatment but still increases relative to control, indicating that it is a characteristic marker.
Bead episodes and depression tend to be characterized by ventral versus dorsal dysfunction in the ventral prefrontal cortex. During attention and rest, mania is associated with decreased orbitofrontal cortex activity, while depression is associated with increased resting metabolism. Consistent with affective disorders due to lesions, mania and lateralized depression in the ventral prefrontal cortex (vPFC) dysfunction, with depression primarily associated with left vPFC, and right vPFC mania. Abnormal vPFC activity, along with the amygdala hyperactivity found during euthymia as well as in healthy families of those with bipolar, exhibit features of possible features.
Euthymic bipolar men show decreased activity in the lingual gyrus, whereas manic man exhibits decreased activity in the inferior frontal cortex, while no difference is found in people with bipolar depression. People with bipolar have increased activation of the left ventral limbic area of ​​the brain and decreased activation of the right hemisphere cortical structures associated with cognition.
One proposed model for bipolar shows that hypersensitivity of a reward circuit comprising a fronto-striatal circuit causes mania and hyposensitivity of this circuit to cause depression.
According to the "kindling" hypothesis, when people who are genetically predisposed to bipolar disorder experience stressful events, the stress threshold at which mood changes occur becomes lower, until the episodes begin (and recur) spontaneously. There is evidence to support the association between early life stress and hypothalamic-pituitary-adrenal axis dysfunction (HPA axis) leading to overactivation, which may play a role in the pathogenesis of bipolar disorder.
Some of the brain components that have been proposed to play a role are mitochondria and ATPase sodium pumps. Circadian rhythms and regulation of the hormone melatonin also appear to be altered.
Neurochemistry
Dopamine, known as a neurotransmitter responsible for mood cycles, has been shown to increase transmission during the mania phase. The dopamine hypothesis states that increased dopamine results in key homeostatic regulation of key systems and receptors such as increased dopamine-mediated protein-paired receptor G. This results in a decrease in the characteristic of dopamine transmission in the depressive phase. The depressive phase ends with a homeostatic regulation that could potentially restart the cycle again.
Glutamate significantly increased in the left dorsolateral prefrontal cortex during the manip phase of bipolar disorder, and returned to normal levels after the phases ended. Increased GABA may be caused by a disruption in early development that causes cell migratory disorders and the formation of normal laminations, the coating of the brain structures commonly associated with the cerebral cortex.
Drugs used to treat bipolar can exert its effect by modulating intracellular signaling, such as through the depleting level of myo-inositol, inhibition of cAMP signaling, and by the conversion of G-coupled proteins. Consistent with this, increased levels of G ? I , G ? S , and G ? Q/11 has been reported in brain and blood samples, along with increased expression of protein kinase A and sensitivity.
Decreased levels of 5-hydroxyindoleacetic acid, a byproduct of serotonin, are present in the cerebrospinal fluid of people with bipolar disorder during the depressive and manic phases. Increased dopaminergic activity has been hypothesized in manic state because of the ability of dopamine agonists to stimulate mania in people with bipolar disorder. Decrease of regulatory sensitivity? 2 adrenergic receptors and increasing cell numbers in the seruleus locus suggest an increase in noradrenergic activity in manic people. Low plasma GABA levels on both sides of the mood spectrum have been found. One review found no difference in monoamine levels, but found abnormal norepinephrine turnover in people with bipolar disorder. Thyrosine depletion was found to reduce methamphetamine effects in people with bipolar disorder as well as symptoms of mania, involving dopamine in mania. The association of VMAT2 was found to increase in one study in people with bipolar mania.
Prevention
Prevention of bipolar disorder has focused on stress (such as childhood difficulties or highly conflicting families) which, although not a specific bipolar causative agent, do not place genetically and biologically susceptible individuals at risk for more severe disease. There is a debate about the causal relationship between marijuana use and bipolar disorder.
Diagnosis
Bipolar disorder is commonly diagnosed during adolescence or early adulthood, but onset may occur throughout the life cycle. This disorder can be difficult to distinguish from unipolar depression and the average delay in diagnosis is 5-10 years after the symptoms begin. The diagnosis of bipolar disorder considers several factors and considers self-reported experiences of symptomatic individuals, abnormal behaviors reported by family members, friends or co-workers, signs of observable disease as assessed by a physician, and often a medical work-until the cause medical disposable. In diagnosis, the scale of assessments assessed by caregivers, especially mothers, has been found to be more accurate than reports of teachers and adolescents in predicting identifying young people with bipolar disorder. Assessment is usually performed on an outpatient; admission to an inpatient facility is considered if there is a risk to self or others. The most widely used criteria for diagnosing bipolar disorder are the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5) and World Health Organization (WHO) Statistics Classification International Diseases and Health Related Issues , Issue 10 (ICD-10). ICD-10 criteria are more commonly used in clinical settings outside the US while DSM criteria are used clinically in the US and are an applicable criterion that is used internationally in research studies. The DSM-5, published in 2013, includes further specifics and is more accurate than its predecessor, the DSM-IV-TR. Semi-structured interviews such as Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) and Structured Clinical Interviews for DSM-IV (SCID) were used to confirm the diagnosis of bipolar disorder.
Several assessment scales for screening and evaluation of bipolar disorder exist, including the Bipolar spectrum diagnostic scale, the Atmosphere Disorder Questionnaire, the General Behavior Inventory and the Hypomania Checklist. The use of evaluation scales can not replace full clinical interviews but they function to systematize symptom memories. On the other hand, instruments for screening for bipolar disorder tend to have lower sensitivity.
Differential diagnosis
There are several other mental disorders with symptoms similar to those seen in bipolar disorder. These disorders include schizophrenia, major depressive disorder, attention deficit hyperactivity disorder (ADHD), and certain personality disorders, such as a personality disorder threshold.
Although there are no biological tests that are diagnostic of bipolar disorder, blood and/or imaging tests can be performed to exclude a medical illness with a clinical presentation similar to bipolar disorder. Neurological diseases such as multiple sclerosis, complex partial seizures, stroke, brain tumors, Wilson's disease, traumatic brain injury, Huntington's disease, and complex migraine may mimic the features of bipolar disorder. EEG may be used to rule out neurological disorders such as epilepsy, and CT scans or head MRI may be used to exclude brain lesions. In addition, endocrine system disorders such as hypothyroidism, hyperthyroidism, and Cushing's disease are in the differential as systemic lupus erythematosus connective tissue disease. Causes of a mania infection that may appear similar to bipolar mania include herpes encephalitis, HIV, influenza, or neurosyphilis. Deficiencies of certain vitamins such as pellagra (niacin deficiency), vitamin B12 deficiency, folate deficiency, and Wernicke Korsakoff syndrome (thiamine deficiency) can also cause mania.
A review of current and latest drugs and drug use is considered to rule out these causes; Common drugs that can cause manic symptoms include antidepressants, prednisone, Parkinson's disease drugs, thyroid hormones, stimulants (including cocaine and methamphetamine), and certain antibiotics.
Bipolar spectrum
Bipolar spectrum disorders include: bipolar I disorder, bipolar II disorder, cyclothimic disorder and cases where subthreshold symptoms are found to cause clinically significant disturbances or distress. This disorder involves episodes of major depression that alternate with manic or hypomanic episodes, or with mixed episodes showing symptoms of both mood states. The concept of the bipolar spectrum is similar to Emil Kraepelin's original concept of manic depression.
Unipolar hypoplasia without depression has been recorded in the medical literature. There is speculation as to whether this condition can occur with greater frequency in the untreated general population; the successful social function of these potentially achieving high-achieving individuals may lead to being labeled as normal, rather than as individuals with substantial disregulation.
Criteria and subtypes
The DSM and ICD characterize bipolar disorder as a spectrum disorder that occurs on a continuum. DSM-5 lists three specific subtypes:
- Bipolar I: At least one episode of mania is required to make the diagnosis; Depressive episodes are common in most cases with bipolar I disorder, but are not necessary for diagnosis. Determinants such as "mild, moderate, moderate-severe, severe" and "with psychotic features" should be added as applicable to indicate presentation and journey interruption.
- Bipolar Disorder II: No episodes of mania and one or more hypomanic episodes and one or more major depressive episodes. Hypomanic episodes do not go to the extreme full of mania (ie, usually not causing severe social or occupational disorder, and without psychosis), and this can make bipolar II more difficult to diagnose, since hypomanic episodes may appear as periods High productivity is successful and reported less frequently than depressive and disabling depression.
- Cyclothymia: A history of hypomanic episodes with depression periods that did not meet the criteria for major depressive episodes.
If relevant, the determinants for peripartum onset and with fast biking should be used with any subtype. Individuals who have subthreshold symptoms that cause clinically significant disturbances or disorders, but do not meet the full criteria for any of the three subtypes can be diagnosed with specific or non-specific bipolar disorder. Other specific bipolar disorders are used when a doctor chooses to explain why complete criteria are not met (eg, hypomania without previous major depressive episodes).
Fast biking
Most people who meet the criteria of bipolar disorder experience a number of episodes, averaging 0.4 to 0.7 per year, lasting three to six months. Fast cycling , however, is a course set that can be applied to one of the subtypes above. It is defined as having four or more episodes of mood disorders within a span of one year and is found in a significant proportion of individuals with bipolar disorder. These episodes are separated from each other by remission (partially or fully) for at least two months or changes in mood polarity (ie from episodes of depression to episodes of mania or vice versa). The fastest cycling definitions quoted most frequently in the literature (including DSM) are Dunner and Fieve: at least four episodes of depression, bead, hypomanic or a major mixture should occur over a 12 month period. Ultra-fast (day) and ultra-ultra-fast or ultradian (in-day) cycling have also been described. The literature examining the rapid cyclical pharmacological treatment is rare and there is no clear consensus with regard to optimal pharmacological management.
Management
There are a number of pharmacological and psychotherapy techniques used to treat bipolar disorder. Individuals can use self-help and pursue recovery.
Hospitalization may be necessary primarily with bead episodes present in bipolar I. It can be voluntary or (if enabling mental health legislation and various state-to-state regulations in the US) are not intentional (so-called civil or non-voluntary commitments). Long-term hospitalized patients are now less common due to deinstalizationalization, although this can still be the case. Following (or in place of) hospital admissions, available support services may include drop-in centers, visits from members of the community mental health team or the Asertive Community Treatment team, employment support and patient-led support groups, intensive outpatient programs. This is sometimes referred to as a partial-inpatient program.
Psychotherapy is aimed at reducing core symptoms, recognizing episode triggers, reducing negative expressed emotions in relationships, recognizing prodromal symptoms before full recurrence, and, practicing factors leading to remission maintenance. Cognitive behavioral therapy, family-focused therapy, and psychoeducation have the most evidence for success in terms of relapse prevention, while interpersonal and social rhythm therapy and cognitive-behavioral therapy appear to be most effective in terms of residual depressive symptoms. Most studies are based only on bipolar I, however, and treatment during the acute phase can be a particular challenge. Some physicians emphasize the need to talk to individuals who experience mania, to develop therapeutic alliances in support of recovery.
Medication
A number of drugs are used to treat bipolar disorder. The best-proven drug is lithium, which is an effective treatment for acute manic episodes, preventing relapse, and bipolar depression. Lithium reduces the risk of suicide, self-harm, and death in people with bipolar disorder. It is unclear whether ketamine is useful in bipolar by 2015.
Mood stabilizer
Lithium and anticonvulsants carbamazepine, lamotrigine, and valproic acid are used as mood stabilizers to treat bipolar disorder. This mood stabilizer is used for long-term atmosphere stabilization but has not demonstrated the ability to quickly treat acute bipolar depression. Lithium is preferred for the stabilization of long-term atmosphere. Carbamazepine effectively treats manic episodes, with some evidence that it has greater benefits in fast-bipolar bipolar disorder, or those with psychotic symptoms or more schizoaffective clinical features. This is less effective in preventing recurrence than lithium or valproate. Since then, valproate has been the usual treatment prescribed, and is effective in treating episodes of the beads. Lamotrigine has several benefits in treating bipolar depression, and this benefit is greater for more severe depression. It has also been shown to have several benefits in preventing the recurrence of bipolar disorder, despite concerns about the study being performed, and not beneficial in fast biking subtypes of bipolar disorder. The effectiveness of topiramate is unknown.
Antipsychotics
Antipsychotic drugs are effective for short-term treatment of bipolar bead episodes and appear to be superior to lithium and anticonvulsants for this purpose. Atypical antipsychotics are also indicated for refractory bipolar depression to treatment with mood stabilizers. Olanzapine is effective in preventing relapse, although supporting evidence is weaker than evidence for lithium.
Antidepressants
Antidepressants are not recommended for their own use in the treatment of bipolar disorder and have not been found for any benefit found with a mood stabilizer. Atypical antipsychotic drugs (eg, aripiprazole) are preferred over antidepressants to increase the mood stabilizing effect due to the lack of antidepressant efficacy in bipolar disorder.
More
Short course of benzodiazepines can be used in addition to other drugs until the stabilization of the atmosphere becomes effective. Electroconvulsive therapy (ECT) is an effective form of treatment for acute mood disorders in those with bipolar disorder, especially when psychotic or catatonic features are present. ECT is also recommended for use in pregnant women with bipolar disorder.
Contrary to widely held views, stimulants are relatively safe in bipolar disorder, and much evidence suggests that they can even produce antimanic effects. In the case of comorbid ADHD and bipolar, stimulants may help improve both conditions.
Alternative medicine
Some studies show that omega 3 fatty acids may have beneficial effects on depressive symptoms, but not bead symptoms. However, only a few small studies on the quality of variables have been published and there is not enough evidence to draw definite conclusions.
Prognosis
Lifetime conditions with partial or full recovery periods between recurrent episodes of recurrence, bipolar disorder is considered a major health problem worldwide due to increased rates of disability and premature death. It is also associated with simultaneous psychiatric and medical problems and high rates of initial errors or misdiagnosis, leading to delays in appropriate treatment interventions and contributing to a poorer prognosis. Once the diagnosis is made, it remains difficult to achieve complete remission of all the symptoms with psychiatric drugs available today and the symptoms often become progressively worse with time.
Drug compliance is one of the most significant factors that can decrease the relapse rate and severity and have a positive impact on overall prognosis. However, the type of drug used in treating BD generally causes side effects and over 75% of individuals with BD inconsistently use their drug for various reasons.
Of the various types of disorders, rapid cycling (four or more episodes in one year) is associated with the worst prognosis due to higher rates of self-harm and suicide. Individuals diagnosed with bipolar who have a family history of bipolar disorder are at a greater risk for more frequent manic/hypomanic episodes. Preliminary and psychotic features are also associated with poor outcomes, as well as non-lithium-responsive subtypes.
Early recognition and intervention also improves the prognosis because the symptoms in the early stages are less severe and more responsive to treatment. Onset after adolescence is associated with a better prognosis for both sexes, and being male is a protective factor against higher levels of depression. For women, a better social function before developing bipolar disorder and becoming a parent is protective against suicide attempts.
Works
People with bipolar disorder often experience a decrease in cognitive function during (or perhaps before) their first episode, after which a certain degree of cognitive dysfunction usually becomes permanent, with more severe interference during the acute phase and moderate disturbance during the remission period. As a result, two-thirds of people with BD continue to experience impaired psychosocial functioning among episodes even when their mood symptoms are in remission. A similar pattern is seen in BD-I and BD-II, but people with BD-II experience lower levels of impairment. Cognitive deficits usually increase during the course of the disease. Higher damage rates correlate with the number of previous manic episodes and hospitalization, and in the presence of psychotic symptoms. Early intervention may slow the progression of cognitive impairment, while treatment at a later stage may help reduce the pressure and negative consequences associated with cognitive dysfunction.
Despite the overly ambitious goals that are often part of the manic episodes, the symptoms of mania undermine the ability to achieve these goals and often interfere with one's social and occupational functions. One-third of people with BD remain unemployed for one year after undergoing hospitalization for mania. Symptoms of depression during and between episodes, which occur far more frequently for most people than hypomanic or manic symptoms during disease travel, are associated with lower functional recovery among episodes, including unemployment or underemployment for BD-I and BD-II. However, the course of the disease (duration, age of onset, number of admissions, and the presence or absence of fast cycling) and cognitive performance are the best predictors of employment in individuals with bipolar disorder, followed by depressive symptoms and years of education.
Recovery and looping
A naturalistic study of first recognition for mania or mixed episodes (representing hospitalized cases and hence the most severe) found that 50 percent achieved syndrome recovery (no longer meet the criteria for diagnosis) within six weeks and 98 percent in two years. Within two years, 72 percent achieved symptom recovery (no symptoms at all) and 43 percent achieved functional recovery (regained employment status and previous residence). However, 40 percent went on to experience new episodes of mania or depression within 2 years of syndrome recovery, and 19 percent switched phases without recovery.
The symptoms that precede relapse (prodromal), especially those associated with mania, can be clearly identified by people with bipolar disorder. There is a purpose to teach patients to overcome various strategies when paying attention to such symptoms with encouraging results.
Suicide
Bipolar disorder can lead to suicidal ideation leading to suicide attempts. Individuals whose bipolar disorder begins with depressive affective episodes or the mixture appears to have a worse prognosis and an increased risk of suicide. One in two people with bipolar disorder attempt suicide at least once during their lifetime and many successful efforts are completed. The average annual suicide rate is 0.4 percent, which is 10-20 times that of the general population. The standard mortality ratio of suicides in bipolar disorder is between 18 and 25. The lifetime risk of suicide has been estimated to be as high as 20 percent in those with bipolar disorder.
Epidemiology
Bipolar disorder is the sixth cause of disability worldwide and has a lifetime prevalence of about 1 to 3 percent in the general population. However, a re-analysis of data from the National Epidemiological Catchment Area survey in the United States shows that 0.8 percent of the population experienced episodes of mania at least once (diagnostic threshold for bipolar I) and another 0.5 percent had hypomanic episodes (diagnostic threshold for bipolar II or cyclothymia ). Including sub-threshold diagnostic criteria, such as one or two symptoms over a short period of time, an additional 5.1 percent of the population, adding up to a total of 6.4 percent, are classified as having bipolar spectrum disorders. More recent data analysis from the second US National Survey of Surveys found that 1 percent met lifetime prevalence criteria for bipolar I, 1.1 percent for bipolar II, and 2.4 percent for subthreshold symptoms.
There are conceptual and methodological constraints and variations in findings. The prevalence study of bipolar disorder is usually done by lay interviewers who follow a structured/fixed interview scheme; responses to a single item from the interview may experience limited validity. In addition, the diagnosis (and therefore the prevalence estimates) varies depending on whether a category or spectrum approach is used. This consideration has caused concern about the potential for both underdiagnosis and overdiagnosis.
The incidence of bipolar disorder is similar in men and women as well as in different cultures and ethnic groups. A 2000 study by the World Health Organization found that the prevalence and incidence of bipolar disorder are very similar across the globe. The prevalence of age standards per 100,000 ranges from 421.0 in South Asia to 481.7 in Africa and Europe for men and from 450.3 in Africa and Europe to 491.6 in Oceania for women. However, the severity can vary greatly throughout the world. Disability-adjusted disability rates, for example, appear to be higher in developing countries, where medical coverage may be worse and less treatment is available. In the United States, Asian Americans have a much lower rate than their African and European American counterparts.
Early adolescence and early adulthood were the peak years for the onset of bipolar disorder. One study also found that in 10 percent of bipolar cases, the onset of mania occurs after the patient is 50 years old.
History
Variations in atmosphere and energy levels have been observed as part of human experience throughout history. The words "melancholia", the old word for depression, and "mania" are from Ancient Greece. The word melankolia comes from weld ( ????? ), which means "black", and chole ( ???? ), meaning "bile" or "bile", indicating the origin of the term in pre- humoral Theory Hippocratic. In humoral theory, mania is seen as arising from excess yellow bile, or a mixture of black and yellow bile. The origins of linguistic mania, however, are not very clear. Several etymologies were proposed by the ancient Roman physician Caelius Aurelianus, including the Greek word ania , meaning "to produce great mental suffering", and manos , meaning "relaxed" or " loose ", which will contextually approach the excessive relaxation of the mind or soul. There are at least five other candidates, and part of the confusion surrounding the word etymology of the right mania is its diverse use in pre-Hippocratic poetry and mythology.
In the early 1800s, the French psychiatrist Jean-ÃÆ' â € ° tienne Dominique Esquirol's lypemania, one of its affective monomas, was the first elaboration of what became a modern depression. The basis of the conceptualization of current bipolar disease can be traced back to the 1850s; In 1850, Jean-Pierre Falret presented his description to the Paris Academy of Psychiatric Society on the journey which he mentioned as "crazy" (la folie circulaire, French pronunciation: Ã, [la f? Li si?.ky.l ??] ); the lecture was summarized in 1851 in "Gazette des hÃÆ'Â'pitaux" ("Hospital Sheet"). Three years later, in 1854, Jules-Gabriel-FranÃÆ'§ois Baillarger (1809-1890) explained to the French Imperial, Nationale de MÃÆ'Â ©, defines a biphasic soul disease that causes repeated oscillations between mania and melancholia, which he calls folie ÃÆ' double forme ( French pronunciation: Ã, [f? li a dubl f? m] , "madness in double form"). The original Bailleer article, "De la folie ÃÆ'â € ž double form," appeared in the medical journal Annales mÃÆ'Â Â| dico-psychologicalques (Medico-psychological annals) in 1854.
These concepts were developed by German psychiatrist Emil Kraepelin (1856-1926), who, using the concept of cyclothymia Kahlbaum, were categorized and studied the natural course of untreated bipolar patients. He coined the term 'manic depressive psychosis', after noting that periods of acute, manic or depressive disease, are generally interspersed by symptom-free intervals in which patients can function normally.
The term "manic-depressive reaction " appeared in the first version of DSM in 1952, influenced by Adolf Meyer's legacy. Subtyping to "unipolar" depressive disorders and bipolar disorder was first proposed by German psychiatrist Karl Kleist and Karl Leonhard in the 1950s and they have been considered as separate conditions since the publication of DSM-III. Bipolar II and fast biking subtypes have been included since DSM-IV, based on works from the 1970s by David Dunner, Elliot Gershon, Frederick Goodwin, Ronald Fieve, and Joseph Fleiss.
Society and culture
There is a widespread problem with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder.
Kay Redfield Jamison, a clinical psychologist and psychiatric professor at Johns Hopkins University School of Medicine, mapped out his own bipolar disorder in his memoir An Unquiet Mind (1995). In his autobiography, Chris Joseph outlined his struggle between creative dynamism that enabled the creation of his millions of pound advertising agency, Advertising Hook, and the darkness of spending money. desperate for his bipolar disease.
Some dramatic works have depicted characters with characteristics that indicate the diagnosis that has been the subject of discussion of psychiatrists and films. An important example is Mr. Jones (1993), where Mr. Jones (Richard Gere) swings from the episode of mania to the depressive phase and back again, spending time in a mental hospital and displaying many features of the syndrome. At The Mosquito Coast (1986), Allie Fox (Harrison Ford) features several features including carelessness, grandiosity, increased goal-directed and mood lability, and some paranoia. Psychiatrists have suggested that Willy Loman, the main character in the classic drama Arthur Miller Death of a Salesman , suffers from bipolar disorder, although the specific term for the condition does not exist when the play is written.
TV specials, eg BBC Stephen Fry: Secret Life of Manic Depressive , MTV True Life: I'm a Bipolar , a talk show, and a public radio show, and a greater will from public figures to discuss their own bipolar disorder, has focused on psychiatric conditions, thereby, raising public awareness.
On April 7, 2009, night drama 90210 on the CW network, aired a special episode where Silver characters were diagnosed with bipolar disorder. Stacey Slater, a character from BBC EastEnders soap, has been diagnosed with the disorder. The storyline was developed as part of the BBC Headroom campaign. Channel 4's Brookside soap has previously featured stories about bipolar disorder when Jimmy Corkhill's character is diagnosed with the condition. Drama political thriller Showtime 2011 Homeland Carrie Mathison's protagonist is bipolar, which he keeps secret since his school days. In April 2014, the ABC's premiere medical drama, Black Box , in which the main character, the world-renowned neurologist, is bipolar.
Creativity
A link between mental illness and success or professional creativity has been suggested, including in accounts by Socrates, Seneca the Younger, and Cesare Lombroso. Although prominent in popular culture, the relationship between creativity and bipolar has not been studied closely. This area of ​​study is also likely to be affected by a confirmation bias. Some evidence suggests that some components of inherited bipolar disorder overlap with inherited creativity components. Probands of people with bipolar disorder are more likely to succeed professionally, as well as to exhibit temperamental properties similar to bipolar disorder. Moreover, while the study of the frequency of bipolar disorder in a sample of the creative population has been contradictory, the study has a positive finding report that bipolar disorder is rare.
Specific population
Children
In the 1920s, Emil Kraepelin noted that manic episodes rarely occur before puberty. In general, bipolar disorder in children is not recognized in the first half of the twentieth century. This problem is diminished by the increase following the DSM criteria in the last part of the twentieth century.
While in adults the course of bipolar disorder is characterized by episodes of depression and discrete mania without obvious symptoms among them, in children and adolescents very rapid mood changes or even chronic symptoms are the norm. Childhood bipolar disorder is generally characterized by angry outbursts, irritability and psychosis, rather than euphoria mania, which is more likely to be seen in adults. Early onset bipolar disorder is more likely to manifest as depression than mania or hypomania.
The diagnosis of controversial childhood bipolar disorder, although it is not discussed that typical symptoms of bipolar disorder have negative consequences for minors who suffer from them. The debate mainly centers on whether the so-called bipolar disorder in children refers to the same disorders as when diagnosing adults, and the question of whether the criteria for diagnosis for adults is useful and accurate when applied to children. Regarding the diagnosis of children, some experts recommend following the DSM criteria. Others believe that this criterion does not separate children with proper bipolar disorder from other problems such as ADHD, and emphasizes rapid mood cycles. Others argue that what distinguishes children with bipolar disorder is irritability. The AACAP exercise parameter encourages the first strategy. American children and adolescents diagnosed with bipolar disorder in community hospitals increased 4-fold to levels up to 40 percent in 10 years around the beginning of the 21st century, whereas in outpatient clinics it doubled to 6 percent. Studies using DSM criteria show that up to 1 percent of adolescents may experience bipolar disorder.
Treatment involves medication and psychotherapy. Prescription drugs usually consist of mood stabilizers and atypical antipsychotics. Among the first, lithium is the only compound approved by the FDA for children. Psychological treatments usually combine education in disease, group therapy and cognitive behavioral therapy. Chronic drugs are often needed.
The current research direction for bipolar disorder in children includes optimizing care, improving genetic and neurobiological baseline knowledge of pediatric disorders and improving diagnostic criteria. Several treatment studies have shown that psychosocial interventions involving the family, psycho-education, and skill development (through therapy such as CBT, DBT, and IPSRT) may be beneficial in pharmacotherapy. Unfortunately, literature and research on the effects of psychosocial therapies on BPSD are scarce, making it difficult to determine the efficacy of various therapies. DSM-5 has proposed a new diagnosis that is considered to include some presentations that are currently considered bipolar onset of childhood.
Elderly
- Bipolar Disorder in Curlie (based on DMOZ)
- An Overview of Bipolar Disorder from the National Institute of Mental Health US website.
- NICE Bipolar Disorder clinical guide from the National College for Health and Clinical Excellence website in the UK
- The International Society for Bipolar Disorder Tasks reports current knowledge in pediatric bipolar disorder and future direction
Source of the article : Wikipedia
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