BIPOLAR DISORDER.

Bipolar affective disorder is a complex psychiatric disorder. Its most striking feature is the alternation, sometimes sudden, of episodes of depression with those of euphoria (mania and hypomania) and asymptomatic periods between them. The seizures may vary in intensity (mild, moderate and severe), frequency and duration. Humorous fluctuations have negative repercussions on the behavior and attitudes of patients, and the reaction they provoke is always disproportionate to the facts that triggered or even depended on them. In general, this mood disorder manifests itself in both men and women, between the ages of 15 and 25, but can also affect children and older people. Types According to DSM.IV and ICD-10 (international manuals for diagnostic classification), bipolar disorder can be classified into the following types: 1) Type IO bipolar disorder disorder presents periods of mania, which last in the minimum, seven days, and depressed mood phases, ranging from two weeks to several months. Both in mania and in depression, symptoms are intense and lead to profound behavioral and behavioral changes that can compromise not only family, affective and social relationships, but also the professional performance, economic position and safety of the patient and the people who live with him. The condition may be severe enough to require hospital admission because of the increased risk of suicide and the incidence of psychiatric complications. 2) Type II bipolar disorder There is alternation between episodes of depression and those of hypomania (milder state of euphoria, excitement, optimism, and sometimes aggressiveness), with no greater detriment to the behavior and activities of the wearer. 3) Unspecified or mixed bipolar disorder Symptoms suggest the diagnosis of bipolar disorder but are not sufficient in number or duration to classify the disease into one of the two types above. 4) Cyclothymic disorder This is the milder picture of bipolar disorder, marked by chronic mood swings, which may occur on the same day. The patient alternates symptoms of hypomania and mild depression, which are often understood as belonging to an unstable or irresponsible temperament. Causes The actual cause of bipolar disorder has not yet been determined, but genetic factors, changes in certain areas of the brain, and levels of various neurotransmitters are known to be involved. Likewise, it has already been demonstrated that some events may precipitate the manifestation of this mood disorder in genetically predisposed people. These include: frequent episodes of depression or early onset of these seizures, puerperium, prolonged stress, appetite suppressant drugs (anorectics and amphetamines), and thyroid dysfunctions such as hyperthyroidism and hypothyroidism. Diagnosis The diagnosis of bipolar disorder is clinical, based on the history and symptom reporting by the patient or a friend or family member. In general, it takes more than ten years to complete because the signs can be confused with those of diseases like schizophrenia, major depression, panic syndrome, anxiety disorders. Depression: depressed mood, deep sadness, apathy, lack of interest in activities that previously gave pleasure, social isolation, changes in sleep and appetite, significant reduction of libido, difficulty in establishing a differential diagnosis before proposing any therapeutic measures. concentration, fatigue, recurring feelings of worthlessness, excessive guilt, frustration and lack of meaning for life, forgetfulness, suicidal ideation. Mania: a state of exuberant euphoria, with appreciation of self-esteem and self-confidence, little need for sleep, psychomotor agitation, lack of control when coordinating ideas, attention deficit, compulsion to speak, increased libido, irritability and growing impatience, aggressive behavior, mania of greatness. At this stage, the patient may take actions that will reverse injury to himself or others, such as dismissal, uncontrolled spending of money, hasty affective involvement, increased sexual activity and, in more serious cases, delusions and hallucinations. Hypomania: the symptoms are similar to those of mania, but much milder and with less repercussion on the activities and relationships of the patient, who is more euphoric, more talkative, sociable and active than usual. In general, the crisis is brief, only lasts a few days. For diagnostic purposes, it is necessary to ensure that the reaction was not induced by the use of antidepressants. Treatment Bipolar disorder has no cure but can be controlled. Treatment includes the use of medications, psychotherapy, and lifestyle changes such as the cessation of psychoactive substance use (caffeine, amphetamines, alcohol, and cocaine, for example), the development of healthy eating and sleeping habits and reduction of stress levels. According to the type, severity and evolution of the disease, the prescription of neuroleptic drugs, antipsychotics, anticonvulsants, anxiolytics and mood stabilizers, especially lithium carbonate, has been shown to reverse acute euphoria and prevent recurrence of crises. The association of lithium with antidepressants and anticonvulsants has been shown to be more effective in preventing relapse. However, antidepressants should be used with caution because they can cause a rapid turn of depression into euphoria, or accelerate the incidence of seizures. Psychotherapy is another important resource in the treatment of bipolarity, since it offers support for the patient to overcome the difficulties imposed by the characteristics of the disease, helps to prevent the recurrence of seizures and, especially, promotes adherence to the drug treatment that, as occurs in the most chronic diseases, must be maintained throughout life. Recommendations: Bipolar disorder patients and their families need to be aware that: * following treatment closely is the best way to prevent emotional instability and recurrence of seizures, which ensures the possibility of practically normal life; * the remedies may not have the desired effect in the first few doses, which often need to be adjusted throughout the treatment; * prolonged depressive episodes without adequate treatment may increase the risk of suicide in bipolar patients by 15%; * the patient may seek relief for symptoms in alcohol and other drugs, a solution that only helps to aggravate the condition; * alternating the phase of depression with that of mania can give the false feeling that the person is cured and no longer needs treatment; * The family may also need psychotherapeutic follow-up, for two different reasons: first, because the disorder may affect all who live directly with the patient; second, because it needs to be guided on how to cope in the day-to-day with the sufferers of the disorder. Source: Psychiatry.