Bipolar Disorder
Bipolar affective disorder is commonly referred as psychotic depressive disorder related to mental health. It is an episodic mood disorder in which the patients face alternating periods of mania and major depressing episodes. It is a dual personality disorder. In children and adults, there is a mood instability, aggressive behavior and impulsivity due to mental issues associated with them. The symptoms appear before the age of 20 years in at least 20% adults with bipolar disorder. Before puberty, symptoms may develop in patients with bipolar disorder and they may be diagnosed as ADHD or other disruptive behavior disorders.
Clinical Findings for Bipolar Disorder
- The first symptoms in about 70% of bipolar patients are depression in the remainder, manic, hypomanic or mixed states of dominate the presentation.
- Patients show a variable pattern elevated, expansive, or irritable mood along with rapid speech.
- There are high energy levels, sustaining concentrations, and a decreased need for sleep.
- Patients may have hyposexual behavior in the absence of history or sexual abuse.
- The clinical picture includes florid psychotic symptoms of delusions and hallucinations. The hallucinations accompany extreme hyperactivity and impulsivity.
- Other illness includes bipolar type 2, which is characterized by recurrent major depressive episodes alternating with hypomanic episodes.
- Cyclothmic disorder which is diagnosed when the patient had 1 year of hypomanic symptoms alternating with depressive symptoms.
- Patients with bipolar disorder have a history of hyperactivity and attentional problems in childhood.
- ADHD and bipolar disorder are in close proximity. ADHD is a life-long chronic disorder.
Differential Diagnosis for Bipolar disorder
Mood disorders are characterized by normal baseline followed by an acute onset of symptoms. These symptoms include acute sleep, appetite and behavioral changes. The disorder is quite heritable, so a positive family history for other affected individual may consider important.
In prepubescent children, mania may be difficult to differentiate from ADHD and other derpressive behavior disorders. Preoccupation with voilence, decreased need for sleep, poor judgment, impulsivity, dysphoria or intense and prolonged rages, hypersexuality and some cycling symptoms suggest bipolar disorder both in children and adults.
The factors such as physical or sexual abuse and exposure to domestic voilence cause the children to develop behavioral changes that are hyperactive and aggressive and PTSD should be considered by knowing the traumatic history of childhood. Diagnostic considerations include acute disorders and sudden changes in personality also accompanied by neurological changes. The Young Mania Rating Scale and The Child Mania Rating Scale may also be helpful in diagnosing the concerning symptoms of disorder.
Complications with Bipolar disorder
- Children and adults with bipolar disorder have inappropriate and aggressive behavior toawards the family members.
- The symptoms cause significant interference with academic learning and close relationships.
- The poor judgment along with manic episodes may cause the patient to involve in ant criminal activity.
- Impulsive acts of patient can cause legal difficulties and acts of vandalism and theft.
- The disorder can cause suicidal thoughts that urge the patient to commit suicide.
Treatment of Bipolar Disorder
How Bipolar Disorder can be treated?
- Use of pharmacotherapy with mood stabilizers such as lithium or atypical antipsychtics that are potentially active as compared to mood stabilizers carbamazepine and valproate that are less promising.
- Use of neuroleptic mediaction is necessary if the symptoms include hallucinations, paranoia, or delisions and aggression.
- Supportive psychotherapy for the patients and education to the family is also very important for the treatment of bipolar disorder.
- In severe case, hospitalization is necessary to maintain safety and treatment.
