Bipolar disorder (Mood Disorder) is a disease characterized by cyclical changes in perception and behavior. It is also known as manic-depressive disorder. As the name suggests, it is characterized by a clinical picture that we call depression at one end and mania at the other.
How is mania defined?
Mania is a clinical picture that lasts for at least 1 week, in which the emotion is exaggerated, there is an exaggerated self-confidence, the need for sleep decreases, there is a rapid thinking and rapid speech, a decrease in attention, and an increase in mobility. As the manic episode intensifies, the person’s assessment of reality may deteriorate and risky behaviors may occur.
The lifetime prevalence of bipolar disorder is 1%. The average age of onset is 30. Bipolar Disorder is thought to occur as a result of the interaction of genetic, biological and psychosocial factors. Noradrenaline and serotonin are thought to play a role in disease formation. In addition, it has been shown that the risk of developing the disease increases in people with a family history of bipolar disorder.
How does the disease begin? Is it related to stress?
It has been determined that stress factors are effective in the onset of attacks in the early stages of the disease. Factors such as deterioration in interpersonal relationships, work-related compelling factors, decreased sleep, and giving birth are thought to trigger attacks. Bipolarity should be investigated in individuals whose affect varies seasonally.
First of all, mood disorders due to other medical conditions and attacks triggered by substance use should be distinguished. Even if the patient has come with depressive complaints, past manic symptoms should be questioned. Psychotic disorders, eating disorders, adjustment disorders, and depressive disorders accompanied by anxiety can often be confused with the diagnosis of Bipolar disorder. Therefore, a detailed history and examination are important.
In the treatment, first of all, the contribution of the patient’s relatives to the process is very important. It is very important to recognize the symptoms of attacks, to be a decision maker in case the patient loses control, and to support the patient. Treatment cooperation with the patient should be established. Confidence between the patient and the doctor should be tried to be ensured. It should be aimed to maintain the functionality of the patient at the highest level. It is useful to make a graph of that patient in the natural course of the disease. Mood stabilizers are primarily used in drug treatment. In the patient presenting with depressive complaints, it should be distinguished whether it is bipolar depression or a depressive episode due to other causes. Because there are differences in treatment.
Psychosocial interventions should be used in addition to drug therapy. These initiatives should be about informing the patient and their relatives, supporting adherence to treatment, increasing social functionality, making an emergency plan, and reducing exclusion and stigma in the environment.
According to studies, approximately 40-50% of patients can have manic attacks again within two years after the first attack. Therefore, it is necessary to initiate preventive treatment in the follow-up of bipolar disorder.