Bipolar Disorder, formerly known as manic-depressive illness, is a mood disorder which is characterized by remitting relapsing episodes of mania/hypomania and major depression. The very word bipolar, first seen in DSM-III in 1980, means “two poles” indicating the polar opposites of mania and depression (Krans & Cherney, 2016). Bipolar disorder, as per the estimation of World Health Organization (WHO), is the 6th leading cause of disability globally. There are about twelve to fifteen million bipolar patients in India.
Mania
A manic episode consists of distinctive period of atypically and persistently elated, expansive, or irritable mood, inflated self-esteem or grandiosity, pressured speech, diminished need for sleep, high disorganization or distractibility, intensified physical and mental activity, poor judgment, excessive goal-directed activity, high stimulation and over involvement in pleasurable behaviors are associated with manic episode (American Psychological Association, 2013). It also includes psychotic features such as mood-congruent delusions, paranoid thinking or auditory or visual hallucinations which clearly disclose the severity of the course. Impulsive thinking, dysfunctional decision making and reckless behaviour incline to create painful consequences in patient’s life. These impairments are associated with excessive neuronal excitability and increased dopamine release in the brain (Almazan, 2008).
Hypomania
Hypomanic episode includes all the symptoms of mania such as elevated or irritable mood, grandiosity, insomnia, flight of ideas, distractibility and overactivity, but is sufficiently less severe and occurs without psychotic features (Sadock & Sadock, 2007). Besides it does not bring considerable impairment in occupational and social functioning (American Psychological Association, 2013). Severity of the symptoms and extend of impairments are distinguished between mania and hypomania.
Major Depression
A major depressive episode comprises at least five of the symptoms among depressed mood, remarkably lack of interest or pleasure in all activities, considerable weight loss, insomnia or hyper-somnia, psychomotor agitation or retardation, fatigue or lack of energy, excessive feelings of guilt and worthlessness, problems concentration, thinking and making decisions, hopelessness, and frequent thoughts of death and suicide. Several studies reveal that manic episodes are commonly seen in men, whereas depressive episodes in women. Another study reported that bipolar patients spend almost half of their life time in depressed mood
Effects of Bipolar Disorder
Cognitive impairment, loss of social and occupational functional ability and well-being, high rate of mortality due to suicide are the pervasive effects of bipolar disorder which cause major burden to the family, society and health systems. Frequent hospitalization, poor psychosocial recovery and high rates of marital conflict are another consequences of this chronic debilitating illness. Cognitive impairment plays a key role in social and occupational dysfunctions. Recent investigations indicated that biological rhythm disturbance is common among bipolar patients. Sleep-wake cycle, daily profiles of body temperature, cortisol, thyrotropin, prolactin, growth hormone and melatonin are also impaired in them. Disruption in biological rhythm reportedly has been connected to poor functioning and quality of life.
Management of Bipolar Disorder
The mainstay of the treatment for bipolar disorder has been and presently remains pharmacotherapy whereas psychotherapy has been strongly recommended as adjunct interventions. Adjunct therapies such as Psychodynamic psychotherapy, Cognitive Behavior Therapy (CBT), Interpersonal and Social Rhythm Therapy (IPSRT), Family Focused Therapy and Functional Remediation therapy have been developed and applied for bipolar disorder.
Team of consultants at Nirvan Hospital – Centre of excellence in Behavioural & Addiction Management, Kalyanpur, Ring Road, Lucknow is expert in management of Bipolar disorder. CBT interventions consist of illness education, identification of early signs of new episodes, social skills training, self-esteem building, learning relaxation strategies, cognitive restructuring, conflict resolution and activity planning. Interpersonal and social rhythm therapy is a kind of interpersonal therapy which is developed to assist the bipolar patients with their regular daily rhythms such as exercise, eating, and sleeping as well as to manage social relationships and the potential precipitants of rhythm dysregulation. Interpersonal and Social Rhythm Therapy encompasses various stages, starting with psychoeducation regarding the symptoms and cause of bipolar disorder and the importance of adherence to pharmacotherapy. Families are being trained in coping strategies, problem solving skills emphasized the potential of emotional expression to trigger the disorder.
