Bipolar Disorder and Current Treatment Options

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Table of Contents

Epidemiology
Pathophysiology
Current Treatment Options
Article Review
References

Manic-depressive psychosis is a chronic disease of the affective sphere. Currently, this disorder is referred to as bipolar affective disorder (BAD). This disease is characterized by the presence of manic, depressive, as well as mixed episodes. However, during periods of remission (improvement of the course of the disease), the symptoms of the above phases almost completely disappear. Such periods of absence of manifestations of the disease are called intermissions. There are two phases of bipolar disorder: depressive and manic.

The BAD can manifest only as a manic phase, only depressive, or only hypomanic manifestations. The number of phases, as well as their change, is individual for each patient. They can last from several weeks to 1.5-2 years (Squarcina et al., 2017). Intermissions also have different durations: they can be quite short or last up to 3-7 years (Squarcina et al., 2017). The cessation of the attack leads to an almost complete restoration of mental well-being. With BAD, there is no formation of a defect (as with schizophrenia), as well as any other pronounced personality changes, even in the case of a long course of the disease and frequent occurrence and phase change. It should be noted that the patients disorders can be significantly pronounced, which can lead to professional and social maladaptation.

Epidemiology

Bipolar disorder often leads to disability; according to data, this is the 12th most common cause of disability. Due to the symptoms of BAD, more people become disabled than due to asthma, and almost as many as due to coronary heart disease. Modern research shows impressive figures more than 5% of the population suffer from bipolar spectrum disorders (Squarcina et al., 2017). Due to the difficulties of diagnosis, people learn their diagnosis only 10 years after the initial treatment, which, of course, prevents timely treatment.

The first symptoms of bipolar disorder appear at a young age. In more than half of cases it happens up to 18 years, in the vast majority of cases up to 30 years (Rowland et al., 2018). Most often, the first episode of the disease occurs in 15-25 years (Rowland et al., 2018). At the same time, the earlier the disease begins, the more severe it is. Bipolar disorder can manifest itself both in childhood and in old age, but it happens quite rarely. As a rule, the disorder begins with depression, although men often have hypomania first. On average, one person experiences 10 episodes in his life (in the absence of treatment). However, with a rapid change of cycles, there may be more than 50 attacks of the disease.

Gender Relationships

According to statistics, type I bipolar disorder occurs with the same frequency in men and women, and type I disease is more often diagnosed in women. It is also known that the female course of the disease is characterized by rapid cycles and mixed episodes (Patel et al., 2017). Comorbid pathologies are often eating disorders, borderline personality disorder, alcohol or drug addiction, as well as the abuse of psychotropic drugs. Women are more susceptible to such somatic diseases as migraine (intense headaches), thyroid pathology, diabetes, obesity.

Men, on average, get sick about one and a half times less often than women, but they have a more complicated disease. Traditionally, men are recognized as less emotional than women. The initial period of the disease is characterized by shallow sleep, a sharp change in emotional status. Unlike women, representatives of the stronger half often suffer from a manic episode at the beginning of the disease (Patel et al., 2017). In some cases, there is a decrease in libido, sexual function is impaired. In men, in particular, a mixed type of bipolar disorder is more common. Also, unlike women, men with diagnosed bipolar disorder have periods of depression and mania lasting about the same time. It is not uncommon for bipolar disorder in men to occur against the background of frequent alcohol consumption.

Cultural Relationships

The latest medical theory connects the disease with changes in the brain, and medical practice considers pharmacological drugs to be the most effective means. Nevertheless, the growing number of people with bipolar disorder and their desire to find themselves in the world is a product of the cultural realities of modern society. The culture of industrial society creates conditions for the widespread emergence of bipolar (manic-depressive) personalities (Rowland et al., 2018). In the early stages of industrialization, there was a massive demand for a disciplined worker capable of performing monotonous work in the office and in the factory. Therefore, the normalization of those who did not meet the norm consisted of hospitalization and coercive measures of influence.

On the contrary, when industrialization reached its modern stage and monotonous work began to be performed by a robot and a computer, there was no need for coercion. Instead, it needed a creative worker who was able to cope with a large volume of extraordinary tasks in the shortest possible time, showing flexibility and the ability to act in an ever-changing environment. In essence, it demands a restless creator a manic type of personality, energetic and unstoppable, drawing endless reserves of energy from the depths of oneself.

Pathophysiology

The study of the pathophysiology of bipolar affective disorder was also carried out on animals, in particular, mice, in which hyperactivity was induced with the help of amphetamine, while experimental mice had not only states resembling mania or some psychoses, at least with manifestations of psychomotor agitation. Another potential model of mania generation in mice was caused by a change in a gene that plays an important role in the generation of circadian rhythms. Patterns resembling mania in experimental mice included a decrease in sleep duration and an increase in activity, as well as an increase in the rewarding effect of cocaine. These changes in the mental state of the mice disappeared after the use of lithium.

Another approach to the study of the pathophysiology of bipolar affective disorder is post-mortem studies of the brain of patients suffering from bipolar affective disorder. These studies showed a decrease in the density and morphology of oligodendrocytes. Other studies have shown changes in gene expression. It should be noted that in such studies it is difficult to differentiate the effect of medications from the consequences of bipolar affective disorder. Some authors noted here a change in the regulation of genes responsible for the processes of myelination, and changes in oligodendrocytes resembled those that were noted in post-mortem studies of the brain of patients with schizophrenia. Recent post-mortem studies show changes in acetylation histones in some patients with bipolar affective disorder.

Current Treatment Options

The course of the BAD is influenced by three factors biological, psychological and social. To minimize the impact of bipolar affective disorder on patients life as much as possible, you need to take control of all three factors. Work on the biological factor includes taking medications and maintaining a healthy lifestyle. In the treatment of BAD, the main role is played by drugs for mood stabilization normotimics (lithium salts, some anticonvulsants (anticonvulsants) and antipsychotics of new generations). Supportive and preventive therapy is a long-term use of medications (antidepressants in combination with normotimics).

The disease can also resume from external influences personal conflicts, stress and overload, so many patients also attend psychotherapy. It helps to regulate and take control of the psychological factor. The recommended type of psychotherapy for bipolar affective disorder is cognitive behavioral therapy (CBT). Psychotherapy promotes the development and harmonization of personality, which prevents the occurrence of some stressful situations (conflicts, destructive relationships).

Article Review

The authors of the article note that with an early diagnosis of BAD, it would be possible to treat the disease more effectively, and also emphasize the lack of research on the issue of treatment of BAD. Epidemiological studies suggest that the prevalence of bipolar disorder in childhood and adolescence is 1% (Youngstrom et al., 2017, p. 244). The article states that the clinical manifestations of bipolar disorder in prepubescent and early adolescence may differ from the manifestations of the disease in older adolescents and adults. Periods of depression alternating with euphoria, megalomania, high levels of activation, rapid confused speech, distractibility, hypersexuality, hyper religiousness, extravagance, hallucinations and delirium are characteristic of classical bipolar disorder; such a typical clinical pattern occurs, as a rule, in late adolescence and in adults. In 70% of these cases, a carefully collected anamnesis reveals at least one episode of depression preceding manic symptoms (Youngstrom et al., 2017). The authors single out the diagnosis of the early onset of symptoms of bipolar disorder as a space for further research.

References

Patel, R. S., Virani, S., Saeed, H., Nimmagadda, S., Talukdar, J., & Youssef, N. A. (2017). Gender differences and comorbidities in U.S. adults with bipolar disorder. Brain Sciences, 8(168), 1-11. doi: 10.3390/brainsci8090168

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269.doi: 10.1177/2045125318769235

Squarcina, S., Bellani, M., Rossetti, M. G., Perlini, C., Delvecchio, G., Dusi, N., & Brambilla, P. (2017). Similar white matter changes in schizophrenia and bipolar disorder: A tract-based spatial statistics study. PLOS ONE, 12(6), 1-17. doi: 10.1371/journal.pone.0178089

Youngstrom, E. A., Halverson, T. F., Youngstrom, J. K., Lindhiem, O., & Findling, R. L. (2017). Evidence-based assessment from simple clinical judgments to statistical learning: Evaluating a range of options using pediatric bipolar disorder as a diagnostic challenge. Clinical Psychology Science, 6(2), 243-265. doi: 10.1177/2167702617741845

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