Psychotherapist Elizaveta Meshkova of the Dawn Clinic explains what bipolar disorder is and how it differs from ordinary mood swings, why it needs to be controlled. He also tells how loved ones can help a person with a disorder and why people should stop being afraid to talk about their diagnosis.
- Bipolar affective disorder (BAR; formerly known as manic-depressive psychosis) is a mental illness that occurs with severe, often unusual mood swings. Periods of good mood, “recovery” (manic episodes) alternate with periods of depressed, depressed state, the general level of activity decreases, energy disappears (depressive episodes). Less pronounced manic episodes, in which there are no strong moods and symptoms of psychosis (delirium, hallucinations), are called hypomania.
In contrast to the normal mood spikes characteristic of every person, with bipolar disorder, differences are so pronounced that they affect the person’s daily life, his ability to work, study, and communicate.
During depressive and manic episodes, people with BAD can commit rash and even fatal acts: lose their family, attempt suicide. In bipolar disorder, mood swings are cyclical, often these changes are seasonal and not related to external circumstances.
Photo: shutterstock. com
According to the American classification of mental illness DSM5, there are two options for the course of bipolar disorder: BAR 1 and BAR 2.
The first is characterized by at least one manic episode, which lasts at least seven days. Depressive episodes last for at least two weeks. In BAR 2, episodes of hypomania lasting at least four days are replaced by episodes of "major" depression.
BAR develops at a young age. The average age of manifestation of the disease is 25 years.
Bipolar disorder is often found in childhood, adolescence.
According to world statistics, 1-3% of people suffer from bipolar disorder. In Russia - about two million people. The number of men and women with BAD is approximately the same.
Bipolar disorder has two phases: mania and depression. Mania is characterized by high, often irritable mood. The need for sleep decreases (a person can sleep 2-3 hours a day, at the same time feel sleepy in the morning), speech is accelerated, many thoughts and ideas “jump” in the head (“the language does not keep up with thoughts”), anxiety and agitation appear ( excitement, excited state .-- Approx.ed.
In the manic phase, people with BAD often commit strange, impulsive, rash acts: lose money, sell real estate, change their place of residence, make many random acquaintances.
Often during manic episodes, people abuse psychoactive substances, alcohol and are prone to impulsive suicides. Mania can provoke real psychosis, a complete loss of connection with reality. A person can hear voices, broadcast delusional ideas that correspond to his high spirits.
Most often these are thoughts of one's own greatness and power.
Photo: shutterstock. com
Mania is a serious condition requiring hospitalization in a psychiatric clinic. Depression is a bad mood, a feeling of sadness, irritability or anger, loss of interest in once beloved activities, irrational feelings of guilt, hopelessness, problems with concentration, decreased or increased appetite ("seizure of melancholy"), pronounced problems with sleep, lack of cheerfulness , thoughts of death and suicide. In depression, people stop going outside, taking care of themselves, meeting friends, and chatting with family.
In severe cases during depression, symptoms of psychosis in the form of hallucinations and delusions are also observed.
A modern view of BAR implies the presence of "mixed" episodes in which there are simultaneously symptoms of mania and depression. For example, a person may have thoughts of his own greatness, interspersed with feelings of guilt and thoughts of suicide. Mixed episodes are considered the greatest risk factor for suicidal and parasuicidal behavior (self-harm, cuts).
It is not clear to the end why bipolar disorder occurs. Modern researchers agree that the development of this disease is strongly influenced by genetic factors - about 85% of cases of BAD are of a genetic nature. Risk factors also include childhood violence and prolonged stress.
BAR is a fully clinical diagnosis. This means that special laboratory or instrumental studies that help in the diagnosis do not exist.
The main tool of the doctor is a detailed collection of anamnesis and symptoms of the disease. The most effective method for recognizing BAR is a conversation not only with a person who is suspected of having a disorder, but also with his family and friends, who may indicate other symptoms. The diagnosis is determined according to the diagnostic criteria for classifying diseases; rating scales and tests can help.
Photo: shutterstock. com
BAD is considered a chronic disorder.
There is no method that can completely cure this disease. Why so, world medicine still does not know.
To control the symptoms of BAR and, above all, to even out mood, three groups of drugs are used: normotimics (most often these are drugs for treating epilepsy and lithium), antipsychotics (drugs used to stop psychotic symptoms) and antidepressants. Often, the appointment of all three groups of drugs is required - for better disease control.
Side effects are present in all groups of drugs, and they can be quite pronounced.
The doctor’s task is to choose a therapy regimen so that the patient has as few side effects as possible and the effectiveness of the therapy is not affected. This requires a lot of time, patience and patient confidence in your doctor.
Cognitive-behavioral psychotherapy is considered the gold standard for a person with BAR throughout the world, where he is taught to be aware of his problems and treat the disease correctly, which also helps to control it. In Europe and the USA, there are support groups for people with bipolar disorder, where they receive counseling, materials on illness, contacts of psychiatrists and psychotherapists.
If the BAR is under medical and psychotherapeutic control, there are no special restrictions in the daily life of a person.
An exception is the use of drugs that affect driving.
Photo: shutterstock. com
First of all, relatives should be aware that the person is sick. Do not explain his behavior, for example, by laziness or bad education, but clearly understand that this is a disease and it requires treatment. Therefore, psycho-education is very important - the attending physician should talk about the disease, methods of its control, and prognoses.
It is necessary to track changes in the state of a person with BAD and report them to specialists who work with him.
But not always a person with bipolar disorder is aware of his illness and turns to specialists. This is a fairly common problem; nowhere else in the world have we learned how to solve it 100%. Information is what helps accept reality. Therefore, if loved ones suspect a person of a mental disorder, they need to talk more about this disease so that the person knows about its existence, so that it understands that BAD is not a myth, but a real problem that you can live and cope with.
Of great importance is the behavior of doctors. It is necessary to honestly and openly tell patients about their diagnosis, talk about forecasts, provide links to quality literature, to support groups.
In Russian society there is a rather serious stigmatization of many diseases, and here mental illness, in my opinion, comes first. "Crazy", "idiot", "down" have long become obscene words. To admit to people that you are suffering from a mental illness means to become an outcast.
But it is impossible to eliminate this stigma without starting to say that mental illness is a very common disorder. Many people live with BAD, depression, schizophrenia. They need help, and to get this help, you need to ask for it and openly talk about the problem.