Tests Required for Diagnosis
Mania:
A manic episode is characterized by an inappropriately elevated mood that can range from nonchalant gaiety to almost uncontrollable excitement. The elevation of mood is accompanied by increased energy, leading to hyperactivity, speech pressure, and reduced need for sleep. The patient becomes immune to social inhibition, does not hold attention, marked distractibility, increased self-esteem, over-optimistic ideas and ideas of greatness are easily expressed. Perceptual disturbances may occur. The patient may perform extravagant and impractical acts, spend money thoughtlessly, or be aggressive, amorous, hypersexual, playful in inappropriate circumstances.
Criteria for a manic episode (three or more symptoms; four if one of the symptoms is irritability):
• Increased self-esteem, a sense of self-importance;
• Reduced need for sleep;
• Increased talkativeness, desire to strike up conversations;
• "Flight of thought";
• Instability of attention;
• Increased social, sexual activity, psychomotor excitability;
• Involvement in risky transactions with securities, thoughtlessly high spending, etc.
Hypomania:
Hypomania is a mild degree of mania that is not accompanied by psychotic symptoms (delusions or hallucinations). Patients have a constant slight rise in mood (at least for several days), increased energy and activity, a sense of well-being. Also, increased social activity, talkativeness, familiarity, hypersexuality, and reduced need for sleep are often noted. Women often put on excessive make-up on their faces, wear unusual and bright clothes. These symptoms do not lead to serious disturbances in work or social rejection of patients. Sometimes, instead of the usual cheerful mood, irritability, increased conceit and rude behavior can be observed. According to the dsm-iv, to diagnose hypomania, symptoms must have been present for at least 4 days.
Major depressive disorder:
Major depressive disorder is the phase of depression, patients usually stay most of their lives. Thus, patients with type I bipolar disorder are on average 32% of the time in a state of depression and 9% in a state of mania/hypomania. Patients with bipolar ii disorder spend 50% of their time in the depressed phase and only 1% in a state of hypomania. Depression is usually the first symptom of bipolar disorder, especially in women. The risk of suicide in this phase is maximum.
Criteria for a depressive episode (five or more symptoms that do not resolve within two weeks, at least one of the symptoms is either depressed mood or loss of interest in life):
• Depressed mood for most of the day, almost every day on its own (eg, sadness, feelings of inner emptiness, tearfulness); in children and adolescents, an irritable mood may be a symptom of depression;
• Noticeably reduced interest in life in everything (almost everything) that happens most of the day
• Significant loss in body weight, even if the patient is not on a diet (weight loss of more than 5% per month), or sharp fluctuations in appetite;
• Insomnia or drowsiness;
• Psychomotor agitation or lethargy;
• Feeling of tiredness;
•Feelings of worthlessness or excessive guilt (may be delusional);
• Decreased attention, inability to concentrate;
• Constant thoughts of death, suicidal thoughts in the absence of a special plan or suicide attempt, the presence of a suicide plan.
Mixed episodes
Mixed manic-depressive episodes are conditions that meet the criteria for both mania and depression and have been symptomatic for more than 7 days. Mixed episodes can occur at any stage of the disease, and their occurrence is considered a predictor of poor patient prognosis.
Cyclothymia
Cyclothymia is characterized by the presence of prolonged subdepressive and hypomanic symptoms. Severe depressive disorders or mania are absent. Cyclothymia is diagnosed if, for at least 2 years, the patient has experienced frequent bouts of depressed mood, alternating with bouts that meet the criteria for hypomania. Subsequently, cyclothymia can transform into a typical bipolar disorder.
Rapid cycling
The criterion for rapid cycling is the presence of at least 4 episodes of bipolar disorder per year with partial or complete remission between them or a direct switch from one polarity to another (from mania to depression or vice versa). Rapid cycling occurs in approximately 10–15% of patients. Rapid cycling is more common in the later stages and is commonly seen in women with bipolar ii disorder. Rapid cycling can be induced by hypothyroidism, alcohol, skull trauma, multiple sclerosis.
Complications of manic-depressive psychosis
Lack of necessary treatment can lead to dangerous consequences:
• Suicide;
• Alcoholization;
• Committing actions that can be dangerous both for the patient himself and for others (when the patient is in a manic state).
Treatment of manic-depressive psychosis
Bipolar affective disorder should be treated by a qualified psychiatrist. Psychologists (clinical psychologists) in this case will not be able to cure this disease.
According to the clinical guidelines adopted by the russian society of psychiatrists, the treatment of bipolar disorder is divided into three main stages:
• Cupping therapy - aimed at eliminating existing symptoms and minimizing side effects;
• Maintenance therapy - preserves the effect obtained at the stage of stopping the disease;
• Anti-relapse therapy - prevents relapses (appearance of affective phases).