Bipolar disorder

Bipolar disorder; Although it is a disease known since ancient times, its definition as we know it coincides with the beginning of the 20th century.

Bipolar disorder is a chronic mood disorder in which there are recurrent depressive or manic episodes, and sometimes “healthy” periods in which sub-threshold disease symptoms can be seen in the person, and sometimes no symptoms are seen. Its lifetime prevalence is around 1-3%.

Although we do not have certain information about the causes of the disease, brain structure and function changes such as prefrontal cortex dysfunction, amygdala enlargement, increase or decrease in the amount of chemical substances such as dopamine, noradrenaline and serotonin in the brain, genetic factors (the probability of the disease in the first degree relatives of those with bipolar disorder) It has been reported that it is about 7 times more common than the general population.) are the possible causes that we know so far.

In general, two attack types of bipolar disorder can be mentioned: manic (moving) and depressive (depressed)

mania; It can be defined as the presence of an unusual mood and a period of unusual and sustained increase in goal-directed activity and inner strength most of the day for at least one week, being persistently bloated (overjoyful), exuberant, or irritable. The person may have a remarkably above-average level of joy and is confident and motivated to engage in work that is normally uninformed. The exaggerated mood of the person also attracts the attention of the environment.

During this period, the person may have an exaggerated increase in self-esteem or thoughts of grandeur (he may think that he is an important person, that he has been given an important task), the need for sleep may decrease and the person may feel vigorous by sleeping very little, the person’s thoughts may seem as if they are competing with each other, they may experience flight of ideas. , and may be more talkative than usual. They may be distracted and have increased activity (at work, school, social or sexual context) and may be overly involved in potentially harmful activities such as overspending, reckless sexual attempts, or making unnecessary business investments.

On the other hand, symptoms such as depressed mood lasting at least two weeks, lack of energy, not being able to enjoy activities that were previously enjoyed, fatigue, reluctance, sleep and appetite disorders, pessimism, worthlessness, guilt and suicidal thoughts can be seen in depression.

In addition, in the depressive periods of patients with bipolar disorder, compared to unipolar depression; earlier age of onset, more psychotic symptoms and suicide attempts, and marked psychomotor retardation (immobility) were observed.

Mood stabilizers such as lithium and valproic acid are widely used in the treatment of bipolar disorder, both in exacerbation and maintenance periods, based on blood levels. Antipsychotic drugs are also frequently used to calm the patient and control their psychotic symptoms. Benzodiazepines are also among the first drugs used during attacks due to their sedative effects.

It should be kept in mind that inpatient treatment is required if there is a risk of harming the patient himself or his environment.

Due to the repetitive nature of the disease, outside of the attack periods, the patient continues to use drugs and controls; The return to daily life before the illness should be planned as much as possible.

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