Bipolar affective disorder is a type of mental illness that causes abrupt changes in mood. These moods can range from arousal and euphoria (mania), to depression and hopelessness.
This disorder is also called manic-depressive disorder or simply bipolar disorder.
This type of disorder affects mood and behavior: the person goes through extreme emotional states (a lot of energy and euphoria, as well as depression and suicidal thoughts), changing abruptly. Symptomatology goes beyond simple mood swings. These extreme moods are maintained for a while, consistently. The intensity of moods should be significant and lead to discomfort or significant risks to the integrity of the person and/or their environment.
One of the poles is that of mania (or hypomania, one of less intensity than that of mania), which is characterized by intense states of euphoria, agitation and acceleration in people. The other pole is that of depression, which is characterized by strong states of hopelessness, apathy, lack of energy, suicidal ideation, among others.
In mixed cases of bipolarity, manic and depressive behaviors are mixed
Types
There are different types of TAB (Bipolar Affective Disorder). The differences between the types are noticeable and to determine precisely which one is suffered, it is necessary to make an in-depth review, both of the symptoms present, and of the history thereof.
There are two main types of TAB and a third type, cyclothymia (where symptoms are lower intensity for each of the poles, although it also has a great influence on different areas of their lives).
These are problems (both type I and type II) that can occur in adolescence. In fact, in the event of depression in this period, it can be understood as one of the risk factors for bipolarity in the future (though never decisively).
Type I bipolar disorder: This type of disorder is distinguished by having a history of at least one manic episode in the past or present, and can be alternated with stages of depression. Both extremes reach a very high severity, so they can even cause psychotic symptoms (especially in the case of mania).
Type II bipolar disorder: characterized by the presence of at least one hypomaniac phase (of less impact than manic, but with similar expression) and another depressive phase, which are exchanged without an apparent order. For this diagnosis it is necessary that a manic episode has never been previously presented, because otherwise it would be a bipolar disorder type I. Mania could go unnoticed, so making this nuance requires an in-depth analysis of past experiences.
Cyclothymia: equivalent to dysthymia, but from a bipolar point of view, that is, acute phases of mild depression and hypomania would occur, the intensity and/or impact of which did not allow any of them to be diagnosed separately. The situation would be maintained for at least two years, causing disruptions to quality of life and/or participation in significant activities.
Uns specified bipolar disorder: Bipolar disorder may not be able to be classified within the previous three types for different reasons. For example, when episodes of hypomania are recurring. For example, also when the psychologist or psychiatrist is unable to determine whether it is primary, due to medical disease, or because it has been induced by a substance.
The most common subtypes of bipolar disorder include:
Very rapid alternation (in days) between manic symptoms and depressive symptoms that do not meet the minimum duration criterion for a manic episode or a major depressive episode.
Relapsing hypomaniacal episodes without intercurrent depressive symptoms.
A manic or mixed episode superimposed on a delirant disorder, residual schizophrenia, or unsopoked psychotic disorder.
Causes
Its cause is essentially biological and genetic. The limbic system is responsible for regulating emotions and for the state of encouragement to be stable and according to circumstances, that is, it influences us to rise with a state of similar and coherent encouragement. This mood will be more or less stable depending on different aspects such as physical health, rest, daily events, etc.
For people who have bipolar disorder, the limbic system malfunctions, so it suffers from abrupt disturbances in the mood, without a justifying reason.
The neurotransmitters that play a crucial role in this disorder are Dopamine, Serotonin and Acetylcholine. In the maniac phases there is an increase in dopamine and in the depressive, a decrease in Serotonin. Hormones like thyroxine are also important.
The first risk factor, and the cause of most relapses, is to stop taking the medication. Another trigger is alcohol and other toxics. Another would be to sleep less than 7 or 8 hours.
Psychological stress or psychological factors also play an important role as a trigger, i.e. they act as the trigger that triggers a manic or depressive episode, as negative life events can trigger a manic or depressive episode in a person vulnerable to the disease. Positive episodes can also trigger an episode.
Many patients with bipolar disorder start with a manic episode after a misfortune, giving the idea of the extent to which biological factors, more than psychological ones, are decisive in this disease.
Symptoms
Manic and depressive symptoms may appear together. When this happens it is called "mixed episode".
Symptoms in the manic phase:
Constant agitation
Excessive arousal
Perception of greatness
Irritability
Remarkable increase in energy
Increased sexual imposition
Verbiage
Impulsivity
Hyperactivity
Insomnia or lack of sleep
Abnormal enthusiasm
There may be drug abuse
Conduct risky behaviors
They can make harmful and negative decisions for them
Etc.
Expansive or occasionally irritable animo is a common phenomenon of bipolar disorder in any of its subtypes. It is not an exultant joy, nor is it associated with a state of euphoria consistent with an objective fact, but acquires an invalidating intensity and does not correspond to precipitating events that can be identified as its cause.
In type I bipolar disorder, mania is a necessary symptom for diagnosis. It is characterized by a state of extreme expansiveness and omnipotence, which translate into impulsive acts, based on disinhibition and the feeling of invulnerability. The person engages in an activity to the point of forgetting to sleep or eating and engages in acts that involve a potential risk or that can have serious consequences for himself or others.
In bipolar disorder type II, the symptom exists, but does not present the same intensity. In this case, a large expansion is shown in contrast to the mood that is usually shown, acting occasionally in an expansive and irritable way. Despite this, the symptom does not have the same impact on life, as the manic episode (so it is considered a milder version of it). Just as mania is essential for type I bipolar disorder, hypomania is necessary for the diagnosis of type II bipolar disorder.
Symptoms in the depressive phase:
Sadness
Loss of energy
Uncontrollable crying
Changes in appetite
Discouragement
Abulia (boredom)
Slow behavior
Insomnio o hipersomnia
Fatigue
Difficulty making decisions
Loss of sexual appetite
Suicidal thinking (in serious cases)
Etc.
Depressive symptoms can occur in both type I bipolar disorder and type II, but there are important differences between them that need to be taken into consideration.
The first is that in type I bipolar disorder, this symptom is not necessary for diagnosis, even though a very high percentage of people who suffer from it, end up experiencing it sometime (more than 90%).
In bipolar disorder1type II, its presence is mandatory. The person who has it must have experienced it at least once. It tends to arise on a recurring basis, interceding with periods in which the mood takes on a different sign: hypomania. It has been observed that depression in type II is usually more durable than in type I, this being another of its differential features.
In the case of cyclothymia, the intensity of depressive symptoms never reaches the threshold of clinical relevance, contrary to what happens in bipolar disorders type I and II. In fact, this is one of the main ones between cyclothymia and type II disorder.
Psychotic symptoms of bipolar disorders:
Most psychotic phenomena that are linked to bipolar disorder are triggered in the context of manic episodes. In this case, the severity of the symptom can reach the point of breaking the perception of reality, so that the person forms beliefs of delusional content regarding his or her abilities or personal relevance (considered to be someone so important that others should address it in a special way or ensure that there is a relationship with well-known figures of art or politics , for example).
In hypomaniacal episodes, associated with type II bipolar disorder, sufficient severity is never observed for such symptoms to be expressed. In fact, if they appeared in one in a person with bipolar disorder type II, they would be suggestive of what is actually being suffered is a manic episode, so the diagnosis should be changed to a bipolar type I disorder.
Craze
Manic episodes are periods when the person experiences an abnormally high mood of mood, which manifests as euphoria overflowed. Sometimes the symptom can acquire a nuance of irritability, showing a critical attitude towards others or yourself and reacting abruptly to circumstances of the environment that might make you feel upset.
To talk about mania, the mood must be prolonged to the child for a week and that due to its intensity, conditions the ability to develop normally the daily responsibilities. It can compromise working or academic life and even require time to hospitalize in order to avoid possible harm to yourself or others
Features:
1. Exaggerated self-esteem or grandiosity
One of the defining characteristics of mania is the inflation of the perception that the person projects on himself, which undergoes an expansion that pushes all the limits of reasonable. The exaggeration of one's worth can be accompanied by the devaluation of others. This symptom acquires its maximum expression through the sense of omnipotence, which harbors unrealistic beliefs about one's abilities and can be associated with risky behaviors for life or physical integrity.
2. Decreasing the need for sleep
People who travel through a manic phase can abruptly reduce their time sleeping (limiting it to 3 hours or less) and even keep watch for whole nights. This is due to the need to engage in activities and the occasional belief that one's dream is an unnecessary waste of time.
3. Taquilalia or speech acceleration
Another feature of a manic episode is the substantial increase in speech latency, with a much higher word output than is common in periods between episodes.
Alterations may arise such as:
Derailment: a speech without an apparent common thread.
Tangentiality: addressing issues irrelevant to the central issue being addressed.
Distracted speech: change of subject in response to stimuli found in the environment and grabbing attention.
Word salad: in the most serious cases, an alteration of verbal communication may break out, in which the content of the speech is devoid of any hint of intelligibility, so the interlocutor feels unable to appreciate its meaning or intention.
4. Tachypsichia or acceleration of thought
The acceleration of thought or tachypsichia connects with the increase in the rate of verbal production. Both aspects are firmly interconnected, such as that the commitment to the integrity of mental content will result in an affected speech. This pressure of thought overwhelms a person's ability to translate it into operational terms for efficient use, observing what is known as a "brainstorming".
This leak of ideas implies disorganization in the hierarchy of priorities of thought, so that the discourse with which a conversation began (and which has a clear communicative intention), is interrupted by a cluster of second ideas that overlap each other in a chaotic way and end up diluting into a fast-paced flow of mental content that flows into an ocean clutched with unconsex words.
5. Distractibilidad
People who experience a manic phase of bipolar disorder may see certain superior cognitive functions altered, particularly attentional processes. Under normal circumstances, they are able to maintain relevant selective attention, giving greater relevance to the elements of the environment that are necessary for proper operation based on contextual keys.
In mania there is an alteration in this filtering process, so that the various environmental stimuli would compete to hoard the resources available to the person, making it difficult for the behavior to express themselves in adaptive terms.
6. Increased intentional activity
In mania there is usually a peculiar increase in the level of general activity of the person. You can spend most of your time performing any task that arouses your interest, be in such a way that you seem not to feel fatigue despite the time elapsed.
7. Impulsivity
It is the difficulty in inhibiting the urge to issue a particular behavior, in the presence of a triggering stimulus and implies the impossibility of stopping it at the time it is underway. It is one of the symptoms that has great descriptive power in manic episodes and is one of those that generates greater prejudice about personal and social life.
In the manic phase, the person often makes risky decisions whose consequences involve a profound impairment of his economic or fiduciary resources.
Depression
There is a set of suggestive signs that depressive symptoms may not be related to an underlying major depression, but to the depressive phase of a bipolar disorder that has not yet shown its true face. None of them, by itself, is sufficient to have absolute certainty but together provide relevant information in terms of probability and should be supplemented by rigorous clinical judgment.
Distinctive features of bipolar depression (which differentiates from unipolar depression):
1. Previous episodes of major depression
Major depression is a condition that tends to occur recurrently throughout life, so most people who have experienced it will once again experience it with high probability in the future. Such relapses are much more common in the specific case of bipolar disorder, where the depressive symptom occurs periodically but very difficult to predict (acute episodes longer than that of maniacs or hypomaniacs).
It is important to delv into personal history, the evolution of mood over the years, and determine the possible existence of vital periods of the past in which depression may have developed. This is an ideal time to explore the possible history of manic symptoms (if the latter are detected, it is essential to suspect bipolar disorder and avoid antidepressant drugs).
2. Presence of atypical depressive symptoms
Although depression usually occurs with sadness and inhibition in the ability to feel pleasure (anhedonia), along with a reduction in total sleep time (insomnia) and a loss of appetite, it can sometimes manifest itself with atypical symptoms, which are different from those that would be foreseeable in those who are depressed, but are common in depressive stages of bipolar disorder.
These symptoms include hypersomnia (increased need for sleep), increased appetite, excessive irritability, restlessness or inner nervousness, physiological hyperreactivity in difficult environmental circumstances, fear of rejection, and accentuated feeling of physical and mental fatigue. All of them are, as a whole, a differential pattern from that of major depression.
3. Recurring depressive episodes before age 25
A weighed review of personal history may object to the appearance of a first episode before age 25. Symptoms of depression are commonly expressed during adolescence, even though they will be masked behind a waterproof facade of irritability. These premature episodes are also more common in bipolar disorder.
4. Briefness of depressive episodes
Depressive episodes of bipolar disorder are shorter than major depression as an independent entity (which often lasts for six months or more). It is considered that the confirmed presence of three or more depressive episodes during life, especially when they occurred in youth and were short-lived (three months or less), may be suggestive of bipolar disorder.
5. Family history of bipolar disorder
The presence of a family history of bipolar disorder may be a cause for suspicion as it has a high genetic component. Direct relatives of a person with bipolar disorder should be cautious when they suffer from what appears to be a major depression because it could be a depressive stage of bipolar disorder.
6. Rapid introduction of depressive symptoms in the absence of stressors
Major depression tends to be the affective result of the experience of an adverse event, which poses significant losses to the person in relevant areas of their life, identifying themselves as the time point from which there was a noticeable change in internal experience. This cause-and-effect relationship can be plotted with relative simplicity in major depression, and when the triggering event is resolved, a frank improvement in emotional state tends to occur.
In the case of bipolar disorder, it is most common for depressive symptomatology to arise without the person being able to identify an obvious reason for it and to be established very quickly. It seems to sprout inadvertently, which also creates some sense of loss of control over mood fluctuations.
7. Presence of psychotic symptoms
Depression can occasionally acquire psychotic dyes characterized by delusional guilt or hallucinations whose content is consistent with negative emotional state. This form of depression is more common in the context of bipolar disorder and is a cause for suspicion. Impulsivity, when it coexists with depression, points in the same direction as these symptoms.
It is essential to note that the presence of psychotic symptoms along with depression may be part of a schizoafective picture, which will have to be ruled out during a diagnostic process.
DIFFERENCES BETWEEN TYPE I AND TYPE II
Distribution by sex
There is evidence to suggest that major depression is the most common problem with mood disorders and is more common in women than in men.
However, bipolar disorder has slight differences from this trend: men and women often develop type I bipolar disorder, but it does not occur with II. In this case, women are the most at-risk population, as is cyclothymia. They are also more prone to changes in mood associated at the time of year (seasonal sensitivity).
Prevalence
This disorder affects 1% of the population and most often affects people between the age of 15 and 25. This disorder is a major mental health problem.
Type I bipolar disorder is slightly more common (0.6%), than type II (0.4%), so it is a relatively common health problem. if both modalities are added at once, 1% of the population may develop it).
Number of episodes
It is estimated that the average number of episodes of mania, hypomania or depression that the person will suffer throughout his or her life is nine. However, those who use illegal drugs have an increased risk of re-experimenting with clinical reversals in their mood.
In some cases, some people may express a peculiar course for their bipolar disorder, which shows a high number of acute episodes, both mania, hypomania or depression. These are fast cyclers, which present up to four clinically relevant ones in each year of their lives.
Severity
Many people might think that type II bipolar disorder is less severe than type I (because manic symptoms are higher), but that's not really true. Subtype II should never be considered as the mild form of bipolar disorder. In both cases, there are significant difficulties in daily life and therefore there is a general consensus on their equivalence in terms of severity.
While in subtype I the episodes of mania are more serious and their presence is mandatory and psychotic episodes may arise during the maniac phases; in subtype II depression is the most severe, its presence is mandatory and its duration is longer than that of type I.
As can be seen each of the types has its peculiarities, so it is the key to articulate an effective and personalized therapeutic procedure that respects the individuality of the person who suffers from them.
HOW TO HELP A PERSON WITH BIPOLAR DISORDER
Help him accept his disorder: the sooner we get the person to accept that he or she has a pathology, the closer we are that he or she is willing to seek the necessary help.
Understanding depressive and manic states: We must understand the behaviors of subjects when they are going through some polar crisis of this disorder. We must not judge or treat the subject as a bad person or someone who does not deserve our respect for serious problems.
Learn to recognize indicators: When a subject is close to switching from one polarity to another, certain indicators that anticipate it often occur. It's important to recognize what they are. It is useful animal to the person to recognize in itself these warning signs.
Accompany you to therapy: the fact that we are willing and available to accompany the subject to therapy, means for them an extra motivation. In addition, we will prevent the person from feeling lonely.
Monitor your medication: Patients with bipolar disorder should be in control in conjunction with the psychologist and psychiatrist. Medication is essential for the subject to remain stable. You have to make it possible to check whether or not you take your medication.
Spend quality time with the person: People with bipolar disorder are not easy to maintain long, stable personal relationships. It is important to spend quality time with these people and be facilitated by the process of relating.
Avoid tense situations in front of the subject: it is advisable to always try to maintain an attitude of assertiveness and respect with people with bipolar disorder, because moments of tension can be triggers of manic or depressive behaviors.
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