Symptoms and Treatment of Bipolar Affective Disorder

During the manic phase there are five stages:

Hypomanic phase is characterized by elevated mood, a sense of spiritual uplift, physical and mental vigor. This verbose expresses typical moderately pronounced motor stimulation. Attention is characterized by increased distractibility. Moderately is reduced sleep time.
Stage of expressed mania is characterized by severe manic further increase expression of the main symptoms of the phase. Patients are constantly joking and laughing, against the background of what may be short-lived outbursts of anger. Speech, motor excitation pronounced. Severe distractibility make it impossible to conduct a coherent conversation with the patient. Against the background of re-evaluation of self appear delusions of grandeur. Sick at work building a brighter future, invest in a hopeless unrealistic projects. Duration of sleep reduced to 3-4 hours per day.
Stage of maniacal fury is characterized by manic frenzy of maximum severity of core symptoms. Motor stimulation has dramatically disorganized nature, it looks incoherent, consists of fragments of phrases, single words or even syllables.
Stage of moving calming is characterized by a reduction of motor sedation motor excitation on the background of continuing high mood and verbal stimulation. The intensity of the latter two symptoms also is gradually reduced.
Reactive stage is characterized by the return of all components of the symptoms of mania to the norm, some reduction in the mood, light and motor retardation, asthenia.
Depressive phase of manic stage shows the opposite triad of symptoms: depressed mood, slowed thinking and motor retardation. The depressive phase is divided into four stages:

The initial stage of depression is manifested as a not sharp weakening of the overall mental tone, decreased mood, mental and physical performance. It is characterized by the appearance of moderate sleep disorders in the form of difficulty falling asleep and superficiality. For all stages of the current depressive phase are characterized by improvement in mood and general well-being in the evening.
Stage of growing depression is characterized by increasing depressive moods that decrease already evident with the emergence of anxiety component, a sharp decline in physical and mental health, motor retardation. It is slow, laconic, quiet. Sleep disturbances translate into insomnia. A marked decrease in appetite.
Stage of severe depression – here all symptoms are reaching their maximum development. Affects depression and anxiety is experienced painfully sick. It dramatically slows, silent or whispered, monosyllabic answers to questions with great delay. Patients can sit or lie in one position (so-called “Depressive stupor”), characterized by anorexia. At this stage there are depressive delusions (self-blame, self-deprecation, own sinfulness, hypochondriacal). Also is characterized by the appearance of suicidal thoughts, actions and attempts. Illusions and hallucinations are rare, but they may be more likely in the form of votes, reporting the status of hopelessness, meaninglessness of life, recommending to commit suicide.
Reactive stage is characterized by a gradual reduction of all symptoms, fatigue persists for some time, but sometimes, on the contrary, there is some talkativeness, increased physical activity.

Diagnosis of Bipolar affective disorder

Diagnosis is based on the identification of repeated episodes of mood changes and the level of motor activity. In diagnosing note it is 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, but does not exclude other types of mental disorders: neuroses, infectious diseases, psychogenic, toxic, traumatic psychosis, mental retardation, psychopathy.

Treatment of Bipolar affective disorder

There are divided the 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 often are used antidepressants, electroconvulsive therapy, sleep deprivation, inhibition of nitrous oxide. When treating the depressive phase of antidepressants it should be considered a risk phase of inversion, that is, the transition from a patient in a manic depressive state, but more likely, a mixed, which may worsen the patient’s condition and, more importantly, the mixed state is very dangerous in terms of suicide. Treatment with antidepressants should be combined with stabilizers fot mood – mood stabilizer, and even better with atypical antipsychotics.

In manic episodes, it is used a combination of lithium carbonate and neuroleptics.