Bipolar disorder : manic depression

How do we define bipolar disorders?

A bipolar disorder is characterised by alternating episodes of mania (elation and psychological and physical excitability) and depression that vary in severity, duration, and clinical characteristics. These differing episodes may be interspersed with symptom-free intervals or, in other words, a return to a state of mental balance.

This disorder affects 1 to 2% of the general population. It causes much suffering for the patient and the patient’s entourage, as well as significant socio-professional disadvantages. Mortality rates are three times higher for sufferers that go untreated than for that of the general population. This high rate is due to suicides, risk taking (e.g. ingesting poisonous substances, dangerous behaviour), and a higher percentage of physical illnesses, particularly those that are cardio-vascular in nature. Quite often, sufferers also encounter difficulties with the law (acts of defiance, non-compliance, abuse towards law enforcement officers, driving offences, fraud, etc.).

Keep in mind that this disturbing data must be counterbalanced against the fact that treatment of this disorder will drastically change the prognosis. Treatments initiated may considerably reduce the risk of suicide, mortality rate, relapse frequency, and may improve a patient’s quality of life, as well as that of the patient’s entourage.

This disorder is subdivided into various sub-categories depending on the nature and severity of the symptoms. It has become standard to distinguish Bipolar Type I Disorder (BPI) from Bipolar Type II Disorder (BPII).

Bipolar Disorder Type I  is characterised by one or more manic or mixed episodes (combination of excitability and depression) and depressive episodes of varying intensity (a diagnosis can also be established in the absence of a depressive state).

Bipolar Disorder Type II  is characterised by one or more hypomanic episodes (milder feelings of elation) and one or more characteristic depressive episodes.

Cyclothymia, on the edge of bipolar disorders, is characterised by fluctuating moods of alternating episodes of hypomania and depression or sub-depressive moods. Il peut être tout aussi invalidant en raison de sa chronicité et de l’absence de prise en charge (le trouble restant le plus souvent méconnu).

Treatment for a Bipolar Disorder

Treatment takes place in several stages, and involves both the patient and the patient’s entourage.

The first stage involves several steps taken simultaneously :   

• Identification of the disorder
• Analysis of its consequences
• Assessment of triggering and precipitating factors
• Analysis of the underlying personality
• Medical check-up

This stage will allow the doctor to determine a treatment plan, in collaboration with the patient, that takes into consideration various aspects of the illness (biological, psychological, and environmental).

The second stage involves the treatment phase.

Treatment is both psychological and drug-related, and is split into two parts :

• The curative treatment of the episode (depression or excitability)
• The preventive treatment that aims to prevent recurrence

In most cases, preventive treatment is initiated at the same time as curative treatment.

Over and above drug-related treatment, it is often critical to provide educational and psychological support to the patient and the patient’s entourage. Indeed, it is important to help the patient learn how to manage his or her vulnerability. To this end, psycho-educative programs led by health professionals offer patients a chance to learn more about their disorder and learn to detect early warning signs of a recurrence.

With proper treatment, it is thus possible to control most mood fluctuations and avoid hospitalisation most of the time. Immediate family members must also be sensitized to the first warning signs.

Adherence to some lifestyle and dietary rules, such as getting enough sleep at regular intervals, avoiding overwork, and limiting consumption of alcohol and psycho stimulants, will result in a higher success rate.

REMINDER of differences between unipolar disorders and bipolar disorders

Reader information: This article is based on discussions and texts from the Medical Comitee – Last update : 03/25/2012