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Manic personality disorder. Bipolar disorder: causes, symptoms, treatment

Bipolar affective disorder is a disease included in the list of mental disorders. Previously, the medical term “manic-depressive psychosis” was used, which more clearly reflects the condition of a sick person for ordinary people. But be that as it may, the disease exists and it is necessary to recognize the symptoms in time in order to undertake adequate treatment.

Surely most of the readers have encountered a person whose mood, ability to work, and intelligence often change. For example, an excellent employee suddenly loses the basic skills of his favorite activity, and a capable student completely loses knowledge of his favorite subject. Often the condition creates a lot of moral problems for those around the patient, whose condition can lead to suicide. This is bipolar affective disorder - manic depressive psychosis. There is an opportunity to influence the patient, and there are also preventive measures that minimize the risk of developing a mental disorder. The risk group includes children at puberty, high school students, and people in the pension category.

Bipolar affective disorder was formerly called manic-depressive psychosis

Determining this disease is very problematic. In sick individuals, there is a disruption of the emotional state in completely opposite poles. Most of us, or to be more precise, everyone, experiences a sharp change in mood, a change from performance to fatigue, and without any good reason. But there is nothing unnatural about this. As for people suffering from bipolar disorder, their condition when the emotional factor is disturbed can last for months, years, and severe depression and mania occur.

How to determine BAR

To know the “enemy” by sight, you need to study the term “bipolar affective disorder”, what kind of condition it is, leading to dangerous consequences. This disease affects approximately one and a half percent of the world's population. The problem in diagnosis arises from poorly manifested signs. Patients turn to doctors, and often, they are taken to a specialist by relatives only a few years after the first symptoms. In some patients they can appear maximum 1-2 times a year, in others almost every day. And most of those who suffer from the disease bipolar affective disorder (BAD) do not understand that they have been overtaken by a serious illness. The disease is characterized by manic and depressive states, and they often accompany a person at the same time.

Bipolar personality disorder: causes

This disease is endogenous in nature. The development of the condition is influenced by both external stimuli and the following points:

Genetic predisposition. When diagnosing a mental illness, experts note that the pathology was present or observed in the patient’s relatives. According to medical statistics, the disease is transmitted from parents in approximately 50% of cases. In addition to this illness, children may develop other mental pathologies.
Has a great influence on the human psyche environment. External stimuli can play the role of a trigger for the development of mental pathology. These include:
Head injury. A concussion can cause disruption of intercellular ligaments and necrosis of entire sections of brain tissue.
Infectious diseases. Meningitis, encephalitis and other diseases destroy brain cells and disrupt the balance of hormones.
Poisoning. When intoxicated, toxic substances and decay products from the death of healthy and pathogenic cells enter the human blood, causing oxygen starvation and a lack of optimal blood supply.
Stress, psychological trauma. After traumatization of the psyche, not only the illness we describe often arises, but also other, serious mental disorders.

Important: one cannot assume that these factors directly cause bipolar affective disorder ICD 10; they only provoke the disease if it is genetic.

Stress may cause bipolar disorder

Bipolar affective disorders: how they manifest themselves

Manic-depressive psychosis, the second name for bipolar disorder, manifests itself either in the form of depression or mania, and sometimes in a combination of two forms at the same time.

For example, a person can be cheerful, overly talkative, optimistic, talk with enthusiasm about his plans, but usually it does not come to true action. A short period passes, and he becomes gloomy, whiny, and incapacitated. Moreover, he loses not only moral, but also physical strength, the ability to remember and think is lost. This person sees the future only in black, gloomy colors, thoughts of suicide arise. For those who do not know what bipolar affective disorder is, this is a clear example. To understand the details, you need to understand each type of psychosis.

Depressive phase of bipolar affective disorder

Depressive episodes are characterized by the following manifestations:

depressed mood;
inhibition of thinking;
fatigue, delay in movement.

The main symptom is a depressed mood. The condition is not affected by any positive news or events, be it the birth of a child, a wedding, a meeting with a loved one, etc. When talking with a doctor, such patients express their condition with words: sad, sad, “sick” at heart.

Inhibited thinking is manifested by difficulty in assimilating information and reproducing it. Previously beloved, mental work has now become a real test, the patient is not able to concentrate, plan, or make decisions.

Important: depression worsens in the morning; it is at this time that the risk of suicide is high. Therefore, it is necessary to be near the patient before waking up or immediately after it.

Depressive phase- bipolar affective disorder, the symptoms of which are supplemented by a complete loss or excessively increased appetite, increased sexual desire. When an illness occurs, the patient’s self-esteem drops, self-confidence, and faith in one’s strengths and capabilities are lost.

Affective personality disorder: manic episodes

This type of pathology is the complete opposite of the depressive phase of the disease. Unlike patients suffering from depression who understand the seriousness of their situation, representatives of the second type rarely consult a doctor on time. They are not able to be critical of the failure in their own psyche; they do not understand what consequences bipolar personality disorder and the symptoms of a dangerous illness can lead to.

A manic state manifests itself in this way:

a person’s mood sharply increases;
the pace of thinking increases;
psychomotor activity is excited.

Increased sex drive in bipolar disorder

During the next phase of the disease, people become overly optimistic, their own self-esteem is inflated, they are not afraid of anything or anyone. You can recognize a sick person if you pay attention to the following points:

he becomes overly talkative and sociable;
anxiety and excessive activity appear;
unable to concentrate on one thing, constantly distracted;
the patient sleeps little;
Sexual desire increases, while intelligibility in sex partners decreases;
behavior becomes reckless and irresponsible.

Before making a diagnosis, it is necessary to exclude such persons from taking psychotropic medications, drugs, after which the clinical picture is similar to bipolar pathology.

BAR - bipolar affective disorder: diagnosis

An experienced doctor must examine psychotic signs, an important factor in the successful treatment of the condition. The following symptoms may occur with BA:

delusions of grandeur, delusional hallucinations of an erotic nature, delusions of persecution;
delusions of a nihilistic nature - denial of the obvious, delusions of guilt, hypochondria, etc.

For an accurate diagnosis, a complete anamnesis is required, taking into account all the details of the disease, including information about the mental state of the patient’s relatives.

It is important for a specialist to establish the form and course of the disease, to find out whether manic or depressive states have been observed before. If so, how long did the mania or depression last, and did remissions occur? Based on information and criteria indicating the patient’s condition and the severity of signs of the disease, the doctor makes a diagnosis.

Depending on what symptoms appeared earlier and how the attacks (phases) proceeded, the specialist distinguishes two types of bipolar disorder:

1st type The disease is diagnosed if the patient has already had previous episodes (manic). This does not take into account depressive phases. Type 1 symptoms are more common in men.
2nd type manifested by a predominance of depressive phases combined with rare episodes of mania. Females are more susceptible to this type.

Bipolar disorder: complications

Patients with bipolar disorder are primarily a danger to themselves. In advanced stages, without proper treatment, they make repeated suicide attempts.

The depressive phase is a constant self-flagellation, a state of grief, melancholy, sadness. Many of us have heard the expression “Cats scratch your soul.” So, in patients with bipolar disorder, this condition lasts from several days to many years. Agree, it is impossible to live with this without adequate therapy.
The manic phase also causes anxiety. Inflated optimism, high self-esteem, promiscuity in sexual intercourse leads to sexually transmitted diseases, intractable diseases, HIV, AIDS, etc. Don't forget about the financial side of the issue. Excessive activity and the desire to conquer business heights can lead to serious expenses, and as a result - loans, debts, unfulfilled obligations to serious people.

Bipolar affective disorder: treatment

At the first signs of a mental disorder, you should consult a doctor. You should not postpone a visit to a specialist if your relatives exhibit symptoms. As we already know, advanced phases can lead to life-threatening consequences for the patient and those around him.

Important: bipolar affective disorder is a mental disorder that cannot be treated independently at home, or with the help of dubious representatives of alternative medicine.

The methods of influencing types and phases are radically different. Treatment of bipolar personality disorder should be comprehensive: medication and psychotherapy.

Bipolar affective disorder should be treated by a psychotherapist

Medical pharmaceuticals used to eliminate the symptoms of bipolar disorder include:

Neuroleptics: eliminate dangerous symptoms, anxiety, hallucinations, delusional states. Doctors often prescribe haloperidol, rispaxol, and quetiapine.
Antidepressants: prescribed both to prevent and relieve a depressive mood. The number of items is huge, they are prescribed according to symptoms, effectiveness, taking into account side effects. Popular drugs: amitriptyline, fluoxetine, fluvomaxin, sertraline, etc.
Timostabilizers: regulate a person’s mood, reduce the severity of opposite vibrations. Previously, drugs of this type were used to eliminate seizures during epileptic seizures and other conditions. During research, experts discovered the ability of thymostabilizers to normalize the course of bipolar disorder. Among the effective agents are carbamazepine, lithium salt, valproate, which are used not only as treatment, but also as prevention of personality disorder.

Bipolar affective disorder: psychotherapy

In recent years, psychotherapy has been widely used; it can be both individual and general. It all depends on what symptoms bother the patient and what brings maximum discomfort in life.

Important: many people think about the question of whether bipolar disorder can be treated only with psychotherapy. Sessions with a psychotherapist are an additional type of treatment; without the use of medications there will be no successful effect.

When communicating with a patient, the doctor can make an accurate diagnosis, identify the main problems, and make it possible to realize the dangerous consequences of the actions taken. Thus, the patient can reevaluate and rethink his life and actions.

As for the relatives of patients, the doctor helps them understand the diagnosis of bipolar affective disorder, what happens to patients, improve the situation in the family, resolve conflict situations and concentrate on the most important thing - helping a loved one suffering from bipolar disorder.

Bipolar affective personality disorder: treatment methods

Psychotherapists most often use the cognitive-behavioral method of influence. During treatment, the specialist teaches the patient to identify problems that aggravate the condition, destructive behavior, and replace a negative perception of reality with a positive one. Thanks to such changes, the patient learns a new approach to life, overcomes difficult circumstances with minimal harm to his own psyche. Manic-depressive psychosis (bipolar affective disorder) requires careful study by the patient. He must understand the nature of the disease, the significance of the prescribed drugs and sessions.

Bipolar disorder: how to move on

There is no need to be upset or panic if you are diagnosed with bipolar disorder. This disease has a favorable prognosis. Most, with adequate therapy, feel stable remission - symptoms are absent or appear in a mild form, which no one notices, including the patient himself.

The prognosis for a diagnosis of bipolar disorder can be quite favorable.

Unlike schizophrenia and other mental disorders that cause changes in character and personality - indifference, lack of emotions, initiative - with bipolar disorder everything is more favorable. Only during acute phases do inadequate mental states arise; during remission, nothing betrays the disease. If you strictly follow your doctor’s recommendations, take medications on time, and attend psychotherapy sessions, the number of attacks will be reduced to a minimum, and stable remission will persist for years.

Bipolar disorder (bipolar affective disorder, manic-depressive psychosis) is a mental disorder that is clinically manifested by mood disorders (affective disorders). Patients experience alternating episodes of mania (or hypomania) and depression. Periodically, only mania or only depression occurs. Intermediate, mixed states can also be observed.

The disease was first described in 1854 by French psychiatrists Falret and Baillarger. But it was recognized as an independent nosological unit only in 1896, after Kraepelin’s works devoted to a detailed study of this pathology were published.

Initially, the disease was called manic-depressive psychosis. But in 1993 it was included in the ICD-10 under the name bipolar affective disorder. This was due to the fact that psychosis does not always occur with this pathology.

There are no exact data on the prevalence of bipolar disorder. This is due to the fact that researchers of this pathology use different evaluation criteria. In the 90s of the 20th century, Russian psychiatrists believed that 0.45% of the population suffered from the disease. The assessment of foreign experts was different - 0.8% of the population. Currently, it is believed that symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease takes on a severe psychotic form. There are no data on the incidence of bipolar disorder in children, which is due to certain difficulties in using standard diagnostic criteria in pediatric practice. Psychiatrists believe that in childhood episodes of the disease often go undiagnosed.

In approximately half of patients, the onset of bipolar disorder occurs between 25 and 45 years of age. In middle-aged people, unipolar forms of the disease predominate, and in young people, bipolar forms predominate. In approximately 20% of patients, their first episode of bipolar disorder occurs after age 50. In this case, the frequency of depressive phases increases significantly.

Bipolar disorder is 1.5 times more common in women than in men. At the same time, bipolar forms of the disease are more often observed in men, and monopolar forms in women.

Repeated attacks of bipolar disorder occur in 90% of patients, and over time, 30–50% of them permanently lose their ability to work and become disabled.

Causes and risk factors

Diagnosis of such a serious illness must be trusted to professionals; experienced specialists at the Alliance clinic (https://cmzmedical.ru/) will analyze your situation as accurately as possible and make the correct diagnosis.

The exact causes of bipolar disorder are not known. Hereditary (internal) and environmental (external) factors play a certain role. In this case, the greatest importance is given to hereditary predisposition.

Factors that increase the risk of developing bipolar disorder include:

schizoid personality type (preference for solitary activities, tendency to rationalize, emotional coldness and monotony);
Statothymic personality type (increased need for orderliness, responsibility, pedantry);
melancholic personality type (increased fatigue, restraint in expressing emotions combined with high sensitivity);
increased suspiciousness, anxiety;
emotional instability.

The risk of developing bipolar disorder in women increases significantly during periods of unstable hormonal levels (menstrual bleeding, pregnancy, postpartum or menopause). The risk is especially high for women with a history of psychosis suffered during the postpartum period.

Forms of the disease

Clinicians use a classification of bipolar disorders based on the predominance of depression or mania in the clinical picture, as well as the nature of their alternation.

Bipolar disorder can occur in a bipolar (there are two types of affective disorders) or unipolar (there is one affective disorder) form. Unipolar forms of pathology include periodic mania (hypomania) and periodic depression.

The bipolar form occurs in several variants:

regularly interspersed– a clear alternation of mania and depression, which are separated by a light interval;
irregularly intermittent– the alternation of mania and depression occurs chaotically. For example, several episodes of depression may occur in a row, separated by a light interval, and then manic episodes;
double– two affective disorders immediately replace each other without a clear interval;
circular– there is a constant change of mania and depression without clear intervals.

The number of phases of mania and depression in bipolar disorder varies among patients. Some people experience dozens of affective episodes throughout their lives, while for others such an episode may be the only one.

The average duration of the bipolar disorder phase is several months. At the same time, episodes of mania occur less frequently than episodes of depression, and their duration is three times shorter.

Initially, the disease was called manic-depressive psychosis. But in 1993 it was included in the ICD-10 under the name bipolar affective disorder. This was due to the fact that psychosis does not always occur with this pathology.

Some patients with bipolar disorder experience mixed episodes, which are characterized by rapid alternation between mania and depression.

The average duration of the clear interval in bipolar disorder is 3–7 years.

Symptoms of Bipolar Disorder

The main symptoms of bipolar disorder depend on the phase of the disease. So, the manic stage is characterized by:

accelerated thinking;
uplifting mood;
motor excitement.

There are three degrees of severity of mania:

Mild (hypomania). There is an elevated mood, an increase in physical and mental performance, and social activity. The patient becomes somewhat absent-minded, talkative, active and energetic. The need for rest and sleep decreases, and the need for sex, on the contrary, increases. Some patients experience not euphoria, but dysphoria, which is characterized by the appearance of irritability and hostility towards others. The duration of an episode of hypomania is several days.
Moderate (mania without psychotic symptoms). There is a significant increase in physical and mental activity, and a significant increase in mood. The need for sleep almost completely disappears. The patient is constantly distracted, cannot concentrate, as a result, his social contacts and interactions are difficult, and he loses his ability to work. Ideas of greatness arise. An episode of moderate mania lasts at least a week.
Severe (mania with psychotic symptoms). There is pronounced psychomotor agitation and a tendency to violence. Jumps of thoughts appear, the logical connection between facts is lost. Hallucinations and delusions develop, similar to the hallucinatory syndrome in schizophrenia. Patients become confident that their ancestors belonged to a noble and famous family (delusion of high origin) or consider themselves a famous person (delusion of grandeur). Not only the ability to work is lost, but also the ability to self-care. Severe mania lasts over several weeks.

Depression in bipolar disorder occurs with symptoms opposite to those of mania. These include:

slow thinking;
low mood;
motor retardation;
decreased appetite, up to its complete absence;
progressive loss of body weight;
decreased libido;
Women stop menstruating and men may develop erectile dysfunction.

With mild depression due to bipolar disorder, patients' mood fluctuates throughout the day. It usually improves in the evening, and in the morning the symptoms of depression reach their maximum.

The following forms of depression may develop in bipolar disorder:

simple– the clinical picture is represented by a depressive triad (depressed mood, inhibition of intellectual processes, impoverishment and weakening of impulses to action);
hypochondriacal– the patient is confident that he has a serious, deadly and incurable disease, or a disease unknown to modern medicine;
delusional– the depressive triad is combined with delusions of accusation. Patients agree and share it;
agitated– with depression of this form there is no motor retardation;
anesthetic– the prevailing symptom in the clinical picture is a feeling of painful insensibility. The patient believes that all his feelings have disappeared, and in their place an emptiness has formed, which causes him severe suffering.

Diagnostics

To be diagnosed with bipolar disorder, a patient must have had at least two episodes of mood disorders. Moreover, at least one of them must be either manic or mixed. To make a correct diagnosis, the psychiatrist must take into account the patient’s medical history and information received from his relatives.

Currently, it is believed that symptoms of bipolar disorder are characteristic of 1% of people, and in 30% of them the disease takes on a severe psychotic form.

The severity of depression is determined using special scales.

The manic phase of bipolar disorder must be differentiated from agitation caused by taking psychoactive substances, lack of sleep or other reasons, and the depressive phase – from psychogenic depression. Psychopathy, neuroses, schizophrenia, as well as affective disorders and other psychoses caused by somatic or nervous diseases should be excluded.

Treatment for Bipolar Disorder

The main goal of treating bipolar disorder is to normalize the patient’s mental state and mood and achieve long-term remission. In severe cases of the disease, patients are hospitalized in the psychiatry department. Mild forms of the disorder can be treated on an outpatient basis.

Antidepressants are used to relieve a depressive episode. The choice of a specific drug, its dosage and frequency of administration in each specific case is determined by a psychiatrist, taking into account the patient’s age, the severity of depression, and the possibility of its transition to mania. If necessary, the prescription of antidepressants is supplemented with mood stabilizers or antipsychotics.

Drug treatment of bipolar disorder in the stage of mania is carried out with mood stabilizers, and in severe cases of the disease, antipsychotics are additionally prescribed.

In the remission stage, psychotherapy (group, family and individual) is indicated.

Possible consequences and complications

If left untreated, bipolar disorder can progress. In a severe depressive phase, the patient is capable of making suicidal attempts, and during a manic phase he poses a danger both to himself (accidents due to negligence) and to the people around him.

Bipolar disorder is 1.5 times more common in women than in men. At the same time, bipolar forms of the disease are more often observed in men, and monopolar forms in women.

Forecast

In the interictal period, in patients suffering from bipolar disorder, mental functions are almost completely restored. Despite this, the prognosis is unfavorable. Repeated attacks of bipolar disorder occur in 90% of patients, and over time, 30–50% of them permanently lose their ability to work and become disabled. In approximately every third patient, bipolar disorder occurs continuously, with minimal duration of light intervals or even their complete absence.

Bipolar disorder is often combined with other mental disorders, drug addiction, and alcoholism. In this case, the course of the disease and the prognosis become more severe.

Prevention

Measures for the primary prevention of the development of bipolar disorder have not been developed, since the mechanism and causes of the development of this pathology have not been precisely established.

Secondary prevention is aimed at maintaining stable remission and preventing repeated episodes of affective disorders. To do this, it is necessary that the patient does not voluntarily stop the treatment prescribed to him. In addition, factors that contribute to the development of exacerbation of bipolar disorder should be eliminated or minimized. These include:

sudden changes in hormonal levels, endocrine system disorders;
brain diseases;
injuries;
infectious and somatic diseases;
stress, overwork, conflict situations in the family and/or at work;
violations of the daily routine (insufficient sleep, busy work schedule).

Many experts associate the development of exacerbations of bipolar disorder with a person’s annual biorhythms, since exacerbations occur more often in spring and autumn. Therefore, at this time of year, patients should especially carefully adhere to a healthy, measured lifestyle and the recommendations of their doctor.

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Causes of bipolar disorder

Most experts agree that there is no one global reason why a patient develops bipolar disorder. Rather, it is the result of several factors that influence the occurrence of this mental illness. Psychiatrists identify several reasons why bipolar disorder develops:

genetic factors;
biological factors;
chemical imbalance in the brain;
external factors.

As for the genetic factors that influence the development of bipolar disorder, scientists have made certain conclusions. They conducted several small studies using the personality psychology method on twins. According to doctors, heredity plays an important role in the development of manic-depressive psychosis. People who have a blood relative with bipolar disorder are more likely to develop the disease in the future.

When it comes to biological factors that can lead to bipolar disorder, experts say that brain abnormalities are often observed when examining patients diagnosed with bipolar disorder. But so far doctors cannot explain why these changes lead to the development of serious mental illness.

Chemical imbalances in the brain, especially with regard to neurotransmitters, play a key role in the occurrence of various disorders, including bipolar disorder. Neurotransmitters are biologically active substances in the brain. Among them are, in particular, the most famous neurotransmitters:

dopamine;
norepinephrine.

Hormonal imbalance can also trigger the development of bipolar disorder.

External or environmental factors sometimes lead to the formation of bipolar disorder. Among environmental factors, psychiatrists distinguish the following circumstances:

excessive alcohol consumption;
traumatic situations.

Symptoms of Bipolar Disorder

Symptoms during the manic stage include the following:

a person feels like the ruler of the world, feels euphoric and is too excited;
the patient is self-confident, he has an excessive sense of self-importance and increased self-esteem prevails;
doctors note a distorted perception in the patient;
a person is distinguished by fast speech and an excess of phrases;
thoughts come and go at high speed (so-called racing thoughts), eccentric statements are made; patients sometimes even begin to embody some strange thoughts in reality;
during the manic stage, a person is sociable and sometimes aggressive;
the patient is capable of committing risky actions, has promiscuous sex life, alcoholism, he can use drugs and participate in dangerous activities;
the individual may be careless with money and spend it excessively.

Symptoms during the depressive stage of bipolar include the following:

the patient feels despondency, despair, hopelessness, sadness, and his thoughts are gloomy;
in severe cases, the patient is visited and he can even take certain actions to carry out what is planned;
doctors note insomnia and sleep disorders;
the patient often experiences anxiety over trifles;
the personality is often overwhelmed by a feeling of guilt about all events;
the depressive phase of bipolar disorder is reflected in food intake - a person eats either too much or too little;
patients note weight loss or, conversely, weight gain;
the patient complains of fatigue, weakness, apathy;
the person has attention problems;
the patient is easily susceptible to irritants: noise, light, smells, reacts to tight clothing;
some patients are unable to go to work or study;
a person notices that he has lost the ability to enjoy activities that previously brought joy.

Psychosis

During both the manic and depressive stages of bipolar disorder, the patient may experience psychosis, when a person cannot understand where the fantasies are and where the reality in which he is located.

Symptoms of psychosis in bipolar disorder are as follows:

illusions;
hallucinations.

Clinical depression or major depressive disorder

Clinical depression is often a seasonal phenomenon. It used to be called seasonal affective disorder. There are mood swings depending on the time of year.

Symptoms of bipolar disorder in children and adolescents:

sudden change of mood;
attacks of anger;
outbursts of aggression;
reckless behavior.

It is important to remember that manic depression is treatable and exists. The symptoms of this mental illness can be reduced with the right approach, and thus the person can return to normal life.

Diagnosis of bipolar disorder

When diagnosing bipolar disorder, a psychiatrist or psychologist is guided by his previous work experience, his observations, conversations with family members, colleagues, close friends, teachers, as well as knowledge of secondary signs of this mental illness.

First, it is necessary to study the physiological state of the patient, do a blood and urine test.

Experts distinguish three common types:

1) The first type of bipolar disorder, the so-called expression of emotions in the mirror

There must be at least one episode of the manic phase of bipolar disorder or a mixed phase (with a previous depressive phase). Most patients experienced at least one depressive episode.

In addition, in this case it is important to exclude clinical affective disorders that are not associated with manic-depressive psychosis, for example:

schizophrenia;
delusional disorder;
other mental disorders.

2) The second type of bipolar disorder

The patient has experienced one or more episodes of depression and at least one episode of hypomanic behavior associated with manic depression.

Hypomanic states are not as severe as manic states. During the hypomanic stage, the patient sleeps little, he is assertive, easy-going, very energetic, but at the same time is able to perform all his duties normally.

Unlike the manic stage of bipolar disorder, during the hypomanic stage, doctors do not observe symptoms of psychosis or delusions of grandeur.

3) Cyclothymia

Cyclothymia is a mental affective disorder in which the patient experiences mood swings, ranging from vague depression to hyperthymia (sometimes even episodes of hypomania occur). Hyperthymia is a persistent elevated mood.

In general, such mood swings with cyclothymia are a mild form of manic-depressive psychosis. Moderate depressive mood is often observed.

In general, a patient with symptoms of cyclothymia feels that his condition is quite stable. At the same time, other people notice his mood swings, ranging from hypomania to a manic-like state; then depression may occur, but this can hardly be called major depressive disorder (clinical depression).

Treatment for Bipolar Disorder

The goal of treatment for bipolar disorder is to reduce the frequency of manic and depressive episodes as much as possible, and to significantly reduce the symptoms of the disease so that the patient can return to normal life.

If the patient does not undergo treatment and symptoms of the disease remain, this can last for one year. If a patient is being treated for manic-depressive psychosis, improvement usually occurs in the first 3-4 months.

At the same time, mood swings still remain a hallmark of patients diagnosed with bipolar disorder who are undergoing treatment. If a patient regularly communicates with his doctor and goes to an appointment, then such treatment is always more effective.

Treatment for bipolar disorder usually involves a combination of several therapies, including medications, exercise, and work with a psychologist.

Nowadays, a patient is rarely hospitalized with symptoms of manic-depressive psychosis. This is only done if he might cause harm to himself or others. Then patients are in the hospital until improvement occurs.

Lithium carbonate is most often prescribed long-term to reduce mania and hypomania. Patients take lithium for at least six months. You must strictly adhere to the psychiatrist's instructions.

Other types of therapy for bipolar disorder include the following:

anticonvulsants;
neuroleptics;
valproate and lithium;
psychotherapy;

Anticonvulsants are sometimes prescribed to help a person in the manic stage of bipolar disorder.

Antipsychotics are aripiprazole, olanzapine and risperidone. They are prescribed if a person behaves too restlessly and the symptoms of the disease are severe.

In what cases are valproate and lithium carbonate prescribed? Doctors use this combination of drugs in rapid cycling.

Rapid cycling is a form of bipolar disorder in which the patient experiences 4 or more episodes of mania or depression per year. This condition is more difficult to treat than varieties of the disease with less frequent attacks, and requires special selection of medications. According to some studies, more than half of patients suffer from this form of the disease.

In general, a sign of rapid cyclicality is unbalanced behavior in a person diagnosed with “manic-depressive psychosis” all the time, and there is no norm in his behavior for a long time. In such cases, psychiatrists prescribe valproate in combination with lithium. If this does not bring the expected effect, the doctor recommends lithium carbonate, valproate and lamotrigine.

The goal of psychotherapy is to:

relieve the main symptoms of bipolar disorder;
help the patient understand the main provoking factors that lead to the disease;
minimize the impact of the disease on relationships;
identify the first symptoms that indicate a new round of the disease;
look for those factors that help you stay normal the rest of the time.

Cognitive behavioral therapy is training the patient in psychological self-help techniques and a type of family therapy. Psychiatrists talk to the patient and his family about how to avoid exacerbation of bipolar disorder.

Interpersonal (or interpersonal therapy) also helps patients with symptoms of depression. Interpersonal psychotherapy is a type of short-term, highly structured, specifically focused psychotherapy. It is based on the working principle of “here and now” and is aimed at resolving the problems of the current interpersonal relationships of patients who suffer.

Manic disorders in a person, in most cases, manifest themselves in an excessively slightly elevated mood, excessive physical activity, as well as an unnatural acceleration of movements and speech.

A mild form of manic disorder is called hypomania. During the entire life cycle, a person can experience only depressive phases, the so-called depressive disorder, and an alternation of depressive and manic episodes, and only manic phases with phases of complete recovery between them. The presence of only episodes of manic disorders with periods of recovery is called manic-depressive psychosis.

People suffering only from manic disorders experience mild depressive states, which manifest themselves in the form of decreased activity. But even while in a depressive phase, a person shows increased activity and accelerated speech for several days. Human hypomania and mania are not as common as depression. Based on this, most patients do not know that they have the disease, seeking medical help only when they are depressed. When making a diagnosis, the doctor first of all excludes a somatic disease, which may be a cause of the disorder.

Symptoms of a person’s mania develop quite quickly, in most cases, within a few days. At the early stage of manic disorder, which is distinguished by its moderation, the patient is in a better mood than in most cases, looks more vibrant, youthful and full of energy. The person is in a state of euphoria, but perhaps picky and irritable. From time to time, there are cases of outright hostility and aggression towards other people. Along with this, the patient is confident that he is in perfect order. The lack of self-criticism leads to the fact that a person becomes tactless, impatient and intrusive. Every attempt to influence him only causes outbursts of irritability.

Along with this, the mental activity of the patient increases, contributing to the origin of a condition called racing ideas. A person is easily distracted and often jumps from one topic to another when talking with an interlocutor. From time to time, false, very exaggerated ideas of the patient regarding his financial situation, social significance, properties, both mental and physical, and his own ingenuity are observed. Exaggerating the scale of one’s own personality can lead to the fact that the patient begins to imagine himself as the Almighty himself.

When a manic disorder develops, the patient is sure that some people are either helping him or they are persecuting him. From time to time, auditory or visual hallucinations appear, illusions that do not actually exist. A person's need for sleep decreases. The patient takes an active part in various fields of activity, including serious business and gambling. A person's sexual behavior can have risky consequences. But despite all this, the patient does not feel the danger awaiting him that such a lifestyle could entail.

In the most severe cases of manic disorders, physical and mental activity becomes so intense that every connection between mood and behavior is lost, resulting in futile excitement. Such a case requires urgent and urgent medical intervention, because. If left untreated, a person may die from physical exhaustion. In less severe cases of manic disorder, hospitalization may be necessary to protect both the patient and his family from devastating financial and sexual failure.

Manic-depressive psychosis (bipolar personality disorder, bipolar affective disorder) is a mental illness manifested by recurrent depressive and manic attacks.

In the intervals between the phases of the disease, regardless of the severity and number of attacks suffered, there are no symptoms.

Manic-depressive psychosis is not characterized by the development of pronounced personality changes or, as in schizophrenia. A person may suffer from this disorder for years, but during the interictal period there will be no symptoms of the disease, which allows him to lead a normal life.

Reasons for development

It has not yet been possible to definitively determine why this emotional disorder occurs.

There are several established patterns in the development of the disease:

Heredity is of great importance in the development of this disease;
this pathology occurs more often in women, it is assumed that there is a link between the genes responsible for the development of this disease and the X chromosome. Thus, manic-depressive psychosis can be attributed to changes in the human body itself.

Main features

The first symptoms of manic-depressive psychosis can appear at any age, but most often the disease occurs in young (after 20 years) and adulthood. Sometimes, with a late onset of the disease, patients can talk about 1-2 erased attacks of depression or mania, which passed on their own, without seeing a doctor.

In most cases, the appearance of the first attack of the disease is preceded by psychotrauma, and subsequent episodes can develop independently, the connection with psychotrauma is lost.

The main signs of manic-depressive psychosis are depressive and manic syndromes. The frequency, severity and duration of each phase differ.

A typical depressive episode lasts from 2 to 6 months; manic episodes are usually shorter.

Manic-depressive psychosis is characterized by a connection with human biorhythms. Many patients note that exacerbation of the disease, the occurrence of depressive or manic episodes, occurs in the spring or autumn.

In women, it is often possible to establish a connection between attacks and a certain phase of the monthly cycle.

Depressive symptoms are characterized by fluctuations in the severity of symptoms depending on the time of day: in the morning, immediately after waking up, the maximum severity of depressive symptoms is noted; in the evening, patients experience some relief. This is why most suicide attempts occur in the early morning.

But in the sequence of changes in the various phases of the disease, no stable patterns are found. Mania may develop following a depressive episode, may precede the onset of depression, or occur independently of periods of depression. In some patients, depressive symptoms are the only manifestation of the disease, and mania does not occur during life. This is characteristic of the monopolar type of disease.

The light intervals between individual attacks can last for several years, or they can be very short.

After the attack stops, mental well-being is almost completely restored. Even multiple attacks do not lead to noticeable personality changes or the development of any defect.

As a rule, attacks of bipolar personality disorder manifest themselves as mania, but there are also erased variants of attacks, when obsessions and complaints from disturbances in the functioning of internal organs predominate. In the transition period between depression and mania, mixed states may be briefly observed (manic stupor, angry mania, agitated depression).

Signs of depression

A typical depressive attack is characterized by melancholy and speech retardation. All drives are suppressed (libido, maternal instinct, food). Patients persistently express ideas of self-blame, and pessimism and a sense of hopelessness often contribute to the commission of suicidal acts.

In adulthood and old age, a depressive episode often occurs atypically; its main manifestations are anxiety, motor restlessness, a feeling of the end of the world or, conversely, callousness and indifference to loved ones, a painful feeling of indifference.

Often, a depressive attack occurs according to the following type: patients do not focus their attention on a decrease in mood, but complaints of pain in various parts of the body (heart, head, joints), sleep disturbances, increased blood pressure, constipation and others come to the fore. Attacks of depression accompanied by uncontrollable drunkenness have been described.

Symptoms of mania

Manic episodes occur less frequently than depressive episodes and are shorter in duration.

Typical signs of mania: activity, initiative, interest in everything, fast racing thinking. Patients in this phase are characterized by increased distractibility and a desire to help others.

All basic drives are intensified:

appetite increases;
hypersexuality is noted;
patients are overly sociable;
the need for sleep decreases.

During a manic attack, patients may spend money thoughtlessly, engage in casual sexual relationships, abuse alcohol, suddenly quit their job, leave home, or bring home strangers. The behavior of manic patients attracts the attention of people around them, although the patients themselves are rarely aware of the absurdity of their actions: they consider themselves absolutely healthy and experience a surge of strength.

With an overly pronounced manic syndrome, the speech of patients becomes incomprehensible, they eagerly express their ideas to their interlocutors, and unstable ideas of greatness may sound in their statements. As a rule, in a state of mania, patients are favorably disposed towards others, although short-term mixed states are possible, in which increased activity is combined with irritability, aggressiveness, and explosiveness (angry mania).