Published in City Times
Diagnosing Bipolar Disorder
It is pay day and Alistair’s pockets are full. He splurges his entire salary in a shoe mart, paying unknown buyers’ bills! Deepa is yet again gregarious and thinks she has it her to change the world! Vesna is at her bleak best – entirely uncommunicative, given to fits of crying for no reason. There could be many others who exhibit similar mood patterns to Alistair, Deepa and Vesna: they might all be suffering from Bipolar Disorder.
Bipolar disorder (BD) is a psychiatric disorder associated with mood swings and is often referred to as manic depression. While almost everyone has occasional highs and lows in the moods, those suffering from BD have extreme mood swings that can cause major disruption in their health and lifestyle says Dr.Hossein Ali R.Mubarak, Psychiatrist, Zulekha Hospital, Dubai. The moods of these people alternates between two completely opposite poles: they are euphoric and happy at during some periods, melancholic and depressed at others. Sometimes, however, they may manifest symptoms of both, mania and depression simultaneously, a situation referred to as mixed state. Between these extreme moods that usually occur in cycles, these individuals are normal and function as well as any other individual.
The cause of Bipolar Disorder (BD) may be physical or biological, psychological and environmental including social and economic factors. However, there is overwhelming evidence to suggest that BD is inherited and that there is a genetic vulnerability to developing the disorder. In families of individuals with BD, first degree relatives, that is, parents, children and siblings, are more likely to have a mood disorder than the relatives of those who do not suffer the condition. In case of identical twins, if one has the disorder, there is 80% chance that both will have it; while in the case of fraternal twins this probability is 16%.
There is a definite link between neurotransmitters and mood disorders. The high or low level of a specific neurotransmitter or an imbalance in the neurotransmitters relative to each other contribute to BD. Stressful life events ranging from death of a loved one to birth of a child or loss of job may act as triggers in an individual who is predisposed to the condition. The bottom line would then imply that a manic depressed is born with the possibility of developing BD and he or she requires a trigger to set off the disorder.
While most people with BD usually start showing up symptoms in the late teens or in young adulthood, children as young as 10 years of age may manifest with its symptoms. Bipolar disorder occurs in both men and women though twice as many women than men suffer from the disorder.
BD is classified as Bipolar Type I, Type II, Cyclothymia and Bipolar not otherwise specified (NOS) for diagnostic purposes. Type I is characterized by manic episodes, the high of the manic depressive cycle. A Depressive period follows the manic period although a few Type I individuals may not experience a major depressive bout. Type II BD is characterized by major depressive episodes alternating with bouts of hypomania which is a milder form of mania. The real problem in diagnosing BD arises when a person suffers from unipolar depression which is depression without mania. A third classification is of Cyclothymia which refers to the alternating of hypo-manic episodes with depression that does not reach major proportions. It has been observed that a third of these individuals with Cyclothymia may go on to becoming Type I or Type II bipolars in later life. The last category, NOS, comprises individuals who do not clearly manifest symptoms of the other three types.
The chief differentiating feature between depression and BD is the existence of mania in the latter. The phases of mania and depression manifest with their specific symptoms though in their extreme form, both are associated with homicidal and suicidal tendencies. During the Manic phase, the patient may appear highly energized, be in a euphoric state for no reason, go on spending sprees, display reckless behaviour in various aspects of life, talk excessively, indulge in senseless talk, are restless, flit from one subject to another very rapidly, may have an inflated self esteem, suffer from insomnia, entertain grandiose ideas and have delusions of grandeur. These individuals deny anything is wrong with them and refrain from seeking medical help.
During the Depressive phase, the patients are sad and given to crying spells, may sleep excessively or suffer from insomnia, experience fatigue, have no appetite or may eat excessively, may show up weight loss, they are not able to concentrate on anything, are withdrawn and do not want to talk to anyone, they have no interest in anything and in the worst scenario, they display suicidal tendencies.
Dr.Mubarak cautions that not everyone with severe mood swings need suffer from BD. Certain medical conditions, medications, drug abuse and psychiatric conditions like schizophrenia, may mimic symptoms of BD. However since BD is associated with extreme and risky behaviour, it needs to be diagnosed correctly so that appropriate treatment can be given to good effect, in terms of management, not cure.
There are many variations of BD. Moods can change quickly, several times in a single day or last for longer time periods – weeks and even months. The diagnosis is made on the basis of all the signs and symptoms during repeated sessions with the psychiatrist. If the person might be a danger to self or others, he or she may require hospitalization to stabilize his or her condition, following which maintenance therapy is given.
Treatment of BD includes medication and psychotherapy. Counseling sessions are held for both patients and family. The duration of treatment which is mostly long term, lasting at least a year or more, depends on the frequency of manic and depressive episodes, their intensity and chronicity of the condition. Good prognosis depends on good, uninterrupted treatment, emphasizes Dr.Mubarak. A number of people mistakenly believe that the anti-depressants or anti psycotics prescribed for patients of BD, is addictive and hence discontinue treatment midway. This can be very harmful to the patients. In addition to timely treatment, a supportive family network, balanced lifestyle, regulated stress level, good nutrition, regimen of exercise and sleep, contribute to sound management of the condition that will enable the individuals to function normally in their environment.