BIPOLAR DISORDER
DEFINITION
Bipolar disorder, or manic-depressive illness (MDI), is one of the most common, severe, and persistent mental illnesses. Bipolar disorder is characterised by periods of deep, prolonged, and profound depression that alternate with periods of an excessively elevated and/or irritable mood known as mania. The symptoms of mania include a decreased need for sleep, pressured speech, increased libido, reckless behaviour without regard for consequences, grandiosity, and severe thought disturbances, which may or may not include psychosis. Between these highs and lows, patients usually experience periods of higher functionality and can lead a productive life. Bipolar disorder presents a serious lifelong struggle and challenge. The aetiology and pathophysiology of bipolar disorder have not been determined, and no objective biological markers exist that correspond definitively with the disease state. However, twin, family, and adoption studies all indicate strongly that bipolar disorder has a genetic component. In fact, first-degree relatives of a person with bipolar disorder are approximately 7 times more likely to develop bipolar disorder than the rest of the population.
RISK FACTORS
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Genetics
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Biochemical causes (abnormalities of dopamine, serotonin, adrenalin and noradrenalin have all been implicated)
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Stress and pregnancy may trigger bipolar disorder
SYMPTOMS & SIGNS
Manic episodes are characterised by the following symptoms:
- At least 1 week of profound mood disturbance is present, characterised by elation, irritability, or expansiveness.
Three or more of the following symptoms are present:
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Grandiosity
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Diminished need for sleep
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Excessive talking or pressured speech
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Racing thoughts or flight of ideas
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Clear evidence of distractibility
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Increased level of goal-focused activity at home, at work, or sexually
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Excessive pleasurable activities, often with painful consequences
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The mood disturbance is sufficient to cause impairment at work or danger to the patient or others.
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The mood is not the result of substance abuse or a medical condition.
Major depressive episodes are characterised by the following:
For the same 2 weeks, the person experiences 5 or more of the following symptoms, with at least 1 of them being either a depressed mood or characterised by a loss of pleasure or interest:
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Depressed mood
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Markedly diminished pleasure or interest in nearly all activities
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Significant weight loss or gain, or significant loss or increase in appetite
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Hypersomnia or insomnia
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Psychomotor retardation or agitation
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Loss of energy or fatigue
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Decreased concentration ability or marked indecisiveness
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Preoccupation with death or suicide; patient has either a plan or has attempted suicide
LIFESTYLE
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Short-term counselling can assist the patient in restoring self-esteem, problem solving, and coping with life stresses.
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Massage, aromatherapy and spa therapies have been shown to reduce anxiety and depression
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Acupuncture is effective in reducing the symptoms of anxiety and depression
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Regular exercise is crucial to reducing sympathetic nervous system overactivity and managing anxiety and elevating mood when depressed
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Yoga, Tai Chi or other relaxing activities may also be useful
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Recreational drugs should be avoided as they can aggravate symptoms and interfere with medications
DIET
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Patients should avoid coffee, cola and other caffeinated drinks.
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Diet should be low in sugar and carbohydrates, as hypoglycaemia is a trigger for anxiety
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Each meal should have protein to provide adequate amino acids for healthy neurotransmitter production
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Emphasise foods high in magnesium, such as green vegetables and nuts.
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Patients should eat small, regular meals
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Avoid excessive alcohol consumption
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EPA has been shown beneficial for mood disorders, so including oily fish in the diet 3-4 times per week will be beneficial
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Avoid known food allergens