Bipolar disorder, also known as bipolar disorder or manic-depressive illness, is a mental disorder characterized by periods of mania and depression. Mania and depression are opposite periods of exacerbation and remission. The mania period is a period in which the person experiences excessive and exaggerated enthusiasm, feels energetic, the need for sleep decreases, feels better, more important and stronger than he is, and his mood is very high. Depression is a period of depression dominated by worthlessness, unhappiness, pessimism, lack of pleasure, and sometimes accompanied by thoughts of death. Except for periods of illness, the person almost returns to normal. In some patients, symptoms that partially affect life may be observed. Although it varies in different societies, it is seen with an average frequency of 1.5%. It is 7 times more common in people with bipolar disorder in their first-degree relatives than in the general population. The age of onset is usually 20-30. The majority of bipolar patients experience their first attacks in late adolescence. It is not always possible to determine the age of onset. Especially if the first symptoms are a depressive episode, the period between recognition and application for treatment is long.
It is seen with similar frequency in men and women. While rapid cycling (4 or more attacks per year) and eating disorders are often accompanied by it in women, in men the disease begins with a manic episode and is accompanied by alcohol abuse/dependence and behavioral problems. Women are at risk for exacerbation of the disease in the first 4 weeks after birth. Attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder and substance use disorders are also common in 40-90% of childhood bipolar disorder patients.
SYMPTOMS
During the manic period; There are intense thoughts about the subject.
The person is very talkative, overly active and enthusiastic.
She may wear colorful clothes and excessive make-up. He may shop/spend money unnecessarily. He may have strange behavior. He easily communicates with people he doesn't know and is sincere, but the relationship is superficial. He may make inappropriate gestures and jokes.
His flow of thought is rapid, that is, he thinks quickly, jumps from topic to topic while talking, and experiences flight of ideas.
He has high self-confidence, is superior in his own way, and is more grandiose than most people.
He has a contagious cheerfulness. Most of the time, they have behaviors and speeches that will make the other person smile. But sometimes joy can be replaced by anger.
Sleep decreases, weight loss occurs, and one becomes exhausted after a while due to his energetic behavior.
Professional and social functionality decreases.
During depression;
/> Their emotional state is dominated by unhappiness, pessimism and hopelessness.
They feel worthlessness, guilt and regret.
An inability to enjoy and not want to do the work and activities they used to do occurs.
Insomnia, loss of appetite, weight loss. There is a decrease in sexual desire.
Thoughts of death and suicide may accompany it.
Depression symptoms sometimes differ from the typical clinical picture. Sleeping too much (hypersomnia) and hyperphagia (overeating) may be observed.
In the mixed period;
It is the co-occurrence of at least three symptoms of depression in addition to a full mania picture. Elevated and exuberant mood, irritability, anger, anxiety, depression, mood swings It is characterized by playfulness, talkativeness, agitation, insomnia and grandiosity. It is more common in women and the risk of suicide is higher.
DIEASE PROCESS AND OUTCOME
Bipolar disorder usually begins with a depressive episode. In 90% of patients, illness periods (episodes) recur after the first manic attack. As a person ages, the time between periods of illness tends to shorten. While the majority of patients are able to fully return to their level of functioning between illness episodes, some continue to experience interpersonal and occupational difficulties. Rapidly cycling illness periods, premorbid low functionality, history of substance and alcohol use disorder, maladaptive psychosis during the illness Experiencing symptoms is associated with poor prognosis. The risk of suicide is 15 times higher than in the general population and usually occurs during depression.
ASSOCIATION WITH OTHER MENTAL DISORDERS AND MEDICAL DISEASES
50-70% of patients with bipolar disorder are accompanied by another mental illness. It is most commonly accompanied by 'Anxiety Disorders' (anxiety) and then substance and alcohol abuse/addiction. In the presence of accompanying mental illnesses, it is predicted that the course of the disease will be worse, the inadequacy in professional functions will be more evident, and the disease periods will be more severe. Bipolar disorder is accompanied by 28% migraine, 58% overweight, 10% type II diabetes and 10% hypothyroidism. It does. Comorbid medical illnesses are more common in women. The reason for obesity in these patients is lack of exercise, excessive carbohydrate consumption, use of antipsychotic medication and accompanying eating disorders.
TREATMENT
With appropriate treatment in bipolar disorder patients, significant mood fluctuations and accompanying disease symptoms can be improved. On the other hand k Without treatment, the course of the disease worsens, the period between attacks becomes shorter, manic and depressive periods become more severe, and the well-being in the non-disease period is partially replaced by ongoing symptoms. With treatment, one can lead a life with less severity of disease and a higher quality of life.
The treatment approach includes treatment of the acute period and a preventive treatment process after the situation subsides. The main goals during the acute mania period are to quickly control risky behaviors and relieve symptoms. When deciding where, how and with what to treat the patient, the current situation characteristics of each patient should be considered one by one. If it is a first attack, if there is behavior that is harmful to oneself and the environment, and if one is unable to comply with outpatient treatment, hospitalization should be considered. If there is insight into the disease, family support is sufficient and medication compliance is available, outpatient treatment can be planned. In acute mania, treatment is given with drugs called 'mood stabilizers', 'antipsychotics' and 'benzodiazepines'. In some special cases, Electroconvulsive therapy (ECT) is planned. In addition to antidepressants, mood stabilizers are preferred during depression, and antipsychotics and ECT are preferred in the presence of psychotic findings. Bipolar disorder is a disease with a very high risk of recurrence. Two-thirds of patients relapse within five years. In addition, preventive treatment is required due to the risk of suicide, the presence of concurrent diseases such as alcohol and substance use disorders that accompany the disease periods, and interpersonal problems. Mood stabilizers are preferred in preventive treatment. Preventive treatment is usually started after the second attack. However, the presence of severe and psychotic findings in the first episode of the disease period causes severe behavior during the disease period. It can also be started after the first attack of the disease if there are work problems, the behavior is at a level that can have serious consequences in vital or psychosocial areas, the patient is in a socially critical period, there is a family history of the disease, the quality of life is impaired, and the person wants preventive treatment.
In addition to drug treatment, psychosocial intervention techniques are also applied as a support. Psychoeducation is necessary to support compliance with medication treatment, educate the patient and family, inform them about drug side effects, understand and overcome resistance to accepting the disease, and relieve concerns. Again, family-focused therapies are applied to provide and increase family support, to raise awareness about the disease and to recognize attacks at an early stage, and to change critical and negative attitudes. Individual psychotherapies are also used to gain insight into the disease, regulate the person's daily activities, minimize interpersonal problems and increase medication compliance. Finally, bipolar disorder patients cannot interpret the liveliness experienced especially during the mania period in favor of the disease. For this reason, the patient should be consulted by a physician when symptoms are noticed by family and friends.
Read: 0
