Bipolar Disorder

Bipolar disorders are characterized by manic and depressive episodes that can alternate, although in many patients one or the other dominates. The exact cause is unknown, but it could genetic factors, changes in neurotransmitter levels in the brain and psychosocial factors play a role. The diagnosis is made on the basis of medical history. It is treated with Stimmungsstabiliserern, sometimes with psychotherapy.

Bipolar disorder usually begin in adolescence, in the third or in the fourth decade of life. The lifetime prevalence is about 4%. Women and men are equally affected in bipolar disorder type. 1

Bipolar disorders are characterized by manic and depressive episodes that can alternate, although in many patients one or the other dominates. The exact cause is unknown, but it could genetic factors, changes in neurotransmitter levels in the brain and psychosocial factors play a role. The diagnosis is made on the basis of medical history. It is treated with Stimmungsstabiliserern, sometimes with psychotherapy. Bipolar disorder usually begin in adolescence, in the third or in the fourth decade of life. The lifetime prevalence is about 4%. Women and men are equally affected in bipolar disorder type. 1 Bipolar disorders are classified as bipolar disorder type 1: Defines manic by the presence of at least one fully formed (the normal social and occupational functioning disturbing) episode and usually depressive episodes Bipolar II disorder: Defined by the presence of major depressive episodes with at least one hypomanic but not fully manic episode unspecified bipolar disorder: disorders with clearly bipolar features that do not meet the specific criteria for allocation to other bipolar disorders with cyclothymia, patients have prolonged (> 2 years) periods both hypomanic and depressive episodes include. However, these episodes do not agree with the specific criteria for bipolar disorder. Etiology The exact cause of bipolar disorder is unknown. Heredity plays a significant role. There is also evidence of dysregulation of the neurotransmitters serotonin and norepinephrine. Psychosocial factors may be involved. The first appearance of symptoms and subsequent exacerbations are often associated with stressful life events related, but no exact cause-effect relationship has been found so far. Certain substances can trigger bipolar disorder exacerbations in some patients; these are sympathomimetic (z. B., cocaine, amphetamines), alcohol certain antidepressants (z. B. tricyclic antidepressants, MAO inhibitors) symptoms and signs A bipolar disorder starts with an acute symptomatic phase, followed by repeating the course of remission and recurrence. Remissions are often complete, but many patients have residual symptoms, and some is the ability to function at work, severely impaired. Recurrences are independent episodes of intense manic, depressive, hypo manic or mixed bipolar characteristics. The duration of the episodes is between a few weeks and 3-6 months. The cycle of the time period between the onset of a up to the onset of the next episode take different lengths in different patients. In some patients, there are rare episodes, maybe (usually defined as a ? 4 episodes per year), only a few in the course of life, while other forms of rapid-cycling have. Only a minority will change with each cycle between mania and depression back and forth; in most patients predominates to a certain degree one or the other. Patients can commit suicide or attempt it. The lifetime incidence of suicide in patients with bipolar disorder is estimated to be at least 15 times the general population. Mania A manic episode is defined as persistently elevated, expansive or irritable mood and constantly rising purposeful activity or energy over ? 1 week plus ? 3 other symptoms: Excessively high self-esteem or megalomania Decreased need for sleep Larger need to communicate than usual flight of ideas or racing thoughts distractibility Increased targeted activity Excessive involvement of activities with high potential for painful consequences (eg. as a shopping spree, foolish business investments) Manic patients can tirelessly excessive and impulsive in various pleasant, high-risk activities (eg. as gambling, dangerous sports, promiscuous sexual activity) be involved, without recognizing potential damage. The symptoms are so severe that they do not work in her starring role (work, school, home economics). Bad investments, shopping sprees and other personal decisions can have irreparable consequences. Patients in a manic episode may be exuberant and flashy or gaudy dressed and often have an authoritarian Umgangsart with fast, not too unterbrechendem fluency. Patients can produce sound associations (new ideas are more likely triggered by the sound of words than by their meaning). Because these patients are easily distracted, they can constantly jump from one subject or activity to the next. Nevertheless, they believe likely to be in the best mental condition. A lack of insight and increased urge to activity often lead to intrusive behavior and can be a dangerous combination. Interpersonal conflict is the consequence and can get them to feel wronged or persecuted patients. Patients may thus be a danger to themselves or to other people. The accelerated mental activity to experience the patient as racing thoughts, the doctor observed as flight of ideas. The manic psychosis is an extreme manifestation of psychotic symptoms that may be difficult to distinguish from schizophrenia. Patients can extreme size or paranoia have (z. B. Jesus to be or are tracked by the FBI), sometimes with hallucinations. The activity level increases significantly; patients can run around and scream, swear or sing. The mood instability often increases with increasing irritability. A fully developed delirium (mania with delirium) with total loss of coherent thought and behavior can auftreten.Hypomanie A hypomanic episode is a less pronounced variant of mania as a distinct episode that lasts at least ? 4 days with behavior that is clearly the stands normal non-depressed Even the patient and the ? 3 additional symptoms including aufgelsitet above. During the hypomanic phase, the mood lightens, decreases the need for sleep, and psychomotor activity accelerates. Some patients find the hypomanic phases to be useful because they produce a lot of energy, creativity, self-confidence and better social functioning. Many do not want to leave the pleasant, euphoric state. Some have a fairly good operability, and for most it is not noticeably impaired. In some patients, however, the hypomania manifests as distractibility, irritability and labile mood, what the patient and others less appealing finden.Depression A depressive episode has the characteristics that are typical of a major depression; the episode must be ? 5 contains the following symptoms in the same two-week period, and one of them must be depressed mood or loss of interest or pleasure: depressed mood most of the day Markedly diminished interest or pleasure in all or almost all activities most time of the day Significant (r) (> 5%) weight gain or loss or decreased or increased appetite Insomnia (often by difficulty sleeping) or hypersomnia from others watched psychomotor agitation or retardation (not self-reported) fatigue or loss of energy feelings of worthlessness or excessive or inappropriate guilt diminished ability to think or concentrate or indecisiveness Recurrent thoughts of death or suicide, suicide attempt or specific plan for ÜR suicide Psychotic features are more common than in unipolar Depressionen.Gemischte forms in bipolar depression An episode of mania or hypomania is determined by the presence of mixed patterns when ? 3 depressive symptoms most days during the episode. This condition is often difficult to diagnose and can merge into a continuous periodic state; the prognosis is worse than a pure manic or hypomanischem state. The risk of suicide during mixed episodes is particularly high. Diagnosis Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) level determination of thyroxine (T4) and TSH to exclude hyperthyroidism exclusion of stimulants abuse, clinical evidence, or urine test The diagnosis of bipolar disorder is based on the identification of manic or hypomanic symptoms as described above, as well as a history of remissions and relapses. The symptoms must be severe enough to interfere with social or occupational functioning clearly or to make hospitalization necessary to prevent harm to themselves or others. Some patients who present with depressive symptoms have possibly previously suffered from hypomania or mania, they report it, but only if they are asked directly. Through skillful questioning pathological signs can be detected (eg. As excessive money spending, impulsive sexual escapades, stimulants abuse), however, it is likely that such information is provided by relatives. A structured inventory of how the Mood Disorder Questionnaire could be useful. All patients must carefully but immediately after suicidal ideations, -plans or suicidal acts are asked. Similar acute manic or hypomanic symptoms may abuse of stimulants, or resulting physical disorders such as hyperthyroidism or pheochromocytoma. Patients with hyperthyroidism typically have other physical symptoms and signs, but are thyroid function tests (T4 and TSH levels) in new patients reasonable. Patients with pheochromocytoma are clearly hypertensive; if they are not, no tests are displayed. Other diseases less common cause symptoms of mania, but depressive symptoms may occur in a number of diseases (see Table: Causes of symptoms of depression and mania). A review of substance use (v. A. Of amphetamines and cocaine) and a urine drug screening can help determine substance-related causes. Since the substance use may, however, have triggered in a patient with bipolar disorder, only one episode, it is important to try to prove symptoms (manic or depressive) unconnected with the substance use. Some patients with schizoaffective disorder have manic symptoms, but these patients rarely return to normal between episodes, and unlike most patients with mania, they show no interest in connection with other people to contact. Patients with bipolar disorder may also have anxiety disorders (eg. As social phobia, panic attacks, obsessive-compulsive disorder), which can make diagnosis more difficult. Causes symptoms of depression and mania type of fault depression mania connective tissues SLE rheumatic fever SLE endocrine system Addison’s disease Cushing’s syndrome diabetes mellitus hyperparathyroidism hyperthyroidism hypothyroidism hypopituitarism hypogonadism hyperthyroidism Infectious AIDS General paralysis (parenchymal Neurosyphilis) Influenza Infectious mononucleosis TB viral hepatitis Viral pneumonia AIDS General paralysis influenza Saint Louis encephalitis Neoplastic head of pancreatic cancer Disseminated carcinomatosis – nervous system tumors Complex partial seizures (temporal lobe) head trauma Multiple sclerosis Parkinson’s disease sleep apnea stroke (left frontal) Complex partial seizures (temporal) between brain tumors head trauma Huntington’s disease multiple sclerosis stroke Due diet pellagra Pernicious anemia – Other * Coronary heart disease fibromyalgia kidney failure or liver failure – Pharmacological amphetamine withdrawal amphotericin B anticholinesterase insecticides barbiturates Beta-blockers (some such. As propranolol) cimetidine corticosteroids cycloserine estrogen therapy Indomethacin interferon mercury methyldopa metoclopramide oral contraceptives, phenothiazines, reserpine thallium vinblastine vincristine amphetamines Certain antidepressants bromocriptine cocaine corticosteroids levodopa methylphenidate sympathomimetic Mentally alcoholism and other substance use disorders Antisocial personality disorder anxiety disorders borderline personality disorder dementia in the early stages of schizophrenic disorders – Depression often occurs in these Erkran restrictions on, but it has made no causal relationship. Treatment mood stabilizers (. Eg lithium, certain anticonvulsants) and / or an antipsychotic of second generation support and psychotherapy The treatment of bipolar disorder usually has three phases: acute: To stabilize and control the initial, sometimes severe manifestations continuation: to achieve a full remission or prevention: in order to keep the patient in remission, most patients with hypomania indeed can be treated as outpatients, severe mania or depression often require a steady management. Drug treatment of bipolar disorder medication for bipolar disorder include Stimmungssstabilisierer: lithium and certain anticonvulsants, particularly valproate, carbamazepine and lamotrigine. 2nd generation antipsychotics: the 2nd generation are aripiprazole, lurasidone, olanzapine, quetiapine, risperidone and ziprasidone. These drugs are used alone or in combination in all stages of the treatment, albeit with different dosages. The choice of the drug in bipolar disorder can be difficult because all drugs have significant adverse effects, drug interactions are common and no drug is universally effective. The selection should be based on what has so far been effective and well tolerated in a particular patient. Without prior experience (or if they are unknown), the choice is based on the medical history of the patient (in view of the adverse effects of the specific Stimmungsstabilisierers) and the severity of symptoms. Specific antidepressants (. Eg SSRIs) are sometimes added for severe depression, but their effectiveness is controversial; they are not empfohlen.Weitere as a single therapy in depressive episodes therapeutic measures electroconvulsive therapy (ECT) is sometimes used in treatment-resistant depression and is also effective in mania. Light therapy may be useful in the treatment of seasonal dependent bipolar I or bipolar II disorder (autumn-winter depression and spring-summer hypomania) useful. She is probably best known as Augmentationsbehandlung geeignet.Aufklärung and psychotherapy the help of relatives is crucial to prevent severe episodes. Patients and their partners is often recommended group therapy, in which they are informed about bipolar disorder, its social impact and the central role of mood stabilizers in the treatment of. Individual psychotherapy can help patients cope better with life practical problems and to adapt to a new self-image. For the patient, especially with bipolar II disorder, adherence compared with the treatment plan may be low with mood stabilizers because they fear that these drugs would limit their alertness and creativity. The doctor can explain that a limitation of creativity is relatively unusual in that mood stabilizers i. Gen. allow a more uniform functionality in interpersonal, educational, occupational, or artistic field. Patients should be advised to avoid stimulants, drugs and alcohol, to minimize sleep deficits and to pay attention to early warning signs of relapse. With a tendency to lavish money management financial matters should be transferred to a trusted family member. Patients with a tendency to sexual excesses should about possible partnership consequences (eg. As divorce) and the risk of sexually transmitted diseases (especially AIDS) to be informed. Self-help groups (eg., Depression and Bipolar Support Alliance [DBSA]) can help patients by providing them with a forum for sharing common experiences and feelings. Important points A bipolar disorder is a cyclic condition which episodes of mania, with or without depression (bipolar-1) or hypomania and depression comprises (bipolar-2). Bipolar disorder affects significantly the ability to function at work and to integrate socially, and that suicide risk is significant. However, weak manic states (hypomania) are sometimes adaptive, because they produce high energy, creativity, self-confidence and a supernatural social functioning. Duration and frequency of cycles vary among patients. Some patients have only a few over a lifetime, while others have ? 4 episodes / year (rapid-cycling forms). Change the number of patients during each cycle between mania and depression back and forth; in most cycles, the dominant one or the other. Diagnosis is based on clinical criteria, but abuse of stimulants and physical disorders such as hyperthyroidism or pheochromocytoma may only be excluded by examination and testing. Treatment depends on the manifestations and their severity, but typically (eg., Lithium, valproate, carbamazepine, lamotrigine) and / or antipsychotics 2nd generation includes mood stabilizers (eg. As aripiprazole, lurasidone, olanzapine, quetiapine, risperidone , ziprasidone).

Health Life Media Team

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