Emotionally disturbed means bipolar disorder

How to recognize bipolar disorder

In Germany, between one and three percent of the population suffer from bipolar disorder. It usually begins in adolescence or young adulthood.

The mental illness can develop in different ways. There are those affected who fall ill in their early 20s and are unable to work in their mid-40s. There are also patients who remain in working life until they retire. Every second person has other psychological complaints such as anxiety, obsessive-compulsive disorders, addictions, personality disorders or attention deficit / hyperactivity disorder (ADHD).

Individual stories of suffering

If you want to find a certain personality type or a professional group that suffers particularly often from bipolar disorder, you will not find it. Managers are just as affected as teachers, doctors, housewives or workers. What they have in common is that they usually live without symptoms and inconspicuously for long periods of time - until a new manic episode begins. Euphoric mood, irrepressible drive, life is turned upside down. In such phases, those affected often lose everything they have: financial resources, friendships, jobs. Mania and depression are the two opposite poles of this disease, also known as manic-depressive illness.

The psychiatrist Professor Andreas Reif, Director of the Clinic for Psychiatry, Psychosomatics and Psychotherapy at the University Hospital Frankfurt am Main, knows many such fates. For example, that of the well-behaved administrative officer who experienced his first mania in his late 40s. During this phase, he decided to quit his job and set up a classic car rental service, for which he went into debt with several hundred thousand euros. In the end, the mess was big: lost the job, debts, marital crisis. Or the silent engineer, member of the board of a company, who in his manic phase suddenly had the idea that he could present his report to his board colleagues this time musically. Which led to his release.

Symptoms: episodes of mania and depression

Affected people go through depressive phases with deepest mood holes and manic phases with euphoric or unusually irritated mood with significantly increased drive. If the manic episodes are rather weak, one speaks of hypomanic phases. In very severe untreated cases, patients have four episodes or even more per year. If the mania is very strong, the symptoms of a psychosis can also occur. This can show itself as a persecution, but also as megalomania. How pronounced the individual episodes are and the sequence in which they occur varies from person to person.

Possible early warning signs for manic phases:

  • Euphoria, new ideas, increased creativity, increased self-confidence
  • Difficulty concentrating, irritability, increased alcohol and drug consumption
  • changed perception, increased need to communicate
  • increased sexual interest

Possible early warning signs for depressive phases:

  • Lack of energy, depression, self-doubt, increased brooding
  • Sleep disorders, lack of interest, decreased performance, difficulty concentrating
  • Restlessness, anxiety, irritability
  • decreased sexual interest

Causes only partially clarified

In addition to a genetic component, early childhood trauma can also play a role in the development of bipolar disorder. "We know that the brain metabolism, but also the plasticity of the nerve cells, are disturbed in patients," says psychiatrist Andreas Reif. The illness or a new episode can then trigger emotional stress experiences of a positive or negative nature. "Disturbances of the sleep-wake rhythm also have a negative effect on genetically predisposed people and can bring the barrel to overflow," warns Reif.

Early diagnosis is important

It is important that the disease is recognized as early as possible and treated consistently. The risk of suicide for patients in mixed bipolar states, when a manic and a depressive episode overlap, is particularly high. Early therapy can reduce the severity and frequency of the episodes. In addition, therapy should start before life becomes a mess. But this is a problem: A meta-analysis with over 9,400 patients from 27 studies showed that those affected have to wait an average of six years before the correct diagnosis is made. The German Society for Bipolar Disorders even assumes an average of ten years. That is far too long, regrets psychiatrist Reif.

Why does it take so long to get a diagnosis?

"Sometimes a patient goes through a depressive phase three to four times and only then goes through a manic phase," explains Reif, who is the treasurer of the German Society for Bipolar Disorders. "At first everything points to a depression. Only when it comes to a mania does it speak for a bipolar disorder." Diagnosis would be easier with special biomarkers in the blood, i.e. certain laboratory values. Their development is promising, but still a long way from everyday clinical practice, says Reif: "Another reason is that the early warning symptoms are very fuzzy. Concentration and sleep disorders as well as mood swings are not uncommon, especially in adolescents."

It is also possible that the first manic phases are not particularly pronounced. In hypomanic phases, people may be a little more talkative than usual, but still have sufficient self-control. Psychiatrist Reif complains that not all doctors ask precisely and attentively enough. Asking family members about behavioral abnormalities can also provide important information. "If, for example, the wife says that her husband suddenly started whitewashing the kitchen at night and no longer sleeps, that strongly suggests a manic phase."

Therapy modules: psychotherapy and medication

The central element in treatment should be psychotherapy to prevent new phases or to delay them as long as possible. The patients learn to recognize stress factors individually and to minimize them. In most cases, psychotherapy is coupled with medication. Often they are the basis for psychotherapy to be possible at all. According to Reif, the aim is to alleviate the symptoms of a current phase or to prevent the next phase: "Although medication cannot generally prevent further episodes completely, they can lengthen the symptom-free time until the next episode and increase mood, drive and sleep - Stabilize the waking rhythm. "

Lithium, for example, can stabilize mood. In a third of the patients, the disease comes to a standstill. Another third responds partially to lithium, the rest unfortunately not at all. Who exactly can benefit from these drugs, however, psychiatrists first poke into the uncertain. Genetic markers are still being developed that might make it possible to make better predictions. It is important that those affected take lithium consistently and regularly and in exactly the right dose. Typical side effects are weight gain, circulatory disorders, tremors, nausea or fatigue.

As an alternative to lithium, antipsychotics and anti-epileptics such as valproate are suitable for treating acute mania and for phase prophylaxis. If the patient is in a depressed phase, antidepressants, mood stabilizers, and some atypical antipsychotics are suitable agents. The drug treatment of mixed conditions is tricky. Antidepressants can worsen the condition here, so they are unsuitable. "We usually use a mixture of lithium and certain anti-epileptic and antipsychotics," says Reif. Waking therapy with sleep deprivation and electroconvulsive therapy should also be mentioned as non-drug methods. And, quite banally, sport can also lighten the mood.

"We can treat a bipolar disorder comparatively well today - always adapted to the respective phase," says the Frankfurt physician Reif. Unfortunately, there is a lack of psychotherapists and psychiatrists who are well versed in the clinical picture. In addition, more money is needed for research in order to further improve the therapy as quickly as possible.

Psychotherapy for relatives too

The relatives who suffer from life with a manic-depressive patient can also be included and trained in psychotherapy. Here they learn how to best deal with the situation and differentiate between healthy and unhealthy behavior. In addition, to protect themselves, they should learn to balance between affection and demarcation. After all, they have to endure the contrasting phases of a manic-depressive illness. Since most of those affected lose insight into the illness during a manic phase - they feel great - knowing about the illness in one's personal environment is all the more important.

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