Bipolar Disorder

Treatment

For the treatment of bipolar disorder, drugs from different groups are used: 
Lithium preparations, Antiepileptic drugs (Valporate, Carbamazepine, lamotrigine), Antipsychotics (Quetiapine, Olanzapine), Antidepressants and Tranquilizers.

Psychotherapy:
Psychosocial support and psychotherapeutic measures can significantly help in the treatment of bipolar disorder. However, they cannot replace drug therapy. To date, there are specially developed techniques for the treatment of arbs that can reduce interpersonal conflicts, as well as somewhat “smooth out” cyclical changes in various environmental factors (for example, daylight hours, etc.).
Various psychoeducational programs are carried out in order to increase the patient's awareness of the disease, its nature, course, prognosis, as well as modern methods of therapy. This helps to establish a better relationship between the doctor and the patient, adherence to the therapy regimen, etc. In some institutions, various psychoeducational seminars are held, at which the above issues are discussed in detail.
There are studies and observations showing the effectiveness of the use of cognitive-behavioural psychotherapy in conjunction with drug treatment. Individual, group or family forms of psychotherapy are used to reduce the risk of relapse.
Today there are cards for self-registration of mood swings, as well as a self-control sheet. These forms help to quickly track changes in mood and timely adjust therapy and consult a doctor.

Phototherapy:
Phototherapy is actively used for seasonal affective disorder (sad). There is no scientific evidence that the method helps with bad, but it is assumed that sad and bad can be combined with each other. Phototherapy is often used because it is relatively safe, but it must be remembered that the method will not help with affects.
 

Tests Required for Diagnosis

Mania: 

A manic episode is characterized by an inappropriately elevated mood that can range from nonchalant gaiety to almost uncontrollable excitement. The elevation of mood is accompanied by increased energy, leading to hyperactivity, speech pressure, and reduced need for sleep. The patient becomes immune to social inhibition, does not hold attention, marked distractibility, increased self-esteem, over-optimistic ideas and ideas of greatness are easily expressed. Perceptual disturbances may occur. The patient may perform extravagant and impractical acts, spend money thoughtlessly, or be aggressive, amorous, hypersexual, playful in inappropriate circumstances.
Criteria for a manic episode (three or more symptoms; four if one of the symptoms is irritability):
•    Increased self-esteem, a sense of self-importance;
•    Reduced need for sleep;
•    Increased talkativeness, desire to strike up conversations;
•    "Flight of thought";
•    Instability of attention;
•    Increased social, sexual activity, psychomotor excitability;
•    Involvement in risky transactions with securities, thoughtlessly high spending, etc.

Hypomania: 

Hypomania is a mild degree of mania that is not accompanied by psychotic symptoms (delusions or hallucinations). Patients have a constant slight rise in mood (at least for several days), increased energy and activity, a sense of well-being. Also, increased social activity, talkativeness, familiarity, hypersexuality, and reduced need for sleep are often noted. Women often put on excessive make-up on their faces, wear unusual and bright clothes. These symptoms do not lead to serious disturbances in work or social rejection of patients. Sometimes, instead of the usual cheerful mood, irritability, increased conceit and rude behavior can be observed. According to the dsm-iv, to diagnose hypomania, symptoms must have been present for at least 4 days.
Major depressive disorder:
Major depressive disorder is the phase of depression, patients usually stay most of their lives. Thus, patients with type I bipolar disorder are on average 32% of the time in a state of depression and 9% in a state of mania/hypomania. Patients with bipolar ii disorder spend 50% of their time in the depressed phase and only 1% in a state of hypomania. Depression is usually the first symptom of bipolar disorder, especially in women. The risk of suicide in this phase is maximum.

Criteria for a depressive episode (five or more symptoms that do not resolve within two weeks, at least one of the symptoms is either depressed mood or loss of interest in life):
• Depressed mood for most of the day, almost every day on its own (eg, sadness, feelings of inner emptiness, tearfulness); in children and adolescents, an irritable mood may be a symptom of depression;
• Noticeably reduced interest in life in everything (almost everything) that happens most of the day 
• Significant loss in body weight, even if the patient is not on a diet (weight loss of more than 5% per month), or sharp fluctuations in appetite;
• Insomnia or drowsiness;
• Psychomotor agitation or lethargy;
• Feeling of tiredness;
•Feelings of worthlessness or excessive guilt (may be delusional);
• Decreased attention, inability to concentrate;
• Constant thoughts of death, suicidal thoughts in the absence of a special plan or suicide attempt, the presence of a suicide plan.
Mixed episodes
Mixed manic-depressive episodes are conditions that meet the criteria for both mania and depression and have been symptomatic for more than 7 days. Mixed episodes can occur at any stage of the disease, and their occurrence is considered a predictor of poor patient prognosis.
Cyclothymia

Cyclothymia is characterized by the presence of prolonged subdepressive and hypomanic symptoms. Severe depressive disorders or mania are absent. Cyclothymia is diagnosed if, for at least 2 years, the patient has experienced frequent bouts of depressed mood, alternating with bouts that meet the criteria for hypomania. Subsequently, cyclothymia can transform into a typical bipolar disorder.

Rapid cycling
The criterion for rapid cycling is the presence of at least 4 episodes of bipolar disorder per year with partial or complete remission between them or a direct switch from one polarity to another (from mania to depression or vice versa). Rapid cycling occurs in approximately 10–15% of patients. Rapid cycling is more common in the later stages and is commonly seen in women with bipolar ii disorder. Rapid cycling can be induced by hypothyroidism, alcohol, skull trauma, multiple sclerosis.

Complications of manic-depressive psychosis
Lack of necessary treatment can lead to dangerous consequences:
•    Suicide;
•    Alcoholization;
•    Committing actions that can be dangerous both for the patient himself and for others (when the patient is in a manic state).
Treatment of manic-depressive psychosis
Bipolar affective disorder should be treated by a qualified psychiatrist. Psychologists (clinical psychologists) in this case will not be able to cure this disease.
According to the clinical guidelines adopted by the russian society of psychiatrists, the treatment of bipolar disorder is divided into three main stages:
•    Cupping therapy - aimed at eliminating existing symptoms and minimizing side effects;

•    Maintenance therapy - preserves the effect obtained at the stage of stopping the disease;

•    Anti-relapse therapy - prevents relapses (appearance of affective phases).

Useful info

It is possible to prevent a rapid change of phases only by medical methods. First of all, normotimics (one or two drugs) are used. Patients with bipolar disorder should not take antidepressants, which lead to rapid phase changes, so it is very important that the drugs are selected by a doctor.

Can it be completely cured?
Maintenance therapy is recommended for life, because the symptoms of the disease may return after a while. However, if the patient insists and there is a stable remission, then the medication can be canceled. Stop taking medications should be gradual and only under the supervision of a psychiatrist.

Bipolar disorder during pregnancy:
Separately, it should be said about the development of bad during pregnancy. This disorder is not an absolute contraindication for pregnancy and childbirth. The most dangerous is the postpartum period, in which various symptoms can develop.
The question of the use of drug therapy during pregnancy is decided individually in each case. It is necessary to evaluate the risk/benefit of the use of drugs, carefully weigh the pros and cons. Also, psychotherapeutic support for pregnant women can help in the treatment of arbs. If possible, drugs should be avoided during the first trimester of pregnancy.  
Prognosis:
The prognosis of bipolar affective disorder depends on the type of course of the disease, the frequency of phase changes, and the severity of psychotic symptoms, as well as the patient's adherence to therapy and control of his condition. Thus, in the case of well-chosen therapy and the use of additional psychosocial methods, it is possible to achieve long-term intermissions, patients adapt well socially and professionally.