BIPOLAR PROBLEMS

Everyone experiences changes in his or her mood. And this is normal. What is not normal is when the mood swings are severe and extreme.

What is Mood and what is Affect??
Affect – It is the outward expression of emotion.
Mood– It is the way the person feels inside.
A Mood is an emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event. Moods generally have either a positive or negative valence. In other words, people typically speak of being in a good mood or a bad mood.
Classification

Depressive Disorders
Major Depressive Disorder (MDD) – It is severe, acute depression for a limited period. It includes :-

  • Inappropriate guilt
  • Sleep disturbances
  • Disturbances in appetite
  • Lack of pleasure
  • Depressed mood

Dysthymic Disorder – It is less severe but chronic.

  • Negative emotions
  • Low self esteem
  • Social isolation
  • Tendency to blame self
  • Inadequacy
  • Irritability

Minor depressive episodes do not fully meet the criteria for major depression but can develop into major depression if left untreated.
Disorders involving alterations in mood
Bipolar disorder is a combination of extreme elation, which is known as mania, and depression.

  • Bipolar I Disorder – Manic or mixed episodes that last at least seven days or the manic episodes are so severe that that the person needs immediate hospital care. Also, the person has depressive episodes lasting for at least two weeks.
  • Bipolar II Disorder – Pattern of depressive episodes shifting back and forth with hypomanic episodes but full-blown manic or mixed episodes are absent.
  • Cyclothymic Disorder – A mild form of bipolar disorder in which the person has episodes of hypomania that shift back and forth with mild depression.
  • Substance – Induced Mood Disorder – It is common for people with mood disorders to turn to substance abuse and the substance abuse in turn exacerbates the effects of the mood disorder.

Causes

  • Biological
    • enetic
    • Bio-chemical
    • Medical
  • Psychological
    • Traumatic life experiences
    • Learned association
    • Distorted perceptions
    • Faulty ways of thinking
  • Socio-cultural
    • Disturbed relations
    • Social unrest
    • Discrimination towards one’s social group

Treatment
Getting an accurate diagnosis is the first step in bipolar disorder treatment. This isn’t always easy. The mood swings of bipolar disorder can be difficult to distinguish from other problems of major depression and borderline personality disorder.

A diagnostic exam for bipolar disorder generally consists of the following:

  • Psychological evaluation – The doctor or bipolar disorder specialist will conduct a complete psychiatric history. You will answer questions about your symptoms, the history of the problem, any treatment you’ve previously received, and your family history of mood disorders.
  • Medical history and physical – There are no lab tests for identifying bipolar disorder, but your doctor should conduct a medical history and physical exam in order to rule out illnesses or medications that might be causing your symptoms. Screening for thyroid disorders is particularly important, as thyroid problems can cause mood swings that mimic bipolar disorder.

In addition to taking your psychiatric and medical history, your doctor may talk to family members and friends about your moods and behaviors. Often, those close to you can give a more accurate and objective picture of your symptoms.

Treatment includes :-

Pharmacotherapy – Depression is treated with anti-depressant medications which work to restore neurotransmitters – serotonin, norepinephrine and dopamine. Bipolar disorder is first treated with mood-stabilizing medications like lithium, valproic acid, etc. For rapid mood cyclers, Rapid Mood Cyclers – Anticonvulsant medications are recommended.

Behavioural Therapy

    1. Assessing range of social interactions
    2. Educating about the disorder
    3. Self- reinforcement techniques

Cognitive Behaviour Therapy

  1. Didactic work
  2. Cognitive restructuring
  3. Behavioural techniques

Psychoeducation

  1. Interpersonal Social Rhythm Therapy
  2. Education on medicine adherence
  3. Exploring about the disorder
  4. Insight building

Somatic Experiencing – Uncovers repressed traumas and to move past them towards growth and mindfulness. It makes us aware of our inner strengths.
Dialectical Behaviour Therapy (DBT)

  1. Core mindfulness
  2. Distress tolerance
  3. Emotion Regulation
  4. Interpersonal effectiveness

Holistic Therapy – Yoga, meditation, acupuncture, massage therapy
Risk Factors

    Factors that seem to increase the risk of developing or triggering depression include:

  • Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
  • Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
  • Childhood trauma or depression that started when you were a teen or child
  • Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
  • History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
  • Abuse of alcohol or illegal drugs
  • Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
  • Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Protective Factors

  • Effective clinical care for mental, physical and substance use disorders
  • Easy access to a variety of clinical interventions and support for help seeking
  • Restricted access to highly lethal means of suicide
  • Strong connections to family and community support
  • Support through ongoing medical and mental health care relationships
  • Skills in problem solving, conflict resolution and nonviolent handling of disputes
  • Cultural and religious beliefs that discourage suicide and support self preservation
  • Presence of mentors and support for development of skills and interests
  • Opportunities for engagement within school and community
  • Clear expectations for behavior
  • Physical and psychological safety

If you suspect you have depression or bipolar disorder, speak with the Doctor.
We at Mumbai Psychiatry Clinics have a dedicated team of counsellors and clinical psychologists who will help you with your problems, cite interventions and assess the progress on regular intervals. There are experienced psychiatrists who will be guiding you throughout your journey and our Multidisciplinary team will try to assure you with the best help possible.
Reference
http://youth.gov/youth-topics/youth-mental-health/risk-and-protective-factors-youth#sthash.a0jGwQtl.dpuf
http://youth.gov/youth-topics/youth-mental-health/risk-and-protective-factors-youth#sthash.a0jGwQtl.dpuf
Linehan, M.M. (1986). Suicidal people: One population or two? Annals of the New York Academy of Sciences, 487, 16-33.