What is Bipolar Affective Disorder

Symptoms of bipolar affective disorder:

Disorder qualified earlier as manic-depressive psychosis. The disease is characterized by repeated (at least two) episodes in which mood and level of motor activity significantly is violated – from manic depressive hyperactivity to lethargy. Exogenous factors have virtually no effect on fluidity. The boundaries are determined by the transition scenes in an episode of opposite polarity, or mixed, or in the intermissions (remission). Seizures have tropism for the season, usually spring and autumn aggravation, although are also possible individual rhythms. The duration of intermissions is between 6 months to 2-3 years. Duration of manic states is from one month to four months during the duration of the disease dynamics of depression from a month to 6 months. Relapses can be about the same length, but can be extended by shortening remission. Depression is clearly endogenous: daily fluctuations of mood, the elements of vitality. In the absence of therapy, the attacks tend to spontaneous breakage, although they are more protracted.

During the disease is sometimes observed social decline.

Clinical example: A patient V., 32, a specialty dentist. The first episode of mood changes was observed in the spring four years ago. Stopped going to work, felt a sense of sadness, there were suicidal thoughts and ideas self-incrimination, he refused to eat. He took leave without pay and two weeks out of the state of depression for the next year in spring saw the opposite position. A lot of productive work and little sleep, increased energy, and there was a set of plans that are successfully implemented. At the height of this state he demanded that the head of the polyclinic to allow him to “night work” for special studies, he quarreled with coworkers, the morning came to work drunk. For outpatient visits to a psychiatrist he refused treatment and hospitalization. Manic episode lasted two weeks and was repeated in a year. At this time the patient was persuaded to take medication, lithium, and his condition stabilized during the year. Latest – depressive – episode again in the spring, but became protracted. Having been dismissed from his jobs, he was inactive. He was heavily affected by his disability. He believed that it was over. He complains of feeling “a stone on his chest,” shortness of breath during inspiration, is not desirable, “the food falls into the void.” Against this backdrop, begins to drink alcohol, but it only deepens the state of boredom .Asked his friend to give him a gun, “to hunt”, trying to make a suicide attempt. When viewed from position of subordination, sad sighs, holding his chest. Considered that it doesn’t need cure, it is better to die in peace. He explained about dreams, which sees in the underground corridors of the dead.  Time passes slowly, as if an eternity. By evening, the state improved somewhat.

Diagnosis of bipolar affective disorder

It is based on the identification of repeated episodes of mood changes and the level of motor activity in the following clinical variants. When diagnosing note are directly observed episode of affective disorders, such as hypomanic, manic without psychotic disorders or psychotic disorders, moderate or mild depression, severe depression with psychotic or not. If the disorder is not observed, it indicates a diagnosis of remission, which is often associated with preventive therapy.

Differential diagnosis

Bipolar disorder is often differentiated from schizoaffective disorder. Schizoaffective disorder is a transient endogenous functional disorder, which is also practically not accompanied by a defect and that affective disturbances occur and is accompanied by longer than the productive symptoms of schizophrenia (F20). These symptoms are not specific to bipolar disorder.

Treatment of bipolar affective disorder:

It is split between treatment of depression, mania and prophylactic treatment of seizures. Features are defined by the depth of treatment of affective disorders and the availability of other productive symptoms. In the depressive episodes are often used tricyclic antidepressants, ECT, sleep deprivation therapy, inhibition of nitrous oxide. In manic episodes, a combination of lithium carbonate and neuroleptics. As maintenance treatment: carbamazepine, sodium valproate or lithium carbonate.