Bipolar Disorder# Dr. Satish Kumar# Best Psychiatrist Delhi NCR

Dr. Satish Kumar

Bipolar Disorder

Bipolar spectrum disorders are syndromes of altered behavior and mood characterized by discrete periods of Mania, hypomania and Depression.

People suffering from this mental disorder have episodes in which they feel extremely happy, grandiose ideas & full on energy and at other times feel sad, hopeless, and sluggish. In between these episodes, these individuals have periods of neutral mood. Such periods of high and low are treated as two poles of mood and hence popularly called Bipolar Disorder. This positive and negative mood change of Bipolar disorder is different from the normal ups and downs that everybody faces from time to time. Bipolar disorder symptoms can result in Socio-Occupational Dysfunction like relationships problems, difficulty at job, deteriorating school performance, and even suicide.

Bipolar disorder is a treatable illness, and people with this illness can lead fully functional lives.

Epidemiology

Lifetime prevalence is 4.5%

Mean age of onset is 20 years

Although this mental illness is a lifelong condition, proper medication and regular follow-up with lifestyle changes can make a huge difference.

Symptoms of Bipolar Disorder

The most important symptoms of bipolar disorder are mood swings, coupled with increased or decreased in energy/ activity levels, sleep & thinking disorder associated with striking change in behavior. The three major symptoms that feature this disorder are depression, hypomania, and mania. An individual may suffer from various types of bipolar disorder based on different combinations of these symptoms. It is also possible to experience a long-lasting period of unstable moods rather than specific episodes of depression or mania.

Common symptoms of mania (“the highs“):

Excessive hopefulness, happiness, and excitement
Increased goal directed activity (Restlessness)
Sudden change in behavior from being joyful to being angry, hostile, and irritable
Decreased need for sleep
Poor concentration & judgment
Increased talkativeness
Increased libido (high sex drive)

Increased use of Alcohol or other drugs of abuse
Impulsive behavior
Boost in self-confidence and wellbeing
Easy distraction
Delusion of Grandiosity or special power

Common symptoms of Depression (“the lows“):

Feeling of sadness
decrease in energy level*
Feelings of worthlessness or hopelessness
Poor concentration
Loss of memory
Decreased talkativeness
Decrease in sex drive
Crying
Insomnia
Though of suicide or self-harm

Bipolar I

Diagnosis of Bipolar I requires:

One phase of mania that should last for a week at least
Symptoms affecting the daily routine of an individual
Symptoms of Mania or Depression not at all related to any other medical or mental health condition.

Bipolar II

Diagnosis of Bipolar II requires:

One phase of hypomania that should last for at least 4 days or more
A period of major depression (lasts for 2 weeks or more) that involves one or more key depression symptoms which significantly influence day to day activity of such patients
Symptoms that are not related to any other medical and mental health condition
There has never been a manic episode

Cyclothymia

Diagnosis of Cyclothymia requires:

Periods of hypomanic symptoms and periods of depression symptoms that shuffle and should last for 2 years or more (1 year in children and adolescents)
Symptoms that do not fit into the full criteria of an episode of depression or hypomania.
Symptoms which are observed for at least half the time of the 2 years and is never absent for more than 2 months at a time
Symptoms that are not at all related to either any other medical condition or mental health condition
Symptoms which cause significant distress and affect daily life activities of an individual

Fluctuating mood is a major symptom of cyclothymia. Studies have shown that cyclothymia is less severe than Bipolar I/ II, but it tends to last longer.

Hypomania usually does not influence an individual’s daily life while depression may affect the day-to-day activity of an individual and may lead to more serious distress.

Causes of Bipolar Disorder

Though the exact causes of bipolar disorder has not been identified, researchers have discovered factors contributing to the development of this mood disorder, such as:

Genetic factors: positive family history increases chance of developing Bipolar disorder

Biological factors: imbalances in hormones or neurotransmitters that affect the brain plays a major role in the development of Bipolar disorder.

Environmental factors: Stressful life events, a significant loss, abuse or early age trauma contribute to an initial episode of Bipolar disorder in an individual.

Complications

Serious problems can crop up when bipolar disorder is left untreated; some of these are +listed below:

Problem related to alcohol/ drug use
Increased chances of suicidal attempts
Financial/ Legal problems
Difficulty maintaining relationships/increased rate of divorce
Poor school/ work performance

Treatment

The primary focus of bipolar disorder treatment is stabilizing a person’s mood and reducing the severity of aggression. Some of the popular treatment of this mental illness is a combination of the following:

Medication
Change in lifestyle
Counselling

Medication:

Mood Stabilizing drugs such as lithium carbonate, valproic acid, lamotrigine & carbamazepine.

Myths vs Facts

Why Anti-epileptic medicines for Bipolar Disorder?

Anti-epileptic medicines are used in Seizure disorder as it stabilizes the neuron from uncontrolled & unsynchronized firing thus relieving seizures, same phenomena is utilized as a mood stabilizer in Bipolar disorder.

Antidepressants like SSRIs etc. help relieve the symptoms of anxiety and depression.
- Second-generation antipsychotics (SGAs) or atypical antipsychotics like risperidone, olanzapine etc. used for treatment of schizophrenia are also used for bipolar disorder. It helps faster recovery and stabilization in Mania. Olanzapine is safest mood stabilizer that can be prescribed in Bipolar in pregnancy.
- Sedatives-Like Clonazepam, Diazepam for insomnia and anxiety

Counseling and Psychotherapy patient & family member’s psycho-education for early recognition of symptoms of developing disease and take essential steps to manage it, is important to prevent full blown disruptive stage of mania and need for regular follow up to prevent such episode in future. It also helps patients with bipolar disorder to maintain positive relationships at personal and professional life

Change in lifestyle: Few lifestyle changes help maintaining a stable mood and managing symptoms of bipolar disorder are-

Regular Exercise & Yoga
Maintain a regular routine in daily life
Follow a healthy diet chart
Establish a regular sleeping pattern
No to alcohol or other drugs

Cure for Bipolar Disorder

As on date, there is no permanent cure for bipolar disorder but the right combination of mood stabilizers and behavioral therapy can help individuals maintain a stable mood for prolonged periods.

Psychiatrist for Bipolar Disorder at Delhi NCR

Dr Satish Kumar MD Psychiatry (AIIMS Delhi) has more than 12 years of experience in treating patient with bipolar disorder. He uses protocol learnt at AIIMS in dealing patient with chronic debilitating illness like bipolar disorder. He knows how to tailor treatment according to need of the patient. He has dealt with several types of patients having bipolar disorder and prescribed the right medicine, or therapy or a combination of both depending on the criticality of the case. Above all he is very polite and humble and give proper time to reassure family members along with patient.