The bipolar affective disorder is also known under the name of manic-depressive disorder. The bipolar depressive disorder is accompanied by mood swings from depression to mania. A person may have normal mood in the period between mood changes.
The frequency of illnesses of different age groups is ranging from 3% to 6.5%. Anyone can get sick with bipolar disorder. In most cases, a doctor cannot determine the cause of this disease. The disease largely impairs the quality of life, limiting a person’s ability to work and interferes with normal functioning in society.
Pathology manifests with severe individual characteristics. Early manifestations may occur in 20 years, but some manifestations may appear only in old age. Bipolar disorder manifests itself in the form of phases with remission. The frequency and depth of these phases are individual.
It is very important to diagnose the disease as early as it is possible and start treatment. The treatment of the bipolar disorder is carried out with medication and psychotherapy. The treatment of bipolar disorder should be conducted only by experts, from the qualification of which the further course of the disease auspiciousness will largely depend on. As bipolar disorder is characterized by mental disease and periodic remissions, the goal of treatment is the promotion of individual stress and maximizing the normal state resistance of a patient. With the right approach, treatment is effective.
Bipolar mental disorder is a treatable condition. An important point in helping factor is timeliness that will speed recovery.
Keywords: bipolar disorder, disease, treatment.
All people are familiar with mood swings. There are days when a man feels depressed and experiences tension. When a person becomes ill of bipolar manic-depressive disorder, these mood swings go far beyond the norm and do not correspond to real-life circumstances.
Bipolar disorder is an endogenous mental illness that manifests itself in the form of affective states (manic or hypomanic), depressive, and sometimes mixed), at which patients show rapidly changing symptoms of mania (hypomania) and depression or symptoms of depression and mania at the same time. These states, which are called episodes or phases of the disease, periodically replace each other either directly or through a light period of mental health (intermissions). At the intermission, psyche and personal characteristics of a patient are fully recovered.
Every year, about 5.7 million American adults or 2.6 % of the population aged 18 years and older are diagnosed with bipolar disorder. Bipolar disorder usually appears in late adolescence or early adulthood. However, in some cases, the first symptoms appear in childhood, and in others, symptoms can be detected only in the later stages of life. Quite often, bipolar disorder cannot be diagnosed, and people have to suffer for years before they are correctly diagnosed. As well as diabetes or cardiovascular disease, bipolar disorder is a chronic disease that must be carefully controlled throughout life.
The periods of excited and passive states are called episodes of mania and depression. The signs and symptoms of mania are: increased energy, activity and restlessness; incredible excitement; irritability; decreased need for sleep; distractibility, inability to concentrate; unreasonable confidence in own abilities and capacities; inadequate assessment of the situation; increased sexual activity; intrusive, provocative, or aggressive behavior; denial of the fact that something is not right. The signs and symptoms of depression are: prolonged state of sadness, anxiety or emptiness; hopelessness or pessimism; reduced level of energy; loss of interest and pleasure to activities (including sex) that brought pleasure before the disease; problems with concentration, difficulty remembering or making decisions; changes in appetite; feelings of guilt, worthlessness or helplessness; hypersomnia or insomnia; chronic pain or other persistent symptoms of the illness that are mot the result of physical illness or injury; thoughts of death or suicide, suicide attempts.
As well as other mental disorders, bipolar disorder cannot be diagnosed by physiological methods, such as a blood test or brain scans. Therefore, bipolar disorder is diagnosed based on a symptom pattern, medical history, and family history.
The cornerstone of the treatment of the bipolar disorder is medicinal therapy. Medications are used in bipolar disorder to treat manic or depressive episodes or both. The main drugs used in the treatment of this disease are drugs called mood stabilizers. Antidepressants may also be used. However, they are used only in conjunction with mood stabilizers. Lithium is the most well-known medical drug for the treatment of bipolar disorder. Atagun, Balaban, Lordoglu, and Evren (2013) state that “although many studies have found a negative effect of lithium on the motor system in patients with bipolar disorder, no studies to date have compared motor and sensory speed in patients on valproate monotherapy to medication-free patients and healthy controls”. In each individual case, own scheme of medical treatment is selected. The selection of drugs and treatment regimens for bipolar disorder should be done by a doctor. It should be remembered that treatment by medical drugs in most cases removes all signs of the disease. Furthermore, after intensive treatment, people recover from bipolar disorder. Medicinal treatment of the bipolar disorder is divided into two stages: intensive treatment and supportive therapy. The main purpose of intensive treatment is to eliminate all symptoms. However, the effect of drugs does not occur immediately. It usually takes 1-2 weeks before medications begin to act and a person begins to feel better. Usually, it takes about one month so that all symptoms disappear. However, bipolar disorder requires significantly longer treatment. Despite the complete absence of symptoms and stay in practically healthy, a patient has to take medications for a long time in order to prevent recurrent attacks. This stage of the treatment of the bipolar disorder is called maintenance therapy. In this case, the dosage of medicines is considerably lower than in the intensive treatment phase. Therefore, a patient should not stop taking medication as soon as he/she feels better. This may trigger a return of the disease. Goodwin (2009) emphasizes that “long-term treatment in general, and lithium specifically, is associated with a reduced risk of suicide in bipolar patients”. Improper use of various drugs can have a negative impact and significantly worsen a patient’s condition. Therefore, the choice of specific medicines for each of the stages of drug treatment, determination of the regime and dosage use of drugs is carried out only by a doctor. Self-medication can be very dangerous.
When one looks closely at people with bipolar disorder, he/she would notice their tendency to readaptation. In the course of their socialization, they have learned to correspond to the expectations of someone else and live according to the criteria of others without asking questions. They try hard to please everyone. They have not developed a strategy of behavior in conflict situations. In depression, it becomes obvious and may even worsen. Mania is manifested in trying to behave in an unconventional way. The sense of liberation remains blank and internally can develop into a disease. The task of long-term maintenance therapy is not to cause adaptation in the normal state, but help to create their own criteria, develop a critical approach to the expectations of other people, and find a place for their unusual manifestations or desires in daily life. The primary task of the symptomatic and long-term treatment is to prevent further injuries and help to go through old ones, direct the treatment on the internal forces of the body, and strengthen and maintain family relationships and social connections.
People with bipolar disorder are offended not only faster than others, but they also become highly sensitive and react more quickly, using whole energy balance. Accordingly, the amplitude of their emotionality increases. During treatment, a patient needs to be set for such interaction, so that he could regulate it by himself.
Patients with bipolar disorder often have thyroid dysfunction. High or low levels of thyroid hormones may itself have an impact on changes in mood and energy levels. Therefore, the indicators of thyroid should be under the constant supervision of the attending physician. In such cases, a patient needs to take drugs for the treatment of thyroid along with medications for bipolar disorder.
Along with medication, it is recommended to use psychosocial methods, including certain forms of psychotherapy. Psychotherapy is a treatment carried out by means of psychological counseling of a patient. The goal of psychotherapy is a different resolution of psychological problems (emotional, personal, etc.). Psychotherapy is an important element of bipolar disorder treatment. Working with a therapist helps a patient learn new skills of regulating emotions, preventing stress or minimizing its impact. It contributes to the restoration of disturbed relationships. This method of treatment requires regular (usually weekly) visits to a therapist.
The psychosocial methods used in bipolar disorder include psychoeducation, cognitive-behavioral therapy, family therapy, and a new technique-interpersonal and social rhythm therapy. Cognitive-behavioral therapy helps patients with bipolar disorder to understand and change negative or distorted thinking patterns and behaviors associated with the disease. Psychological education introduces patients with information about the disease and its treatment and also helps to learn how to recognize signs of relapse. Family therapy uses a strategy of lowering the level of tension in the family that can aggravate symptoms of the disease or provokes them. Assistance to relatives of a patient (individually or in groups) will bring therapeutic benefits to patients. The work with bipolar patients without attracting close people is a medical error. Interpersonal and social rhythm therapy helps patients with bipolar disorder to improve interpersonal relationships and organize the schedule. A regular schedule and orderly sleep help to prevent manic episodes. Johnson and Leahy (2004) state that “interpersonal psychotherapy focuses on improving the quality and number of interpersonal relationships in the patient’s life and the patient’s degree of comfort with his or her primary social roles”. As with medical treatment, a patient should strictly follow the prescribed course of treatment in order to achieve a successful outcome of psychosocial therapy.
There are other treatment methods, such as electroconvulsive therapy, medical herbs, and natural supplements. Electroconvulsive therapy (ECT) is used in cases where medication, psychosocial therapy or combination do not have the desired effect or are too slow in relieving severe symptoms such as psychosis or suicidal manifestations. The use of ECT may also help during an acute episode when the physical condition of a patient (including pregnancy) does not allow the use of drugs.
People, who have had bipolar disorder, should remember that they have a risk of return (recurrence) of the disease. Therefore, they must adjust their way of life in order to minimize this risk. Regulation of lifestyle implies: observance of the regime of sleep (a patient must fall asleep at the same time, always sleep at night, not to work late); avoiding exhaustion; if it is possible, a patient should change job, requiring intensive work; regular rest; a patient must adhere to the daily, weekly and yearly vacation mode; avoiding alcohol, preferably completely abandon; trying to avoid and minimize stressful situations.
It is very important to combine medication and psychotherapy in order to achieve the best result in bipolar disorder treatment. One of these methods cannot guarantee the desired effect. Moreover, it is important to remember about the regulation of lifestyle. The treatment will be more effective if a patient openly discusses all doubts with a doctor and proposes treatment options.
Bipolar disorder is a serious and potentially dangerous disease. Therefore, it is crucial to establish a diagnosis and begin treatment. Despite the severity of the disease, this disorder is very treatable. In most cases, all signs (symptoms) of the disease pass after adequate therapy; and people, who recover from bipolar disorder, have an absolutely full life. If a man has previously suffered from bipolar disorder, he should remember that, despite the possible return (relapse) of the disease, he controls this disease instead it controls his life.