Bipolar disorder, also known as manic depression, is a mental health disorder characterised by a
swinging variation in mood. Sufferers experience both episodes of elation and depression. The
condition may significantly impact an individual's ability to function, frequently causing
detrimental effects on home, school and work-life. Amongst the worst cases, episodes of self-harm
or suicide may be present. Up to 20% with bipolar disorder successfully commit suicide,
an unacceptably high number. Therefore, improving our understanding
of this mental health condition is imperative to help us identify
the signs in ourselves and our loved ones. So, want to learn more about bipolar disorder?
Keep watching as we will break down here. So, let us talk about mental health.
My name is Dr Hart-Pinto. In this series,
we aim to break down the social barriers to mental health.
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Ok so what is Bipolar Disorder?
Bipolar disorder, previously known as manic depression, belongs to a group of mental health
conditions known as mood disorders. This condition gains its name from patients swinging polarities
in mood, ranging from elation to depression. The term BIPOLAR literally means the two opposites.
Some consider the symptoms of bipolar disorder to be the most severe and persistent amongst
psychiatric illnesses. The condition can have a significant impact on the individuals
social and family life. Suicidal thoughts and attempts can emerge in the most severely affected.
Who gets Bipolar Disorder? Approximately 1 in 100 people
will be diagnosed with bipolar disorder at some point in their lives.
Suggesting this condition is relatively common. The condition equally affects men and women,
usually presenting during the late teens to early twenties. The condition may affect people from
all ethnicities and walks of life. Why, exactly, bipolar disorder occurs
is not fully understood; however, we think the condition results from abnormalities
in the brain's biochemistry. Bipolar disorder tends to run in families, suggesting the presence
of a genetic link. No single gene is responsible for the condition, and a complex interplay of
genetic and environmental factors is likely. Several factors can trigger episodes of
bipolar disorder, including: • Stressful life events
• Poor sleep and, • Physical illness.
What do people with bipolar disorder experience?
People with Bipolar disorder experience fluctuations in their mood,
from elation to depression. Symptoms of bipolar disorder will, therefore, depend
on which mood you are currently experiencing. So, let’s look at symptoms of elation known as
mania or manic episodes. Whilst everyone will naturally experience periods of elation in their
life, like when exposed to happy events, manic episodes are different. During manic episodes,
individuals experience feelings of being very high and overactive. Symptoms are persistent
and often out of context with current events.
Patients may express rapid changes in mood from highs to irritability or even anger.
We can break down episodes, dependant on severity, into two groups Hypomania and Mania.
Hypomania • > 3-day history
of persisting mild elevation in mood • Individuals feel more energetic and
show increased levels of activity. • A resulting knock-on effect on
their sleep patterns may occur as individuals experience a reduced
sensation of tiredness or need to rest. • Individuals during the manic phase are
more talkative, overfamiliar and may demonstrate an increased sex drive, also known as libido.
Mania • Definition of mania includes;
greater than one week of mood elation or increased irritability. In Manic episodes,
there is a significant impact on day-to-day life. • Again, patients demonstrate increased levels of
energy associated with a significant reduction in sleep and the potential for exhaustion.
• An increase in sexual disinhibition causes sexually explicit behaviour, including flirtation,
inappropriate touching or sexual propositioning. • Individuals may go on to experience
psychotic symptoms including: o Auditory hallucinations
o Significant grandiose delusions • Individuals may experience the feeling
of increased creativity and intelligence, often resulting in grandiose delusions.
o Common delusions include the presence of superhuman powers,
a requirement to complete a mission or the belief in great wealth.
o Individuals may go on to spend large sums of money, which can lead to considerable debts.
During episodes of elation, patients may dress inappropriately, frequently in bright or even
outlandish colours. There may be a notable deterioration in personal hygiene at this time.
Generally, an individual's insight into episodes of mood elation is poor.
Separate episodes of depression will occur. Individuals will display the same symptoms as
those experiencing clinical depression, discussed in an earlier lecture and linked here. Depression
also can have dramatic implications on everyday life. Doctors characterise
depression as a pervasive, unshakable low mood, plus a reduced interest in normal activities.
We have previously taken a detailed look at the symptoms of depression in a previous video.
If you want to learn more, I will provide a link in the description below.
How will my doctor diagnose my Bipolar Disorder?
Bipolar disorder can be one of the trickier psychiatric conditions to diagnose,
given the vast variation in symptoms patients have on initial presentation.
However, your GP or primary care physician will suspect Bipolar Disorder where you demonstrate
a mixture of symptoms including; hypomania, mania and depression.
Symptoms must have been present for at least two weeks. To confirm the diagnosis
of Bipolar disorder, your doctor will request a review by a specialist in mental health.
Your doctor will want to rule out any other medical causes for your symptoms. A review of your
prior medical history and any other psychiatric conditions and medications you
are taking is imperative. Additionally, your doctor will want to rule out any undiagnosed
physical illness, including thyroid disorders, and therefore is likely to request blood tests.
Treatment
The recommendation for treatment will vary based on the nature of the episode you are experiencing.
As always, the best treatment includes shared decision making between you and your doctor.
During episodes of acute mania, most patients will require inpatient hospital admission under
specialist psychiatric care. For many cases, hospital admission is compulsory
due to the potential risks of harm. During acute episodes, specialists prescribe
a trial of benzodiazepines or antipsychotic medications. These medications aim to regain
control of your symptoms quickly. If you develop symptoms of mania whilst taking antidepressants,
your psychiatrist will stop this medication. Antidepressants could potentially worsen
any manic episodes. If your mania symptoms remain poorly
controlled, a second antipsychotic medication or lithium, a mood stabiliser, can be taken.
Following the resolution of your acute manic episode, your psychiatrist may offer
long term lithium. Lithium is an effective mood stabiliser that aims to prevent relapses.
After commencing lithium, you will require regular monitoring. Lithium levels are measured, via
a blood test, one week after starting treatment and weekly until the levels are stable. Once your
specialist is happy with your level, monitoring is required every three months. Additionally,
every six months, the doctor will monitor your body mass index (BMI), blood salt and calcium
levels, kidney function and thyroid function. Whilst lithium is an excellent mood stabiliser
this medication may not be effective in everyone. Some will require the addition of
a second medication such as sodium valproate. For patients unable to tolerate lithium an
alternative combination therapy with sodium valproate plus an antipsychotic is available.
The management of depressive episodes in bipolar patients is usually in the form of:
• Quetiapine or • Fluoxetine combined with olanzapine or
• Olanzapine or • Lamotrigine
Additionally, psychotherapies can also prove beneficial in the management of depressive
symptoms. Prognosis
Unfortunately, no cure exists for bipolar disorder. The natural history of bipolar
disorder means relapse is likely, with individuals expected to experience an average of 10 episodes
in their lifetime. The chance of recurrence within 12 months of the initial episode is around 50%.
However, most relapses are associated with poor medication compliance.
Understandably, the strain on social and work life can occur for some individuals. Thus,
the condition may significantly impact the quality of life of those experiencing this condition
Conclusion
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Outro
Of course, this video does not provide individual medical advice
and is intended for informational purposes only.
Do not consider this as a substitute for professional medical advice,
diagnosis or treatment. Please do not ignore professional
medical advice in seeking treatment because of something you have heard here.
If you believe you may have a medical emergency, immediately call your doctor or ambulance service.