Bipolar disorder: causes, symptoms, treatment. Manic personality disorder: how it manifests itself and is treated And with manic disorders associated

Causes of bipolar disorder

Most experts agree that there is no one global reason why a patient develops bipolar disorder. Rather, it is the result of several factors that influence the appearance of this mental illness. Psychiatrists identify several reasons why bipolar disorder develops:

• genetic factors;
• biological factors;
• chemical imbalance in the brain;
• external factors.

As for the genetic factors that influence the development of bipolar disorder, scientists have made certain conclusions. They conducted several small studies using the personality psychology method on twins. According to doctors, heredity plays a role important role in the development of manic depressive psychosis. People who have a blood relative with bipolar disorder are more likely to develop the disease in the future.

If speak about biological factors that can lead to bipolar disorder, experts say that brain abnormalities are often observed when examining patients diagnosed with bipolar disorder. But so far doctors cannot explain why these changes lead to the development of serious mental illness.

Chemical imbalances in the brain, especially with regard to neurotransmitters, play a key role in the occurrence of various disorders, including bipolar disorder. Neurotransmitters are biological active substances in the brain. Among them are, in particular, the most famous neurotransmitters:

• dopamine;
• norepinephrine.

Hormonal imbalance can also trigger the development of bipolar disorder.

External factors or factors environment sometimes lead to the formation of bipolar disorder. Among environmental factors, psychiatrists distinguish the following circumstances:

• excessive alcohol consumption;
• traumatic situations.

Symptoms of Bipolar Disorder

Symptoms during manic stage The following are distinguished:

• a person feels like the ruler of the world, feels euphoric and is too excited;
• the patient is self-confident, he has an excessive sense of self-importance and increased self-esteem prevails;
• doctors note a distorted perception in the patient;
• a person is distinguished by fast speech and an excess of phrases;
• thoughts come and go with high speed(so-called thought leaps), eccentric statements are made; patients sometimes even begin to embody some strange thoughts in reality;
• during the manic stage, a person is sociable and sometimes aggressive;
• the patient is capable of taking risky actions, there is disorderly behavior sex life, alcoholism, he may use drugs and participate in dangerous activities;
• the individual may be careless with money and spend it excessively.

Symptoms during the depressive stage of bipolar include the following:

• the patient feels despondency, despair, hopelessness, sadness, and his thoughts are gloomy;
• in severe cases, the patient is visited and he can even take certain actions to carry out what is planned;
• doctors note insomnia and sleep disorders;
• the patient often experiences anxiety over trifles;
• the personality is often overwhelmed by a feeling of guilt about all events;
• the depressive phase of bipolar disorder is reflected in food intake - a person eats either too much or too little;
• patients note weight loss or, conversely, weight gain;
• the patient complains of fatigue, weakness, apathy;
• the person has attention problems;
• the patient is easily susceptible to irritants: noise, light, smells, reacts to tight clothing;
• some patients are unable to go to work or study;
• a person notices that he has lost the ability to enjoy activities that previously brought joy.

Psychosis

During both the manic and depressive stages of bipolar disorder, the patient may experience psychosis, when a person cannot understand where the fantasies are and where the reality in which he is located.

Symptoms of psychosis in bipolar disorder are as follows:

• illusions;
• hallucinations.

Clinical depression or major depressive disorder

Clinical depression is often a seasonal phenomenon. Previously it was called that way: seasonal affective disorder. There are mood swings depending on the time of year.

Symptoms of bipolar disorder in children and adolescents:

• sudden change of mood;
• attacks of anger;
• outbursts of aggression;
• reckless behavior.

It is important to remember that manic depression is treatable and exists. The symptoms of this mental illness can be reduced with the right approach, and thus the person can return to normal life.

Diagnosis of bipolar disorder

When diagnosing bipolar disorder, a psychiatrist or psychologist is guided by his previous work experience, his observations, conversations with family members, colleagues, close friends, teachers, as well as knowledge of secondary signs of this mental illness.

First, it is necessary to study the physiological state of the patient, do a blood and urine test.

Experts distinguish three common types:

1) The first type of bipolar disorder, the so-called expression of emotions in the mirror

There must be at least one episode of the manic stage of bipolar disorder or a mixed phase (with a previous depressive stage). Most patients experienced at least one depressive episode.

In addition, in in this case It is important to exclude clinical mood disorders that are not associated with manic-depressive psychosis, for example:

• schizophrenia;
• delusional disorder;
• other mental disorders.

2) The second type of bipolar disorder

The patient has experienced one or more episodes of depression and at least one episode of hypomanic behavior associated with manic depression.

Hypomanic states are not as severe as manic states. During the hypomanic stage, the patient sleeps little, he is assertive, easy-going, very energetic, but at the same time is able to perform all his duties normally.

Unlike the manic stage of bipolar disorder, during the hypomanic stage, doctors do not observe symptoms of psychosis or delusions of grandeur.

3) Cyclothymia

Cyclothymia is a mental affective disorder in which the patient experiences mood swings, ranging from vague depression to hyperthymia (sometimes even episodes of hypomania occur). Hyperthymia is a persistent elevated mood.

In general, such mood swings with cyclothymia are: light form manic-depressive psychosis. Moderate depressive mood is often observed.

In general, a patient with symptoms of cyclothymia feels that his condition is quite stable. At the same time, other people notice his mood swings, ranging from hypomania to a manic-like state; then depression may occur, but this can hardly be called major depressive disorder(clinical depression).

Treatment for Bipolar Disorder

The goal of treatment for bipolar disorder is to reduce the frequency of manic and depressive episodes as much as possible, and to significantly reduce the symptoms of the disease so that the patient can return to normal life.

If the patient does not undergo treatment and symptoms of the disease remain, this can last for one year. If a patient is being treated for manic-depressive psychosis, improvement usually occurs in the first 3-4 months.

At the same time, mood swings still remain hallmark patients diagnosed with bipolar disorder who are undergoing treatment. If a patient regularly communicates with his doctor and goes to an appointment, then such treatment is always more effective.

Treatment for bipolar disorder usually involves a combination of several therapies, including medications, exercise, and work with a psychologist.

Nowadays, a patient is rarely hospitalized with symptoms of manic-depressive psychosis. This is only done if he might cause harm to himself or others. Then patients are in the hospital until improvement occurs.

Lithium carbonate is most often prescribed long-term to reduce mania and hypomania. Patients take lithium for at least six months. You must strictly adhere to the psychiatrist's instructions.

Other types of therapy for bipolar disorder include following methods effects on the patient:

• anticonvulsants;
• neuroleptics;
• valproate and lithium;
• psychotherapy;

Anticonvulsants are sometimes prescribed to help a person in the manic stage of bipolar disorder.

Antipsychotics are aripiprazole, olanzapine and risperidone. They are prescribed if a person behaves too restlessly and the symptoms of the disease are severe.

In what cases are valproate and lithium carbonate prescribed? Doctors use this combination of drugs in rapid cycling.

Rapid cycling is a form of bipolar disorder in which the patient experiences 4 or more episodes of mania or depression per year. This condition is more difficult to treat than varieties of the disease with less frequent attacks, and requires special selection of medications. According to some studies, more than half of patients suffer from this form of the disease.

In general, a sign of rapid cyclicality is unbalanced behavior in a person diagnosed with “manic-depressive psychosis” all the time, and there is no norm in his behavior for a long time. In such cases, psychiatrists prescribe valproate in combination with lithium. If this does not bring the expected effect, the doctor recommends lithium carbonate, valproate and lamotrigine.

The goal of psychotherapy is to:

• relieve the main symptoms of bipolar disorder;
• help the patient understand the main provoking factors that lead to the disease;
• minimize the impact of the disease on relationships;
• identify the first symptoms that indicate a new round of the disease;
• look for those factors that help you stay normal the rest of the time.

Cognitive behavioral therapy is training the patient in psychological self-help techniques and a type of family therapy. Psychiatrists talk to the patient and his family about how to avoid exacerbation of bipolar disorder.

Interpersonal (or interpersonal therapy) also helps patients with symptoms of depression. Interpersonal psychotherapy is a type of short-term, highly structured, specifically focused psychotherapy. It is based on the working principle of “here and now” and is aimed at resolving the problems of the current interpersonal relationships of patients who suffer.

Classification of manic episodes based on severity includes hypomania, mania without psychotic episodes, and mania with psychotic episodes.

Under hypomania understand mild degree mania, in which changes in mood and behavior are long-term and pronounced, not accompanied by delusions and hallucinations. Elevated mood manifests itself in the sphere of emotions as joyful serenity, irritability, in the sphere of speech - as increased talkativeness with relief and superficial judgments, increased contact. In the sphere of behavior, there is an increase in appetite, sexuality, distractibility, a decrease in the need for sleep, and certain actions that go beyond morality. Subjectively, ease of associations, increased performance and creative productivity are felt. Objectively, the number of social contacts and success increase. At the same time, there are episodes of reckless or irresponsible behavior, increased sociability or familiarity.

The main diagnostic criterion is an elevated or irritable mood that is abnormal for the individual, persists for at least several days, and is accompanied by the above symptoms.

It should be noted that hypomanic episodes are possible in some somatic and mental disorders. For example, with hyperthyroidism, anorexia or therapeutic fasting in the phase of food arousal; in case of intoxication with certain psychoactive substances- surfactants (amphetamines, alcohol, marijuana, cocaine), however, there are other manifestations of somatic and mental pathology and surfactant intoxication.

IN typical form full-blown manic state manifests itself in the so-called manic triad: painfully elevated mood, accelerated flow of thoughts and motor agitation. The leading sign of a manic state is manic affect, manifested in elevated mood, a feeling of happiness, contentment, wellness, an influx of pleasant memories and associations. It is characterized by an intensification of sensations and perceptions, strengthening of mechanical and some weakening of logical memory, superficiality of thinking, ease and unproductivity of judgments and conclusions, ideas of overestimating one’s own personality , up to delusional ideas of grandeur, disinhibition of drives and weakening of higher feelings, instability, ease of switching attention.

Mania without psychotic symptoms. The main difference from hypomania is that elevated mood affects changes in the norms of social functioning and manifests itself in inappropriate actions that are not controlled by the patient. The pace of time accelerates and the need for sleep is significantly reduced. Tolerance and need for alcohol increase, sexual energy and appetite increase, and a craving for travel and adventure arises. Thanks to the leap of ideas, many plans arise, the implementation of which is not carried out. The patient strives for bright and catchy clothes, speaks in a loud voice, makes a lot of debts and gives money to people he barely knows. He easily falls in love and is confident in the love of the whole world. Gathering many random people, he arranges holidays on credit. There is reckless driving, a noticeable increase in sexual energy, or sexual promiscuity. There are no hallucinations or delusions, although there may be perceptual disturbances (eg, subjective hyperacusis, vivid color perception).

The main symptom is an elevated, expansive, irritable (angry) or suspicious mood that is not typical for the individual. The change in mood should be clear and last for a week.

Mania with psychotic symptoms. It is a pronounced mania with a vivid leap of ideas and manic excitement, which is joined by secondary crazy ideas greatness, high origin, hypereroticism, value. There may be hallucinatory calls confirming the importance of the individual, or “voices” telling the patient about emotionally neutral things, or delusions of meaning and persecution. The greatest difficulties lie in differential diagnosis with schizoaffective disorders, but these disorders must have symptoms characteristic of schizophrenia, and delusions in them are less consistent with mood. However, the diagnosis can be considered as an initial diagnosis for the evaluation of schizoaffective disorder (first episode).

Bipolar affective disorder

A mental disorder formerly called manic-depressive psychosis (MDP). Characterized by repeated (at least two) manic, depressive and mixed episodes, which are replaced without a specific sequence. A feature of this psychosis is the presence of light interphase intervals (intermissions), during which all signs of the disease disappear, observed full recovery critical attitude towards the painful condition suffered, premorbid characterological and personality traits, professional knowledge and skills. Its non-psychotic form (cyclothymia) is clinically a reduced (weakened, ambulatory) version of the disease.

Manic episodes usually begin suddenly and last from two weeks to 4-5 months ( average duration episode about 4 months). Depression tends to last longer (average duration is about 6 months), although rarely more than a year (excluding elderly patients). Both episodes often follow stressful situations or mental trauma, although their presence is not required for diagnosis. The first episode can occur at any age. The frequency of episodes and the nature of remissions and exacerbations are quite variable, but remissions tend to shorten with age, and depressions become more frequent and prolonged after middle age.

Although the previous concept of manic depression included patients who suffered only from depression, the term "MDP" is now used primarily as a synonym for bipolar disorder.

ATTENTION!!! Self-medication is not allowed in any cases; a psychotherapist is needed

Manic (manic syndrome, manic episode) personality disorder – affective state personality, which is characterized by three main components: increased instinctive behavior, inability to concentrate, and overestimation of one’s own importance.

Most often, a manic episode is part of another medical condition, rather than a separate diagnosis. So it may be a stage of manic-depressive bipolar disorder.

However, if the syndrome occurs during drug treatment for depression, then you should be careful when making a diagnosis. In this case, the final verdict can be made either in the case of the described clear clinical picture before the start of therapy, or a month after its cessation.

Cases of its occurrence against the background of infectious and toxic poisoning have been described; can also be observed in organic psychoses, as well as in somatic and cerebral diseases (for example, in hyperthyroidism, when thyroid works in hyperfunction mode). The syndrome may also occur after injuries and surgical operations.

Do not also forget that similar symptoms are often observed when using narcotic drugs drugs such as opiates, cocaine and hallucinogens, or in overdose of certain medicines. Thus, a triad of symptoms may be characteristic of abuse of antidepressants, teturam, bromides, and corticosteroids. And here, of course. It is important to conduct a thorough toxicological examination and consultation with a narcologist and toxicologist is necessary.

How it manifests itself

Manic personality disorder consists of three main and several additional signs, which can be safely contrasted with depressive disorder.

• awakening instinctive behavior in the form of overeating and increased sexual activity without a real assessment of all risk factors;
• encouragement to obtain pleasure in the form of excessive consumption of alcohol, drugs, people can make thoughtless purchases, get into debt and loans, get involved in gambling, even at risk to health, and also try extreme sports and not pay attention to injuries and damages;
• awakening a large number of diverse activities with damage to its productivity. Patients actually “grab at everything at once, without finishing what they started).

Classification of the disorder

1. “mania of joy” (hyperthymic), which is characterized by super-elevated mood, constant jubilation and joy;
2. “mania of confusion”, which is characterized by jumps of various ideas or superideas against the background of associative acceleration (tachypsia);

• When a symptom is replaced by its opposite

1. "mania of anger" : acceleration of thought processes and motor activity exhausts the patient’s body, which in turn manifests itself in the form of attacks of anger and irritability, and decreased mood. This can lead to destructive behavior in the form of explicit harm to others or self-destructive behavior, such as self-harm.
2. “unproductive mania,” which is characterized by a slowed thought process combined with increased vigorous activity, which often corresponds to the proverb “much ado about nothing.”
3. “manic stupor”, which is characterized by a sharp decrease in motor activity while maintaining elevated mood and acceleration of thought processes.

• Mixed psychotic complexes:

When do disorders occur?

Manic personality disorders can occur with: encephalitis, Kraepelin's disease, traumatic or organic lesions of cerebral vessels, epilepsy, alcohol, drug and toxic intoxication (for example, a bright oneiric-hallucinatory effect is observed when inhaling vapors of Moment glue, as if by accident, and to achieve the effect of intoxication), traumatic brain injuries, schizophrenia and bipolar disorder.

When should you suspect a disorder?

In general, the question of the possibility of making a diagnosis arises when the patient is involved in the described conditions for a period of one week or more. In this case, persistent activity or a stable change in mood is observed, which is not typical in the normal state.

At the same time, people around them notice differences in behavioral reactions. However, do not forget that toxic or narcotic intoxication can cause short-term bursts of manic episodes. In this case, of course, it is worth noting the frequency of their occurrence and trying to track possible reception the mentioned funds.

To further confirm our suspicions, we use the following scheme:

1. Watching a person . A patient with manic personality disorder is too cheerful, optimistic (and often unreasonably), not critical of current events, takes on several tasks or jobs, and makes unplanned and not always necessary purchases. He takes out loans without thinking, borrows, spends a lot, and sometimes begins to prefer gambling.

In addition, patients often strive to look younger, their appetite and sexual desire increase. However, vegetative changes may be observed, increased salivation, sweating, increased heart rate. However, one should not suspect all young people of such a disorder. Sometimes crisis periods of certain ages can be a little reminiscent of such manifestations. If we recall the main symptoms of a midlife crisis, then it is precisely the desire to look younger, the search for new young sexual partners, falling in love, mood swings, increased activity and the ideas of “fundamentally changing your life” have nothing to do with mental disorders. Therefore, in addition to the mentioned observations, talk to the person.

However, the diagnosis and final diagnosis must be made by a doctor who will evaluate:

• increased assessment of the patient’s personal significance;
• decreased need for sleep;
• increased talkativeness;
• shifting attention to unimportant details;
• increased “efficiency”, swagger;
• increased activity, inability to sit still;
• excessive participation in other people's affairs or social events (including entertainment).

Also taken into account:

A blood test may also be necessary, including taking into account ALS levels, glucose levels, alkaline phosphatase and other indicators.

It is worth noting that such a patient resists treatment because, on the contrary, he feels an increase in strength and cannot evaluate his condition critically. Therefore, initially patients most often end up in psychiatric hospitals for relief therapeutic procedures that are aimed at Current state sick.

Lithium and valproic acid salts are mainly prescribed; for sleep disturbances, sleeping pills (nitrazepam, temazepam and others) are prescribed. In cases of severe aggressive agitation, the use of neuroleptics is possible. Cupping acute condition can last up to three months.

Stabilizing and supportive therapy is possible outside the hospital and is best done with the assistance of a psychotherapist. On average, this stage can last six months or more.

I would like to say that many Western celebrities, such as Stephen Fry and Catherine Zetta-Jones and Kurt Cobain, openly talk about life against the background of manic personality disorders. They all discuss their symptoms, conditions and how they overcome them or what consequences they can lead to. This greatly helps people who are forced to live with a similar diagnosis. Because the patient does not always clearly understand what exactly is happening to him and what will happen tomorrow. Unfortunately, in our open spaces there is very little such necessary information, and advice to visit a psychiatrist often causes violent protest and fear of making such a diagnosis, which can subsequently harm one’s life or career. But sometimes the advice is very simple. For example:

• accept that this feature of yours requires correction, even if you feel super good about it;
• Keep a calendar where you mark the days when you are able to “move mountains,” while noting how many hours you slept. This will help identify the frequency of the onset of a manic episode;
• during the period of remission, determine for yourself maximum amount, which you can spend and write it everywhere in large numbers, so that at the time of the episode you try not to get into unbearable debt;
• if you wake up in a super high spirits, be sure to tell your loved ones about it, remember that in such a state irreparable quarrels and unjustified betrayals are not uncommon;
• the selection of therapy is not always successful the first time, this is normal for such conditions and does not indicate poor knowledge of the doctor; openly and boldly discuss what you don’t like or what by-effect worries;
• Don’t be afraid that after therapy you will become a “bored and exhausted” person. You will simply be more stable and not go to extremes;
• be prepared for the fact that maintaining strong social connections will sometimes require a lot of effort, go for it so as not to offend significant people or managers;
• learn to live with your condition, just as a child learns to live. Remember that the success of your life depends only on you.

Manic-depressive psychosis (bipolar personality disorder, bipolar affective disorder) – mental illness, manifested by periodically occurring depressive and manic attacks.

In the intervals between the phases of the disease, regardless of the severity and number of attacks suffered, there are no symptoms.

Manic-depressive psychosis is not characterized by the development of pronounced personality changes or, as in schizophrenia. A person may suffer from this disorder for years, but during the interictal period there will be no symptoms of the disease, which allows him to lead a normal life.

Reasons for development

It has not yet been possible to definitively determine why this emotional disorder occurs.

There are several established patterns in the development of the disease:

• Heredity is of great importance in the development of this disease;
• this pathology occurs more often in women, it is assumed that there is a connection between the genes responsible for the development of this disease, with the X chromosome. Thus, manic-depressive psychosis can be attributed to changes in the human body itself.

Main features

The first symptoms of manic-depressive psychosis can appear at any age, but most often the disease occurs in young people (after 20 years) and mature age. Sometimes, with a late onset of the disease, patients can talk about 1-2 erased attacks of depression or mania, which passed on their own, without seeing a doctor.

In most cases, the appearance of the first attack of the disease is preceded by psychotrauma, and subsequent episodes can develop independently, the connection with psychotrauma is lost.

The main signs of manic-depressive psychosis are depressive and manic syndromes. The frequency, severity and duration of each phase differ.

A typical depressive episode lasts from 2 to 6 months; manic episodes are usually shorter.

Manic-depressive psychosis is characterized by a connection with human biorhythms. Many patients note that exacerbation of the disease, the occurrence of depressive or manic episodes, occurs in the spring or autumn.

In women, it is often possible to establish a connection between attacks and a certain phase of the monthly cycle.

For depressive symptoms Characteristic fluctuations in the severity of symptoms depending on the time of day: in the morning, immediately after waking up, the maximum severity of symptoms of depression is noted; in the evening, patients experience some relief. This is why most suicide attempts occur in the early morning.

But in the sequence of changes in the various phases of the disease, no stable patterns are found. Mania may develop following a depressive episode, may precede the onset of depression, or occur independently of periods of depression. In some patients, depressive symptoms are the only manifestation of the disease, and mania does not occur during life. This is characteristic of the monopolar type of disease.

The light intervals between individual attacks can last for several years, or they can be very short.

After the attack stops, mental well-being is almost completely restored. Even multiple attacks do not lead to noticeable personality changes or the development of any defect.

As a rule, attacks of bipolar personality disorder manifest themselves as mania, but there are also erased variants of attacks, when obsessions and complaints of work impairment predominate internal organs. In the transition period between depression and mania, mixed states may be briefly observed (manic stupor, angry mania, agitated depression).

Signs of depression

A typical depressive attack is characterized by melancholy and speech retardation. All drives are suppressed (libido, maternal instinct, food). Patients persistently express ideas of self-blame, and pessimism and a sense of hopelessness often contribute to the commission of suicidal acts.

In adulthood and old age, a depressive episode often occurs atypically; its main manifestations are anxiety, motor restlessness, a feeling of the end of the world or, conversely, callousness and indifference to loved ones, a painful feeling of indifference.

Often, a depressive attack occurs according to the following type: patients do not focus their attention on a decrease in mood, but complaints of pain in various parts of the body (heart, head, joints), sleep disturbances, increased blood pressure, constipation and others come to the fore. Attacks of depression accompanied by uncontrollable drunkenness have been described.

Symptoms of mania

Manic episodes occur less frequently than depressive episodes and are shorter in duration.

Typical signs of mania: activity, initiative, interest in everything, fast racing thinking. Patients in this phase are characterized by increased distractibility and a desire to help others.

All basic drives are intensified:

• appetite increases;
• hypersexuality is noted;
• patients are overly sociable;
• the need for sleep decreases.

During a manic attack, patients may spend money thoughtlessly, engage in casual sexual relationships, abuse alcohol, suddenly quit their job, leave home, or bring home strangers. The behavior of manic patients attracts the attention of people around them, although the patients themselves are rarely aware of the absurdity of their actions: they consider themselves absolutely healthy and experience a surge of strength.

With excessively expressed manic syndrome the speech of patients becomes incomprehensible, they fervently express their ideas to their interlocutors, and unstable ideas of greatness may sound in their statements. As a rule, in a state of mania, patients are favorably disposed towards others, although short-term mixed states are possible, in which increased activity is combined with irritability, aggressiveness, and explosiveness (angry mania).

Course of the disease

If both depressive and manic episodes are observed during the disease, then we are talking about a bipolar type of manic-depressive psychosis.

If only depressive episodes are present, the disease is classified as the unipolar type.

Individual episodes of mania do not occur without depressive attacks.

Manic-depressive psychosis (bipolar affective personality disorder) is a serious mental illness that can be identified in children and adults. Bipolar disorder characterized by mood swings - from mania to severe depression, regularly replacing each other. The duration of each phase in bipolar disorder can vary: from several days to a year. Depressive state can also be different: from bad mood to severe disorders.

The emotional-volitional sphere of the human psyche is very important and its normal functioning is the key to a calm and prosperous life of an individual. It is common that every person experiences certain difficulties and emotional changes throughout his life, i.e. the so-called emotional “swing”.

But it does not cause concern when a person has real reasons for changing his mood. When grief occurs, then sadness - natural state person, and a joyful event entails happiness. However, if these extreme states (depression and euphoria) occur without visible reasons and reach incredible exacerbations, then we can talk about a disease that requires professional medical care and is called manic-depressive psychosis or otherwise bipolar affective disorder.

Bipolar disorder in children

For the first time, signs of this disease may appear in adolescents during the “transition” period at 13-14 years old, then at 21-23 years old, when the personality is formed. Ultimately, full bipolar personality disorder is diagnosed at 25-30 years of age. The disease is defined by the alternation of two periods: mania and depression. Biphasic or bipolar disorder is manifested by extreme mood swings that do not allow a person to exist calmly.

Depression is manifested by the patient's depressed state, apathy towards life, and depression. Mania is characterized by euphoria, an increase in the speed of mental functions and motor processes, i.e. the need to do something and run somewhere. This condition is especially aggravated in the spring and autumn period. IN difficult cases it is necessary to place the patient in a specialized institution; the lungs are treated on an outpatient basis. Manic-depressive psychosis occurs more often among the female population than among the male population. The ratio is approximately 3:1.

The first manifestations of bipolar affective disorder occur in childhood (before 10 years of age)

Attacks are rare, and recognition of them is even rarer. In some cases, one can observe a circular type of illness (change of both periods - manic and depressive, but without intermission, i.e. there is no quiet break between phases) and the diagnosis is made only after the fact, i.e. analyzing past behavior.

A depressive state is marked by melancholy, extreme slowness of movements, indifference with the appearance of physical ill health. Children speak little and are slow. In games they are inactive and inattentive. They are not happy with toys and books. They look tired and sick, complain of aches and pain throughout the body. Children are not doing well at school. Communication function is impaired, behavior is depressed. The taste of food disappears, insomnia appears. Recognizing depression in children is difficult. Requires lengthy behavior analysis and Additional Information about heredity, there is also a need to exclude psychogenic influences.

Manic manifestations at this stage are also difficult to define. Their symptoms may be normal manifestations of childhood behavior. Natural joy during leisure time during manic states turns into euphoria. Violence of behavior appears to unimaginable manifestations. It is impossible to calm a difficult-to-control child. He cannot adequately balance his actions. This behavior allows us to determine a manic state. In bipolar disorder, the contrast is clear.

As you get older, the phases of bipolar disorder can be clearly identified.

Manic-depressive psychosis among adolescents

The history of bipolar disorder in adolescents reveals the main characteristic symptoms. The obvious state of depression (decreased fine motor skills and difficulties in verbal communication, lack of initiative, indifference, etc.) is accompanied by a certain feeling of apathy, anxiety, lack of intelligence, poor memory.

These manifestations of depressive psychosis occur along with self-examination, heightened sensitivity to interpersonal relationships with peers, gloominess and statements that often resemble delirium. Along with nihilism, thoughts of suicide appear, and attempts to commit suicide are also common. These signs relate to the depressive side of the disease.

The manic component of bipolar disorder during adolescence is determined by “laxness” of movements and foolish behavior and heboid syndrome (a kind of emotional disorder with partial preservation of intelligence), isolation from real life, unrealistic ambitions and far-fetched illusions.

Teenagers commit unimaginable antics, lose their edge in pranks, the consequence of which is, at a minimum, damage to things.

Suffering from insomnia, they compose poems and make “scientific discoveries”, during the day they go to circles, sections and easily get along with people; without feeling tired. Identifying a manic period is not difficult. Obvious symptoms of adolescence are when the peaks of such behavior greatly contrast with the calm period of life, and actions with obvious delusions of grandeur and panic attacks also attract attention. However, if this occurs in the form of milder forms of affective disorder, then the disease can be identified by the subjective feelings of the subject.

If a doctor is dealing with so-called “difficult teenagers” from dysfunctional families, in this situation it is very difficult to distinguish manic psychosis from bad behavior.

Having considered how the symptoms of bipolar disorder manifest themselves at the stages of a child’s development and having outlined what to pay attention to if you notice strange behavior of loved ones when “sounding the alarm”, it is necessary to move on to the actual diagnosis of manic-depressive psychosis in an adult.

Stages of manic-depressive psychosis

The symptoms of bipolar disorder are easy to notice, but it can be difficult to diagnose. An experienced psychiatrist knows that the disease goes through several stages in its development.

Firstly, hypomania is an early rise from sleep, strange restlessness, the inability to concentrate on any one object or thought, a million unfinished tasks, a constant desire to be seen at noisy parties, irritability leading to outbursts of anger. Hypomanic psychosis does not have such a strong effect on social behavior person.

Secondly, impaired diction, illogical statements, theatrical behavior, rejection of criticism, periods of hypochondria, weight loss, irritability and anger over minor life troubles and an understanding of the impossibility of living up to your dreams.

Depression is characterized by withdrawal into one's own inner world and an irresistible need for solitude, nightmares and late rising from sleep, inhibition of verbal and motor function, the desire to distance oneself from everyone, hiding behind the door, constant thoughts of suicide. A depressive episode may not be as obvious at first. However, all this remains at the stage of talk; suicide rarely happens, but with worsening depression, the likelihood of committing suicide increases.

Types of depression as the first phase of bipolar affective disorder

Clinical depression is any depression that causes harm to a person.

Manic-depressive psychosis is clinically manifested affectively - volitional disorders, somatic symptoms that talk about vegetative tone nervous system. Bipolar disorder in a patient manifests itself in the form of “sympathicotonic syndrome,” which means a whole complex of symptoms:

• heart rhythm disturbance,
• weight loss,
• hypertension,
• elevated blood sugar,
• dermatitis,
• pupil dilation,
• constipation

Non-clinical depression – respectively, melancholic and apathetic.

Melancholic or “classical” depression consists of three symptoms:

1. hopeless melancholy (on physical level- heartache);
2. slowing down of thought processes;
3. motor stupor.

Classic depression is characteristic of manic-depressive psychosis or affective disorders when diagnosed with schizophrenia. In this state, a person can injure himself (cut his face, hit his head against a wall, etc.) Transitions from the patient's motionless state to an attack of excitement are dangerous.

• Apathetic depression:
• Indifferent behavior, lack of interest in what is happening, unemotional reaction, absolute abstraction from everything and everyone.
• Mental inertia is marked by a paucity of associative thinking. A person stops taking care of himself and experiences a feeling of self-pity.
• Unipolar depression is the types described above.
• Bipolar depression is another name for MDS.
• The second phase of bipolar affective disorder is a manic state.

In manic-depressive psychosis, the manic phase is diagnosed when three main signs are detected:

Happens:

1. violations in emotional sphere person, euphoria occurs;
2. destruction of thought processes by increasing the speed of associations, in severe cases reaching “leaps of ideas”;
3. general increase in directed activity and focusing of attention.

Even when receiving bad news, the patient “sparkles” with an optimistic attitude.

Subjectively, the patient believes that those around him treat him wonderfully and what an interesting person he is. Sociability, talkativeness, thirst for entertainment are characteristic manifestations of the disease. The pace of thinking increases. The patient is restless, sings songs and everything like that. He reinforces his speech with expressive facial expressions and gestures, overestimates his capabilities and abilities, the idea of ​​greatness, skills in invention, and awareness of his own chosenness are manifested.

There is a need for activity, dangerous and frightening excitement. Attention is unstable and easily distracted. They are constantly in a hurry, showing increased interest in activities. The instincts of those who are in a manic state become stronger.

The erotic component of behavior increases, which manifests itself in coquetry, exotic accessories, and the search for adventure. The instinct of gluttony intensifies. This period is characterized by tirelessness in patients. They may hardly sleep for a long time.

In difficult cases, hallucinations appear. The duration of the manic stage is 3-4 months.

Manic-depressive psychosis is characterized by seasonal exacerbations of the course of the disease - phases usually occur in autumn and spring. The duration of the phases varies from 3 to 6 months. Women get sick 3-4 times more often, but unipolar forms of depression predominate in them, but the bipolar course of the disease is more common in men. MDS begins at the age of 35-40 years, bipolar affective disorder earlier - at 20-30 years.

Bipolar affective personality disorder occurs for unknown reasons, but with a hereditary predisposition, i.e. People who have had mental pathologies in their family are at risk. A child's chance of getting sick increases up to 30% if one of the parents suffers from bipolar affective disorder.

The mechanism of the disease is associated with a disruption in the functioning of the hypothalamus of the brain, which is responsible for affective manifestations. Manic-depressive psychosis is treated or by medicinal method, or through psychotherapy, because patients with this syndrome have unpredictable behavior and are dangerous to themselves and people around them. This also follows from the fact that some patients are receptive to only one type of treatment.

How to treat manic-depressive psychosis?

Treatment of MDS consists of therapeutic interventions in conjunction with psychotherapy.

Treatment can be divided into three stages:

• I – therapy that relieves acute affective symptoms (in a medical institution);
• II – therapy that stabilizes the achieved effect to a stable intermission (quiet state);
• III – prophylactic and outpatient therapy, which will last more than 1 year.

It is important to take into account the patient’s age at the onset of the disease, as well as the symptoms that occur during the first phase.