The bipolar disorder is a mental illness in which manic and depressive episodes are alternated, although mixed states are also possible. The disorder is partly genetic. Designations such as manic-depressive psychosis, Manic depression used for bipolar disorder.
Infogram of the causes and neural reasons for depression. Click image to enlarge.
Since bipolar disorder leads to mood changes that cannot be influenced by those affected, it is - like manias and depression - counted among the so-called affective disorders.
The manic phases of bipolar disorder are characterized, among other things, by an increased energy level, reduced need for sleep and excessive self-confidence. During such episodes, those affected may be capable of exceptional performance, but they can also become delusional and find themselves in difficult or dangerous situations.
The depressive phases, on the other hand, are characterized by listlessness and dejection - those affected in this phase often regret the things they said or did in a previous manic episode. During these depressive phases, people with bipolar disorder are at a significantly increased risk of suicide.
A number of factors are believed to be responsible for bipolar disorder. Since the disorder occurs more frequently in some families and changes in chromosomes have been found in those affected, it must be assumed that the bipolar disorder is partly hereditary.
Studies from twin research confirm the influence of genes. Often a drastic life event or stress is the trigger for bipolar disorder to make itself felt for the first time. In the rest of life, even a small amount of stress can be enough for an affected person to slide into a manic or depressive episode.
The disease usually breaks out relatively early in life, before the personality is sufficiently established. Since this can lead to low self-esteem, it is possible that it could make symptoms of bipolar disorder worse.
The main symptom of bipolar disorder is chronic and often lifelong fluctuations in mood, drive, and activity. The change from depressive and manic moods, which are interrupted by neutral phases, exceeds the usual level and must be clearly differentiated from normal mood swings that everyone knows. Further symptoms of the disease are the inevitable social and occupational impairments as well as great psychological suffering of those affected.
The contrasting moods cause the different symptoms of the disease. Depressive phases usually occur more frequently and last at least two weeks. The main symptoms are a very depressed mood, reduced drive and lack of interest. In addition, there may be a loss of positive self-esteem, thoughts of death, suicidality, sleep disorders, loss of appetite or even cognitive deficits such as memory disorders.
Symptoms of a manic phase that lasts for several days are an increased level of arousal and a noticeably elevated mood. This often seems inappropriate to the situation and can quickly turn into irritable and aggressive mood. Other symptoms include increased drive, loss of social inhibitions, and sexual overactivity.
The attitude towards oneself is extremely positive, one's own abilities are clearly overestimated. The result is risky behavior without recognizing any risks. Symptomatic of the mania are also the urge to talk, racing thoughts, ideas of size, impulsiveness, little or no need for sleep, and willingness to make decisions.
The phases of bipolar disorder are each characterized by very different symptoms. Several of these symptoms must be observed for an extended period of time in order for the disorder to be correctly diagnosed.
For most people, bipolar disorder first becomes apparent in adolescence or early adulthood. The duration and intensity of the manic or depressive episodes can be very different: Manic phases usually last a little shorter; in addition, there may be phases of hypomania, a weakened form of mania.
About a third of the sick have problems with addictive substances - it can be assumed that this is a form of self-medication. Depressive episodes become more common as people get older, and about 20 percent of people with bipolar disorder commit suicide.
Complications resulting from the manic episodes are most common in bipolar I disorder. The hypomanic episodes in the context of bipolar II disorder, however, are milder. During a manic episode, those affected are often prone to risky behavior, experience increased sexual needs or spend a lot of money. This can lead to conflicts and debts.
Suicidality is a serious complication that can occur especially during the depressive episodes. 30 percent of all those affected commit at least one suicide attempt in the course of their illness. Some people with bipolar disorder also engage in self-harm. However, this does not necessarily have to have the goal of ending your own life. Wounds and scars can lead to other complications: inflammation, muscle and nerve damage, and stigma are some of them.
Even outside of the depressive episodes, the bipolar disorder can be accompanied by depressive mood or the persistence of individual depressive symptoms. Circadian disorders are common: those affected typically get up late and feel better in the late evening hours. As a further complication, sleep disorders or other mental illnesses may develop.
Severe lifestyle restrictions are possible with a form of progress known as rapid cycling. The manic and depressive episodes alternate very quickly. The rapid change is often a challenge for the social environment of the person concerned. In addition, there is the risk that the episodes are played down as mood swings.
A doctor should then be consulted when everyday life and togetherness suffer. A distinction must be made between the depressive phase and mania. If, from his point of view, the patient is in a high (mania), it is hardly possible to get him to go to the doctor. Usually there is a complete lack of insight into the disease and the person concerned feels better than ever before. However, a doctor and the police can be called if there is a danger to oneself or others. This is often the case when the patient becomes aggressive and makes threats. Unfortunately, one has to speak of help against his will here.
It is easier to encourage the patient to see a doctor when the depression occurs. Usually he is barely able to do everyday things like getting up, washing clothes or doing the shopping. Due to the lack of drive and the dark thoughts from self-hatred to suicide intentions, the patient will be more willing or even feel the urge to go to the doctor.
Many doctors diagnose depression rather than bipolar disorder. A good family doctor or specialist must therefore ask the relatives and include them in the treatment. Since psychological causes and / or trauma are the cause of the illness in many cases, an appropriately trained psychologist should definitely be consulted.
The different phases of bipolar disorder can be treated with different drugs: In the depressive phases antidepressants are used, in the manic phases neuroleptics are used.
It is often necessary to combine different medications - especially in phases when symptoms of depression and mania occur at the same time. In addition, it can be useful to conduct talk therapy. The excessive self-confidence in the manic phases usually prevents those affected from reflecting on their own behavior in order to recognize it as harmful or risky if necessary.
In order to prevent the patients from putting themselves or others in danger, forced placement in a psychiatric hospital can be used in such cases. Over time, people can learn to deal with bipolar disorder, but there is no complete cure at this time.
Many people with bipolar disorder experience recurring manic and depressive episodes. Rapidly changing episodes are known as rapid cycling and occur in 20% of those affected. Women are more likely to suffer from rapid cycling than men.
Manic and depressive episodes are particularly common when certain risk factors are present. These risk factors include, for example, mixed episodes (with manic and depressive characteristics at the same time), a young age at the onset of the disease, critical life events, female gender and psychotic symptoms.
In addition, the prognosis of bipolar disorder is often unfavorable if drugs that are supposed to prevent the manic and depressive episodes do not work reliably in the person concerned. 30% of people with bipolar disorder will attempt suicide during their lifetime.
It is also possible that residues may remain after the manic and depressive episodes. Psychology calls these residuals. Many bipolar people also suffer from single or multiple depressive symptoms outside of the definable depressive episodes.
Some sufferers only experience a few manic and depressive episodes and are generally barely restricted in their lifestyle. "Spontaneous healing" without treatment is possible; however, it usually occurs in younger people and is usually unpredictable. Early treatment is therefore recommended.
Over time, people with bipolar disorder can learn to watch out for certain warning signs that herald a new manic or depressive episode. It is important that professional help is sought as early as possible - even if the symptoms are rather inconspicuous. Even if a cure is not expected, the damage that bipolar disorder causes can be kept to a minimum.
Follow-up care for a manic or depressive episode includes preventing further episodes. Various means can be used for this. After an inpatient stay, it makes sense to continue the treatment on an outpatient basis. A psychotherapist supports the patient on a psychological and social level, while a psychiatrist decides together with the patient on the intake of medication.
It is not always necessary for people with bipolar disorder to take psychotropic drugs on a long-term basis. However, especially in severe manic and depressive episodes, they can help restore a biochemical balance in the brain. Doctors prescribe certain active substances with the aim of reducing the risk of the manic-depressive episodes returning. For this purpose, six active ingredients for bipolar disorders are approved in Germany: lithium, olanzapine, quetiapine, carbamazepine, lamotrigine and valproic acid.
In psychotherapy, patients learn about their individual causes and triggers for bipolar disorder. For aftercare it is crucial to reduce these factors as much as possible in order to establish a stable living situation. [[Depressive symptoms often persist even after an acute manic or depressive episode, which is why their treatment in follow-up care also plays a role. In addition, suicidal ideation prevention is important in follow-up care for bipolar disorder.
Since bipolar disorder is a serious mental illness, self-help on its own is not recommended. In bipolar disorder, the extreme fluctuations in mood and drive should always be treated and monitored by experts. In acute therapy, mood-stabilizing drugs are used, which are then often given for life as part of phase prophylaxis.
In addition to treatment from experts, a healthy lifestyle with a good diet and adequate exercise is advisable. Good nutrition helps the body to maintain its functions. Sufficient exercise units in everyday life help to reduce stress and ensure an increased release of happiness hormones. This can have a great effect, especially in a depressive phase.
Artistic activities in the field of painting, music and dance also have a positive influence on many of those affected. Visiting self-help groups can also provide consolation for those affected. You can talk to like-minded people about your ailments and gain more knowledge about your illness.
By means of a mood calendar, those affected can record the course of the mood swings and thus have good control over the individual course of the disease. The course of the mood in the mood calendar can also give the therapist an important insight, so that the treatment measures can be better adapted to the patient's individual problems.