Bipolar Disorder

**counselor** Mon Oct 15, 2012 10:44 am

Bipolar Disorder

Mood that is accompanied by episodes of mania and / or hypomania. In DSM-IV-R includes three subtypes of primary db The bipolar I disorder is characterized by manic episodes with or without episodes of mania type. In bipolar II disorder, however, you may experience one or more episodes of manic, manic but never in the full sense. Manic episodes may be less severe than depression. The distinction between the d.b. I and II draws evidence from many sources. Patients with d.b. II never develop mania, despite the recurrence of many hypomanic-like episodes. Furthermore, the d.b. II is really family as patients with a similar diagnosis have close relatives with hypomania, but not mania, while patients with db The year some relatives who have experienced mania and others who experience only hypomania.

The rapid cycling mood seems to be more common in the db II. Despite the diagnosis of bipolar disorder III is not recognized by the DSM-IV-R the definition has been used to describe patients with a history of depression that have at least one blood relative suffering from mania, on the basis of the fact that such patients may have a bipolar diathesis that is not yet apparent. In DSM-IV-R, mania or hypomania that appears in response to antidepressant treatment is not valid for a diagnosis of db, but many doctors consider the mania induced by antidepressants an indicator of the ability of the subject to spontaneously develop mania or hypomania and, therefore, a sign of a bipolar disorder.

The d.b. fast cycle probably does not constitute a distinct pathology, but a phase in the evolution of db that can last for years, is not permanent. The rapid cyclization seems to cause a reduction of the response to lithium. It is also more common in women and in patients with db II and occurs most likely after an onset of mania or hypomania than depression. Among the additional risk factors for the development of a rapid cyclization include hypothyroidism, right cerebral hemisphere damage, mental retardation and intake of alcohol and stimulants. It has been found that the 60-90 0ei patients who have rapid cyclization has a hypothyroidism and that this condition is often too slight to produce clinical symptoms, but not so slight as not to affect the stability of mood. Inducing hypothyroidism, lithium can cause a rapid cyclization. It has been widely debated the causal role of antidepressants in the rapid cyclization. Some authors believe that antidepressants may contribute to the rapid cyclization inducing mania or accelerating the cyclicality inherent in bipolar mood disorders. The majority of patients with d.b. rapid-cycling takes antidepressants, but it is difficult to prove that these drugs are the cause of the rapid cyclization. Probably antidepressants are administered more frequently to patients with rapid cycling or other forms of mood disorder with a tendency to deteriorate, as depression is severe or there is no response to other treatments. The only way to prove if there is a causal relationship would be to follow in time paired groups of patients with db which, in case it should be given the antidepressant or placebo experiment, this is difficult to achieve in terms of both technical and ethical. If there is no relationship between retrospective initiation of therapy with antidepressants and the development of rapid cycling, the results tend to be distorted by recall medical history was influenced by the mood and the difficulty to remember the exact time of onset of the complex mood swings. Even in a prospective study is difficult to establish with certainty whether the rapid cycling that occurs after prolonged treatment with antidepressants is of iatrogenic origin or reflects only the natural history of the disease. In a malignant form of rapid cyclization called ultradian cycling patients appear chronically depressed. A closer examination, however, is found to have many episodes of mania and depression within hours or days. For example, a patient may wake up feeling emotionally paralyzed and unable to get out of bed. A few hours later, you feel so full of energy that I could not sit still and refrain from acting impulsively and soon after, suddenly plummeting into a suicidal despair. The patient feels relatively well for a short time, but it goes on a rampage when criticized by voices that call a situation hopeless. The thoughts that are piled up in the mind prevent him from sleeping, but when he finally falls asleep sleep lasts for 14 hours and the next day is exhausted. The mood and behavior of patients with unstable ultradian cycling are often wrongly diagnosed as manifestations of a borderline personality disorder. It is unclear whether the cyclization ultradian is a progressive form of rapid cyclization or a pathological condition different. However, there is no evidence that the ultradian cycling represents a distinct subtype of db Research has been conducted on patients with a cyclization of this type that have shown that this disorder is more refractory to treatment than the rapid cyclization diagnosed with the traditional characters.

1) Bipolar Disorder subsindromico. When the features are evident and persistent symptom, the diagnosis of db is simple. However, short swings with mixed symptoms that come and go and not have a clear remission and relapse may be more difficult to identify. The hypomania is presented not as a sharp increase in the mood, but as the set of anxiety attacks, insomnia, difficulty concentrating, irritability, dysphoria, agitation, impulsiveness or hypersexuality, and therefore can be easily, but misinterpreted as an anxiety disorder or personality. Bipolar depression with hypomanic symptoms dysphoric - seen as anxiety, restlessness and agitation - can be confused with a unipolar depression agitated. Because mania is often associated with formal thought disorder and hallucinations in bizarre content, some bipolar psychosis can be confused with schizophreniform psychosis agitated. The clinical forms of disguised d.b. ranging from psychosis agitated with alterations in mood regulation related to the temperament of the subject. As with depressive disorders, the more subtle forms of db subsindromici approach to personality disorders.

The ipertimia mode is a chronic mood-elevating less clear of hypomania. Individuals hyperthymic are expansive, dynamic, cheerful and optimistic and have a strong sense of well-being, a reduced need for sleep, reduced appetite, increased energy and creativity and a family history of db Although not observed any impairment in social or occupational functioning, subjects hyperthymic are designed for more frequent episodes of hypomania and depression. Some researchers consider hyperthermia style premorbid personality or bipolar disorder. The craze subtimica can simulate personality traits such as arrogance, intrusiveness, irritability and insensitivity, logorrhea, promiscuity, restlessness, hypersensitivity and unpredictability. The person, always ready to give answers suitable for sharp or an excuse, for example, can take the lead in new movements, and then lose interest after everyone else involved. Are often found mixed forms of mania and depression subsindromica, as exemplified by wild with aspects macabre jokes or cynical, looking for hazards with a risk of self-destructive or suicidal mood. Bipolar individuals who are chronically nervous, intractable, exhibitionists, awesome, hypersensitive and unstable, often thought to have personality disorders such as borderline personality disorder or narcissistic personality. Seek, in fact, the excitement through theft or are habitually aggressive. They can also appear with an antisocial personality disorder. In fact, numerous diagnostic criteria for borderline personality disorder are also typical of the db mood. In general, to make a distinction between narcissistic and borderline personality disorders and chronic bipolar disorder is very difficult.

2) Seasonal Affective Disorder. Many people who live in climates where there are clear seasonal differences in the length of day have seasonal changes in mood and energy. Seasonal variations are observed also in the majority of mood disorders. For example, it is more likely that the unipolar depression tends to recur in the spring, while the bipolar depression tends to recur in summer. Contrary to popular opinion, the time of maximum risk of suicide are not the Christmas holidays, but the months of May and June. The seasonal peak of incidence of suicide is independent of the latitude, but the amplitude of the peak is greater where there is maximum seasonal variation in the light. Hospital admissions for unipolar depression show a peak in the spring, while those for mania reaches the maximum in summer. The comments relating to the fact that the seasonal variations in mood disorders in the Southern Hemisphere are the reverse of those in the northern hemisphere and that the pattern of seasonal affective disorder (SAD) is reversed in the two hemispheres, confirming the hypothesis that these changes are dependent on the changes in daylight available. The SAD occurs more commonly in women than in men, in children as in adults.

3) Pharmacotherapy of bipolar disorder. For the treatment of bipolar disorder, because of the risk of mania by rapid cyclization induced by antidepressants, it is useful to start with an anti-manic. The lithium proved to be an effective antidepressant in 30-79 1081344000ei patients. Other drugs that are currently in use are effective as carbamazepine, valproic acid, and verapamil. In particular, valproic acid seems to be equally effective in bipolar disorders in rapid cyclization and not rapid. The high rate of recurrence, and the increasing severity and decreasing the latency of each relapse, justify the continuation of treatment with mood-stabilizing drugs after the remission of any acute episode of mania or bipolar depression. In general, the case studies indicate that the combination of two or three mood stabilizers may be more effective than monotherapy in the prophylaxis of relapses. The addition of neuroleptics may be necessary in the maintenance treatment of bipolar disorders psychotic, although, as mentioned earlier, it is thought that in some cases these drugs may promote recurrence of depression. It is an important goal of psychotherapy keeping improving adherence to therapy drug. We have seen, in fact, that the pace of social and interpersonal therapy stabilizes circadian rhythms and the preliminary results suggest that it may enhance the effect of mood-stabilizing drugs.