Bipolar personality disorder - characteristics of the disease and methods of treatment

1. Bipolar disorder is...
2. Reasons and statistics
3. Symptoms of a manic episode
4. Signs of a depressive episode
5. Disease in children and adolescents
6. Diagnosis and treatment of bipolar disorder

Hello, dear readers of the KtoNaNovenkogo.ru blog. They don’t pay attention to sudden and frequent changes in mood. They say that a person “gets a little stormy, it happens.”

In the morning I am ready to dance and run towards a bright and alluring future. And towards the evening he lashes out at his colleagues and loved ones and feels depressed.

Such an emotional “roller coaster” in society is attributed to the normal state for a woman. Although men also experience fluctuations.

However, you should not take this so lightly, since it may be a disease - bipolar disorder. What is it, and is it possible to completely cure it?

Causes of bipolar disorder

Among the reasons that can provoke the development of mental illness, doctors identify the following.

• Genetic predisposition. The likelihood of the disease increases in those people whose relatives suffered from this diagnosis. However, this factor can only be realized when exposed to unfavorable environmental conditions.
• Physical fatigue, emotional stress. This type of reason can include any stressful situations that have a strong impact on a person’s emotional background - divorce proceedings, serious illness or death of a loved one, difficult financial situation, problems in school or at work.
• Hormonal disbalance. For this reason, women are mainly at risk - during pregnancy, after childbirth and at the stages of menopause.
• Features of character. The diagnosis of bipolar disorder in most cases is given to melancholic people. They are characterized by a craving for hyper-responsibility and orderliness, the desire for which often leads to stressful situations.
• Biological factors. They are associated with disruption of brain function due to various injuries - traumatic brain injury, consequences of viral infections.
• Alcohol abuse and use of psychotropic substances.

What to do if you suspect you have bipolar disorder

Don't ignore your feelings. If you are familiar with 10 or more of the signs listed above, this is already a reason to consult a doctor. Especially if from time to time you catch yourself feeling suicidal.

First, go see a therapist. The doctor will suggest Diagnosis Guide for Bipolar Disorder for you to do several tests, including a urine test as well as a blood test to check your thyroid hormone levels. Often, hormonal problems (in particular, developing diabetes, hypo- and hyperthyroidism) are similar to bipolar disorder. It is important to exclude them. Or treat if they are found.

The next step will be a visit to a psychologist or psychiatrist. You will have to answer questions about your lifestyle, mood swings, relationships with other people, childhood memories, traumas, and family history of illnesses and drug use incidents.

Based on the information received, the specialist will prescribe treatment. This can be either behavioral therapy or medication.

Let’s finish with the same phrase from Catherine Zeta-Jones: “There is no need to endure. Bipolar disorder can be controlled. And it's not as difficult as it seems."

Classification by polarity type

Bipolar mental disorder is characterized by the presence of two alternating phases – mania and depression. Between them is the stage of stabilization, when the patient’s emotional state becomes calm. These “enlightenments” can be quite long - from 3 to 10 years.

Bipolar affective disorder is divided into several types, depending on the duration and correct sequence of phases.

• The right type. The disease flows in the desired sequence. After the past phase, a period of opposite mood begins. Thus, mania is replaced by depression, and depression by mania.
• Wrong type. With this course of bipolar disease, the chronology is disrupted. Mania is replaced again by a heightened emotional state, and depression by a depressed, melancholy state.
• Unipolar type. It is characterized by the manifestation of the same phase. Symptoms and signs of this type of bipolar disorder are most common in women. The difference from the incorrect one is the complete absence of the second phase. Patients are characterized by only depression, alternating with periods of intermission, or only mania.
• Bipolar type. Classic alternation of two phases with a stabilization period. Symptoms of this bipolar disorder are most often found in men.

Bipolar personality disorder is also classified depending on the severity of psychosis.

• Bipolar disorder type 1 – with severe manic phases.
• Bipolar disorder type 2 - symptoms of mania in bipolar disorder are significantly smoothed out or blurred.

Symptoms of mania

During the period of mania, a person has a lot of energy, is in a good mood, regardless of whether there is a reason for it, has a very optimistic attitude and increased self-esteem, is confident that he can cope with all or many difficulties at the same time, thinks that he is very gifted, that has many abilities and skills, and often begins to take risks and participate in events for which he does not have the resources.

Symptoms of mania may include provocative and compulsive behavior

To detect a manic episode of bipolar disorder, 3 or more of the following symptoms must be present:

• Fast and chaotic speech
• Increased self-esteem or grandeur, feeling of euphoria
• High energy and being more active than usual
• Decreased need for sleep or trouble sleeping
• Irritability, hyperactivity, frequent aggression and anger, provocative and obsessive behavior
• Poor concentration and lack of common sense
• Risk taking (risky/reckless sexual behavior, spending money, etc.)

Unfortunately, the symptoms of bipolar disorder are often not recognized in time either by the patient’s relatives or by the patient himself. People in a manic episode may irritate their loved ones, but they attribute their behavior not to the illness, but to bad character traits.

During the period of mania, they are very prone to taking unnecessary risks, such as spontaneous family and child planning or taking out loans for large-scale purchases, reckless actions due to excessive self-confidence and much more.

Typically, patients do not notice changes in their behavior, do not seek medical help or refuse it because they consider it inappropriate. During this period, they experience euphoria and good health and do not understand the need for treatment. Episodes of mania can lead to rash and disastrous decisions for the future. This is why early recognition of symptoms and prompt treatment of the episode and the disease in general is important to prevent the next one.

Phases of bipolar disorder

The duration of one phase is individual in each case. For some it can be several months, for others it can be several years. However, doctors identify a general trend that is typical for all patients. Over time, the duration of the depression phase increases approximately three times compared to the manic phase.

Manic phase

Bipolar psychosis most often manifests itself during the manic phase. It has several stages of development .

• Hypomania . This stage is characterized by increased arousal and emotional upsurge. The patient feels an extraordinary surge of strength. He is ready for great achievements and deeds - he can continuously engage in creativity, actively communicate with people, and work hard. However, attention in this state is extremely unstable. The patient cannot concentrate on one thing; he constantly jumps from one task to another. All things remain unfinished.
• Mania . All of the above signs become more pronounced. Added to these are strong negative emotional outbursts. The person becomes aggressive, irritable, hot-tempered and furious.
• Peak phase. At this stage, all signs reach their peak. The patient constantly experiences nervous excitement, he cannot relax. All his emotions are “heated up” to the limit, coordination of movements is impaired, thoughts are illogical and abrupt. The person cannot finish a single sentence and constantly jumps from one sentence to another.
• Relief of symptoms. The patient gradually calms down. Movement disorders are on the decline. The speed of thinking and heightened emotional mood remain unchanged.
• Return to normal. All symptoms and signs of bipolar disorder in the manic phase gradually disappear, and the patient returns to normal.

Symptoms and signs of bipolar disorder in the manic phase.

• Elevated mood, feeling of euphoria.
• Physical activity.
• Accelerated course of mental processes.
• Heightened self-esteem.
• Excessive sociability.
• Tendency to extreme hobbies.
• Unreasonable waste of money.

Bipolarity in the manic phase is expressed in a huge surge of energy. A person feels that he has superpowers and may imagine himself as a superhero. He is drawn to accomplish great things, unjustifiably dangerous actions. Such a patient is also characterized by a passion for gambling. A person spends large sums of money unreasonably. Maybe in one evening you can “lose” all the funds accumulated over the past years.

Elevated mood is often combined with outbursts of aggression and anger. A person commits actions and actions that do not correspond to the current situation. He may laugh loudly at a funeral, or, conversely, cry constantly at a wedding.

Motor activity is expressed by restlessness and restlessness. The patient cannot remain in one position and do something for a long time. Acceleration of mental processes in the stage of mania means unproductive thinking. All the patient’s conclusions are superficial. A person constantly has many thoughts in his head, but none of them has a logical conclusion.

The only cognitive function that “wins” during these periods is memory. During bipolar mania , a person can easily remember large amounts of information.

If you notice alarming signs of behavior in your relative, contact us for advice. Call us by phone .

Depressive phase of bipolar disorder

The clinical picture of depression in bipolar disorder is similar to classical depression, but differs in longer duration. The more often this phase occurs, the longer it becomes each time. Periods of depressed mood may persist for several years. A person cannot cope with this condition on his own; he needs professional medical help.

You can always call the “Balance” clinic by phone +7 (499) 495-45-03. Our specialists will advise you and tell you what needs to be done to “pull” your loved one out of depression.

Symptoms of bipolar depressive disorder:

• decreased mood;
• decreased physical activity;
• slowing down of thought processes.

Mornings with bipolar depression usually begin with a low, depressed mood, which improves in the late afternoon. A person’s appetite disappears, sleep is disturbed, motivation disappears, and the circle of interests and communication narrows . The patient does not want to make contact with his friends and relatives, abandons all activities and hobbies, and stops going to work or attending classes.

A person spends most of the day in bed. He has a lot of time to think. He begins to comprehend all his actions committed during the manic phase. Self-analysis leads to self-flagellation, the emergence of a feeling of guilt for everything previously done.

All internal problems that the patient had become aggravated. He is very worried about his complexes regarding appearance, low self-esteem, and difficult financial situation. He experiences a feeling of melancholy, his own uselessness, the worthlessness of his existence.

Decreased appetite and insomnia lead to weight loss. Many women suffer from menstrual irregularities due to nervous exhaustion. At the peak of depression, symptoms of bipolar affective disorder such as depersonalization and derealization may be observed. The boundaries of one’s own “I” and the surrounding world become blurred. They experience “interruptions” in their perception of reality.

• Familiar places seem new.
• The color scheme of the surrounding world changes. The patient sees everything in different colors.
• Sounds become muffled. Even if someone is speaking very close, it seems to the person that the voices are coming to him from afar.
• The patient constantly experiences a feeling of déjà vu, “viewing” the same scenes of his life several times.

A depressive state contributes to the emergence of hypochondriacal obsessions. A person considers himself terminally ill; he is convinced that no one can help him. Depression, dulling of emotions, self-flagellation become the causes of suicidal thoughts. It is very important that in such a state someone constantly looks after the patient.

What to do if your relative shows signs of bipolar disorder ? Under no circumstances should you make a diagnosis or prescribe medications on your own. This can only be done by an experienced doctor. The mental health center “Balance” employs competent psychiatrists. Our specialists will advise you, tell you what to do and what measures to take.

If you notice that a loved one is prone to suicidal thoughts, you should be concerned. Call us by phone. Our specialist will come to your home, examine the patient, advise and give the necessary recommendations for further treatment. If necessary, the team will help transport the patient to the clinic. We will provide your relative with comfortable living conditions and round-the-clock monitoring of his condition. Medical staff will constantly monitor the patient’s intake of medications, food and water, and the doctor will analyze the effectiveness of the chosen course of treatment and make timely adjustments.

We provide services on conditions of strict anonymity. All information received about the patient and his medical history remains within the walls of our clinic.

How do you know if you have bipolar disorder?

A person may not suspect that he has a serious disorder, but sometimes thoughts creep in that something is wrong. This is all a matter of cyclicality, it is important to see the direct relationship with mood cycles that occur in circles. How can you identify bipolar disorder in yourself? You need to start paying attention to your mood, analyzing it, how often there are swings, how long periods of uncontrollable mania and depression last. Thoughts of suicide and feelings of hopelessness will be an alarm bell; it is important to share your experiences with loved ones.

Consequences of bipolar disorder

Bipolar disorder has a negative impact on a person's social standing. People around him do not understand the goals and actions of the patient, his causeless aggression and rage towards them. Illness often causes family breakdown.

In a state of depression, a person closes himself at home. Patients become socially maladapted and lose touch with society. They are fired from work and expelled from educational institutions for absenteeism without a valid reason.

Recommendations for people with bipolar disorder

Many people are concerned about the question of how to live with bipolar disorder? To control the symptoms of BD on an ongoing basis, it is necessary to minimize the manifestations of symptoms and prevent their recurrence in the future.

In addition to psychotherapy and medications, other methods are practiced that help improve the patient’s condition:

• Educate yourself: Understand your treatment thoroughly so you can monitor it and make the best decisions.
• Take responsibility for the course of your treatment. Healing from BD before the initial positive effects appear involves a long process, which requires certain efforts from the patient. You should be patient, take medications and not take breaks in treatment.
• Track your mood and symptoms: understand your mood swings. Try to find out the cause of manic and depressive episodes (changes in weather, stress, quarrels, insomnia) and avoid these unfavorable moments.
• Adopt healthy habits: get enough sleep, exercise, minimize your intake of alcohol, coffee and sweets, eat healthy, stick to your medication schedule, and engage in psychotherapy.
• Consider a plan in case of an exacerbation: periods of manic or depressive episodes may occur with BD, thinking through a clear course of action in case of an exacerbation of the crisis will help you take control of your actions.
• Don't neglect social support: the fact of social support is very important for finding a state of mental balance. Improve family relationships and friendships, attend therapy groups and make new acquaintances.
• Get your stress under control: practice relaxation techniques and organize active recreation.

Diagnostics

Many of the symptoms and signs of bipolar disorder are similar to other mental illnesses such as schizophrenia, neurosis and psychosis. Along with disturbances in mood and behavior, changes in the cognitive sphere are often observed. All this creates certain difficulties for diagnosing the disease. To establish an accurate diagnosis, it is necessary to observe the patient for a long time. This will help determine:

• symptoms characteristic of this disorder;
• the degree of its severity, features of manifestation;
• BAR type, duration of phases.

To clarify the diagnosis and differentiate it from others, the doctor uses additional methods in the form of tests.

• BSDS – for bipolar personality disorder.
• Zung test - to determine the depressive state.
• Altman scale - helps to distinguish ordinary depression from mental disorder.
• Cyctolomia test.

Only on the basis of all the test results and studies performed, the doctor makes a diagnosis and selects an individual treatment regimen.

At the Equilibrium Clinic you can undergo a diagnosis of mental illness. Our doctors have modern research methods and will help you identify the problem and find effective means to solve it.

How to Recognize Early Symptoms of Bipolar Disorder

To detect unhealthy mood swings, you first need to find out whether you are experiencing emotional extremes - mania and depression.

7 Key Signs of Mania

1. You experience elation and a feeling of happiness for long periods (several hours or more).
2. Your need for sleep is reduced.
3. You speak quickly. And so much so that those around you do not always understand, and you do not have time to formulate your thoughts. As a result, it is easier for you to communicate in instant messengers or via emails than to talk to people in person.
4. You are an impulsive person: you act first, think later.
5. You are easily distracted and jump from one thing to another. As a result, bottom line productivity often suffers.
6. You are confident in your abilities. It seems to you that you are faster and smarter than most of those around you.
7. You often exhibit risky behavior. For example, you agree to have sex with a stranger, buy something you can’t afford, or take part in spontaneous street races at traffic lights.

7 Key Signs of Depression

1. You often experience prolonged (several hours or more) periods of unmotivated sadness and hopelessness.
2. You become isolated in yourself. You find it difficult to come out of your shell. Therefore, you limit contact even with family and friends.
3. You have lost interest in those things that used to really captivate you, and have not gained anything new in return.
4. Your appetite has changed: it has sharply decreased or, on the contrary, you no longer control how much and what exactly you eat.
5. You regularly feel tired and lack energy. And such periods continue for quite a long time.
6. You have problems with memory, concentration and decision making.
7. You sometimes think about suicide. Catch yourself thinking that life has lost its taste for you.

Manic-depressive psychosis is when you recognize yourself in almost all the situations described above. At some point in your life you clearly show signs of mania, at another you show symptoms of depression.

However, sometimes it happens that the symptoms of mania and depression manifest themselves simultaneously and you cannot understand which phase you are in. This condition is called mixed mood and is also one of the signs of bipolar disorder.

Treatment

Treatment of bipolar disorder is a complex therapy - medication and psychotherapy . The doctor individually selects medications and dosage, depending on gender, age and the presence of symptoms. The patient is prescribed:

• Atypical antipsychotics – these help relieve symptoms of mania and depression.
• stabilizers .
• Antidepressants – adjust mood.
• Normalizers are usually used in the initial stages of the disease.
• Sleeping pills – to normalize sleep.

During pharmacotherapy, the doctor carefully monitors the effect of the drugs on the patient’s condition. For example, taking antipsychotics can lead to sudden weight loss and the development of diabetes. Therefore, the patient’s physical indicators are regularly checked to prevent complications and side effects.

After the main symptoms of bipolar , the doctor supplements the course of treatment with psychotherapy. During individual trainings, patients are taught:

• recognize changes in your mood, feel their precursors and block attacks;
• control the manifestation of violent emotions;
• switch negative thoughts to positive ones;
• restore interpersonal communication skills.

The support of loved ones and family plays a big role. We offer the patient's relatives to undergo family therapy. Sessions with a psychiatrist will help you understand what bipolar disorder means and how it manifests itself. Knowing basic information about the behavior of a person with this mental illness, you will be able to better understand the reasons for the patient’s aggressive outbursts, see the harbingers of an approaching change in mood, and provide him with timely help.

At the Balance Clinic, patients can undergo both inpatient and outpatient treatment. After discharge, the patient’s relatives will need to ensure the patient’s daily presence at medical procedures and psychological trainings, and also monitor the implementation of all doctor’s recommendations.

Correctly selected therapy allows you to achieve stable remission and relieve the patient from the painful signs of the disorder. The disease does not impair thinking abilities, so after a course of treatment the patient can return to a full life.

Reasons and statistics

Scientists say that bipolar personality disorder is a genetic disease . Although the specific gene that is responsible for this has not been found. Perhaps this is a combination of defects in several of them.

In a study of twins, it was noticed that if one of them is sick, then the probability of this disorder in the other is 40-70%.

And also, if there are relatives with attention deficit disorder or prone to depression, then there is a chance that the person will learn for himself what bipolar disorder is, since the risk increases.

There is a hormonal theory in which the cause is an imbalance between the neurotransmitters norepinephrine and serotonin (what is it?).

The correlation between mental disorders and the endocrinological system is confirmed by the fact that during menstruation in women, the symptoms of bipolar disorder are more pronounced.

Some psychiatrists believe that this is a manifestation of self-regulation and adaptation, which have their origins in evolution. When a person has few vital resources, he falls into apathy (how is that?) in order to save and renew them.

When a person is full of energy and desire to perform actions, mania sets in, when all forces are fully released.

According to statistics, people with type I disease make up about 2% of the population of our planet, with type II – up to 7% .

In the CIS countries (where is this?) up to 0.02% of such cases are diagnosed, which does not indicate an extremely low frequency of the disorder. And the fact that it is not differentiated (how is that?) with schizophrenia or ordinary depression. This leads to inappropriate treatment of patients.

prevention

There is no surefire way to prevent bipolar disorder. However, treatment at the earliest sign of a mental disorder can help prevent bipolar disorder or other mental conditions from getting worse.

If you have been diagnosed with bipolar disorder, some strategies may help prevent minor symptoms from occurring during episodes of mania or depression:

• Pay attention to warning signs. Treating symptoms early can prevent episodes from getting worse. You may have identified a pattern for your bipolar episodes and what triggers them. Call your doctor if you feel like you are going into an episode of depression or mania. Involve family members or friends in watching for warning signs.
• Avoid drugs and alcohol. Using alcohol or recreational drugs may worsen your symptoms and make them more likely to return.
• Take your medications as directed. You may be tempted to stop treatment, but don't. Stopping the medication or reducing the dose yourself may cause withdrawal effects, or your symptoms may worsen or return.

Alternative medicine

There is little research into alternative or complementary medicine, sometimes called integrative medicine, and bipolar disorder. Most studies focus on major depression, so it is unclear how these unconventional approaches work for bipolar disorder.

If you prefer to use alternative or complementary medicine in addition to the treatment recommended by your doctor, take some precautions first:

• Don't stop taking your prescribed medications or skip therapy sessions. Alternative or complementary medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.
• Be honest with your doctors and mental health professionals. Tell them what alternative or complementary treatments you use or want to try.
• Be aware of potential hazards. Alternative and complementary products are not regulated like prescription drugs. Just because it's natural doesn't mean it's safe. Before using alternative or complementary medicine, talk with your doctor about the risks, including possible serious drug interactions.

Treatment Methods for Bipolar Personality Disorder

Therapy helps normalize the patient’s mental state to a stable phase of remission. Severe forms of bipolar disorder require hospital treatment. Lungs can be docked on an outpatient basis.

Medications

The use of medications helps to cope with attacks of mania and depression and stabilize mood. Antidepressants and psychotics are prescribed to treat the disease.

The medications, dosage and course are selected by the doctor strictly individually for each patient.

Uncontrolled use of antidepressants is especially dangerous because:

1. These drugs are no more effective than mood stabilizers;
2. Medicines can trigger an increase in mania. To prevent this effect, it is necessary to supplement antidepressants with lithium or valproic acid.
3. With long-term treatment, they can provoke the opposite effect and cause an increase in the frequency of episodes of mania and depression.

Psychotherapy

Psychological assistance is a prerequisite for successful treatment.

Communication with a psychiatrist helps the patient:

• accept your condition;
• learn to recognize borderline states and manage them;
• control emotions;
• improve communication skills.

Psychological assistance consists of:

1. Adjustments to cognitive-behavioral function. At this stage, the patient manages to understand and come to terms with the disease, as well as learn to manage it. The specialist, together with the patient, analyzes the mental state and determines at what point emotions begin to get out of control. The doctor teaches the patient to manage his inner world, avoid stressful situations and reduce their pathogenic influence.
2. Interpersonal psychotherapy aimed at adjusting the patient’s life in society.
3. Psychotherapy of social rhythms. People with bipolar disorder are very sensitive to their biological clock. Under the influence of social rhythms, the clock malfunctions, provoking the appearance of stress, which is a “trigger” for the occurrence of attacks. Psychotherapy helps stabilize social rhythms and establish their relationship with the biological processes responsible for mood stability.
4. Family psychotherapy. A special place for establishing stable remission has the establishment of a favorable psychological climate in the family. Family psychotherapy is carried out with the patient’s loved ones, helps the family establish contact and help jointly stop attacks of mania and depression.

Other methods

To combat bipolar disorder, a patient needs:

1. Develop a workout regimen that helps you release the necessary amount of energy and fight stress. Patients should spend as much time as possible outdoors, walk a lot, and do physical exercise.
2. Set the light mode. The biological clock is directly dependent on the length of daylight. With the help of artificial lighting, it is possible to create favorable conditions that allow patients to maintain the 10 hours of sleep they need in the dark.
3. Stick to proper nutrition. Fatty acids and Omega-3 are needed by people suffering from manic-depressive psychosis, as they help reduce the manifestations of stress. Proper nutrition, including a large amount of fruits and vegetables in the diet, will also help minimize the side effects of drugs that cause weight gain. In case of manic depressive syndrome, it is necessary to avoid alcohol and caffeine-containing products.
4. Develop a sleep and wakefulness routine. Lack of sleep provokes stress and causes a manic or depressive phase. Patients are required to rest for at least 8-10 hours in a darkened room.

In addition to traditional methods, help in fighting the disease can be provided by:

1. Meditations that help stop the development of the depressive phase. Meditation relaxes muscles and reduces excitability. It is recommended to combine meditation with yoga and breathing exercises.
2. Acupuncture, which triggers the body's response to stress and relieves symptoms of mania.

In the interval between attacks, a person completely restores his psychological functions.

Unfortunately, repeated relapses occur in 90% of people suffering from bipolar disorder, and about 40% eventually lose touch with reality and become disabled. More than 3 patients have minimal intervals of light streaks, or continuous phases of mania and depression.

General information

Manic depression is a mental disorder characterized by mood swings. It is also called bipolar disorder. This condition is represented by the transition from a depressive to a manic phase. At the initial stage of the manic phase, a person may look quite healthy, but the symptoms will begin to progress, and mental abnormalities will become noticeable even to a non-specialist.

According to statistics, women are more susceptible to developing depressive diseases than men.

When considering manic depression, we distinguish between its classic form and its atypical form. If everything is clear with the first, then the second complicates the process of making a diagnosis due to the mixing of both phases. The depression phase may be accompanied by excitability, and the manic phase by inhibited thinking.

This disease also has an erased form. In this case, the symptoms will be completely blurred. The person will remain fully functional, and the disease will only manifest itself as a change in mood. The person will not realize why he is depressed, why he constantly feels anxious. The problem is that erased symptoms allow the disease to start, which often leads to suicide.

You need to know that a person may have an exacerbation, which requires urgent hospitalization. Without proper treatment, prolonged depression can lead to complete numbness. If proper assistance is not provided at the moment, mental disorders of an irreversible nature cannot be avoided. When an exacerbation occurs during the manic phase, hysterics and sudden surges of emotions occur, even for minor reasons. This is due to the fact that control over the situation has been lost, the person urgently needs help.

Bipolar disorder can become severe without proper treatment.

Development of the depressive phase

The depressive phase, which has 4 stages of development, ends the MDP episode. The phase has its own triad of signs in the form:

• hypothymia – depressed (even to the point of complete decline) mood;
• bradypsychia – slowness of thinking;
• motor retardation.

Manic-depressive psychosis in the depressive stage has the following symptoms and goes through the following stages:

1. In the initial stage, there is an unexpressed decrease in mental tone with a decreased level of mood and weakened performance both mentally and physically; sleep is slightly disturbed - it is sensitive and makes it difficult to fall asleep.
2. Characteristics of the stage of increasing depression include a noticeable decrease in the level of mood with the inclusion of alarming fragments, the plot of which is retold in a quiet, “tiredly slow” and sparing speech. In addition to a decrease in appetite and degeneration of sleep into insomnia, there is a pronounced decline in mental activity and physical activity with retardation of movements.
3. For the stage of severe depression, significantly pronounced psychotic affective manifestations in the form of a melancholy-anxious state, which is extremely difficult for the patient, are typical. There is no desire to share one’s feelings, but if such a need arises, the presentation is carried out in a whisper, or in a quiet speech with long pauses with monosyllabic answers to the questions asked. A characteristic symptom is “depressive stupor” with a long stay in one position (sitting or lying down). Appetite is suppressed to the point of anorexia. Despite the poverty of external mental manifestations, the mind actively works for hypochondria - in the direction of self-deprecation of the individual, analysis of the “sinfulness”, “depravity” and “worthlessness” of the life lived and being lived. Which leads to suicidal acts often committed against oneself, most often performed either in the prologue or in the epilogue of the stage, when, against the background of extreme hypothymia, the development of motor retardation has not yet occurred. Visits with hallucinations (mostly auditory) and illusions even more convince the patient to end his meaningless existence once and for all, but these phenomena are quite rare for this pathology.
4. In the reactive stage, recovery occurs - reactivation of all mental and physical manifestations of life, asthenia may persist for a short time; in some cases, there is a revival of mood and speech to a state of hyperthymia and significantly increased activity in movements.

Some nuances when changing bipolar phases

The state of depression in bipolar disorder, as a rule, occupies a longer period of time than its manic component, occurring with states of extreme mental depression characteristic of a certain time of day (morning).

It is worth noting that in women of childbearing age, menstruation stops during depression, which is a sign of severe psychophysical distress.

With a variant of the development of the depressive phase, reminiscent of atypical depression, an inversion of symptoms in the form of hyperphagia and hypersomnia is possible, leading to a feeling of the body being massively heavy, and the psyche, despite its significant inhibition, remains sensitive to situations and emotionally labile, with a high level of irritability and anxiety . This allows a number of authors to classify these manifestations of pathology as a variant of the course of bipolar depression.

In contrast to simple depression (without delirium), which has a classic triad of symptoms, there are variants of the development of the depressive phase that have the nature of a disorder:

• hypochondriacal – with affective delusions of hypochondriacal content;
• delusional (or Cotard's syndrome);
• agitated – with a low level of motor retardation or its complete absence;
• anesthetic – with manifestations of mental “insensitivity”, indifference to the environment (up to complete indifference to the fate of one’s own body and life in it), deeply and acutely experienced by a sick person.

Diagnosis and types of bipolar affective disorder in psychiatry

Affective disorders (mood disorders) remain the subject of controversy among psychiatrists, because their causes are unknown and their classification is unclear. Treatment for bipolar affective disorder and other mood disorders is symptomatic, which at best makes the patient's life easier, but does not provide a complete cure.

These people often cannot live a full life, even suffering from bipolar affective disorder without psychotic manifestations (and psychosis does occur). They live from phase to phase, amid depression and anxiety, and often from one hospitalization in a psychiatric hospital to repeated treatment there. Bipolar affective disorder significantly reduces the ability to study, work, communicate with people, that is, lead a full social life. And psychiatry does not offer a complete cure for mood disorders.

Bipolar affective disorder involves alternating periods of the so-called mood phases throughout life - depressive and manic. These phases can go one after another, can replace each other, or manifest themselves as only one depressive phase more than once. Between phases there may be remissions of equal mood (intermission).

Clinical manifestations of mood phases can be expressed in different ways - from subdepression to severe depression with suicidal tendencies, from a hypomanic state to psychotic mania with sexual promiscuity and the commission of illegal acts. In addition, hallucinations, delusions, complete refusal of food, insomnia, aggressive inappropriate behavior and other psychotic symptoms may occur. There may also be mixed mental states, mixed mood disorders. They have one thing in common in their classification: the phase nature of the flow.

The American Classification of Mood Disorders (affective) is divided into bipolar affective disorder type I and bipolar affective disorder type II. In bipolar II disorder, only depressive and hypomanic phases are observed (elevated mood, but not to the level of mania).

Patients with bipolar affective disorder may also suffer from anxiety, phobias due to severe mood swings, panic attacks and other neurotic diseases. As you can see, the spectrum of mood disorders is quite wide. Understanding the causes of symptoms with the help of system-vector psychology by Yuri Burlan helps to find the ground under one’s feet - both for the specialist and for the patient himself.

Affective insanity

Manic-depressive psychosis is a severe mental pathology of endogenous nature. A more modern name for this disease, more often used nowadays, is bipolar affective disorder.

The main feature of manic-depressive psychosis is the patient’s demonstration of symptoms of two polar states: a depressive episode and the stage of mania (hypomania). As a rule, the patient experiences an alternation of these two opposite phenomena, during which the mood background fluctuates significantly - from deep melancholy to pronounced euphoria. Also, when polar phases change in manic-depressive psychosis, the subject’s level of activity also undergoes enormous changes - from a decline in energy and lethargy to a surge of energy and nervousness.

Manic-depressive psychosis: general information

This type of psychosis was classified as a separate nosological form more than a century ago. The disease is included in ICD 10 (International Classification of Diseases, 10th revision) under the term “bipolar affective disorder.” Although many clinical studies of cases of this pathology have already been conducted, there is no precise unambiguous definition of this form of psychosis in scientific circles. For this reason, it is customary to divide manic-depressive psychosis into separate types depending on the dominance of the symptoms of a particular episode, their intensity, and the frequency of changes in polar cycles.

At this stage of medical development, it is impossible to provide data reflecting the true prevalence of manic-depressive psychosis, since different psychiatric schools and different countries have different criteria for determining this diagnosis. However, a comparative analysis of various authoritative sources allows us to make the assumption that the number of people with bipolar affective disorder ranges from five to eight people for every 1000 people on the planet.

The ratio of males and females who experienced symptoms of mania and depression at least once is almost the same. Also, no significant influence on the formation of manic-depressive psychosis has been established for the factors of age, race, nationality, level of education, social status, and intelligence quotient.

Most often (about 50% of all recorded cases), the disorder manifests itself in a person between the ages of 17 and 30 years. Early onset of the disease is associated with a high risk of suicidal behavior. This type of psychosis is characterized by a sharp onset of symptoms, and retardation and hypersomnia . At the same time, the depressive version of psychosis is more typical for women. Manic phases are more common among men.

In some patients, manic-depressive psychosis occurs in the form of diverse variations of mixed psycho-emotional statuses. For some people, the symptoms of depression and mania in their “pure” form change each other very quickly. In other patients, mild, non-intense symptoms are observed simultaneously, characteristic of both a depressive episode and a manic stage. For example: with manic-depressive psychosis, an individual may have strong motor agitation, combined with depressing sadness and melancholy. Or, conversely, the subject may experience mental retardation and depression of motor activity, adjacent to high spirits and inspiration.

Each individual episode of manic-depressive psychosis can directly follow the previous phase of the disorder, giving the disease a permanent, continuous nature. Or the symptoms of one phase of bipolar affective disorder subside, and the manifestations of another episode of psychosis appear after a certain time interval.

Such a “bright” segment during manic-depressive psychosis is usually called the intermission (otherwise interphase). During this asymptomatic interval, the patient’s emotional status can completely return to normal, cognitive and mnestic functions can be fully or partially restored, and the level of activity can stabilize. During the interphase, the personal portrait of an individual regains its integrity and acquires pronounced individuality.

The seasonal characteristics of manic-depressive psychosis also deserve attention. Thus, in autumn and winter, patients with this affective disorder more often develop depressive states, and in the spring, manic episodes are observed. This existing connection between the season and the demonstrated phase can be explained by the ongoing changes in solar activity and the corresponding changes in the serotonergic and dopaminergic systems of the body.

It should be noted that the overwhelming majority of patients with manic-depressive psychosis (over 75% of all cases) have other severe disorders. Most often, this psychosis is accompanied by symptoms of generalized anxiety disorder (anxiety neurosis) or isolated phobias.

Manic-depressive psychosis: causes of the disorder

The etiological causes and mechanism of development of manic-depressive psychosis have not been sufficiently studied to date. However, academic minds have put forward several plausible hypotheses about the origin of bipolar affective disorder, which have been confirmed in clinical psychiatric practice. Accumulated data show that the influence of genetic factors in the development of manic-depressive psychosis is approximately 75%, and the contribution of environmental influences and personal characteristics does not reach 25%.

Let us describe the most studied causes of manic-depressive psychosis in more detail.

Reason 1. Genetic tendency to psychotic reactions

A study of the family history of patients with manic-depressive psychosis showed that a child born to parents suffering from affective disorders has a twice as high risk of developing the pathology compared to other children.

To the question of how exactly a predisposition to mental disorders , modern science has no answer. However, a focus of hereditary transmission of a tendency to psychotic reactions has been discovered in the human genome. Also, the genetic cause of this form of psychosis is a deficiency of the G6PD enzyme, observed from generation to generation.

Another reason for the development of manic-depressive psychosis is the age of the parents at which the child was conceived and born. The older the father and mother, the more likely it is that their heir will exhibit symptoms of an affective disorder.

Reason 2. Features of a person growing up

The environment in which a person spent his childhood has a significant impact on the development of personality and his mental health. Conducted studies show that a child who was raised by parents who have certain problems with mental activity very often develops various affective disorders in adulthood. Colossal damage to a child’s psyche is caused by living with adults who suffer from alcoholism or drug addiction, have sexual defects, or suffer from an eating disorder.

Psychologists point out that a common cause of manic-depressive psychosis is the so-called pendulum education. This is a model of parental behavior in which there is no unity of views between mother and father, excessive encouragement alternates with strict punishments, permissiveness is adjacent to prohibitions. Being in conditions of fickle parental opinion, the little person simply does not understand what exactly they want from him. Lack of stability and consistency leads to frequent mood swings, which later becomes the cause of affective disorders.

Reason 3. Features of the personal constitution

Psychologists and psychotherapists have well studied the relationship between mental disorders and the characteristics of an individual’s personal constitution. Accentuated character traits, having reached their maximum, give rise to the development of various psychoses.

Thus, subjects of melancholic, asthenic, depressive constitution, cyclothymic and extroverted types are predisposed to the formation of manic-depressive psychosis . People of the statothymic type are dominated by such qualities as low mood, pessimistic perception of the world around them, excessive hard work, excessive responsibility, exaggerated love of order, and the need for solitude. The basis for the formation of endogenous depression is also the presence of accentuated traits in an individual: pedantry, inflated demands on one’s own person, self-criticism, and a tendency to focus on one’s own shortcomings.

Another cause of manic-depressive psychosis is a deficiency of mental activity and a lack of endurance of the nervous system . Many people suffering from affective disorders have a lack of mental resources necessary for fruitful long-term activity. They get tired of mental stress very quickly, are unable to do monotonous work, and cannot maintain attention on one task for a long period of time. Often, patients with manic-depressive psychosis do not have clear goals for the future and do not have a unified strategy for achieving them.

Reason 4. Failures in internal environmental processes

One of the leading biological causes of endogenous depression is insufficient production of neurotransmitters and a failure in neurotransmitter metabolism. The functions of these active substances are to control the processes of mental activity. A deficiency of norepinephrine, dopamine, and serotonin leads to instability of the emotional state.

A disturbance in the exchange of neurotransmitters causes a distorted perception of reality, provokes chaotic and inconsistent thinking, and causes uncontrolled antisocial behavior. Lack of neurotransmitters is the cause of insufficiency of cognitive and mnestic functions. It is the lack of these substances that is responsible for eating disorders and decreased sexual activity.

A well-studied cause of manic-depressive psychosis is hormonal shocks in the body. Very often, the manifestation of problems in the emotional sphere in women occurs during the menstrual period and menopause. Often, manic-depressive psychosis develops against the background of postpartum depression, which also arises due to intense changes in hormonal status.

Disturbances in the body's natural biorhythm can cause the development of depression. Changes in the regime, pace and intensity of biological processes negatively affect the human psyche. Disruptions in the circadian rhythm are the source of insomnia, frequent waking up at night, and waking up too early. Lack of quality, adequate sleep often causes emotional disruptions, eventually leading to affective disorders. Also, shifts in the circadian rhythm act as specific precursors of an approaching episode of mania in patients with bipolar depression.

Reason 5. Addictions

Alcohol abuse, drug use, and uncontrolled consumption of psychotropic drugs have a detrimental effect on the human nervous system and destroy the mental sphere of the individual. This fact is confirmed by examinations of patients with manic-depressive psychosis. Almost half of patients with this disorder had a personal history of serious alcohol problems, or had previously used drugs or taken psychotropic medications.

Reason 6. Impact of stress factors

Constantly acting low-intensity or one-time severe stress can act as a basis for the development of manic-depressive psychosis. Often the debut of the disorder in patients occurred after serious mental trauma. Psychotraumatic events can be not only phenomena of the negative spectrum, but also situations that are considered to be positive changes. Often, sudden pleasant news greatly shocked a person, leading the nervous system into a state of strong excitement. The lack of sufficient inhibition in the processes of nervous activity gave rise to the development of a state of euphoria, against the background of which the first episode of the manic phase was recorded. However, stressors acting on a person only push towards the onset of affective disorders: they themselves are not the cause of psychosis.

Manic-depressive psychosis: variants of the course of the disorder

Psychiatrists distinguish several forms of this psychosis, defined depending on the dominance of the symptoms of a particular phase. subtypes of manic-depressive psychosis are currently described

• BAR I – the patient has a history of more than one manic or mixed episode and more than one depressive phase;
• BAD II is the presence in a person’s history of at least one severe depressive episode combined with a period of hypomania with high comorbidity with anxiety disorders.

According to the variants of the course of the disease, manic-depressive psychosis is usually divided into types:

• periodic mania (the patient experiences only manic phases);
• periodic depression (the subject develops only depressive episodes);
• regular intermittent (intermittent) type (a phase of mania and an episode of depression alternate sequentially, between which there is an interphase);
• irregularly intermittent type (change of depressive periods and manic episodes occurs through interphase without observing the order);
• double form (an episode of depression is immediately followed by a manic phase, followed by a period of intermission);
• circular view (change of polar phases in the absence of interphase).

The most unfavorable prognosis is for manic-depressive psychosis with a rapid change of phases, which is characterized by the development of at least four affective episodes in the patient during the year. This type of disorder is recorded in a large group of patients - about 45% of all cases.

The average duration of the manic phase is four months, although its duration can range from two weeks to five months. The depression phase in some patients lasts from six months to a year. The duration of interphase can be from three to seven years.

Manic-depressive psychosis: symptoms of the disorder

In the clinical picture of manic-depressive psychosis, the prevailing position is occupied by significant disturbances in the emotional state of a person, defects in the cognitive sphere of the psyche, and pronounced changes in behavior.

Depending on the intensity of the symptoms demonstrated, a manic episode is divided into types: mania and hypomania. In the manic or hypomanic phase, the patient experiences symptoms:

• elevated mood, up to euphoria;
• irritability and nervousness;
• tendency to communicate excessively randomly;
• Conducting a conversation at an accelerated pace of speech;
• speed of thought processes, lack of integrity, inconsistency;
• excessive sexuality;
• impulsiveness and thoughtlessness of actions;
• increasing activity level;
• decreased need for sleep.

A common symptom of the manic phase is a heightened perception of surrounding reality . The person reacts violently and inadequately to appeals addressed to him. He responds quickly to all presented stimuli and does not maintain attention on them for a long time. Another symptom of the manic phase is the appearance of overvalued delusional ideas. The patient significantly exaggerates his capabilities and attributes non-existent advantages. During the manic phase, the patient may demonstrate risky antisocial and immoral behavior. He may become a gambler and lose all his savings. It is often during the manic phase that patients begin to abuse alcohol or take the path of drug addiction.

During depression, symptoms that are diametrically opposed to the painful manifestations of a manic episode prevail. Leading symptoms of the depressive phase:

• reduced, depressed mood;
• vision of the surrounding world as faded, colorless;
• irritability and aggressiveness;
• causeless anxiety, anticipation of misfortune;
• slowness of thought processes;
• difficulty concentrating and maintaining attention on one task;
• loss of activity;
• slow pace of speech, pronouncing phrases in a quiet voice;
• deliberate avoidance of social contacts, preference for solitude.

Alarming symptoms of a depressive episode are the emergence of ideas of one’s own worthlessness and insignificance, and the subsequent development of suicidal thoughts. Frequent symptoms of the depressive phase are chronic fatigue, asthenic condition, lack of energy after sleep. A common complaint of patients is persistent debilitating insomnia. Quite often, in the depressive phase of manic-depressive psychosis, symptoms of changes in eating behavior are observed: the individual loses his appetite and loses weight.

It should be noted that a depressive episode in this form of psychosis is characterized by an increase in the subject’s mood and an improvement in his well-being in the evening.

Manic-depressive psychosis: treatment of the disorder

The dominant position for the effective treatment of manic-depressive psychosis is occupied by timely differential diagnosis of the disorder and the subsequent competent selection of a comprehensive treatment regimen using pharmaceuticals. The primary goal of drug treatment is to relieve the symptoms of the current stage and prevent the occurrence of a polar episode.

Today in psychiatry, the most relevant is a multiphase strategy for drug treatment of bipolar affective disorder , which is based on the stages of therapeutic manipulations, taking into account the stage and severity of symptoms of episodes of depression or mania. Persons suffering from manic-depressive psychosis are prescribed several potent drugs of various pharmacological classes, the use of which must be under the supervision of the attending physician in order to avoid the development of side effects.

Manic-depressive illness is treated with “aggressive” drugs in order to prevent the emergence of drug resistance, while at the same time selecting drugs that have the best tolerance. In the first days of treatment, it is advisable to use the maximum permissible dosages of pharmacological agents.

In the initial stage of treatment of manic-depressive psychosis with high severity of symptoms, the first choice is electroconvulsive therapy, which is especially relevant in the presence of signs of suicidal behavior. In the absence of a threat to life, treatment is usually carried out using mood stabilizers in a dose tolerated by the patient. If necessary, anxiolytics can be added to the treatment program. The inclusion of antidepressants in the treatment regimen in the acute phase of the disorder is a controversial issue. However, if there is no risk of rapidly changing phases of the disorder, patients with a severe depressive episode may be prescribed drugs of this class. Most often, in this situation, treatment is carried out with selective serotonin reuptake inhibitors in combination with powerful atypical antipsychotics.

of cognitive behavioral therapy can be used as psychotherapeutic measures during the recovery phase and in the inversion phase

Manic-depressive psychosis is a difficult disease to diagnose and difficult to treat. Therefore, to overcome the disorder, it is necessary to manage the patient by an experienced doctor, provided that the patient strictly adheres to the recommendations received. Treatment of manic-depressive psychosis in the stage of exacerbation of symptoms takes place in an inpatient department of a hospital.

SUBSCRIBE TO THE VKontakte GROUP dedicated to anxiety disorders: phobias, fears, obsessive thoughts, VSD, neurosis.

TIR Development Mechanism

To date, there is no accurate data regarding the reasons for the development of TIR. According to experts in the field of psychiatry, this disease is multifactorial, which suggests that not only internal but also external factors play an important role . One of the main reasons for the development of manic-depressive psychosis is the influence of heredity. However, exactly how this mental disorder is transmitted is still not known. Repeated studies have not been able to identify how many genes are involved in the transmission of the disease. There is a theory according to which some forms of the disease in question are transmitted through several genes, while others only through one.

MDP is an endogenous disease based on hereditary predisposition

Let's look at the main risk factors:

1. Melancholic personality model – increased sensitivity in combination with restraint in expressing one’s own emotions, accompanied by a rapid loss of performance.
2. Statothymic personality model - characterized by pedantry, responsibility and an increased need for order.
3. Schizoid personality model - manifests itself in the form of emotional monotony, a tendency to solitude and rationalization.

In addition, among the risk factors, experts identify excessive suspiciousness, frequent anxiety and disturbances in psycho-emotional balance.

Also, scientists do not have an answer about the connection between the disease in question and the patient’s gender. According to outdated data, women develop MDP several times more often than men, but recent studies on this topic completely refute this theory.

According to experts who study mental disorders, bipolar disorders are more common in men, while women suffer from unipolar pathologies. The risk associated with the development of MDP in women increases several times with hormonal imbalances caused by BiR, menstrual irregularities or menopause. In addition, there is a possibility of developing manic-depressive psychosis due to mental disorders during childbirth.

The prevalence of this mental disorder is also difficult to estimate, due to the use of different criteria by scientists. According to statistics, at the turn of the twentieth and twenty-first centuries, only half a percent of the population had this disease. Russian researchers say that this figure is much lower and note that only thirty percent of patients with severe psychotic illnesses receive such a diagnosis. According to the latest data provided by WHO, today, symptoms characteristic of manic-depressive psychosis are detected in approximately one percent of the population of our planet.

It is quite difficult to talk about the prevalence of the disease among children due to the inability to use standard diagnostic methods. Often, a disease suffered in childhood or puberty never manifests itself again. Most often, clinical symptoms characteristic of bipolar mental disorder appear between the ages of twenty-five and forty-five years . Such pathologies appear much less frequently in older people.

Patients with MDP make up 3-5% of all hospitalized patients in psychiatric clinics

Etymology of the disease

What manic-depressive psychosis is can be explained in simple words: this is what is commonly called a periodically alternating state of idle euphoria and complete depression .

In psychiatry, experts call this a disease that is characterized by the appearance in a person of two periodically alternating polar states that differ in psychosomatic indicators: mania and depression (positive is replaced by negative).

This disease is often referred to in the literature on psychiatry, which also studies MDP, as “manic depression” or “bipolar disorder”.

Causes of the depressive phase in bipolar affective disorder

The dominant sound vector in negative states plunges a person into depression with all the variety of its symptoms, which are largely a consequence of insufficient realization of the desires of the sound vector. The severity of these conditions depends on the duration and degree of this dissatisfaction, on the degree of self-absorption, on the psychological trauma experienced in childhood and the current circumstances in which the person lives.

When a person also has an anal vector, it can be responsible for stupor, fetal position, catatonic symptoms, the content of delusional statements (resentment, guilt, sinfulness, self-abasement). The skin vector can bring fussiness and flickering, irritable mood into the clinical picture; in the content of delusional statements, these can be delusional ideas of influence. The visual vector sets anxiety and mood swings. It is noteworthy that in the evening there may be some improvement. Night is the “sound” time of day.