Treatment bipolar 1
Bipolar disorder - Diagnosis and treatment
To determine if you have bipolar disorder, your evaluation may include:
- Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.
- Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.
- Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
- Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Diagnosis in children
Although diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories.
Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended.
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- Bipolar disorder care at Mayo Clinic
- Bipolar in children
Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.
Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:
- Medications. Often, you'll need to start taking medications to balance your moods right away.
- Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
- Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
- Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
- Hospitalization. Your doctor may recommend hospitalization if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic or major depressive episode.
The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.
A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.
Medications may include:
- Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
- Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
- Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic.
- Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
- Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis.
Finding the right medication
Finding the right medication or medications for you will likely take some trial and error. If one doesn't work well for you, there are several others to try.
This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.
Mild side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications. Talk to your doctor or mental health professional if you have bothersome side effects.
Don't make changes or stop taking your medications. If you stop your medication, you may experience withdrawal effects or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.
Medications and pregnancy
A number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to your baby. Certain medications, such as valproic acid and divalproex sodium, should not be used during pregnancy. Also, birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.
Discuss treatment options with your doctor before you become pregnant, if possible. If you're taking medication to treat your bipolar disorder and think you may be pregnant, talk to your doctor right away.
Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:
- Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.
- Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
- Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify issues, make a plan to prevent relapse and stick with treatment.
- Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.
Other treatment options
Depending on your needs, other treatments may be added to your depression therapy.
During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as pregnancy or are at high risk of suicide.
Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven't responded to antidepressants.
Treatment in children and teenagers
Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors. Generally, treatment includes:
- Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There's less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
- Psychotherapy. Initial and long-term therapy can help keep symptoms from returning. Psychotherapy can help children and teens manage their routines, develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems common in older children and teens with bipolar disorder.
- Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's developmental age, the situation and appropriate cultural behavior. Understanding about bipolar disorder can also help you support your child.
- Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.
- Bipolar disorder care at Mayo Clinic
- Bipolar medications and weight gain
- Bipolar treatment: I vs. II
- Cognitive behavioral therapy
- Electroconvulsive therapy (ECT)
- Family therapy
- Transcranial magnetic stimulation
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Lifestyle and home remedies
You'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:
- Quit drinking or using recreational drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
- Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts.
- Create a healthy routine. Having a regular routine for sleeping, eating and physical activity can help balance your moods. Check with your doctor before starting any exercise program. Eat a healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or mental health professional about what you can do.
- Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you're taking for bipolar disorder.
- Consider keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted.
There isn't much research on alternative or complementary medicine — sometimes called integrative medicine — and bipolar disorder. Most of the studies are on major depression, so it isn't clear how these nontraditional approaches work for bipolar disorder.
If you choose to use alternative or complementary medicine in addition to your physician-recommended treatment, take some precautions first:
- Don't stop taking your prescribed medications or skip therapy sessions. Alternative or complementary medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.
- Be honest with your doctors and mental health professionals. Tell them exactly which alternative or complementary treatments you use or would like to try.
- Be aware of potential dangers. Alternative and complementary products aren't regulated the way prescription drugs are. Just because it's natural doesn't mean it's safe. Before using alternative or complementary medicine, talk to your doctor about the risks, including possible serious interactions with medications.
Coping and support
Coping with bipolar disorder can be challenging. Here are some strategies that can help:
- Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan and recognize mood changes. Help educate your family and friends about what you're going through.
- Stay focused on your goals. Learning to manage bipolar disorder can take time. Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.
- Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.
- Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
- Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.
Preparing for your appointment
You may start by seeing your primary care doctor or a psychiatrist. You may want to take a family member or friend along to your appointment, if possible, for support and to help remember information.
What you can do
Before your appointment, make a list of:
- Any symptoms you've had, including any that may seem unrelated to the reason for the appointment
- Key personal information, including any major stresses or recent life changes
- All medications, vitamins, herbs or other supplements you're taking, and the dosages
- Questions to ask your doctor
Some questions to ask your doctor may include:
- Do I have bipolar disorder?
- Are there any other possible causes for my symptoms?
- What kinds of tests will I need?
- What treatments are available? Which do you recommend for me?
- What side effects are possible with that treatment?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage these conditions together?
- Should I see a psychiatrist or other mental health professional?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can have?
- What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:
- When did you or your loved ones first begin noticing your symptoms?
- How frequently do your moods change?
- Do you ever have suicidal thoughts when you're feeling down?
- Do your symptoms interfere with your daily life or relationships?
- Do you have any blood relatives with bipolar disorder or depression?
- What other mental or physical health conditions do you have?
- Do you drink alcohol, smoke cigarettes or use recreational drugs?
- How much do you sleep at night? Does it change over time?
- Do you go through periods when you take risks that you wouldn't normally take, such as unsafe sex or unwise, spontaneous financial decisions?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
By Mayo Clinic Staff
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Treatment - Bipolar disorder - NHS
Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow as normal a life as possible.
Treatment options for bipolar disorder
If a person is not treated, episodes of bipolar-related mania can last for between 3 and 6 months.
Episodes of depression tend to last longer, often 6 to 12 months.
But with effective treatment, episodes usually improve within about 3 months.
Most people with bipolar disorder can be treated using a combination of different treatments.
These can include 1 or more of the following:
- medicine to prevent episodes of mania and depression – these are known as mood stabilisers, and you take them every day on a long-term basis
- medicine to treat the main symptoms of depression and mania when they happen
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment – such as talking therapies, which help you deal with depression and provide advice on how to improve relationships
- lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep
Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.
But hospital treatment may be needed if your symptoms are severe or you're being treated under the Mental Health Act, as there's a danger you may self-harm or hurt others.
In some circumstances, you could have treatment in a day hospital and return home at night.
Medicines for bipolar disorder
Several medicines are available to help stabilise mood swings.
These are commonly called mood stabilisers and include:
- anticonvulsant medicines
- antipsychotic medicines
If you're already taking medicine for bipolar disorder and you develop depression, your GP will check you're taking the correct dose. If you're not, they'll change it.
Episodes of depression are treated slightly differently in bipolar disorder, as taking antidepressants alone may lead to a relapse.
Most guidelines suggest depression in bipolar disorder can be treated with just a mood stabiliser.
But antidepressants are commonly used alongside a mood stabiliser or antipsychotic.
Find out more about antidepressants
If your GP or psychiatrist recommends you stop taking bipolar disorder medicine, the dose should be gradually reduced over at least 4 weeks, and up to 3 months if you're taking an antipsychotic or lithium.
If you have to stop taking lithium for any reason, talk to your GP about taking an antipsychotic or valproate instead.
In the UK, lithium is the main medicine used to treat bipolar disorder.
Lithium is a long-term treatment for episodes of mania and depression. It's usually prescribed for at least 6 months.
If you're prescribed lithium, stick to the prescribed dose and do not stop taking it suddenly unless told to by your doctor.
For lithium to be effective, the dosage must be correct. If it's incorrect, you may get side effects such as diarrhoea and getting sick.
Tell your doctor immediately if you have side effects while taking lithium.
You'll need regular blood tests at least every 3 months while taking lithium. This is to make sure your lithium levels are not too high or too low.
Your kidney and thyroid function will also need to be checked every 2 to 3 months if the dose of lithium is being adjusted, and every 12 months in all other cases.
While you're taking lithium, avoid using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless they're prescribed by your GP.
In the UK, lithium and the antipsychotic medicine aripiprazole are currently the only medicines that are officially approved for use in teenagers with bipolar disorder.
But the Royal College of Paediatrics and Child Health says that other bipolar medicines may be prescribed for children if recommended by their doctor.
Anticonvulsant medicines include:
These medicines are sometimes used to treat episodes of mania. They're also long-term mood stabilisers.
Anticonvulsant medicines are often used to treat epilepsy, but they're also effective in treating bipolar disorder.
A single anticonvulsant medicine may be used, or they may be used in combination with lithium when bipolar disorder does not respond to lithium on its own.
Valproate is not usually prescribed for women of childbearing age because there's a risk of physical defects in babies, such as spina bifida, heart abnormalities and cleft lip.
There may also be an increased risk of developmental problems, such as lower intellectual abilities, poor speaking and understanding, memory problems, autistic spectrum disorders, and delayed walking and talking.
Learn more about the risks of valproate medicines during pregnancy
In women, your GP may decide to use valproate if there's no alternative or you have been assessed and it's unlikely you'll respond to other treatments.
They'll need to check you're using a reliable contraception and will advise you on the risks of taking the medicine during pregnancy.
Find out more about pregnancy and taking medicine for a mental health condition
Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low and then gradually increased.
Your progress will be carefully monitored if you're taking other medication, including the contraceptive pill.
Blood tests to check your liver and kidney function will be carried out when you start taking carbamazepine and again after 6 months.
You'll also need to have a blood count at the start and after 6 months, and you may also have your weight and height monitored.
If you're prescribed lamotrigine, you'll usually be started on a low dose, which will be increased gradually.
See your GP straight away if you're taking lamotrigine and develop a rash. You'll need to have an annual health check, but other tests are not usually needed.
Women who are taking the contraceptive pill should talk to their GP about switching to a different method of contraception.
Antipsychotic medicines are sometimes prescribed to treat episodes of mania.
They may also be used as a long-term mood stabiliser. Quetiapine may also be used for long-term bipolar depression.
Antipsychotic medicines can be particularly useful if symptoms are severe or behaviour is disturbed.
As antipsychotics can cause side effects, such as blurred vision, a dry mouth, constipation and weight gain, the initial dose will usually be low.
If you're prescribed an antipsychotic medicine, you'll need to have regular health checks at least every 3 months, but possibly more often, particularly if you have diabetes.
If your symptoms do not improve, you may be offered lithium and valproate as well.
You may be prescribed a combination of lithium and valproate if you experience rapid cycling, where you quickly change from highs to lows without a "normal" period in between.
If this does not help, you may be offered lithium on its own, or a combination of lithium, valproate and lamotrigine.
But you will not usually be prescribed an antidepressant unless an expert in bipolar disorder has recommended it.
Learning to recognise triggers
If you have bipolar disorder, you can learn to recognise the warning signs of an approaching episode of mania or depression.
A community mental health worker, such as a psychiatric nurse, may be able to help you identify your early signs of relapse from your history.
This will not prevent the episode occurring, but it'll allow you to get help in time.
This may mean making some changes to your treatment, perhaps by adding an antidepressant or antipsychotic medicine to the mood-stabilising medication you're already taking.
Your GP or specialist can advise you on this.
Some people find psychological treatment helpful when used alongside medicine in between episodes of mania or depression.
This may include:
- psychoeducation – to find out more about bipolar disorder
- cognitive behavioural therapy (CBT) – this is most useful when treating depression
- family therapy – a type of talking therapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health
Psychological treatment usually consists of around 16 sessions. Each session lasts an hour and takes place over a period of 6 to 9 months.
Pregnancy and bipolar medicines
One of the main problems is that the risks of taking bipolar medicines during pregnancy are not well understood.
If you're pregnant and you have bipolar disorder, a written plan for your treatment should be developed as soon as possible.
The plan should be drawn up with you, your partner, your obstetrician (pregnancy specialist), midwife, GP and health visitor.
The following medicines are not routinely prescribed for pregnant women with bipolar disorder, as they may harm the baby:
- benzodiazepines (tranquillisers), such as diazepam (Valium) and lorazepam (Ativan)
If you become pregnant while taking medicine that's been prescribed for bipolar disorder, it's important that you do not stop taking it until you have discussed it with your doctor.
If bipolar medicine is prescribed for bipolar disorder after the baby's born, it may also affect your decision whether to breastfeed.
Your pharmacist, midwife or mental health team can give you advice based on your circumstances.
Bipolar affective disorder (BAD), its signs, types and methods of treatment
Manifestations of various emotions, a change in a person's mood, manifestations of both sadness and joy are normal and depend on many factors - from temperament and character to ongoing events that influence from the outside. However, when these changes are excessive, often unexpected and for no apparent reason, emotions get out of control, or a person remains in a radically positive or negative mood for a long time, it is very likely that bipolar disorder can be diagnosed. This disease was first described at the end of 19century, the famous German psychiatrist Emil Kripelin, calling it manic-depressive psychosis. Many world famous personalities such as Vincent van Gogh, Isaac Newton, Ludwig van Beethoven, Abraham Lincoln suffered from this disease. The pronounced form of this disease, which in the international classification of diseases is called bipolar affective disorder (BAD), is detected in 3% of the world's population.
TABLE OF CONTENTS
- 1. Bipolar Personality Disorder - Overview
- 2. Symptoms and signs
- 3. Types of bipolar disorder
- 4. Phases of Bipolar Disorder
- 5. Bipolar disorder in women
- 6. Treatment of Bipolar Personality Disorder
It is not uncommon for women to be treated with a combination of drug therapy and cognitive behavioral or interpersonal therapy with a psychotherapist.
Bipolar personality disorder - general information
According to statistics, bipolar disorder affects people between 14 and 44 years of age. Unlike adults, children and adolescents experience more frequent mood swings from mania to depression, sometimes several times a day. 90% of young people make their debut precisely from the phase of depression or melancholy. Another feature of bipolar disorder is that, due to the low level of diagnosis, the patient can live with this disease for 5-10 years without knowing the cause of the painful symptoms.
Most often, bipolar disorder is diagnosed in people whose immediate family members have had a similar problem. The causes of this disease are unknown, but stress, overstrain, and various diseases can provoke the manifestation of its symptoms. However, having fenced off a person from the influence of these factors, it is impossible to get rid of the problem, you need to seek help from a psychotherapist.
Bipolar disorder is a disease that cannot be completely cured. But with properly selected medication and psychotherapy, the quality of life is significantly improved and the periods between phases are lengthened. The person remains socialized and able to work.
Symptoms and signs
From the name it is clear that we are talking about two different poles of affective manifestations, that is, mood manifestations. One of these conditions is depression. Depression in bipolar disorder is pronounced, with vivid symptoms. It can last up to a year and is manifested not only by low mood, lack of ability to enjoy and interest in ongoing events, but also by psychosis, when ideas of self-accusation arise, the patient feels inferior, unnecessary, poisoning the life of others. There are also nihilistic thoughts about suffering from some kind of severe illness, despite medical evidence to the contrary. There may be delusional thoughts, as well as suicidal thoughts and even attempts.
The other pole of bipolar disorder is a hypomanic state or hypomania, the characteristic features of which are an increased euphoric emotional background, the patient is constantly on the move, hyperactive, and is distinguished by very fast, associative speech. The patient is constantly cheerful, often hypersexual, almost always awake or sleeping 2-3 hours a day.
Hypomania is often followed by a manic bipolar state with psychotic manifestations. The patient develops convictions in his own greatness, he believes that he is capable of anything, feels that he has a special calling in this world or that he is a descendant of great people. In extended manic episodes of mania with psychotic manifestations, anger, irritability, and direct aggression often occur. This condition leads the patient into extremely unpleasant and sometimes dangerous situations.
In addition to the typical symptoms of the disease, there are a large number of comorbid mental disorders. Comorbid mental disorders are those that accompany the underlying disease. The most common disorder of this kind is anxiety, which is manifested, among other things, by nonspecific autonomic symptoms, including sweating, palpitations, tremors of the limbs, various disorders of the gastrointestinal tract, dizziness, headaches, suffocation, and many others. In the case when these symptoms occur suddenly, mainly in public places, they are called panic attacks.
Types of Bipolar Disorder
Bipolar disorder can be Ι and ΙΙ types.
Bipolar I disorder is a condition in which the patient has persistent manias, i.e. overexcitation, enthusiastic inappropriate behavior, manic psychosis, as well as severe depressions. Symptoms of this type are more severe, so hospitalization is indicated in most cases.
Bipolar I disorder is characterized by short periods of hypomania followed by periods of deep depression. Hypomania is a pre-manic state with less active manifestations. Hypomania lasts a very short period of time - from several days to several hours, so sometimes patients do not even notice them and do not inform the doctor about it. Only careful, painstaking work with the patient makes it possible to identify hypomania, make the correct diagnosis and prescribe treatment.
Phases of bipolar disorder
There are several phases of bipolar personality disorder:
- Depressive (unipolar depression). People experience a depressed mood, despair and despondency, complain of a lack of energy and mental concentration, they can either eat too much or too little and sleep.
Depersonalization and derealization may occur at the peak of bipolar depressive disorder. The boundaries of their own "I" and the world around them become blurred, patients experience difficulties in perceiving what is happening. Familiar places seem new, the colors of the surrounding world change, the patient constantly experiences a feeling of "déjà vu". Sounds become muffled, even if someone is talking very close, it seems to the patient that the voice is coming from afar.
- Manic (hypomanic). In this state, patients are full of energy, overly happy or optimistic, euphoric, and have extremely high self-esteem. At first glance, these are positive signs, but when a person experiences large-scale manic episodes, these symptoms and such an emotional state can reach dangerous extremes. A patient in this phase may indiscriminately spend huge amounts of money or behave carelessly, not realizing the full danger. In conversation, people may choke on words, speak at a high speed, or jump from one thought to another. These episodes may also be accompanied by delusions of grandeur or the adoption of serious decisions without thinking about the further consequences.
In the development of the manic phase, the following stages of development can be distinguished:
- Hypomania - increased excitement, emotional upsurge.
- Mania - all signs are more pronounced, aggression, irritability, irascibility and rage are possible.
- Phase peak. The patient constantly experiences nervous excitement, he cannot relax. All his emotions are "heated" to the limit, coordination of movements is disturbed, thoughts are illogical and abrupt, in speech he constantly jumps from one sentence to another.
- Relief of symptoms. The patient gradually calms down. Movement disorders are on the decline. The speed of thinking and increased emotional mood remain unchanged.
- Return to normal.
- Mixed. Sometimes people have complaints that are characteristic of both depression and mania at the same time. They may also experience frequent phasing—4 or more episodes in one year.
In the intervals between depressive and manic phases in bipolar disorder, there is a light period during which the general background of mood becomes relatively stable, the person continues to adequately respond to certain events, the emotional sphere is under his control. This is the main criterion for remission of bipolar disease.
Bipolar disorder in women
According to statistics, bipolar Ι disorder occurs with the same frequency in men and women, and type ΙΙ 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. Comorbidities often include eating disorders, borderline personality disorder, alcohol or drug addiction, and psychotropic drug abuse. Women are more susceptible to such somatic diseases as migraine (intense headaches), thyroid pathologies, diabetes, and obesity.
For women, a special technique is being developed to alleviate this disorder, since from adolescence to menopause there are specific changes in hormonal levels that must be taken into account. In addition, psychotropic substances, which are supposed to stabilize the condition, can adversely affect the intrauterine development of the fetus if the woman is in position. It is noted that in the first trimester of pregnancy this disorder is milder, but after childbirth they often have to deal with postpartum depression. Thus, at each stage of the development of the female body, a competent doctor must review and adjust the treatment regimen. Often in the treatment of women, a complex method is used that combines drug therapy and cognitive-behavioral or interpersonal therapy with a psychotherapist. This approach gives the fastest results.
Treatment for bipolar disorder
Attempts to get rid of bipolar disorder on your own do not bring the desired result and, ultimately, lead to an aggravation of the situation, including the development of drug or alcohol dependence. In the diagnosis of the disease, keeping a mood diary can help, where the patient records all his thoughts, emotions, feelings, changes in mood. Such records will help the doctor to assess the mental state in detail and make the correct diagnosis. If you suspect bipolar disorder, you should consult a doctor, and the sooner a person realizes that he has a disease and comes to the clinic for help, the sooner professional help will be provided to him and painful symptoms will be replaced by a stable condition. It is impossible to get rid of the disease on your own, since a person cannot fully adequately assess not only his actions, but also the alternation of the phases of the disease.
Bipolar disorder is one of the few mental disorders in which medication is indicated in 100% of cases, and psychotherapy is an auxiliary tool. This disease is incurable, but its diagnosis and treatment is extremely important. Treatment can reduce the number of episodes, their severity and intensity, as well as prevent negative life events, help prevent relationship breakups, job loss, and even suicidal attempts. Thus, the quality of life of a patient with bipolar disorder who is undergoing treatment will be several times higher than that of a person who neglects treatment. If the patient loses touch with reality and harms himself and others, he is subject to hospitalization, outpatient treatment in this case is not permissible.
If you have a disease, it is recommended to exclude coffee, strong tea, alcoholic and energy drinks from your diet in order not to provoke an overexcited state. If possible, you should stop smoking and in no case should you take even soft drugs. It is also very important to establish a sleep pattern, sleep at least 8 hours a day and try to go to bed at about the same time. You should learn to recognize mood swings and notice the early manifestations of new episodes.
If you suspect that you have bipolar personality disorder, there is no need to panic, only a doctor can diagnose the disease, so you need to make an appointment with a psychotherapist with extensive experience in managing such patients at our MedAstrum clinic. If the diagnosis is confirmed, the doctor will make the necessary medication, if necessary, prescribe psychotherapeutic sessions and give recommendations for further lifestyle adjustments. You can make an appointment yourself on the website or by contacting our administrators.
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Treatment of bipolar affective disorder in St. Petersburg
- Treatment of bipolar disorder
Usually the symptoms of bipolar disorder are attributed to personality traits or mood swings, which are logically explained. And, as a rule, even close relatives may not suspect that a person suffers from one of the most common mental disorders.
Bipolar affective disorder is difficult to diagnose at an early stage of the disease. Therefore, we recommend that the patient himself or his relatives begin to keep a diary, recording daily the features of the psycho-emotional state and key events that affect the occurrence of depressive and / or manic episodes. Such a diary will help the doctor determine the type of disease and prescribe the necessary treatment for bipolar disorder, and in the future to monitor the dynamics of the state of health.
Bipolar affective disorder is treated as an outpatient or inpatient clinic. At the peak of a depressive episode, when there is a risk of suicide, as well as to reduce the timing of the selection of pharmacotherapy, treatment of bipolar disorder should be carried out in a hospital. Bipolar personality disorder, left untreated, can progress and cause a deterioration in quality of life. Over a long distance, the disease inevitably leads to family conflicts, alcoholism or drug addiction, social degradation and, ultimately, suicide.
With the right treatment for bipolar disorder, you can stabilize your psycho-emotional state and eventually achieve remission. Usually, it takes 15 to 20 days of hospital treatment to stabilize the psycho-emotional state. Achieving remission is possible subject to compliance with the prescribed drugs, with periodic outpatient visits to the attending physician to correct therapy.
Doctor's consultation on the treatment of bipolar disorder:
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- Post discharge management
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Causes of bipolar disorder
The main causes of bipolar affective disorder include genetic predisposition, disturbances in the metabolism of neurotransmitters and changes in nerve cells, and severe stress. In other words, the disease can occur in any person, regardless of age, gender and social status.
Genetic causes of bipolar disorder are a risk factor for the development of the disease. It should be emphasized that the disease itself is not inherited. However, inherited features of the regulation of neurotransmitters in the brain increase the risk of developing bipolar disorder in close relatives (for example, siblings) by 4–7 times.
Metabolic disorders in the brain
Another cause of bipolar disorder may be a metabolic disorder in the brain. An abnormal increase and decrease in the concentration of biologically active chemical compounds (mainly dopamine, serotonin and norepinephrine), which transmit nerve signals, is the cause of the manic and depressive phases.
Severe stress and the “biological defect” model
The psyche of each person has an individual threshold for resistance to stress. And the word "stress" does not necessarily mean difficult life situations - be it a dismissal, financial problems, family conflicts, divorce, or the death of a loved one. Stress factors can be an upcoming birthday, puberty, marriage or the birth of a child.
Fig. Zubin and Spring's stress-vulnerability model.
a) Low vulnerability, BD can only develop under severe stress.
b) High vulnerability, BAD develops even under low intensity stress.
c) Individual vulnerability, corresponds to the intensity of stress.
Symptoms of bipolar disorder
Treatment of bipolar disorder in our clinic
Typically treatment of bipolar disorder is carried out in the hospital of the clinic. The conditions of the hospital allow to reduce the duration of treatment - to conduct an examination, quickly normalize the patient's psycho-emotional state, select drugs and their minimum effective dosage, conduct dynamic monitoring and adjust pharmacotherapy.
On the day of hospitalization, the patient undergoes an examination, which includes:
- consultation of a therapist;
- consultation with a neurologist;
- laboratory tests;
Lab tests include blood tests for hormonal status (generally, thyroid problems are found in people with bipolar disorder). Pathology of the thyroid gland directly affects mood swings, therefore, when treating bipolar disorder, it is important for a doctor to know the patient's hormonal background, for example: to prescribe drugs that normalize the thyroid gland, or to exclude lithium, which inhibits its work.
Based on the results, the doctor will prescribe a treatment for bipolar disorder - select drugs that relieve autonomic symptoms and normalize the psycho-emotional state (normotimics, antidepressants). Usually, the first signs of improvement in mental health are observed on the fifth day after the start of drug treatment for bipolar disorder. However, the final correction of psychopharmacotherapy can take up to 10 days.
After stabilization of the psycho-emotional state, the patient begins attending group psychotherapy sessions. Group sessions with psychotherapists and psychologists of our clinic are held daily. Under the guidance of experienced facilitators, the patient will have the opportunity to work through their experiences and fears, get rid of pathological patterns, and receive professional help from psychologists and psychotherapists with clinical experience.
Discharge is usually done after remission, 14-21 days treatment for bipolar disorder . Then the patient continues to take the prescribed drugs and visit the attending physician once every 1-3 months for 1 year. Subject to the achievement of stable remission, after 1 year, in some cases, it is possible to completely abandon the drug treatment of bipolar disorder.
Treatment of bipolar disorder in St. Petersburg is carried out at: st. Marata, 78. We take on complex cases, including the treatment of adolescent patients and patients with drug resistance.
Treatment of bipolar comorbidities
Psychotherapeutic treatment of bipolar disorder
Psychotherapeutic treatment of bipolar affective disorder, as an adjunct to pharmacotherapy, allows a faster deep remission. Such treatment begins already in the hospital and can be continued after discharge. The number of sessions, their frequency and the form of psychotherapy (individual, family or hypnotherapy) you can choose together with the doctor.
In addition to individual psychotherapy sessions that correct the patient's personality, family consultations are possible. At family therapy sessions, relatives can better understand the nature of the disease and learn the right behavior that contributes to a speedy recovery. In addition, studies show that psychotherapeutic care reduces the number of hospitalizations for relapses.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy corrects abnormal behavior and thought patterns that occur in patients with bipolar affective disorder. In addition, during psychotherapy sessions, the patient will be able to learn to recognize relapses of the disease, cope with them on their own or seek help in time, preventing a full-blown episode.
If bipolar disorder has caused a deterioration in relationships with those closest to you, we recommend that you seek the help of a family therapist. The doctor will help relatives understand the features of the disease, resolve interpersonal conflicts and restore harmony in the family.
Individual sessions of psychotherapy help overcome mood swings during the formation of stable remission. By learning to control the psycho-emotional state, as well as working through pathological patterns, it becomes easier for the patient to cope with exacerbations of the condition, which may occur for some time after undergoing treatment in the hospital.
Consequences of not getting help
To describe what bipolar disorder is in simple terms, it is necessary to understand the specifics of the condition in which people with this disease find themselves. Living with bipolar affective disorder is not easy. People learn to live with bipolar disorder over the years, experiencing rapid ups and downs in both career and family life. Imagine that you are walking on a zebra - now you are full of strength and enthusiasm, and the next minute you stop in a stupor and everything falls out of your hands: life loses its meaning, achievements no longer seem so significant, you want to escape from everyday life, hide from your eyes relatives, change their place of residence and work.
Add to this state of misunderstanding on the part of relatives and friends, who begin to consider you frivolous and incapable of finishing what you started to the end. At some point, you quarrel with relatives and, it would seem, nothing keeps you in this familiar and gray life. You can stay in this state for months, and then everything starts all over again. You are full of strength and enthusiasm - set yourself bold tasks, hardly sleep, call friends and want to hug strangers (just like that, because you are full of boundless love).
However, few "lucky ones" with bipolar disorder manage to experience a depressive episode on their own from year to year. Moreover, the depressive state distorts reality no less than the euphoria of the manic stage. It can take years or decades to learn how to "live" with bipolar disorder. But many do not succeed in doing this - and the lives of these people cannot be envied. Unfortunately, some of them are socially degraded or commit suicide.
Bipolar disorder in women
If you do not seek help in time, bipolar disorder in women can lead to family conflicts, divorce, promiscuity, and the development of borderline mental disorders. To a lesser extent, women with bipolar disorder are prone to alcoholism and drug addiction, although this scenario cannot be completely excluded.
Bipolar disorder in men
The development of bipolar disorder in men causes deterioration of relationships at work (possibly dismissal), family quarrels, looking for relationships on the side, addiction to alcohol and / or gambling (gambling, Internet surfing). Ultimately, domestic violence is not ruled out against the backdrop of a depressive episode.