Bipolar Disorder in Malaga
What is bipolar disorder?
The bipolar disorder is a disease of the nervous system that affects both the brain and the body.
The bipolar disorder is a chronic, mildly degenerative and highly relapsing entity, which is associated with chronic affective oscillations, as well as with a high rate of medical and psychiatric comorbidities, which are manifested together with cognitive deterioration, particularly in advanced cases, after multiple episodes. All this makes it the second most disabling condition after neurological disorders.
What causes or triggers bipolar disorder?
Lying somewhere between temperament and psychosis, bipolar is both a fascinating and tragic human illness.
Mental health professionals treating these patients should use pharmacotherapy and psychosocial strategies compassionately, judiciously, rigorously and only exceptionally aggressively.
Severe bipolar illness is not a common illness that is medicated like any other illness. "Medication of this illness is a real art on the part of the psychiatrist".
Important aspects of bipolar disorders in public health.
A.- IMPACT ON DISABILITY AND QUALITY OF LIFE.
According to the W.H.O. of the top 10 causes of disability in the world, 50% are mental disorders.
Depression is the leading cause of disability and accounts for 27% of all disability years generated by all conditions.
B.- ECONOMIC IMPACT.
Expenditure on mental disorders is estimated to account for 3 % of the GDP of any developed country.
C.- MORTALITY.
This is another very remarkable problem as a consequence of the high suicide rates of these patients, which in some studies exceed 20%.
The mortality risk is estimated at 19%, similar to those found for other diseases such as cancer or heart disease.
D) EVOLUTION OVER TIME.
An untreated bipolar disorder usually worsens with age. In the case of uncontrolled BD, the brain deteriorates in certain areas, called the prefrontal and temporal areas, in the amygdala and the hippocampus.
-We believe that when episodes of mania and depression are controlled, the worsening process is halted and the patient does not suffer the psychorganic deterioration as when uncontrolled.
Diagnosis
- The bipolar disorder encompasses a heterogeneous group of disorders characterised by cyclical disturbances of mood, cognition and behaviour.
- Diagnosis requires a history of mania for at least one week or hypomania for at least four days.
- Bipolar disorder type 1: Refers to patients who have had at least one episode of mania. It corresponds to the classical pattern of the disease, and its basic differential feature is the presence of mania.
- Psychotic symptoms may appear in both the manic and depressive phases, but may also be absent.
- The main difficulties in differential diagnosis occur with schizophrenia, probably due to overestimation of the possible presence of bizarre psychotic symptoms and a lack of attention to the previous course of the illness.
- Bipolar disorder type 2: refers to people with a history of hypomania and major depressive episodes. It basically consists of a combination of major depressive episodes with spontaneous hypomania.
- It is theoretically more benign than type 1, but is often accompanied by a greater malignancy over time, in the sense of a greater number of episodes.
- Between 5 and 15% evolutionarily become type 1.
- Cyclothymia refers to patients with chronic mood swings (lasting at least two years), fluctuating between hypomania and minor depression. It basically consists of a combination of major depressive episodes with spontaneous hypomania.
- It is theoretically more benign than type 1, but is often accompanied by a greater malignancy over time, in the sense of a greater number of episodes.
- Between 5 and 15% evolutionarily become type 1.
Bipolar Disorder Denominations
All the names of the disease have been changing for 150 years:
- 24 July 1850 the term circular insanity was born with the French psychiatrist Jean Pierre Falret.
- 31 January 1850, the term double-form insanity, also introduced by the Frenchman J. Baillarger, was born.
- 1921 German psychiatrist Emil Kraepelin: Introduced the term manic-depressive insanity.
- 1962 American psychiatrist, Leonard introduced the term bipolar and emphasised the differences between unipolar and bipolar.
- 1970, Dunner et al. subdivided bipolars into two types 1 and 2.
- Today the modern concept of bipolar spectrum disorder encompasses patients with bipolar disorder type 1 and 2, cyclothymia, hyperthymia (chronic hypomania) and pseudo-unipolar depression.
- Pseudo-unipolar depression corresponds to patients with highly recurrent unipolar illness, a positive family history of bipolar disorder and a positive therapeutic response to treatments used in BD.
Epidemiology of bipolar disorder
It is estimated that between 1-3 % of the US population has bipolar disorder. Approximately half of them will never get the correct diagnosis or treatment.
Similarly, in other countries, the lifetime prevalence of bipolar disorder is estimated to be around 1-3%. Sin meaning different in terms of gender.
However, unipolar depression is twice as common in women as in men.
Studies of families have shown that when one parent has a major affective disorder, the risk of the children is 25 to 30% for the disorder.
As for when both parents have an affective disorder, the risk of the children may be as high as 50-75 % for affective disorder.
Suicide is common in untreated bipolar disorder; 25-50% of sufferers attempt suicide on at least one occasion.
There are variations with respect to the time of year. Depression is more frequent in spring and autumn, while mania is more frequent in summer.
The peak incidence of suicide occurs in May and October.
Causes of bipolar disorder
The bipolar disorder can be found in every country in the world and in every culture since time immemorial.
Contrary to past theories, B.T. is not caused by hardship, poverty or discrimination; nor does it result from poor education or upbringing; nor, of course, is it caused by childhood trauma or abuse at an early age.
The pressures and stresses of life circumstances do not cause bipolar disorder, although it is true that the symptoms of the illness are exacerbated in stressful situations.
Course and course of bipolar disorder
Bipolar disorder appears in the second-third decade of life.
The average duration of a manic episode is 5-10 weeks.
That of bipolar depression is 19 weeks.
That of a mixed episode up to 35 weeks.
Only 1/3 of patients with acute bipolar affective episodes remain euthymic for 1 year.
Residual hypomanic symptoms increase the risk of depressive relapse, while the risk of relapse decreases as the asymptomatic period increases.
Consequences of error or delay in diagnosis
- Global worsening of the disorder.
- Social and occupational impairment.
- Diminished response or resistance to treatment.
- Suicide risk.
- Substance abuse.
- Increased medical comorbidity.
In 2004, a report by the World Federation for Mental Health (2004) found that:
"research in many countries has confirmed that patients with psychiatric disorders often suffer from other physical illnesses, most of them undiagnosed.
Such research has raised alarm bells in many countries and health professionals have been called upon to pay more attention to the diagnosis and treatment of co-morbidities in the mentally ill.
To date, there is no evidence that psychiatric patients receive adequate care for their physical health, as evidenced by the higher mortality rate of psychiatric patients, more than double that of the general population.
Suicide risk in bipolar disorder
Lifetime risk of 18.9%-29% (meta-analysis of 29 studies).
Risk per year of 0.4%.
Higher risk in bipolar II.
High lethality (5:1 attempt-to-fatality ratio).
Associated with depressive symptoms.
Lithium confers protection, but is still 10 times higher than for the general population.
Mortality for the untreated similar to that for heart disease or cancer
Symptoms of bipolar disorder
Manic syndrome
The syndrome maniac is essentially characterised by exaltation, disinhibition and instinctive-affective overflow.
The mood is expansive, euphoric, but easily passes, at the slightest opposition, into irritation and violent discharges: strictly speaking it is an extremely labile mood.
The vigorous elevation of feelings of self-worth and self-power translates into a very high and invulnerable self-consciousness, which often leads the individual to quixotic undertakings and ruinous prodigality.
The exuberance of feelings is especially noticeable in what "Weitbrecht" describes beautifully as the increased sensitivity to aesthetic impressions.
Cognitive processes are accelerated but intellectual performance is poor and superficial; learning is weak and the ability to associate is very limited.
The leakage of ideas is evident in both spoken and written language.
The association of ideas is rapid and superficial, and is established by elementary mechanisms (assonance, sayings, puns, rhymes, etc.) and in severe cases ends in mental confusion.
Logorrhea, inability to sustain attention and project fecundity, are probably the clearest and most frequent symptoms of the syndrome.
In general, there is a marked increase in motor activity: restlessness and indefatigable hyperactivity can even lead to exhaustion and sometimes even endanger the individual's life.
The approach to others is easy and direct, although it quickly becomes quarrelsome.
The treatment is familiar, jokes and puns abound, but it soon becomes tawdry and rude.
Organic disorders such as a very marked decrease in sleep, weight loss (even occasionally accompanied by hyperphagia), hypersexuality and hyperthymia, complete the typical description of this picture.
To differentiate it from hypomania, in mania it is considered that the disturbance must be severe enough to cause clear impairment in social and occupational activities or to require hospitalisation to prevent possible harm to self or others.
When hallucinations or delusions are present, their content is usually, but not always, related to the state of mind.
In fact, symptoms traditionally considered exclusive to schizophrenia may be present in bipolar patients during the manic episode, and this is one of the fundamental sources of diagnostic confusion, and so the ICD-10 classifies them as schizoaffective.
Thymic symptoms.
- Irritability: 80%
- Euphoria: 71%
- Depression: 72%
- Readability: 69%
- Expansivity: 70%
Symptoms Psychotics
- Any delusional idea: 48%
- Megalomania: 47%
- Pursuit: 28%
- Passivity, influence: 15%
- Any hallucination: 15%
- Auditory hallucinations: 18%
- Visual hallucinations: 10%
- Olfactory hallucinations: 17%
Cognitive symptoms.
- Megalomania: 78%
- Brainstorming: 71%
- Concentration and Attention Disorder: 71%
- Confusion: 25%
Activities and behaviour
- Hyperactivity: 87%
- Reduced sleep: 81%
- Violence, aggression: 49%
- Logorrhea: 98%
- Nudism, sexual display:29%
- Hypersexuality: 57%
- Extravagance: 55%
- Religiosity: 39%
Hypomania
It consists of the predominance of an elevated, expansive or irritable mood and symptoms characteristic of mania for a certain period of time, but to a degree not severe enough to cause marked impairment at work or socially.
In general all symptoms are milder and psychotic symptoms do not appear.
The hypomania is a difficult syndrome to detect, especially retrospectively, as many patients overlook or ignore its pathological quality.
Factors related to difficulties in the diagnosis of hypomania
- Absence of Disease Awareness.
- Subjective well-being of the patient.
- Moderate psychopathological severity.
- Difficult to differentiate from non-pathological joy, especially after remission of depression.
- Duration often short.
- Tendency to better remember states of psychopathological distress.
- Diagnostic criteria too strict.
- Popular ignorance of its existence.
- Frequent confusion with characterological behavioural disorders.
- Masking due to concomitant use of stimulant substances.
- Difficulty in separating it from the temperamental substratum of the often hyperthymic subject.
Mood depression is a sad and hopeless mood, often unmotivated or at least disproportionate.
The loss of the ability to feel pleasure and the feeling of lack of feeling is often a torment that is difficult to bear.
The concepts of vital sadness (Kurt Scheneider) and vital anguish (López Ibor), which designate special forms of these affects in which there is a significant impairment of vital feelings, define well what many of these patients feel.
The feeling of inadequacy is expressed in a variety of ways: negative ideas about oneself, the world and the future (Beck Triad).
Complaints, demands, ideas of guilt, ruin and self-reproach.
Desire to be punished and self-destructive thoughts that not infrequently lead to suicide.
Disregard for one's own body image and lack of attention to body care can lead to a beggar image.
The course of thought is profoundly slowed: painful associations of ideas, inability to focus attention, impaired memory and inadequate learning are easily noticed; the inability to plan is the most common cause of the disease. Dissatisfaction in assessing the present is aggravated by indecision about action; this can lead the sufferer to feel permanently in a dilemma situation, which he only imagines he can tragically resolve.
Social life is practically replaced by withdrawal into oneself.
The general appearance may be one of premature ageing, markedly dulled mimicry, and of delayed and delayed responses to external stimuli.
There is a general slowness of movement and, in particular, a decrease in expressive movements: downturned corners of the mouth, wrinkling of the forehead and deepening of the nasolabial folds.
The gait loses elasticity, is heavy, as if the patient were crawling instead of walking.
The voice loses modulation, writing becomes difficult and is often twisted downwards.
in short, all physical activity decreases markedly and sometimes permanent fatigue sets in.
The most frequent somatic symptoms are:
- Inhibition of sexual desire.
- Insomnia (painful as in no other case).
- Weight loss.
- Constipation and dry mouth.
Mixed States
They are characterised by the simultaneous appearance of manic and depressive symptomatology, in different combinations depending on the alteration of mood, cognitions and behaviour.
The most common form, called manic depression, consists of a picture characterised by psychomotor hyperactivity and restlessness, global insomnia, tachypsychia, verbosity, combined with depressive thinking, crying, emotional lability and ideas of guilt.
However, multiple combinations are possible and probable, and with the current DSM-V criteria, the occurrence of a mixed disorder necessarily implies a diagnosis of Bipolar Disorder Type 1.
Pharmacological treatment of bipolar disorder
Treatment is complex and difficult to standardise for everyone with bipolar disorder.
How is it that we sometimes associate many drugs?
How are some prioritised over others?
Which are most effective in each of the clinical phases or periods of bipolar disorder?
This is why only a medical professional, a specialist in psychiatry and specialised in the treatment of bipolar disorder can indicate the best treatment in each case through an assessment of your medical history, in Malaga you can count on the help of our entire team of specialists in our medical centre. Cips Malaga
Addressing Bipolar Disorder in Malaga
In Malaga we have a specialised centre for the approach to bipolar disorder, Cips Malaga has a solid experience accumulated over more than 25 years treating patients with this pathology.
At Cips Clinic Malaga we carry out an adequate diagnostic assessment and patient safety.
We quantify the level of functionality in order to propose a decision on the optimal treatment.
Psychopharmacology for symptom control.
Psychoeducation to improve knowledge of the disease, improve coping strategies, reduce substances, improve adherence...
Individual psychotherapy.
Family education to improve patient supports and manage family stress.
Interpersonal therapy and regulating social rhythms.
Cognitive and social rehabilitation to improve personal and social functioning.
We try to establish a Therapeutic Alliance between the patient, the psychiatrist, psychologist, relatives and the Association of patients and relatives with bipolar disorder.
Cips Malaga is a centre specialised in mental health located in Malaga city and directed by the Dr. Eloy Rodriguez Arrebola, Psychiatrist with more than 25 years of experience in the approach and treatment of bipolar disorders.
He is a scientific collaborator of the Bipolar Association of Eastern Andalusia "BAO MALAGA"Since its foundation, he has been a collaborator-organiser of the annual conferences held by the Association in Malaga. He is also a founding member of GETBA (Andalusian Group for the Study of Bipolar Disorder) to which he belongs as an active member and speaker at various annual conferences held in Antequera (Malaga).
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