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Home » Topics » Health and Medicine » Bipolar Disorder Bipolar disorder is characterized by severe and unusual changes in energy level, mood, and interactions with others. The mood swings associated with bipolar disorder are unpredictable, and range from mania (elevated or irritable mood) to depression (a mood characterized by loss of interest and sadness). Bipolar disorder causes significant impairment in social, occupational, and general functioning. Bipolar disorder is a manic-depressive psychiatric disorder that causes extreme fluctuations in mood and energy levels, which alternate over long time periods. These episodes are referred to as mania and depression, and appear in cycles throughout life. Between episodes, approximately two-thirds of bipolar patients are free of symptoms, with the remainder experiencing residual symptoms. A small percentage of patients experience chronic incessant symptoms despite treatment. Bipolar disorder type I is the classic form of the illness, involving recurrent cycles of extreme manic and depressive episodes. Type II bipolar disorder patients never develop severe mania. Type II bipolar patients experience milder episodes called hypomania that alternate with depression. A third type, rapid-cycling bipolar disorder, involves four or more episodes of illness occur within a 12-month period. Multiple episodes may occur within one week or day. Rapid cycling tends to occur later in the course of illness and is most common in women. Manic episodes are commonly associated with irritability, decreased need for sleep, euphoria (an exaggerated perception of feeling good), social extroversion (excessive friendliness), and feeling more important than one truly is (grandiosity). Depressive episodes are commonly associated with fatigue, impaired concentration and judgment, and altered sleep and appetite patterns. The depressive cycle can further progress to feelings of excessive shame and guilt, and lead to suicidal thoughts. Bipolar disorder is also called manic-depressive psychosis, and is a major affective disorder. There is no single gene or environmental factor that causes bipolar disorder. Like other mental illnesses, multiple factors together may contribute to the illness. Bipolar disorder has a strong genetic component. According to the Mayo Clinic, 60% of bipolar cases have a family history of the disease. The Child and Adolescent Bipolar Foundation (CABF) reports that the risk for a child of one bipolar parent to develop the disorder is l5–30%. If both parents have bipolar disorder, the risk for each child increases to 50–75%. The risk in siblings and fraternal twins is 15–25%. The risk in identical twins, who share the same genes, is approximately 70%. Research in identical twins indicates that both genes and other factors play a role in developing bipolar disorder. No specific gene mutations have been identified that consistently show up in bipolar patients. However, there appears to be a potential genetic correlation between bipolar disorder and mutations in specific regions of chromosomes 13, 18, and 21. The building blocks of genes, called nucleotides, are normally arranged in a specific order and quantity. If these nucleotides are repeated in a redundant fashion, a genetic abnormality often results. Some evidence exists for a special type of nucleotide sequence (CAG/CTG repeats) in patients with type II bipolar disorder on chromosome 18. However, not all bipolar patients have this mutation and the presence of this sequence does not worsen the disorder or change the age of onset. Further research is needed to determine which genes are involved in bipolar disorder. The specific genetic defect for bipolar disorder has not yet been identified, and it is likely that both genetic and environmental factors contribute to the disease. According to the National Institutes of Mental Health (NIMH), approximately 1–1.3% of the United States adult population has bipolar disorder. It is estimated that approximately 2.3 million adult Americans are affected. Approximately 0.8% of the population has bipolar disorder type I, and 0.5% of the population has bipolar disorder type II. Approximately 25–50% of individuals with manic-depressive disorders attempt suicide, with 11% actually committing suicide. No racial predilection exists. While bipolar type I occurs equally in both sexes, type II and rapid-cycling bipolar disorder is more common in females than in males. Women may also be at increased risk of developing subsequent episodes in the immediate time period after giving birth. Bipolar disorder runs in families, with the rate disease in identical twins being higher than that in fraternal twins. The age of onset varies greatly. The age range of onset may be in early childhood or up to 50 years of age, with a mean of 21 years. The most frequent age of onset lies between 15 and 19 years of age. The second most frequent age of onset is between 20 and 24 years of age. Some patients previously diagnosed with recurrent major depression may have bipolar disorder and not develop a manic episode until 50 years of age. However, for most patients, mania onset after 50 years of age is due to other medical disorders such as cerebrovascular disease. Bipolar disorder causes recurrent dramatic mood swings that range from a manic high to a depressive low. There are often periods of normal mood in between episodes of mania and depression. Severe changes in energy and behavior accompany the swings in mood. Manic episode symptoms include: Depressive episode symptoms include: Some cases of type II bipolar disorder have depressive episodes concurrent with mood reactivity (mood improves with positive event), and can switch from depression to hypomania. Hypomania is characterized a mild or moderate level of mania. Because hypomania is less severe, it may be associated with increased functioning and enhanced productivity. However, hypomania is not a normal state of mind. Without proper treatment, hypomania may eventually progress into severe mania or switch into depression. Severe episodes of mania or depression may also include symptoms of psychosis. Psychotic symptoms include visual or auditory hallucinations and delusions (illogical, false, but strongly held beliefs). Psychotic symptoms in bipolar disorder tend to reflect the current extreme mood episode. During mania, psychotic delusions may include grandiosity, such as believing one has special powers of flight or extreme financial wealth. During depressive episodes, delusions may include paranoid fears of being poisoned or the belief that one has committed a terrible crime. Because of these psychotic symptoms, bipolar disorder is sometimes mistaken for schizophrenia . Some bipolar cases present with a mixed state of symptoms. A mixed bipolar state is characterized by symptoms of agitation, sleeplessness, appetite changes, psychosis, and suicidal tendencies. A depressed and hopeless mood may occur in conjunction with extreme energy. Signs of bipolar disorder may also be demonstrated outside of mental illness symptoms in behaviors such as alcohol or drug abuse, poor work performance, strained interpersonal relationships, or excessive promiscuity. Symptoms of bipolar disorder with postpartum onset usually occur within four weeks after childbirth. Bipolar disorder with a seasonal pattern displays symptoms related to seasonal change and latitude. The prevalence of the season-specific bipolar symptoms increases with higher latitudes and winter months. Children and young adolescents with bipolar disorder tend to have episodes that are less clearly defined than adults with the disorder. Young people often experience very fast swings (rapid cycle) between mania and depression within the same day. Children in a manic episode are more likely to be irritable and destructive than elated. Children and young adolescents are also more prone to mixed symptoms. Bipolar disorder in children and adolescents can be difficult to distinguish from other problems associated with this age group. Symptoms of irritability and aggressiveness may indicate bipolar disorder, or be symptoms of attention deficit hyperactivity disorder , conduct disorder, oppositional defiant disorder, other types of mental disorder, or drug abuse. Bipolar disorder is a manic-depressive psychiatric disorder that is difficult to diagnose. Like other mental illnesses, bipolar disorder cannot yet be identified through simple tools such as a blood test. A diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). A manic or hypomanic episode is diagnosed if elevated mood, including three or more associated symptoms, lasts one week or longer. A depressive episode is diagnosed if five or more of the associated symptoms last two weeks or longer. For a mixed episode, the criteria must be met for manic and depressive episodes, but the depressive episode need only last one week. The episodes must be of sufficient severity to cause impairment and not be due to substance abuse or some other illness. A mental status examination during an episode reveals obvious symptoms associated with bipolar disorder. Bipolar manic depression should be distinguished from unipolar (major) depression. Individuals who exhibit bipolar disorder depressive episodes often present with signs of eating more (hyperphagia), sleeping more (hypersomnia), very low energy levels, are overweight, and experience worsening of mood during evening hours. The bipolar affected individual also tends to deny or minimize obvious signs of illness. Unipolar (major) depression usually presents with anxiety, difficulty sleeping, loss of appetite, loss of weight, and feeling worse during morning hours, which improves as the day progresses. Close friends, family members, and roommates are often very helpful in assisting the clinician make the correct diagnosis. Suicide is the major complication of bipolar disorder, and is related to the duration of the depressive episode. The longer the depressive episode lasts, the higher the risk of suicidal tendencies. Alcoholics and patients with other chronic medical diseases are particularly prone to planning and implementing a suicide attempt. The four main groups that are likely to carry out a suicide attempt include the following: Most individuals with bipolar disorder can achieve substantial stabilization of mood swings and related symptoms with proper treatment. Treatment of bipolar disorder is achieved through medication and psychosocial interventions. Medications for bipolar disorder are prescribed by psychiatrists, medical doctors with expertise in the diagnosis and treatment of mental disorders. While primary care physicians may also prescribe medications used in bipolar disorder, it is recommended that bipolar patients see a psychiatrist for treatment. Mood-stabilizing medications may be utilized for long-term maintenance and preventative treatment of bipolar disorder episodes. In the acute phase, the choice of medication for bipolar disorder is dependent on the stage or type of current episode. There are numerous drugs used to treat an acute manic episode, primarily the antipsychotics and benzodiazepines (lorazepam, clonazepam). In the presence of psychotic symptoms, atypical antipsychotics may be used to treat the psychotic symptoms and acute mania, and contribute to mood stabilization. For depressive episodes, antidepressants may be used. These may be added temporarily, to treat episodes of mania or depression that break through despite mood-stabilizer treatment. Mood stabilizers have a stabilizing effect that dampens the extremes of manic and depressive episodes. Lithium was the first mood stabilizer approved by the U.S. Food and Drug Administration (FDA) for the treatment of mania and the prevention of both manic and depressive episodes. Lithium carbonate is a first-line medication used in the long-term preventative treatment of extreme mood episodes in bipolar disorder, and was demonstrated in 2003 to play a neuroprotective role in brain function. The beneficial effects of lithium carbonate usually appear one or two weeks after administration of oral doses. Lithium treatment has a high response rate, with 70–80% of patients experiencing acute manic attacks showing an improvement of symptoms. However lithium treatment has many side effects, including gastrointestinal discomfort, diarrhea, baldness, skin eruptions, and fluid retention. Lithium is primarily useful as a prophylactic (prevention) medication for future attacks. Multiple anticonvulsant medications, such as valproate (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal), also act as mood stabilizers. However, not all anticonvulsant medications have been FDA-approved for this use. Valproic acid is a second-line medication intended for patients who respond poorly to, or cannot tolerate the side effects of, lithium. Valproic acid has proven effective in treating and preventing mania. It can be used alone or in combination with lithium, and is especially useful in treating rapid-cycling bipolar disorder. For treatment of depressive bipolar episodes, mood stabilizers are preferred to antidepressants because antidepressants may cause a switch into a manic episode or aggravate irritability in mixed-symptom mania. Gabapentin (Neurontin) is not a mood stabilizer, but may have antidepressant and anti-anxiety effects. Psychosocial interventions include both patient education and psychotherapy. It is important for patients to receive social support and illness management skills. Family and friends must be aware of the high rates of social dysfunction and marital discord. Involvement in national support groups is advisable (e.g., National Depressive and Manic-Depressive Association). Psychoeducation usually focuses on all of the following: Genetic counseling should be included in family education programs since the predisposition for this disorder has been genetically proven to increase among first-degree relatives. Although the episodes of mania and depression appear in cycles, bipolar disorder is a long-term illness that currently has no cure. The long-term prognosis for bipolar disorder is variable. It is critical that bipolar patients maintain consistent and strict compliance with medications. Patients taking psychotropic medications must understand the importance of regular dosing as prescribed and the necessity for constant psychiatric follow-up visits. In comparison to major depression (unipolar), bipolar disorder is usually associated with longer depression, more severe depressive symptoms, more relapses (having active symptoms return after a period of remission), and more incapacitation and hospitalization. Some studies have shown that early-onset bipolar disorder is associated with more recurrences, but not necessarily worse outcomes. Psychotherapy and education can improve prognosis by assisting the patient and family members with pertinent information concerning relapses, noncompliance with prescription medications, and specific adjustments necessary for the welfare of the affected individual. Many individuals with bipolar disorder can lead productive lives when the illness is effectively treated. However, without treatment, the prognosis is very poor. The natural course of bipolar disorder tends to worsen over time, with increased frequency and severity of manic and depressive episodes. In most cases, proper treatment can reduce the frequency and severity of episodes and help to maintain a good quality of life. Remaining on medications, even during well times, is essential for keeping the disease under control and reducing the risk of recurrent, worsening episodes. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Washington, DC: American Psychiatric Association, 1994. Maxmen, J. S., and M. G. Ward. Essential Psychopathology and Its Treatment. New York, NY: W. W. Norton & Company, 1995. Muench, K. H. Genetic Medicine. New York, NY: Elsevier Science Publishing Co., Inc., 1988. Benazzi, F. "Early versus Late-onset Bipolar II Disorder." Journal of Psychiatry and Neuroscience 25 (2000): 53–56. Callahan, A. M., and M. S. Bauer. "Psychosocial Interventions for Bipolar Disorder." The Psychiatric Clinics of North America 22 (1999): 675–686. Parikh, S. V., J. B. Vincent, and J. L. Kennedy. "Clinical Characteristics of Bipolar Disorder Subjects with Large CAG/CTG Repeat DNA." Journal of Affective Disorders 55 (1999): 221–224. Sanchez, L., O. Hagino, E. Weller, and R. Weller. "Bipolarity in Children." The Psychiatric Clinics of North America 22 (1999): 629–639. Schaffer, C. B., and L. C. Schaffer. "Open Maintenance Treatment of Bipolar Disorder Spectrum Patients Who Responded to Gabapentin Augmentation in the Acute Phase of Treatment." Journal of Affective Disorders 55 (1999): 237–240. National Depressive and Manic-Depressive Association. 730 N. Franklin, Suite 501, Chicago, IL 60610-7204. "About Pediatric Bipolar Disorder." Child & Adolescent Bipolar Foundation. American Psychological Association. Bipolar Disorder 2001. National Institutes of Mental Health. Bipolar Disorder Risk Factors. Mayo Clinic. E-medicine. "Bipolar Affective Disorder." National Mental Health Organization. "The Numbers Count." National Institutes of Health. Maria Basile, PhD The Washington Post; October 15, 2018 The Washington Post; October 12, 2018 The Washington Post; October 12, 2018 The Washington Post; October 2, 2018 The Washington Post; September 30, 2018 Pediatric Nursing; January 1, 2008 Clinical Advisor; March 1, 2017 Clinical Advisor; March 1, 2017 Family Practice News; August 1, 2005 Internal Medicine News; January 15, 2005 HighBeam Research is operated by Cengage Learning. © Copyright 2018. All rights reserved. The HighBeam advertising network includes: womensforum.com GlamFamily
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Shizoafektivni poremećaj – uzroci, simptomi, liječenje i prognoza Shizoafektivni poremećaj je psihički poremećaj u kojem se simptomi poremećaja raspoloženja (depresije ili manije) preklapaju s izraženim psihotičnim simptomima koji mogu trajati i kada nestane poremećaj raspoloženja. Od shizofrenije se razlikuje po pojavi jednog ili više napada simptoma depresije ili manije. Vrste shizoafektivnog poremećaja Prema kriterijima DSM-5 („Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition“), shizoafektivni poremećaj može biti bipolarni tip (F25.0) ili depresivni tip (F25.1). Bipolarni tip se primjenjuje ako je manična epizoda dio kliničke slike, a mogu se pojaviti i depresivne epizode. Depresivni tip se primjenjuje ako su samo velike depresivne epizode dio kliničke slike. Shizoafektivni poremećaj može biti povezan i s katatonijom i tada se šifrira kao F06.1 kako bi se označilo da je riječ o katatoniji povezanoj s drugim psihičkim poremećajima. Kako se manifestira shizoafektivni poremećaj? Kako bi se utvrdilo da je riječ o shizoafektivnom poremećaju, moraju biti prisutni klasični produktivni simptomi shizofrenije kao što su halucinacije i sumanute misli. S obzirom na to da je često riječ i o maničnim epizodama, prisutna je grandioznost te ideje samopoštovanja, veličine i moći. Tijekom istog vremenskog razdoblja javljaju se sumanutosti ili halucinacije najmanje dva tjedna u odsutnosti upadljivih simptoma raspoloženja. Uobičajena dob početka shizoafektivnog poremećaja je mlađa odrasla dob, iako poremećaj može započeti bilo kada od adolescencije do starije dobi. Shizoafektivni poremećaj se javlja nešto rjeđe od shizofrenije, a češće od afektivnog poremećaja. Uzroci shizoafektivnog poremećaja Još uvijek se ne zna točan uzrok, ali pretpostavlja se da je u pitanju neravnoteža neurotransmitora serotonina i dopamina u mozgu. Nadalje, smatra se da je kod shizoafektivnog poremećaja prisutna genetska i fiziološka podloga za nastanak bolesti. Ako je u obitelji ili u bliskom srodstvu prisutna shizofrenija, shizoafektivni poremećaj ili bipolarni poremećaj, povišen je rizik od nastanka ovog poremećaja. Sa sigurnošću se tvrdi da je u obitelji osoba sa shizoafektivnim poremećajem veći udio i shizofrenih i osoba s afektivnim poremećajem nego u općoj populaciji. Osobe sa shizoafektivnim poremećajem pod povišenim su rizikom za kasniji razvoj epizoda velikog depresivnog poremećaja ili bipolarnog poremećaja, a postoji i povezanost s poremećajima vezanim uz alkohol i druge psihoaktivne tvari. Simptomi shizoafektivnog poremećaja Shizoafektivni poremećaj uključuje kombinaciju simptoma poremećaja raspoloženja i psihotičnih simptoma. Tijek pojave tih simptoma može varirati ovisno o osobi, stoga nije baš uvijek jednostavno uspostaviti točnu dijagnozu. Profesionalno funkcioniranje često je oštećeno, ali to nije definirajući kriterij (za razliku od shizofrenije). Uz shizoafektivni poremećaj vežu se i reducirani socijalni kontakti i poteškoće skrbi za samoga sebe, ali negativni simptomi mogu biti blaži i kraći nego oni koji se vide kod shizofrenije. Psihotični simptomi u podlozi shizoafektivnog poremećaja su: - halucinacije, - sumanute ideje (najčešće paranoidne), - dezorganizirano mišljenje, - emocionalna nestabilnost, - deluzije ili bolesne ideje, - tjeskobne situacije. Simptomi poremećaja raspoloženja su najčešće bipolarnog ili depresivnog tipa, a neki od njih su: - izmjene maničnih i depresivnih epizoda, - česte iznenadne promjene raspoloženja, - osjećaj grandioznosti ili pak osjećaj krivnje i bezvrijednosti, - psihomotorni nemir ili usporenost, - suicidalne misli, - nemogućnost kontroliranja vlastitog raspoloženja. Dijagnoza shizoafektivnog poremećaja Navedene skupine simptoma se mogu javljati istovremeno ili naizmjenično, a dijagnoza se postavlja samo kada su shizofreni i afektivni simptomi izraženi istodobno ili unutar nekoliko dana, unutar iste epizode bolesti. Također, ne postoje testovi ili biologijski nalazi koji mogu pomoći u postavljanju dijagnoze shizoafektivnog poremećaja te nije razjašnjeno razlikuje li se shizoafektivni poremećaj od shizofrenije u odnosu na popratna obilježja poput strukturalnih ili funkcionalnih abnormalnosti mozga, kognitivnih deficita ili genetskih rizičnih čimbenika. Liječenje shizoafektivnog poremećaja Kao i kod većine bolesti i poremećaja, liječenje će biti najadekvatnije ako se primijeni na vrijeme. Shizoafektivni poremećaj dovodi do dugotrajne onesposobljenosti u svakodnevnom, radnom i obiteljskom funkcioniranju te je stoga obično potrebno opsežno liječenje uz kombinaciju lijekova, psihoterapije i potpore okoline. Daleko je najvažnija farmakoterapija, ali je nužno uključiti i druge psihoterapijske i socioterapijske postupke kako bi se bolesnika moglo lakše vratiti u normalno društveno funkcioniranje. Izbor lijekova ovisi o kliničkoj slici, odnosno o formi i intenzitetu psihotičnih i afektivnih simptoma. Od lijekova se najčešće propisuju antipsihotici (klozapin, risperidon, olanzapin), stabilizatori raspoloženja (litij, divalproat, karbamazepin, valproat) i antidepresivi (citalopram, escitalopram, fluoksetin). U svim slučajevima ovog poremećaja, nužna je primjena antipsihotika. Shizoafektivni poremećaj – prognoza Ako se ovaj poremećaj adekvatno liječi, tijek bolesti je povoljan, a moguće je izbjeći kronične komplikacije od kojih su najčešće razvoj shizofrenije, velikog depresivnog poremećaja, bipolarnog poremećaja, ovisnost o alkoholu ili psihoaktivnim tvarima te suicid. Prognoza je nešto bolja nego kod shizofrenije, ali lošija nego kod poremećaja raspoloženja. Saznajte više o depresiji u sljedećim tekstovima: - Kako efikasno balansirati posao i privatni život? - Prepoznajte skrivene znakove depresije - Što je Tensilen, kako djeluje i gdje ga kupiti? - Kako se osloboditi stresa? - Stres – kako ga prepoznati i smanjiti? - Pasiflora – prirodna pomoć kod stresa - Loše ste volje? Isprobajte ovih pet stvari za bolje raspoloženje - Stvari koje nikad ne smijete reći depresivnoj osobi - PMS simptomi – kako ih ublažiti? - Shizofrenija – duševna bolest koja narušava kvalitetu života NAJČITANIJI TEKST DANAS: Ocjena članka: