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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Bipolar affective disorder (BPAD)

 

Bipolar affective disorder is a mood disorder in which the patient suffers from both depressive episodes and manic/hypomanic episodes.  It was called manic depressive psychosis in the past. Patients suffer from intense mood swings in this disorder.

What are the symptoms of BPAD?

The patients have both depressive and manic symptoms

Symptoms suggestive of mania are

  1. Felling happy ( elated or euphoric) 
  2. Increased self esteem
  3. Decreased need for sleep- feels rested even after sleeping for only 3 hrs
  4. Talks excessively and it is difficult to stop the patient from talking
  5. Gets multiple ideas and thoughts ( racing thoughts ) 
  6. Jumps from one topic to another while speaking
  7. Easily distractible and concentration is impaired
  8. Spends more  money than usual/ spending sprees
  9. Increased sexual drive
  10. Is over active and  over familiar with people
  11. Has great ideas and plans which are not practical
  12. They can hear voices which no one else can hear
  13. Can have grandiose delusions like claiming to be god or a very prominent person in the society
  14. Can be irritable 
  15. Does not complete tasks given and jumps from one task to another.  
    The duration of the symptoms should be at least one week.  
    The symptoms of depression are as document under the depression section.

What causes BPAD?

The exact cause of BPAD is still not known but some of the factors are

  1. Genetic factors : Bipolar illness is known to run in families
  2. Dysfunction in certain chemicals in the brain called neurotransmitters can lead to BPAD. Some of the neurotransmitters implicated are nor epinephrine and serotonin.
  3. Life events and stress can precipitate an episode of the illness in vulnerable individuals

What is the course of BPAD?

Patients usually experience their first episode in their early 20s. Manic episode typically begins suddenly with a rapid escalation of symptoms over a few days; hence it is advisable to see a psychiatrist at the earliest.  The manic episode normally responds well to treatment and the patient generally has periods when he has no symptoms of the illness. However some patients may continue to have persistent symptoms without coming back to pre morbid levels.

What is the treatment for BPAD?

The main stay of treatment for BPAD is medications.

If a patient has a manic episode and also if he has psychotic symptoms he is treated with antipsychotic medications like olanzapine, quitipine, risperidon etc.

If a patient has depressive symptoms he is treated with antidepressants like serotonin specific reuptake inhibitors like sertraline, fluoxetine, escitalopram etc. 

Patients are also given a group of medication called mood stabilizers like lithium, sodium valproate, carbamezapine, lamotrigine etc.  Mood stabilizers help in treating the mood swings much like how a voltage stabilizer works, if the mood goes high it gets it down, if it goes low it gets it up.

Mood stabilizers can also prevent future episodes in some patients or reduce the intensity of the episode or increase the gap between episodes.

In addition to medications your psychiatrist will help you identify early warning symptoms of an episode so that help can be sought at the earliest.

Remember the earlier the patient is taken to a doctor the better and faster is the response to medication.

 

How long are medications given for BPAD?

Mood stabilizers are normally given for at least 2 years after one episode and up to five years with multiple episodes.

Remember an untreated episode of mania can last up to 6 months on an average and an untreated episode of depression on an average for 12 months.

 

What is a rapid cycler ?

A person who has BPAD  who gets 4 or more episodes of the illness in a year is called a rapid cycler.

 

How can carers help?

It is of paramount importance that the carer of a person who is suffering from BPAD learns about the illness and its manifestation. They should be aware of the early warning signs and seek help at the earliest. They should also keep a watch on the patients spending during an episode and be aware of his credit card expenditure. If possible methods to stop access to money and credit cards should be decided with the patient when he is doing well and plan executed if needed.