Personality is recognized as normal, depressed or anxious. Normal personality is a learnt behavior appropriate for the surrounding, situation and circumstance. Normal personality may shift to left or right side. Shift to left often leads to quite personality and shift to right leads to hyperactive personality. Shift to left beyond range of quite personality leads to depression and shift to right beyond normal range of personality leads to anxiety disorder. Diversion of mood following anger, fear or threat is always expressed within expected outburst by normal individual. Normal personality is governed and controlled by normal brain. Normal personality is influenced by learnt behavior, education and upbringing. Such influence can shift the normal personality to left or right side resulting in “Quite Normal Individual” or “Hyperactive Normal Individual.”
Causes of Abnormal Personality
Brain controls the cognitive function by influencing various subcortical centers. The communication between brain (cortex) and subcortical center involves several chemical neuro-transmitters. Abnormal secretions of normal neurotransmitter results in increased or decreased concentration of neurotransmitter. Change of quantity of neurotransmitter in brain or subcortical centers may result in depression or anxiety disorder. Such change of neurotransmitter can cause shift of behavior beyond normal range to left or right. The shift to left beyond normal range results in “depression” or shift to right beyond normal range results in “mania or hyper anxiety disorder”.
Bipolar Disorder: An Abnormal Personality
Bipolar disorder is random shift of mood or behavior to extreme left or right in same individual. The extreme left and right point of shift of abnormal personality is considered as left and right pole of abnormal personality. In bipolar disorder mood fluctuates between left extreme (depression) and right extreme (maniac). This patient is often in depressed or in manic phase. Mood shifts with low or high energy. Low energy mood shift is expressed as bad mood (depression) and high-energy mood is expressed as extreme good mood (manic phase). Patient suffering with bipolar disorder can function normal between episodes of depression or manic disorder.
Progressions of Bipolar Disorder
Bipolar disorder fluctuates between depression and hyper-anxiety manic episodes. Cycle of depression or manic episode may last for several days. Such fluctuation of mood changes interferes with ability to function as a normal individual. Patient may suffer with signs of hypomania, which is less intense than manic symptoms
Risk Factors or Triggers of Bipolar Disorder
Risk or trigger factors are important to eliminate frequent episode of depression or manic phase. Patient, family members and physician treating patient should identify risk factors. Patient suffering from bipolar disorder often is single, since living with patient suffering with bipolar is difficult.
- Job Stress– Job stress or loss of job can trigger the episode of depression or manic phase.
- Stress from Family Separation– Loss of family member or threat of divorce can trigger the bipolar episode.
- Stress of Failure– Failure to obtain job or pass examination often triggers bipolar episodes.
- Sleep Deprivation – Insomnia or sleep deprivation triggers manic symptoms.
- Change of Antidepressants – Change of antidepressants or removal of antidepressants can cause symptoms of bipolar disorder.
- Over the Counter Medications– Medication often taken for weight reduction, allergies improve appetite, caffeine, and pain medications triggers bipolar episode.
- Alcohol Abuse– Alcohol abuse can trigger the episode of depression.
- Substance Abuse– Consumption of cocaine, heroine, amphetamine or ecstasy can trigger the manic symptoms.
- Seasonal Changes – Manic episode is more often observed during warm season and depression during cold season.
Symptoms of Bipolar Depression
Symptoms are different during manic and depressive episode phase.
1. Common Symptoms of Bipolar Depression
- Loss of appetite.
- Loss of weight.
- Fatigue and feeling of loss of energy.
- Loss of memory.
2. Symptoms of Manic Episode
- Cheerful– Patient seems to be happy and care free. Patient may resign and quit the job, take vacation and spend all the savings. Patient may spend all savings in gambling or involved in foolish investment.
- Insomnia– Manic bipolar patient can survive with 2 to 4 hours of sleep. Patient seems to posses extra energy and performs extra work at home or outside.
- Euphoria– Patient shows excitement in all daily activities. Patient often talks or sings for several minutes or hours. Patient sometime behaves out of control and become nuisance to neighbors.
- Aggressive Behavior– Patient may express frustration with anger and provoke fistfight or start using any equipment to provoke fight.
- Delusion– Manic symptoms if not treated, patient may experience delusion suggesting seeing unnatural things or hearing voices.
- Irritable– Patient becomes irritable and talks very rapidly. Conversation is most of the time difficult to follow.
3. Symptoms of Depressive Episode
- Narcolepsy– Patient sleeps long and at many occasion patient goes to sleep in public or during family get together.
- Frequent Change of Job– Patient is unable to hold the job for long time. Patient blames others for loosing job.
- Hopeless Feeling– Patient often feels hopeless. Patient often blames himself for being useless. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood.
- Change in Cognitive Function– Patient finds it difficult to concentrate and lacks self esteem. Patient suggests recent changes in memory and appetite to close family members.
4. Symptoms of Hypomania Episode
- Hypomania is often associated with depression.
- Mania is isolated from depression.
- Hypomania is less severe than mania.
- Patient suffering with bipolar depression may show mix symptoms of milder mania and depression.
5. Symptoms of Bipolar and Depression Episode
- Symptoms and signs suggest depression associated with agitation.
- Symptoms fluctuate between depression and manic anxiety.
- Mood swing- Random mood swings are observed between depression and manic symptoms.
- Symptoms and Signs of Agitations- Irritable, restless, anxious and hyperactive
- Symptoms and Signs of Depression- Patient sleeps for longer hour, complaints of decreased appetite
- Social Activities- Patient often avoids meeting family and friends. Patient is very uncomfortable at dinner table with family and friends. Patient expresses difficulties in communication.
Classification of Bipolar Depression
- Bipolar I Disorder– Mania and Depression.
- Bipolar II Disorder– Hypomania and Depression
- Cyclothymic– Hypomania and Mild Depression
Treatment Approach for Bipolar Disorder
Medication Treatment for Bipolar Disorder
- Mood Stabilizing Medication- Patient is prescribed mood-stabilizing medication.
- Minimize the highs and lows of bipolar disorder- Medication and symptoms are monitored to prevent highs and lows of bipolar disorder.
- Medications and Dosage- Medications are changed and dosages are modified according to change in symptoms.
Psychotherapy Treatment for Bipolar Disorder
- Therapist– Patient is referred to psychologist or therapist.
- Treat Mood Swing Appropriately– Frequent visit to a physician office or therapist is beneficial to understand and diagnose the early mood swing.
- Treat Triggering Symptoms– Discuss how to cope with symptoms like irritability, insomnia and restlessness.
- Domestic Issues– Discuss domestic issues and attempt to correct the problems.
- Stress– Discuss stress symptoms and treat appropriately before stress triggers bipolar symptoms.
- Mood Changes– Discuss social behavior and mood swing during therapy sessions and advise appropriate treatment.
Bipolar Disorder Education
- Provide information of the disease and treatment options.
- Provide information of social activities, how to cope with daily stress and information of triggering events or symptoms.
Lifestyle Management for Bipolar Disorder
- Sleep-Therapist will discuss the regular sleep schedule and activities interfering with regular sleep. Patient will be advised to modify social activities according to the sleep pattern.
- Alcohol and Drugs– Patient is advised to avoid alcohol and drugs,
- Exercise– Patient is encouraged to participate in daily exercises.
- Stress– Avoid stress inducing events.
Support for Bipolar Disorder
- Family Support– Family support is discussed with patient. Patient is encouraged to obtain family support. Group is meeting often held between therapist, patient and family members.
- Friend’s Support– Patient is often more open to discuss their problems with friends or therapist. Patients thus are encouraged to discuss risk or triggering factors with friends.
Meditation for Bipolar Disorder
- Meditation has been found to be helpful in reducing symptoms.
- Meditation also decreases triggering symptoms and relapse of bipolar disease.
- Meditation- includes exercise, yoga and breathing exercise.
Acupuncture Treatment for Bipolar Disorder
- Symptoms- Modulates anxiety, restlessness and irritability.
- Triggering Factors- Acupuncture modulated stress symptoms and prevents relapse of bipolar depression.
Suicide and Suicidal Thoughts
Suicide is observed more often with patient suffering with bipolar disorder. Suicide is common during depression phase.
Risk Factors For Suicidal Ideation And Thoughts-
- Severe depression
- Loss of income during depressive phase
- Inadequate medications
- Unsupervised change of medication
- History of alcohol abuse
- History of drug abuse
- Family history of suicide
Prevention of Relapse of Bipolar Depression
- Family participation
- Patient education
- Avoid stress
- Frequent monitoring of mood
- Avoid alcohol
- Avoid drugs
- Take medication as prescribed.
- Goodwin GM, Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2009;23(4):346-388. doi:10.1177/0269881109102919
- Baldessarini RJ, Tondo L. Does lithium treatment still work? Evidence of stable responses over three decades. Arch Gen Psychiatry. 2000;57(2):187-190. doi:10.1001/archpsyc.57.2.187
- Fagiolini A, Kupfer DJ, Scott J, Swartz HA, Cook D, Novick DM. Suicide risk in bipolar disorder: a systematic review of lithium trials and its implication for suicide prevention. Expert Rev Neurother. 2013;13(11):1147-1163. doi:10.1586/14737175.2013.845702
- Gonzalez-Pinto A, Mosquera F, Alonso M, et al. Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment. Bipolar Disord. 2006;8(5 Pt 2):618-624. doi:10.1111/j.1399-5618.2006.00373.x
- Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet. 2013;381(9878):1672-1682. doi:10.1016/S0140-6736(13)60857-0