What is bipolar disorder?


Bipolar Disorder

By Dr. Dewasmika Ariyasinghe

Bipolar disorder is a mental illness, which affects both men and women equally. It can start at any age but commonly does so in late teens. The main characteristic of the illness is that, as indicated by the name of the illness, it has two types of episodes (an episode is a period, which can range from 3-12 months, where the patient has symptoms of the illness) occurring on and off during the life time of the patient. Usually, the patient remains well in-between episodes. During a depressive episode, the patient feels sad and lethargic. He also has lack of motivation, lack of interest in day to day activities, suicidal ideas, pessimistic views of himself, others (world) and the future and impaired sleep and appetite. During a depressive episode, the patient is often seen preoccupied and withdrawn with neglect of himself and other work. In contrast, when the patient is in a manic episode, he feels unduly happy and energetic. He can be very talkative and can have elaborate plans on how to go about impossible tasks/ undertakings. He has no need to sleep and would try to work non-stop. He would not listen to others and would pick up fights whenever he feels he is prevented from achieving his goals. (Some patients experience only depressive episodes during the life time, but no manic episodes. Then it is not bipolar disorder, but recurrent depressive disorder). Some patients can experience a mixture of both during one episode and then it is called a mixed episode.

What are the risks of untreated bipolar disorder?

1. Risk of committing suicide. (Any person who talks about ending his life/ expressing views like 'no point in living', 'I wish I would be dead', should be taken seriously and be directed to the nearest hospital, despite whether they have a mental illness or not)

2. Risk of aggression/violence. This is common during a manic episode, but can happen even during a depressive episode as well.

3. Risk of deterioration of academic performance/ performance at work.

4. Prone to develop other mental illnesses like substance abuse/dependence and dementia.

5. Risk to finances due to poor judgment. overspending

6. Risk of unwanted pregnancies/ acquiring sexually transmitted diseases, as during a manic episode their sexual desires can increase and also they can be sexually dis-inhibited.

7. Risk of neglecting the children/ family/ one's health.

8. Risk to one's reputation as one can act in an inappropriate and irresponsible manner during a manic episode.

9. With frequent episodes the patient's memory, thinking and work performance can deteriorate.

How do we treat bipolar disorder?

The patient can be treated as an inpatient or an outpatient depending on the severity of the problems. After the management of the initial disturbed behaviours, the patient is started on a medication (called 'mood stabilizer'), to minimize the recurrence of episodes. It is important that the patient continues. these until a specialist in psychiatry decides that the medication can be stopped. The duration of treatment varies from patient to patient and usually it is for many years. If a patient experiences frequent episodes, then it is likely that his level of function will also deteriorate with time. So it is important that one continues treatment.

Important facts to know while on treatment

1. To continue treatment as prescribed by the doctor. If you experience any side effect/s you can always discuss it with your doctor and he/she will prescribe another medication.

2. To have a regular sleep pattern. The patients with the illness should not break rest and ideally should not do frequent night shifts at work.

3. To use a reliable contraceptive method. Some medications prescribed for the illness may harm the developing foetus. If the patient wants to get pregnant, then it should be discussed with a specialist in psychiatry and medications will be changed to those which can be taken during pregnancy and breast feeding. It is advisable not to stop treatment by the patient herself as the illness can recur during pregnancy/ after delivery and it can be detrimental for the baby and as well as for the mother. It is also recommended that the patient should not get pregnant soon after getting an episode of depression or mania. She should wait at least six months after the full recovery.

4. To take medications prescribed for other physical illnesses. It is always important to show the medications one already is on when seeing a doctor for any reason, as some medications can interact in the body and can give rise to unpleasant effects. One's mental health and physical health are closely linked, so taking optimum care of both is essential for satisfying life.

5. Some medications need regular monitoring of blood tests and the doctor can advise the patient regarding this

6. One should do regular physical exercises and take a balanced diet to avoid weight gain and to avoid nutritional deficiencies.

7. Not to take substances of abuse (alcohol, cannabis etc) as these can precipitate recurrence of episodes.

8. The medications prescribed for long term management do not cause addiction.

9. The medications prescribed for long term management are not harmful to the brain, but recurrent episodes are.

Bipolar affective disorder is a recurring illness, which can be treated successfully. If the patient adheres to a treatment plan, has regular time to relax, and avoid taking substances and breaking rest he/she can function well in his/her day to day life while doing a job like anyone without an illness.

Dr. Ariyasinghe (MBBS,MD-Psych) is Senior Lecturer, Department of Psychiatry, Faculty Of Medicine, University of Peradeniy and Honourary Consultant Psychiatrist, Teaching Hospital Peradeniya


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