Bipolar affective disorder

Because the coverage of affective disorder is too wide, and the most important thing is bipolar disorder, here I will write about bipolar disorder in detail. Most of the content comes from research papers (Anderson, haddad &; Scott. , 20 12) translation excerpts, basically covering all aspects you want to know (my hand was broken, I spent most of the afternoon reading papers, and some nights playing cards crazily _ (┐ "ε:) _), hoping to help people who want to know about bipolar disorder or solve their doubts about bipolar emotion.

The subject of a conversation or article.

Bipolar disorder, originally called bipolar disorder, is one of the most difficult mental diseases to control. Although it is also related to genius and creativity, its negative impact on patients' lives is enormous. In recent 20 years, more than 6% patients died of suicide.

Mania is usually used when the mood rises seriously and is maintained or accompanied by other mental symptoms, causing obvious behavioral disorders. Hypomania is used when the symptoms are relatively mild. Patients usually don't notice the need to seek treatment, but hypomania will develop into mania.

What is bipolar disorder?

Bipolar disorder is characterized by recurrent mood swings and depression, accompanied by changes in behavior and energy, which affect cognitive, physiological and behavioral symptoms.

Type I bipolar disorder is characterized by mood swings (depression) and persistent mania, while type II bipolar disorder is mainly characterized by depression with mild mania.

Depressive symptoms are usually more common and last longer during emotional ups and downs, accompanied by endogenous mild symptoms, which is the reason for most negative emotions.

Other mental illnesses, such as anxiety, alcohol and drug abuse or misuse, are also common.

The chances of suicide and various natural factors (such as cardiovascular disease) increase.

Treatment is usually a combination of drugs and auxiliary psychotherapy. No matter in the stage of severe attack or maintenance recovery, the treatment will be based on which side is dominant: mania or depression.

Who will suffer from bipolar disorder?

The recent global survey covering 1 1 countries shows that the median age of patients is 25 years old, and the prevalence rate is 0.6% (type I bipolar disorder, mostly male) and 0.4% (type II bipolar disorder, mostly female). The global prevalence of mild symptoms is 1.4%. The prevalence rate in the United States is the highest, once 1.0%, 1. 1%, 2.4%. Mania before puberty is relatively young. Generally speaking, emotional disorders in youth will develop into depression and mania in adulthood (Duffy et al, 20 10).

What causes bipolar disorder?

The heritability of type I bipolar disorder is 0.75, which is mostly caused by common allele variation, and some genes overlap with schizophrenia genes (Sullivan, Daly &; O'donovan, 20 12). The dominance of genes is caused by the influence of genes and environmental factors. The incidence of physical or sexual abuse in childhood is twice that of the normal population, and the symptoms are earlier and more serious (Etain et al., 2008). Life experience or long-term stress is also an important factor to trigger emotional changes (Martinowich, Schicesser. , & Manji, 2009).

What makes bipolar disorder so challenging?

At the same time, it is accompanied by other mental diseases, among which anxiety is the most common. Patients who exceed13, especially those with early onset, also have alcohol or drug disorders.

Moreover, compared with other stages of the disease, critically ill patients usually underestimate the severity of the disease and easily refuse treatment, which makes treatment extremely difficult. Violence in mania can also cause danger to them and lead to criminal behavior. On the contrary, hypomania often cannot escape the attention of the medical system, and even if it is found, it is easy to be refused treatment. Because patients tend to see this hypomania as positive and associated with personal energy and creativity.

When patients seek treatment for depressive symptoms, previous manic episodes are often undetected. Therefore, the exact diagnosis may be delayed for several years, which indirectly leads to ineffective and harmful treatment. The "conversion rate" from depression to bipolar disorder is about 1% per year, and undiscovered bipolar disorder is more likely to occur in depressed patients with ineffective antidepressants.

Rapid circulation (four or more emotional attacks every year) is a sign of the severity of the disease and poor response to treatment. Even if the patient is in a normal state, there will be mild to severe cognitive impairment, such as language learning, memory, behavioral ability, etc., and cause functional defects.

30-40% patients will have intentional self-harm behavior-especially behaviors closely related to depression, mixed symptoms, insanity and substance abuse. In the recent large-scale survey, among people over 18 years old, the suicide rate of men is 7.8% and that of women is 4.8%, which is higher than that of depression and schizophrenia.

How is bipolar disorder diagnosed?

The most critical diagnostic factor is hypomania or manic history. It is worth noting that the main irritability may be masked by mania, and mental symptoms may also be mistaken for schizophrenia symptoms. Therefore, the diagnosis requires a very careful understanding of the past medical history and mental tests, combined with other relevant information. At the same time, mood swings may be ignored or not reported. Hypomania may also be ignored, and patients may only seek medical help if they have repeated attacks or have adverse reactions and others put pressure on them. The similarity between bipolar disorder and other mental illness symptoms can also lead to misdiagnosis. For example, attention deficit hyperactivity disorder (ADHD) is very similar to the symptoms of bipolar disorder. Because ADHD is common, it is necessary to make sure that patients have obvious emotional attack (mania and euphoria) stage when diagnosing bipolar disorder. The same is true of schizophrenia, because its symptoms are closely related to mood swings.

In order to avoid misdiagnosis, it is necessary to have a clear manic episode and obvious euphoria (not just irritability) and the onset stage (Norvik, Swartz. & Frank. , 20 10)。

For most people, personal scales, such as the Emotional Disorder Questionnaire or the Mania Scale, are helpful to understand the prophase symptoms of hypomania and mania.

How to distinguish bipolar affective disorder from unipolar affective disorder?

Regardless of medical history and personal factors, it is difficult to distinguish the two. A study summarized their characteristics as follows (Mitchell, Goodwin. , & Johnson. , 2008).

Characteristics of type I bipolar disorder: unusual depressive symptoms (hypomania, increased appetite, feeling weak and paralyzed, unable to move); Emotional instability; Characteristics of mental illness or guilt in the case; Mental and behavioral retardation; Early onset time (

Characteristics of unipolar affective disorder: decreased sleep or insomnia; Loss of appetite and weight loss; Normal or increased activity frequency; Physical problems; Late onset of depression (> 25 years old); The onset period of depression is longer (> 6 months); No family history.

How to control bipolar disorder?

The purpose of first aid is to relieve symptoms and reduce the harm of patients to themselves or others. The purpose of long-term treatment is to prevent future attacks, help patients return to their pre-onset state, enhance their health and reduce the chance of suicide. Patients who cycle between mania or hypomania and depression are particularly difficult to treat. In an emergency, emotional stability is the most critical treatment factor.

The curative effect of drugs on mild diseases has not been well confirmed. Special psychotherapy is very important for reducing relapse, treating depression and enhancing physical function. Other important aspects include establishing a good relationship with the therapist, continuous treatment and attention, recording the illness and so on.

Due to the lack of sufficient evidence on how to treat mental diseases (such as anxiety) at the same time, the usual process is to treat specific diseases carefully after stabilizing emotions.

What medicine is effective?

Most studies are limited to the treatment of mania and bipolar disorder, but there is little evidence of hypomania and mild mood swings. Most drugs are more effective for some symptoms, so patients may not treat other symptoms at the same time during the "emotional stability" stage (lithium or anticonvulsants are usually recommended).

What role does psychotherapy play?

At present, there is no definite evidence to show which treatment method to choose. All kinds of therapies have their specific effects, but they all need to be determined according to the doctor's understanding, the condition, whether the patient abides by the course of treatment, the patient's life and rest, etc. Cognitive behavioral therapy (CBT) helps patients understand and solve wrong thinking and behavior patterns; Family therapy focuses on strengthening the ability to solve problems and coping methods; Interpersonal relationship and social therapy focus on solving interpersonal relationship and daily communication problems; Psychological knowledge education provides patients with an opportunity to understand their own illness, which is conducive to patients' self-adjustment and treatment. At the same time, there is evidence that cognitive correction (enhancing cognitive performance through behavior training) is effective not only for bipolar disorder, but also for schizophrenia patients (Anaya et al., 20 12). The challenge now is how to combine appropriate treatment methods according to the needs of patients.

When should I seek medical help?

When a serious illness occurs, it is necessary to seek the help of professional doctors and nurses with emotional disorders, treat the serious illness, control and reduce the harm, make a diagnosis, and propose or check a long-term treatment plan.

In the following cases, patients need professional care: when patients encounter difficulties in medical services or treatment; Frequent recurrence, weak ability to control the disease, or persistent symptoms; Have serious other mental symptoms, such as anxiety, alcoholism or drug abuse; It is necessary to control the situation of suicide or to control the harm to them.

Patients with stable conditions need to seek professional care in the following situations: preparing for pregnancy or already pregnant; Have side effects on treatment or need to change medicine; Prepare to change or stop treatment; Need to contact a professional doctor.

How to control mood swings?

Mania usually requires professional medical care to reduce harm and provide treatment. This sometimes requires compulsory intervention, and severe behavioral disorders may require the use of antipsychotics or benzodiazepines or both. It is necessary to provide a quiet environment and exclude external stimuli. Hypomania may be treated by a support group in a professional institution.

The first step is to understand any reasons, such as drug withdrawal and sudden life stimulation. Prescribed antidepressants need to be stopped because they may cause mood swings. It is necessary to check the efficacy and tolerance of any treatment in the past medical history (Goodwin, 2009).

Antipsychotics are the first choice for the treatment of mania, especially in severe cases. A meta-analysis study on various treatment methods (Cipriani et al., 20 1 1) shows that antipsychotics, lithium, anticonvulsants, epilepsy drugs and Lipitor are more effective than placebo. The most effective drugs are haloperidol, risperidone and olanzapine. They are all more effective than anticonvulsants, and droperidol is also more effective than lithium. The second generation antipsychotic drugs such as risperidone, olanzapine and quetiapine are less likely to be abandoned.

If combined medication, the effect will be better. Studies have shown (Smith et al., 2007) that the combination of antipsychotics and lithium or anticonvulsants is much better than lithium, anticonvulsants or psychotropic drugs alone. Benzodiazepines may be used to treat impulsive behavior and insomnia in the short term, but they lack antimanic properties.

How to control the depression of patients with bipolar disorder?

For mania, it is necessary to remove prescription drugs and check the treatment history. Select appropriate drugs from medical history to prevent mood swings caused by drugs. Studies show that olanzapine and the combination of olanzapine and fluoxetine are very effective. Moreover, some studies have found that antidepressants are as effective as placebos in patients with bipolar disorder. Mcqueen. , 20 1 1)。 Antidepressants need to be used in combination with antimanic drugs to reduce the chance of mood swings. Selective serotonin reuptake inhibitor (SSRI) is also an option because it is not easy to cause manic episodes. Unless the medical history shows that continuous use of antidepressants is effective for patients, it is recommended to consider stopping using antidepressants after the depressive symptoms are relieved (Goodwin, 2009). At the same time, consider the combination of psychotherapy and drug therapy.

What's the difference between women with bipolar disorder giving birth?

As mentioned above, patients need to seek professional care during delivery. A large-scale study found that 23% of female patients will relapse during childbirth, and the probability of recurrence after childbirth is higher, at 52%. Most recurrent symptoms are depression (Sharma &; Pope, 20 12). If the mood stabilizer is stopped, the probability will increase. Studies have shown that compared with pregnant women who continue to take emotional stabilizers, the recurrence probability of pregnant women who do not continue to take stabilizers is as high as 85- 100%. Lithium and anticonvulsants can increase the deformity probability of infants, and anticonvulsants have the highest deformity probability and delay the development of nerves. Therefore, it is forbidden to use such drugs during pregnancy. If you use it, you need to consider contraceptive measures. Other drugs are similar, such as lithium, which needs to be used under the supervision of an obstetrician. If possible, avoid taking medicine for the first three months. Antipsychotics are an option during pregnancy, and cognitive therapy is the most popular among patients with depression (NIHCE, 2006). At the same time, lithium, olanzapine and lamotrigine are prohibited during lactation.

What if treatment doesn't work?

When the treatment effect is not good, check the diagnosis and try to understand the complexity of the condition, such as drug abuse or alcoholism, and do not cooperate with the treatment (nearly half of bipolar disorder is not treated according to the doctor's advice). At the same time, according to the guidance of professional doctors, increase the dosage of drugs or replace substitute drugs. At the same time, cooperate with psychotherapy to minimize the influence of environmental factors. Studies have shown that ECT (Electroshock Therapy) is effective for bipolar disorder and single affective disorder. ECT is also one of the ways to suppress mania. When the drug treatment is ineffective or the condition is quite serious, ECT can be used.

What are the treatment expectations of bipolar disorder?

Most patients recover in the first stage after onset, but about 80% relapse within 5 ~ 7 years, and most patients have more than three onset experiences in 20 years (Wittchen, MH LIG&: Pezawas, 2003), which is a risk of continuing into old age. In the long-term follow-up study, patients experienced moderate to severe functional loss in 26-32% of the time. The aggravation of illness and dysfunction are more obvious in patients with severe symptoms, early onset and cognitive decline (Treuer &; Tohen, 20 10). Early treatment of diseases will be more effective, and early intervention and long-term treatment are particularly important. Nevertheless, most patients still have a good curative effect and a complete and healthy life, but at the same time, we need to pay attention to and control the factors that will cause recurrence.

Please refer to my previous answer about whether psychotropic drugs should be used.

How to evaluate antidepressants and their placebo effect? -Ye gambler's answer

Thank you for reading. This article can be used as a reference, and the specific treatment and diagnosis still need to consult a professional doctor.

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