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Bipolar disorder
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Bipolar affective disorder

AGE  Usually develops in the early 20sGENDER  Not a significant factor
LIFESTYLE  Life events may trigger episodesGENETICS  Sometimes runs in families

Bipolar disorder is when mood fluctuates between extremes of highs and lows.

What is bipolar disorder?
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About 8 in 1,000 people in the UK have bipolar affective disorder, also known as manic depression. In this disorder, episodes of elation and abnormally high activity levels (mania) tend to alternate with episodes of low mood and abnormally low energy levels (depression). More than half of all people with bipolar affective disorder have repeated episodes.

The factors that trigger manic and depressive episodes are not generally known, although episodes are sometimes brought on in response to a major life event, such as a marital breakup or bereavement. Bipolar affective disorder usually develops in the early 20s and can run in families, but exactly how it is inherited is not known.

What are the symptoms of bipolar affective disorder?

Symptoms of mania and depression tend to alternate, each episode lasting an unpredictable length of time. Between periods of mania and depression, mood and behaviour are generally normal. However, occasionally, a manic phase may be followed immediately by depression.

Sometimes, either depression or mania predominates to the extent that there is little evidence of a pattern of changing moods. Occasionally, symptoms of depression and mania occur in the same period. The symptoms of a manic episode may include:

  • Elated, expansive, or sometimes irritable mood.
  • Inflated self-esteem, which may lead to delusions of great wealth, accomplishment, creativity, and power.
  • Increased energy levels and decreased need for sleep.
  • Distraction and poor concentration.
  • Loss of social inhibitions.
  • Unrestrained sexual behaviour.
  • Spending excessive sums of money on luxuries and holidays.

Speech may be difficult to follow because the person tends to speak rapidly and change topic frequently. At times, he or she may be aggressive or violent and may neglect diet and personal hygiene.

During an episode of depression, the main symptoms include:

  • Feeling generally low.
  • Loss of interest and enjoyment.
  • Diminished energy level.
  • Reduced self-esteem.
  • Loss of hope for the future.

While severely depressed, a person affected by the disorder may not care whether he or she lives or dies. About 1 in 10 people with bipolar disorder eventually attempts suicide (see Attempted suicide and suicide).

In severe cases of bipolar affective disorder, delusions of power during manic episodes may be made worse by hallucinations. When manic, the person may hear imaginary voices praising his or her qualities; in the depressive phase, these voices may describe the person's failures. In such cases, the disorder may resemble schizophrenia.

What might be done?

During a manic phase, people usually lack insight into their condition and may not be aware that they are ill. Often, a person's erratic behaviour is first noticed by a relative or friend, who seeks professional advice. A diagnosis of bipolar affective disorder is based on the full range of the person's symptoms, and treatment will depend on whether the person is in a manic or a depressive phase.

For the depressive phase, antidepressants are used, but their effects have to be monitored to ensure that they do not precipitate a manic phase. During the first days or weeks of a manic phase, symptoms may be controlled initially by antipsychotic drugs. During both phases, treatment with a mood-stabilizing drug, such as lithium, may be started for longer-term symptom control.

Some people may need to be admitted to hospital for assessment and treatment during a manic phase or a severe depressive phase. They may feel creative and energetic when manic and may be reluctant to accept long-term medication because it makes them feel “flat”.

Most people make a recovery from manic-depressive episodes, but recurrences are common. For this reason, initial treatments for depression and mania may be augmented with lithium, which has to be taken continuously to prevent relapse. If lithium is not fully effective, other drugs, such as certain anticonvulsants, may be given. In severe cases, in which drugs have no effect, electroconvulsive therapy (ECT) may be used to relieve symptoms by inducing a brief seizure in the brain under a general anaesthetic.

Once symptoms are under control, the person will need regular checkups to look for signs of mood changes. A form of psychotherapy (see Psychological therapies) may help the person come to terms with the disorder and reduce stress factors in his or her life that may contribute to it.

Posted 04.05.2011

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