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Bipolar Disorder

Bipolar Disorder
What is bipolar disorder?

Bipolar disorder (also called “manic depression”) is a type of mood disorder, in which a person experiences both manic and depressive episodes. During a manic episode, patient commonly feels overly happy or irritable, over-confident, full of energy, and has lots of ambitious plans and ideas. During a depressive episode, the patient experiences persistent feelings of sadness, loss of interest in usually enjoyable activities, pessimism, hopelessness, and fatigue. When the disorder is active, the patient’s mood will become overly elated or depressed, and the patient’s thoughts, behaviour and normal life will be significantly disrupted.

How common is bipolar disorder?
Prevalence rate

About 1 in every 100 adults has bipolar disorder at some point in their life.

Gender ratio

Men and women are affected equally.

Age of onset

It usually starts during or after teenage years. It is unusual for it to start after the age of 40.

 

What causes bipolar disorder?

Research suggests that many causes may be involved, which include genetic factors, environmental factors and their interactions. There is a genetic component of this disorder. Those who carry the genes may develop the disorder when they encounter certain environmental factors, e.g. physical illness or other life stressors.

 

What are the symptoms of bipolar disorder?

What are the symptoms of bipolar disorder?

The patient may have manic or depressive symptoms depending on which way his mood has swung. Usually, the patient will be either manic or depressed, but it is possible for the patient to be in a mixed state. After the first occurrence of bipolar disorder, the patient faces a risk of relapse. If you find these symptoms in your family or friend, professional help should be sought.

Manic phase

In the manic phase, the patient will have abnormally elevated mood and may become overly excited, optimistic, grandiose, or easily get irritated. These feelings can be so intense that they affect the patient’s thinking and judgment. Overestimation of oneself may lead to bad decision making, embarrassing, harmful or even dangerous results.

Main symptoms of mania:

Emotion
  • Abnormally and persistently elevated, expansive, or irritable mood
Thought
  • Always full of new and exciting ideas
  • Thoughts move quickly from one to another
Physiology
  • Full of energy
  • Could not or not wanting to sleep
  • Increase in sex drive
Behaviour
  • Talk quickly, and speech is difficult to interrupt
  • Make inappropriate decisions, e.g. recklessly spending his money, gambling or risky investment
  • Grandiosity, impulsivity and over friendliness, which may be out of his character, may lead to immature relationships with strangers, e.g. casual sex
  • If an episode of mania becomes very severe, there may even be psychotic symptoms, which tend to be grandiose beliefs about self - that he is on an important mission or that he has special powers and abilities
Depressive phase

During depressive phase, the patient will persistently have depressed mood, lose interest or the ability to feel pleasure from most activities, frequently feel tired or experience sleep disruptions. This can make daily living tasks difficult to handle. In severe cases the person may even have suicidal ideations or attempts.

Main symptoms of depression:

Emotion
  • Persistent depressed mood, such as sadness
  • Loss of interest or the ability to feel pleasure
Thought
  • Feeling useless and not valuable to society or others
  • Inappropriate and excessive self-blame or having a sense of guilt
  • Feeling that life is hopeless
  • Thoughts of suicide
Physiology
  • Frequently feeling tired
  • Significant change of appetite, both increase or decrease
  • Significant change in weight
  • Sleep disturbances or excessive sleep
Behaviour
  • No longer doing things or joining activities that were previously enjoyable
  • Signs of agitation in body movements such as restlessness, pacing, wringing of the hands, pulling of clothes etc.
  • Slower speed in speech, thinking or movement, reduced or stopped talking
  • Suicidal attempts or preparation behaviours, such as writing a suicide note or gifting important belongings to others

Know more – About different types of bipolar disorder

Depending on the severity of the manic and depressive phases, people with bipolar disorder can be diagnosed as suffering from bipolar I disorder (with severe mania), bipolar II disorder (with less severe mania, also known as hypomania), and cyclothymic disorder (less severe manic and depressive symptoms often alternately presenting themselves).

 

What are the treatments of bipolar disorder?

Effective treatments include medication, electroconvulsive therapy and psychotherapy.

Medication

Drug treatment is very important in the management of bipolar disorder.

Type Mood stabilisers Second generation antidepressants
Common drugs
  • Lithium
  • Anti-convulsants, e.g.
    • Carbamazepine(Tegretol)
    • Sodium Valproate(Epilim)
  • Second generation antipsychotics, e.g.
    • Aripiprazole (Abilify)
    • Clozapine (Clozaril)
    • Olanzapine (Zyprexa)
    • Quetiapine (Seroquel)
    • Risperidone (Risperdal)
  • Selective Serotonin Re-uptake Inhibitor (SSRI), e.g.
    • Citalopram (Cipram)
    • Escitalopram (Lexapro)
    • Fluxetine (Prozac)
    • Paroxetine (Seroxat)
    • Sertraline (Zoloft)
Indications
  • Use to treat both manic and depressive episodes
  • Reduce the frequency of relapse
Mainly to relieve the symptoms of depression in bipolar disorder such as depressed mood, worthlessness, lack of motivation or concentration
Mechanism of action Exact mechanism is unclear Work by regulating the neurotransmitters activities, such as serotonin in the brain
Side effects/ points to note
  • Common side effects of lithium:
    • Mild hand tremor, metallic taste, mild degree of nausea or diarrhoea, malaise
  • Ladies taking lithium should use contraceptive methods to avoid pregnancy
  • Doctors will regularly monitor the levels of lithium in the blood
  • Consult the doctor immediately in case of lithium overdose, e.g.:
    • nausea, vomiting, diarrhoea, confusion, muscle weakness, gross tremor, muscle twitching, unsteady gait, irrelevant speech
  • Nausea, vomiting, gastrointestinal discomfort, somnolence, dry mouth, tremor, headache, sweating, sexual dysfunction, weight loss
  • Some patients may experience excitement, anxiety, insomnia, restlessness or seizure

If patients experience any undesirable side effects during drug treatment, please consult the doctor as soon as possible to clarify the worries and make appropriate adjustments.

Tips for medications: How to prevent relapse?

Bipolar disorder runs a relapsing course. Drug treatment can effectively control the symptoms and prevent relapse. Lithium reduces relapse risk by 30 to 40%. Depending on the severity of the symptoms and the number of previous relapses, patients usually need to take mood stabiliser for at least two years. Frequent previous episodes of relapse increase the likelihood of future relapse. Therefore, it is essential to have good compliance with the drugs according to doctor's instructions to prevent relapse. In addition, maintaining a healthy lifestyle, including adequate sleep, can also help prevent relapse.

Electroconvulsive therapy

Mainly used for severely depressed persons.

Psychotherapy

When used in conjunction with medication, psychotherapy can help patients with bipolar disorder better manage their symptoms. Empirically supported interventions include psychoeducation, cognitive behavioural therapy, interpersonal and social rhythm therapy, and family-focused therapy.

Type Ways of treatment
Psychoeducation Educating the patient with knowledge on bipolar disorder helps them become more compliant with medication and more aware about signs of recurrence, and thus lowering the chances of relapse.
Cognitive behavioural therapy Cognitive behavioural therapy aims at changing the individual’s maladaptive belief, thinking and behavioural pattern, so that they can cope with mood changes and behavioural problems more effectively.
Interpersonal and social rhythm therapy Bipolar disorder often disrupts a person’s circadian rhythm. Interpersonal and social rhythm therapy aims at helping the patient adjust their circadian rhythm and build a more regulated and healthy lifestyle. This improves their medication compliance, ability to cope with daily stressors, and minimize the disruptions caused by bipolar symptoms to their interpersonal and social relationships.
Family-focused therapy Family-focused therapy requires participation from both the patient and their family/caregiver. This therapy utilises family as a unit to resolve problems caused by bipolar disorder. It focuses on improving communication and cooperation among the patient and family members, reducing family conflict caused by bipolar symptoms, and educating family members about bipolar disorder so they can better help the patient for recovery.
How to support and help people with bipolar disorder?
Tips for caregivers:
Avoid conflicts:

When a person with bipolar disorder is having active symptoms, they may become impulsive or irritated. Families should be aware that this is a symptom of their illness and respond calmly. Avoid reacting with negative emotions and quarrelling with them.

Monitor closely:

Sometimes it is easier for others to notice the patient’s mood changes than for the patients to be aware of it themselves. Caregivers can help monitor their mood changes and especially notice any sign of a manic episode, such as losing sleep, more talkative, and acting more impulsively. Seeking professional help early when these happen can help prevent or mitigate the manic episode.

Be a good listener:

People in recovery needs support from family and friends, try to be a good listener instead of only telling them what they should do.

Provide regular life:

Provide them with a peaceful and comfortable living environment, and with an organised daily schedule.

Encourage social interactions:

Encourage them to have social contacts; when possible, accompany them to engage in social activities, keep contacts with those they have good relationship or they feel comfortable to meet.

Take care of yourself:

Supporting emotionally disturbed people is a long-term challenge. So carers need to look after their own physical and mental health, to rest and regenerate, and then to accompany patients to get through the troubled time. Ask for help when necessary.

 

 

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Radio i Care 友心情網上電台 [同路情真] Wallis Cho曹震豪 - 擁抱音樂 第二節 香港社會服務聯會- 社聯頻道 不容忽視青少年精神健康 Radio i Care 友心情網上電台YouTube channel中有關躁鬱症的短片

Reference source(s): Websites of the Institute of Mental Castle Peak Hospital and Kwai Chung Hospital