Also called bipolar affective disorder in Turkish, better known as manic-depressive illness, is a psychiatric disease that expresses the unusual change of a person's mental state from one extreme to the other. On one side of this extreme is mania and on the other side is depression. In this article we will review the manic part of this disease. Happiness and sadness are natural emotions we feel when we experience different excitements and difficulties in the course of life. However, in bipolar disorder, these feelings become extremely exaggerated. It may harm a person's family, work or social life or lead to legal problems. Sometimes it may require hospitalization and treatment.
HOW DO WE RECOGNIZE A MANIC EPISODE
Manic period; It is known for the persistence of an unusual, different mood period in which one is angry. This unusual mood period lasts at least 1 week.
In order to diagnose bipolar disorder during the manic period, at least 3 of the following symptoms must be present:
- Increased self-esteem or thoughts of grandiosity (people may talk about feeling on top of the world)
- Decreased need for sleep.
- Pressed speech, being more talkative than usual , jumping from one subject to another Excessive involvement in activities that may cause harm (spending excessive money, making reckless sexual advances, or making unnecessary business investments) This disorder leads to deterioration in professional life, social activities, or relationships with others. To oneself or to others Hospitalization may be required to prevent it from harming someone.
The most common types of bipolar disorder are; bipolar I and bipolar II. Bipolar I; Bipolar II with cycles of mania and depression; It is characterized by cycles of hypomania and depression. In 50-60% of cases, a manic episode begins immediately after a depression, and mania without a history of depression is extremely rare. The most noticeable symptoms of the manic period are; Patients are initially social, sympathetic, self-confident, and very talkative people; it is difficult to interrupt their conversations.
Their conversations may be full of jokes and irrelevant topics. As the severity of the disease increases, conversations may become louder, faster, and harder to follow. They can get angry easily and become aggressive and threatening. They can be seductive and hypersexual. They may dress in colorful, eye-catching clothes and wear exaggerated make-up.
They feel very active and euphoric. They can get involved in more than one project and spend large amounts of money without planning or calculating the necessity and feasibility. They may make too many unnecessary purchases and get into debt. Changes in sleep patterns may be a clue to recognize bipolar disorder. During mania, sleep time is greatly reduced. People feel rested and energetic with 2-3 hours of sleep. One of the reasons that triggers the disease is the disruption in the sleep-wake cycle. This symptom, seen before a manic attack, is important in warning us that an attack is coming. In 50-60% of cases, a manic episode begins immediately after a depression. A decrease in mood may also occur following the manic episode. Patients feel great sadness and grief and lose their desire for all activities. Sometimes they may withdraw into themselves and develop suicidal thoughts. Between manic and depressive periods, mood may be normal or close to normal. During this period, the day They can continue their daily lives and work without any problems.
- What is the difference between Mania and Hypomania?
Manic period; He experiences the above symptoms for at least 1 week (any period if hospitalization is required)and in addition, the disease is accompanied by psychotic symptoms (hallucinations, delusions, paranoia) can. In hypomania, symptoms last 4 days or less and are not severe enough to require hospitalization. These symptoms can lead to a person being more functional and productive than ever before. Increased energy, better concentration, being more social, etc.) This stage of the disease sometimes appeals to the patient and reduces the desire to continue treatment.
WHO IS BIPOLAR DISORDER
The lifetime prevalence of bipolar disorder is 1-2%. Although it is seen equally frequently among men and women, severe bipolar disorder is more common in women. The type of bipolar disorder called rapid cycling, which is characterized by having more than four manic episodes a year, is also more common in women. Mood disorders are more common in first-degree biological relatives of people with bipolar disorder than in the general population. Although it is known that it is a hereditary disease, an exact inheritance mechanism has not been identified. In individuals with a genetic predisposition, stress, serious life traumas, stimulant drugs and substances, and insomnia may trigger the emergence of the disease. No laboratory findings are diagnostic of bipolar disease or manic-hypomanic episode. More than90%of people with a single manic episode have a mood-renewing episode. Bipolar disorder is more common in high-income countries and in low-income countries. It is more common than other countries. It is more common in people who are separated, divorced or widowed than in people who are married or have never been married. The average age of onset is around the 20s for both men and women. Bipolar I disorder (type with episodes of mania and depression) is generally recurrent. The majority of people who have a single manic episode may subsequently experience a depressive or manic episode again. Challenging life events, changes in sleep-wake patterns, use of alcohol or psychoactive substances affect the course of the disease, disrupt and prolong the healing process.
CAN A NEW ATTACK BE PREVENTED?
Although some bipolar disorder has seasonal characteristics; It is often unpredictable when a new attack will begin, such as manic periods that begin in the spring months. However, some measures can be taken to reduce the occurrence of acute attacks. Accepting the disease and maintaining a regular lifestyle, avoiding stress, staying away from alcohol and psychoactive substances, paying attention to sleep patterns and duration, following the recommended treatment without skipping doses, etc.
TREATMENT
Treatment has two parts: acute and preventive treatment. In the acute period, when the symptoms of the disease are intense, the aim is to control and quickly soothe these symptoms. During this period, hospitalization may sometimes be required. Preventive treatment aims to prevent the recurrence of the disease. Three groups of drugs have a place in the treatment of bipolar disorder. These; mood stabilizers, antipsychotics and antidepressants. Education and psychotherapy are also important in treating the disease and preventing relapses.
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