What triggers bipolar disorder? What are the causes and what are the symptoms?
What is bipolar disorder? What are the causes and what are the symptoms? Comorbidity, trigger events and the value of a multidisciplinary team in the treatment of the well-known mood disorder, also known as bipolar disorder
What is bipolar disorder
Bipolar disorder is characterised by alternating phases, where one phase may prevail over the other:
- depression;
- mania.
Symptoms of depression
Depression or, more precisely, the major depressive episode, is characterised by at least 5 of the following symptoms
- constant depressed mood throughout the day
- significant decrease in interest in most activities and lack of motivation;
- weight gain/loss with corresponding altered appetite;
- sleep alteration (insomnia or hypersomnia);
- agitation, anxiety, recurrent crying;
- reduced concentration;
- excessive or inappropriate feelings of guilt;
- possible suicidal ideation: it is estimated that the incidence of suicide in patients with bipolar disorder is at least 15 times higher than in the general population.
The symptoms of mania
Mania, on the other hand, involves:
- excessive euphoria;
- reduced need for sleep;
- increased talkativeness;
- accelerated mental activity and distractibility;
- loss of contact with reality;
- high-risk behaviour, of which the subject is unaware, such as out-of-control spending and shopping, gambling, promiscuous sexual activity, extreme sports.
Manic episode
A manic episode is defined as an episode lasting more than or equal to 1 week, characterised by:
- euphoric mood;
- marked increase in energy;
- presence of 3 or more of the typical symptoms of mania.
Patients in this phase believe they are in their best state of mind; however, it is during the manic phase that subjects can become a serious danger to themselves and others.
Manic episodes differ from mania in the following respects:
- manic psychosis: a more extreme manifestation, with symptoms that are often difficult to distinguish from schizophrenia, in which patients may have delusions of grandeur or persecution, with frequent loss of coherent thought and behaviour (delirium);
- hypomania: a less extreme form of mania. For some patients, functioning is not significantly impaired: energy and psychomotor activity increase, while the need for sleep decreases. For others, hypomania leads to increased distractibility, irritability and low mood.
How bipolar disorder is classified
Bipolar disorder generally has its onset during adolescence or around the age of 20/30 and is classified into:
- bipolar disorder type I, distinguished by the presence of at least 1 manic episode and depressive episodes;
- bipolar disorder type II, distinguished by the presence of major depressive episodes and at least one hypomanic episode;
- bipolar disorder not otherwise specified: overt bipolar features that cannot be classified as either of the types presented above.
The causes of bipolar disorder
Although the exact cause remains unknown, the triggering factors (triggers) for bipolar disorder may be various:
- psychosocial
- genetic;
- biological.
Familiarity plays an important role, increasing the likelihood of developing the disorder.
Other risk factors are:
- period of severe stress;
- bereavement;
- traumatic event;
- use of substances such as alcohol, certain antidepressants, cocaine and amphetamines: the literature establishes an important association between bipolar disorder and substance use, although the direction of causation is uncertain.
There is also a frequent correlation with:
- anxiety disorders;
- hyperactivity
- attention deficit
- eating disorders;
- other personality disorders.
Remissions and relapses of bipolar disorder
As mentioned above, bipolar disorder is characterised by alternating phases.
The onset is characterised by an acute phase of symptoms, followed by remissions and relapses.
The term remission refers to a decrease in the severity of the symptoms characteristic of a given morbid picture: in other words, the absence of signs indicating that the illness is in progress.
In some patients remission is complete, in others residual symptoms may occur.
When we speak, on the other hand, of relapse, we mean the flare-up of a morbid process that is healing or apparently cured.
In this phase, symptoms return in a marked manner and may be manic, depressive or hypomanic, often coexisting with one another.
An episode may last from a few weeks up to 3-6 months and generally depressive phases last longer than manic ones.
The frequency with which episodes occur may vary from patient to patient: it is possible for little time to elapse between one episode and the next or, conversely, for a long period to pass without the occurrence of markedly symptomatic events.
Diagnosis
It is, first of all, necessary to investigate and identify the symptoms of mania or hypomania, should they be present, through the exclusion of certain medical problems, such as hyperthyroidism, the influence of drug abuse that may have a significant influence on these symptoms.
The diagnosis of bipolar disorder type 1 is, of all, the most severe, involving the presence of manic symptoms such as to significantly impair the subject’s functioning and to require hospitalisation in certain circumstances, dangerous for the subject himself and for others.
It often happens that the patient in a depressive phase does not spontaneously report having previously experienced an episode of mania or hypomania: the specialist may therefore avail himself of questionnaires useful in revealing pathological signs, in addition to the support of the patient’s family.
How bipolar disorder is treated
The treatment of bipolar disorder ideally includes:
- pharmacological treatment;
- psychotherapeutic support.
The combination of the two is necessary and essential for the patient to be assisted and treated correctly.
In most cases, outpatient treatment is sufficient.
Only when severe symptoms occur is hospitalisation of the patient necessary.
First, acute episodes must be stabilised and controlled (acute phase).
Once under control, treatment continues until a complete remission is achieved (continuation) and maintained (maintenance and prevention).
Pharmacological treatment
The appropriate pharmacological treatment is established through a psychiatric consultation and may include
- mood stabilisers, such as lithium and some anticonvulsants;
- second-generation antipsychotics, in more severe cases.
They are used alone or in combination for all phases of treatment, even at different dosages.
Adverse events linked to the use of the drugs must be taken into account, and they must be chosen on the basis of efficacy and tolerability if the patient has previously been given drugs to treat bipolar disorder, and on the basis of the anamnesis and severity of symptoms if the situation is unknown.
Finally, antidepressants can be used, although they are not recommended as the sole and exclusive therapy.
Psychotherapeutic treatment
Once the psychiatric evaluation has been carried out and the pharmacological support chosen, psychotherapy allows the integration of those parts of the ego that have not been sufficiently elaborated or consciously realised.
Alternating between individual and group therapy is fruitful; the latter could be led by the psychotherapist and psychiatrist together.
Group therapy is often recommended for patients and family members, in many cases partners, whose support is essential to prevent more serious episodes.
The topics covered can be varied:
- anger and relationship management;
- planning;
- social consequences of the disorder;
- the role of stabilising drugs, the latter not always accepted by the patient, who feels that they exert too much control over him, making him less vigilant.
Individual psychotherapy, by analysing the different spheres of life, can help patients rethink themselves through the elaboration of traumatic events, storytelling, and the creation of new meanings.
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