Depressive-manic syndrome. Causes, symptoms, treatment

Manic-depressive psychosis is a mental illness characterized by the development of two polar states in one person, which replace each other: euphoria and deep depression. The mood is changeable and has big swings.

In this article we will look at the symptoms, signs, and methods of treating this mental disorder.

general characteristics

Patients experience a period of intermission and the immediate course of the disease. Usually the disorder manifests itself only as one of the phases of psychosis during a certain period. In the pauses between active manifestations of the disease, a moment comes when the individual leads completely normal, habitual life activities.

In medicine, the concept of bipolar affective disorder is sometimes used, and the acute phases of its manifestation are called psychotic episodes. If the disease occurs in milder forms, then it is called cyclothymia.
This psychosis is seasonal. Basically, the difficult periods are spring and autumn. Both adults and children suffer from it, starting from adolescence. As a rule, it is formed by the person’s thirtieth birthday.

According to statistics, the disease is more common in women. According to general data, 7 out of 1000 people suffer from manic-depressive syndrome. Almost 15% of patients in psychiatric clinics have this diagnosis.

Usually, the first symptoms of a developing disease appear weakly; they can be easily confused with other problems of growing up during puberty, or at 21-23 years of age.

Genetic theory of the development of the disorder

Today, the theory that explains the origin of manic-depressive state is genetic, which studies hereditary factors.

Statistics have repeatedly shown that this disorder is transmitted genetically in 50 percent of cases. That is, there is a family continuity of the disease. It is important to diagnose the disease in a timely manner in a child whose parents suffer from this syndrome in order to eliminate complications. Or to accurately establish whether there are characteristic manifestations, or whether the children managed to avoid the disease.

According to geneticists, the risk of illness in a child is 25% if only one of the parents is sick. There is evidence that identical twins are susceptible to the disease with a 25% probability, and in fraternal twins the risk increases to 70-90%.

Researchers who adhere to this theory suggest that the gene for manic psychosis is contained on chromosome 11. The information, however, has not yet been proven. Clinical trials indicate a possible localization of the disease in the short arm. The subjects were patients with a confirmed diagnosis, therefore the reliability of the information is quite high, but not one hundred percent accurate. The genetic predisposition of these patients has not been studied.

Main Factors

Researchers give significant influence to the following factors:

Unfavorable environmental conditions. They stimulate the active development of pathology, although experts are considering the possibility of compensating for hereditary defects.
Unhealthy food. Products containing preservatives, flavors, and carcinogens can provoke mutations and diseases.
Modified products. Their consumption affects not the person who uses such products, but his children and subsequent generations.

Experts note that genetic factors are only 70% of the likelihood of a person developing manic-depressive syndrome. 30% - the above factors, as well as the environmental situation and other possible etiological issues.

Minor causes of psychosis

Manic-depressive psychosis has been poorly studied, so there are still no clear reasons for its occurrence.

In addition to genetic and the above factors, the occurrence of a disorder in a child's fetus is influenced by the stress experienced by the pregnant mother, as well as how her childbirth proceeds. Another feature is the functioning of the nervous system in an individual individual. In other words, the disease is provoked by disturbances in the functioning of nerve impulses and the neural system, which are located in the hypothalamus and other basal areas of the brain. They appear due to changes in the activity of chemicals - serotonin and norepinephrine, which are responsible for the exchange of information between neurons.

Most of the reasons influencing the appearance of manic-depressive disorder can be classified into two groups:

Psychosocial
Physiological

The first group is those reasons that are caused by the individual’s need to seek protection from severe stressful conditions. A person unnecessarily strains his mental and physical efforts at work, or, on the contrary, goes on a merry spree. Promiscuous sex, risky behavior - everything that can stimulate the development of bipolar disorder. The body wears out and gets tired, which is why the first signs of depression appear.

The second group is disruption of the thyroid gland and other problems associated with the processes of the hormonal system. As well as traumatic brain injuries, severe head diseases, tumors, drug and alcohol addiction.

Types and symptoms

Sometimes in the clinical picture of various patients only one type of disorder is observed - depressive. The patient suffers from deep despondency and other manifestations typical of this type. In total, there are two bipolar disorders with manic psychosis:

Classic – the patient has certain symptoms that affect different mood phases;
The second type is difficult to diagnose, in which the signs of psychosis are weak, which can cause confusion with the usual course of seasonal depression and the manifestation of melancholy.

There are signs that experts consider for a manic-depressive state: those that are characteristic only of manic psychosis and those that appear only in depressive psychosis.

So, what are the symptoms of manic-depressive psychosis? In medicine, they are combined into the general concept of “sympathicotonic syndrome.”

All patients in the phase of manic disorder are characterized by increased excitability, activity and dynamism. People can be described like this:

They are too talkative
They have high self-esteem
Active gestures
Aggressiveness
Expressive facial expressions
Pupils are often dilated
Blood pressure is higher than normal
Irritable, vulnerable, react sharply to criticism

Patients have decreased sweating and a lot of emotion on their face. They think they have a fever, signs of tachycardia, problems with the gastrointestinal tract, and insomnia. Mental activity may remain unchanged.

Patients in the manic phase experience a desire to take risks in various areas, from gambling to committing crimes.

At the same time, people feel unique, omnipotent, very lucky, and they have unprecedented faith in their own abilities. Therefore, patients quite easily succumb to financial scams and frauds in which they are drawn. They spend their last savings on lottery tickets and place sports bets.

If the disease is in the depressive phase, then such patients are characterized by: apathy, taciturnity and quiet, inconspicuous behavior, a minimum of emotions. They are slow in their movements and have a “sorrowful mask” on their face. Such a person complains of breathing problems and a feeling of pressure in the chest. Sometimes patients refuse to eat food, water, and stop taking care of their appearance.

Patients with depressive disorder often think about suicide, or even commit it. At the same time, they do not tell anyone about their desires, but think through the method in advance and leave suicide notes.

Diagnostics

We mentioned above that bipolar disorder is difficult to diagnose because the signs and symptoms of manic-depressive psychosis sometimes coincide with other mental conditions of the person.

In order to establish an accurate diagnosis, doctors interview patients and their close relatives. Using this method, it is important to determine whether a person has a genetic predisposition or not.

The patient takes a series of tests, based on the results of which the level of his anxiety is determined, addictions, propensity to them, and emotional state are indicated.

In addition, if a person is suspected of manic-depressive psychosis, he is prescribed EEG studies, radiography, and MRI of the head. They are used to exclude the presence of tumors, brain injuries, and intoxication consequences.

When the full picture is established, the patient receives appropriate treatment.

Treatment for bipolar disorder

Manic-depressive psychosis is sometimes treatable. Specialists prescribe medications, psychotropic drugs, antidepressants - those drugs that stabilize the general emotional state and mood.

One of the main components that has a positive effect on the treatment of the disease is lithium salt. It can be found in:

Micalita
Lithium carbonate
Lithium oxybutyrate
And in other similar drugs

However, it should be borne in mind that such medications are contraindicated in patients with kidney and gastrointestinal diseases and hypotension.

In particularly difficult situations, patients are prescribed tranquilizers, antipsychotics (Aminazine, Galaperidol, as well as thioxanthene derivatives), antiepileptic drugs (Carbamazepine, Finlepsin, Topiramate, etc.).

In addition to medical therapy, for effective comprehensive care, the patient should also undergo a course of psychotherapy. But visiting this specialist is possible only during the period of stabilization and intermission.

In addition, to consolidate the effect of drug therapy, the patient must additionally work with a psychotherapist. These classes begin after the patient’s mood has stabilized.

The psychotherapist allows the patient to accept his illness and realize where it stems from, and what its mechanisms and symptoms are. Together, they build a behavioral strategy for periods of exacerbation and work on ways to control emotions. Often, the patient’s relatives are also present at the sessions, so that they can calm him down during attacks; the classes will also help loved ones prevent exacerbation situations and control them.

Preventive measures

In order to avoid frequent episodes of psychosis, a person must provide himself with a state of peace, reduce the amount of stress, be able to always seek help, and talk to someone significant during difficult periods. Medicines based on lithium salts help delay the acute phase of manic-depressive syndrome, but here the dosage prescribed by the doctor must be followed; it is selected in each case separately, and it depends on the degree of development of the disease.

But sometimes patients, after successfully overcoming the acute period, forget or refuse medications, which is why the disease returns with a vengeance, sometimes with much more severe consequences. If the medication continues, according to the doctor’s instructions, then the affective phase may not occur at all. The dosage of medications may remain the same for many years.

Forecasting

It should be noted that a complete cure for manic-depressive disorder is almost impossible. Having experienced the symptoms of psychosis once, a person runs the risk of having a repeated experience of the acute experience of the disease.

However, it is within your power to stay in remission as long as possible. And go without attacks for many months and years. It is important to strictly adhere to the prescribed doctor's recommendations.

(bipolar affective disorder) is a mental disorder manifested by severe affective disorders. Alternation of depression and mania (or hypomania), periodic occurrence of only depression or only mania, mixed and intermediate states are possible. The reasons for the development have not been fully elucidated; hereditary predisposition and personality traits are important. The diagnosis is made on the basis of anamnesis, special tests, and conversations with the patient and his relatives. Treatment is pharmacotherapy (antidepressants, mood stabilizers, less often antipsychotics).

General information

Manic-depressive psychosis, or MDP, is a mental disorder in which there is a periodic alternation of depression and mania, periodic development of only depression or only mania, the simultaneous appearance of symptoms of depression and mania, or the occurrence of various mixed conditions. The disease was first described independently by the Frenchmen Baillarger and Falret in 1854, but MDP was officially recognized as an independent nosological entity only in 1896, after the appearance of Kraepelin’s works on this topic.

Until 1993, the disease was called “manic-depressive psychosis.” After the approval of ICD-10, the official name of the disease was changed to “bipolar affective disorder”. This was due both to the inconsistency of the old name with the clinical symptoms (MDP is not always accompanied by psychosis), and to stigmatization, a kind of “stamp” of a severe mental illness, due to which others, under the influence of the word “psychosis,” begin to treat patients with prejudice. Treatment of MDP is carried out by specialists in the field of psychiatry.

Causes of development and prevalence of manic-depressive psychosis

The causes of TIR have not yet been fully elucidated, but it has been established that the disease develops under the influence of internal (hereditary) and external (environmental) factors, with hereditary factors playing a more important role. It has not yet been possible to establish how MDP is transmitted - by one or more genes, or as a result of disruption of phenotyping processes. There is evidence in favor of both monogenic and polygenic inheritance. It is possible that some forms of the disease are transmitted through the participation of one gene, others through several.

Risk factors include melancholic personality type (high sensitivity combined with restrained external expression of emotions and increased fatigue), statothymic personality type (pedantry, responsibility, increased need for orderliness), schizoid personality type (emotional monotony, tendency to rationalize, preference for solitary activities ), as well as emotional instability, increased anxiety and suspiciousness.

Data on the relationship between manic-depressive psychosis and the patient’s gender vary. Previously, it was believed that women get sick one and a half times more often than men; according to modern research, unipolar forms of the disorder are more often detected in women, bipolar – in men. The likelihood of developing the disease in women increases during periods of hormonal changes (during menstruation, postpartum and menopause). The risk of developing the disease also increases in those who have suffered any mental disorder after childbirth.

Information on the prevalence of MDP in the general population is also controversial, as different researchers use different assessment criteria. At the end of the 20th century, foreign statisticians claimed that 0.5-0.8% of the population suffers from manic-depressive psychosis. Russian experts cited a slightly lower figure - 0.45% of the population and noted that severe psychotic forms of the disease were diagnosed in only a third of patients. In recent years, data on the prevalence of manic-depressive psychosis have been revised; according to the latest research, symptoms of MDP are detected in 1% of the world's inhabitants.

Data on the likelihood of developing MDP in children are not available due to the difficulty of using standard diagnostic criteria. At the same time, experts believe that during the first episode suffered in childhood or adolescence, the disease often remains undiagnosed. In half of the patients, the first clinical manifestations of MDP appear at the age of 25-44 years, bipolar forms predominate in young people, and unipolar forms predominate in middle-aged people. About 20% of patients experience their first episode over the age of 50, and there is a sharp increase in the number of depressive phases.

Classification of manic-depressive psychosis

In clinical practice, the MDP classification is usually used, taking into account the predominance of a certain variant of affective disorder (depression or mania) and the characteristics of the alternation of manic and depressive episodes. If the patient develops only one type of affective disorder, they speak of unipolar manic-depressive psychosis, if both - of bipolar. Unipolar forms of MDP include periodic depression and periodic mania. In the bipolar form, four variants of the course are distinguished:

Properly interleaved– there is an orderly alternation of depression and mania, affective episodes are separated by a light interval.
Irregularly interspersed– there is a chaotic alternation of depression and mania (two or more depressive or manic episodes in a row are possible), affective episodes are separated by a light interval.
Double– depression immediately gives way to mania (or mania to depression), two affective episodes are followed by a clear interval.
Circular– there is an orderly alternation of depression and mania, there are no clear intervals.

The number of phases may vary for a particular patient. Some patients experience only one affective episode during their life, while others experience several dozen. The duration of one episode ranges from a week to 2 years, the average duration of the phase is several months. Depressive episodes occur more often than manic episodes; on average, depression lasts three times longer than mania. Some patients develop mixed episodes, in which symptoms of depression and mania occur simultaneously, or depression and mania alternate rapidly. The average duration of the light period is 3-7 years.

Symptoms of manic-depressive psychosis

The main symptoms of mania are motor agitation, elevation of mood and acceleration of thinking. There are 3 degrees of severity of mania. A mild degree (hypomania) is characterized by improved mood, increased social activity, mental and physical productivity. The patient becomes energetic, active, talkative and somewhat absent-minded. The need for sex increases, while the need for sleep decreases. Sometimes dysphoria (hostility, irritability) occurs instead of euphoria. The duration of the episode does not exceed several days.

With moderate mania (mania without psychotic symptoms), there is a sharp rise in mood and a significant increase in activity. The need for sleep almost completely disappears. There are fluctuations from joy and excitement to aggression, depression and irritability. Social contacts are difficult, the patient is distracted and constantly distracted. Ideas of greatness appear. The duration of the episode is at least 7 days, the episode is accompanied by loss of ability to work and the ability to socially interact.

In severe mania (mania with psychotic symptoms), severe psychomotor agitation is observed. Some patients have a tendency towards violence. Thinking becomes incoherent and racing thoughts appear. Delusions and hallucinations develop, which differ in nature from similar symptoms in schizophrenia. Productive symptoms may or may not correspond to the patient's mood. With delusions of high origin or delusions of grandeur, they speak of corresponding productive symptoms; with neutral, weakly emotionally charged delusions and hallucinations - about inappropriate.

With depression, symptoms occur that are the opposite of mania: motor retardation, severe decreased mood and slowed thinking. Loss of appetite and progressive weight loss. In women, menstruation stops, and in patients of both sexes, sexual desire disappears. In mild cases, there are daily mood swings. In the morning, the severity of symptoms reaches a maximum, by the evening the manifestations of the disease are smoothed out. With age, depression gradually takes on an anxious character.

In manic-depressive psychosis, five forms of depression can develop: simple, hypochondriacal, delusional, agitated and anesthetic. In simple depression, the depressive triad is identified without other severe symptoms. With hypochondriacal depression, there is a delusional belief in the presence of a serious illness (possibly unknown to doctors or shameful). With agitated depression there is no motor retardation. With anesthetic depression, the feeling of painful insensibility comes to the fore. It seems to the patient that an emptiness has appeared in place of all previously existing feelings, and this emptiness causes him severe suffering.

Diagnosis and treatment of manic-depressive psychosis

Formally, to make a diagnosis of MDP, two or more episodes of mood disturbances must be present, with at least one episode being manic or mixed. In practice, the psychiatrist takes into account a larger number of factors, paying attention to life history, talking with relatives, etc. Special scales are used to determine the severity of depression and mania. Depressive phases of MDP are differentiated from psychogenic depression, hypomanic phases are differentiated from agitation caused by lack of sleep, taking psychoactive substances and other reasons. In the process of differential diagnosis, schizophrenia, neuroses, psychopathy, other psychoses and affective disorders resulting from neurological or somatic diseases are also excluded.

Treatment of severe forms of MDP is carried out in a psychiatric hospital. For mild forms, outpatient observation is possible. The main goal is to normalize mood and mental state, as well as achieve stable remission. When a depressive episode develops, antidepressants are prescribed. The choice of drug and determination of the dose are made taking into account the possible transition of depression to mania. Antidepressants are used in combination with atypical antipsychotics or mood stabilizers. During a manic episode, mood stabilizers are used, in severe cases - in combination with antipsychotics.

During the interictal period, mental functions are completely or almost completely restored, however, the prognosis for MDP in general cannot be considered favorable. Repeated affective episodes develop in 90% of patients, 35-50% of patients with repeated exacerbations become disabled. In 30% of patients, manic-depressive psychosis occurs continuously, without clear intervals. MDP is often combined with other mental disorders. Many patients suffer

Symptoms and treatment

What is manic-depressive psychosis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. E. V. Bachilo, a psychiatrist with 9 years of experience.

Definition of disease. Causes of the disease

Affective insanity- chronic disease of the affective sphere. This disorder is currently referred to as bipolar affective disorder (BD). This disease significantly impairs a person’s social and professional functioning, so patients need the help of specialists.

This disease is characterized by the presence of manic, depressive, and mixed episodes. However, during periods of remission (improvement in the course of the disease), symptoms above the indicated phases almost completely disappear. Such periods of absence of manifestations of the disease are called intermissions.

The prevalence of bipolar disorder averages 1%. Also, according to some data, on average 1 patient per 5-10 thousand people suffers from this disorder. The disease begins relatively late. The average age of patients with bipolar disorder is 35-40 years. Women get sick more often than men (approximately in a ratio of 3:2). However, it is worth noting that bipolar forms of the disease are more common at a young age (up to about 25 years), and unipolar (the occurrence of either manic or depressive psychosis) - at an older age (30 years). There are no exact data on the prevalence of the disorder in childhood.

The reasons for the development of bipolar disorder have not been precisely established to date. The most common genetic theory of the occurrence of the disease.

The disease is believed to have a complex etiology. This is evidenced by the results of genetic and biological studies, studies of neuroendocrine structures, as well as a number of psychosocial theories. It was noted that in first-degree relatives there is an “accumulation” of the number of cases of bipolar disorder and.

The disease can occur for no apparent reason or after some provoking factor (for example, after infectious diseases, as well as mental illnesses associated with any psychological trauma).

An increased risk of developing bipolar disorder is associated with certain personality characteristics, which include:

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of manic-depressive psychosis

As noted above, the disease is characterized by phases. Bipolar disorder can manifest itself only in a manic phase, only in a depressive phase, or only in hypomanic manifestations. The number of phases, as well as their changes, are individual for each patient. They can last from several weeks to 1.5-2 years. Intermissions (“light intervals”) also have different durations: they can be quite short or last up to 3-7 years. The cessation of an attack leads to an almost complete restoration of mental well-being.

With bipolar disorder, the formation of a defect does not occur (as with), as well as any other pronounced personality changes, even in the case of a long course of the disease and frequent occurrence and change of phases.

Let's look at the main manifestations of bipolar affective disorder.

Depressive episode of bipolar disorder

The depressive phase is characterized by the following peculiarities:

the occurrence of endogenous depression, which is characterized by the biological nature of painful disorders involving not only mental, but also somatic, endocrine and general metabolic processes;
decreased mood, slowed thinking and speech motor activity (depressive triad);
diurnal mood swings - worse in the first half of the day (patients wake up in the morning with a feeling of melancholy, anxiety, indifference) and somewhat better in the evening (little activity appears);
decreased appetite, perversion of taste sensitivity (food seems to have “lost its taste”), patients lose weight, women may lose their periods;
possible psychomotor retardation;
the presence of melancholy, which is often felt as a physical feeling of heaviness behind the sternum (precardiac melancholy);
decreased or complete suppression of libido and maternal instinct;
an “atypical variant” of depression is likely to occur: appetite increases, hypersomnia occurs (waking intervals become shorter, and the sleep period becomes longer);
quite often a somatic triad (Protopopov’s triad) occurs: tachycardia (rapid heartbeat), mydriasis (pupil dilation) and constipation;
manifestation of various psychotic symptoms and syndromes - delusions (delusional ideas of sinfulness, impoverishment, self-blame) and hallucinations (auditory hallucinations in the form of “voices” accusing or insulting the patient). The indicated symptoms can arise depending on the emotional state (mainly a feeling of guilt, sin, damage, impending disaster, etc.), while it is distinguished by a neutral theme (that is, incongruent with affect).

The following are distinguished: Variants of the course of the depressive phase:

simple depression - manifested by the presence of a depressive triad and occurs without hallucinations and delusions;
hypochondriacal depression - hypochondriacal delirium occurs, which has an affective overtones;
delusional depression - manifests itself in the form of “Cotard’s syndrome”, which includes depressive symptoms, anxiety, delusional experiences of nihilistic fantastic content, and has a wide, grandiose scope;
agitated depression - accompanied by nervous excitement;
anesthetic depression (or “painful insensibility”) - the patient “loses” the ability to have any feelings.

It should be separately noted that in bipolar disorder (especially in the depressive phase), a fairly high level of suicidal activity in patients is observed. Thus, according to some data, the frequency of parasuicides in bipolar disorder is up to 25-50%. Suicidal tendencies (as well as suicidal intentions and attempts) are an important factor determining the need for a patient to be hospitalized in a hospital.

Manic episode of bipolar disorder

Manic syndrome can have varying degrees of severity: from mild mania (hypomania) to severe with the manifestation of psychotic symptoms. With hypomania, there is an elevated mood, formal criticism of one’s condition (or lack thereof), and no pronounced social maladjustment. In some cases, hypomania can be productive for the patient.

A manic episode is characterized by the following: symptoms:

the presence of a manic triad (increased mood, accelerated thinking, increased speech motor activity), the opposite of the triad of depressive syndrome.
patients become active, feel a “strong surge of energy”, everything seems “on their shoulders”, they start many things at the same time, but do not complete them, productivity approaches zero, they often switch gears during a conversation, cannot focus on something one, there is a constant change from loud laughter to screaming, and vice versa;
thinking is accelerated, which is expressed in the emergence of a large number of thoughts (associations) per unit of time; patients sometimes “cannot keep up” with their thoughts.

There are different types of mania. For example, the manic triad described above occurs in classic (cheerful) mania. Such patients are characterized by excessive cheerfulness, increased distractibility, superficial judgments, and unjustified optimism. Speech is inconsistent, sometimes to the point of complete incoherence.

Mixed episode of BAR

This episode is characterized by the coexistence of manic (or hypomanic) and depressive symptoms, which last at least two weeks or replace each other quite quickly (in a matter of hours). It should be noted that the patient’s disorders can be significantly expressed, which can lead to professional and social maladjustment.

The following manifestations of a mixed episode occur:

suicidal thoughts;
appetite disorders;
various psychotic features as listed above;

Mixed states of BAR can occur in different ways:

Pathogenesis of manic-depressive psychosis

Despite the large number of studies on bipolar disorder, the pathogenesis of this disorder is not completely clear. There are a large number of theories and hypotheses of the occurrence of the disease. Today it is known that the occurrence of depression is associated with disturbances in the metabolism of a number of monoamines and biorhythms (sleep-wake cycles), as well as with dysfunction of the inhibitory systems of the cerebral cortex. Among other things, there is evidence of the participation of norepinephrine, serotonin, dopamine, acetylcholine and GABA in the pathogenesis of the development of depressive conditions.

The causes of the manic phases of bipolar disorder lie in the increased tone of the sympathetic nervous system, hyperfunction of the thyroid gland and pituitary gland.

In the figure below, you can see a dramatic difference in brain activity during the manic (A) and depressive (B) phases of bipolar disorder. Light (white) zones indicate the most active areas of the brain, and blue ones, respectively, vice versa.

Classification and stages of development of manic-depressive psychosis

Currently, there are several types of bipolar affective disorder:

bipolar course - in the structure of the disease there are manic and depressive phases, between which there are “light intervals” (intermissions);
monopolar (unipolar) course - in the structure of the disease there are either manic or depressive phases. The most common type of course is when only a pronounced depressive phase is present;
continuum - phases replace each other without periods of intermission.

Also, according to the DSM classification (American classification of mental disorders), there are:

Complications of manic-depressive psychosis

Lack of necessary treatment can lead to dangerous consequences:

Diagnosis of manic-depressive psychosis

The above symptoms are diagnostically significant when making a diagnosis.

Diagnosis of bipolar disorder is carried out according to the International Classification of Diseases, Tenth Revision (ICD-10). So, according to ICD-10, the following diagnostic units are distinguished:

Bipolar disorder with a current episode of hypomania;
Bipolar disorder with a current episode of mania, but without psychotic symptoms;
Bipolar disorder with current episode of mania and psychotic symptoms;
bipolar disorder with a current episode of mild or moderate depression;
Bipolar disorder with a current episode of severe depression, but without psychotic symptoms;
Bipolar disorder with a current episode of severe depression with psychotic symptoms;
BAR with a current mixed episode;
bipolar disorder with current remission;
Other BARs;
BAR unspecified.

However, it is necessary to take into account a number of clinical signs that may indicate bipolar affective disorder:

the presence of any organic pathology of the central nervous system (tumors, previous trauma or brain surgery, etc.);
the presence of pathologies of the endocrine system;
substance abuse;
lack of clearly defined full-fledged intermissions/remissions throughout the course of the disease;
lack of criticism of the transferred state during periods of remission.

Bipolar affective disorder must be distinguished from a number of conditions. If the structure of the disease includes psychotic disorders, it is necessary to separate bipolar disorder from schizophrenia and schizoaffective disorders. Type II bipolar disorder must be distinguished from recurrent depression. It is also necessary to differentiate bipolar disorder from personality disorders, as well as various addictions. If the disease developed in adolescence, it is necessary to separate bipolar disorder from hyperkinetic disorders. If the disease developed at a late age - with affective disorders that are associated with organic diseases of the brain.

Treatment of manic-depressive psychosis

Treatment for bipolar affective disorder should be carried out by a qualified psychiatrist. Psychologists (clinical psychologists) in this case will not be able to cure this disease.

relief therapy - aimed at eliminating existing symptoms and minimizing side effects;
maintenance therapy - maintains the effect obtained at the stage of stopping the disease;
anti-relapse therapy - prevents relapses (the occurrence of affective phases).

For the treatment of bipolar disorder, drugs from different groups are used: lithium drugs, antiepileptic drugs ( valproate, carbamazepine, lamotrigine), neuroleptics ( quetiapine, olanzapine), antidepressants and tranquilizers.

It should be noted that therapy for bipolar disorder is carried out for a long time - from six months or more.

Psychosocial support and psychotherapeutic measures can significantly help in the treatment of bipolar disorder. However, they cannot replace drug therapy. Today, there are specially developed techniques for the treatment of ARB, which can reduce interpersonal conflicts, as well as somewhat “smooth out” cyclical changes in various environmental factors (for example, daylight hours, etc.).

Various psychoeducational programs are carried out with the aim of increasing the patient’s level of awareness about the disease, its nature, course, prognosis, as well as modern methods of therapy. This contributes to the establishment of a better relationship between the doctor and the patient, adherence to the treatment regimen, etc. Some institutions conduct various psychoeducational seminars, which cover the issues outlined above in detail.

There are studies and observations showing the effectiveness of using cognitive behavioral psychotherapy in conjunction with drug treatment. Individual, group or family forms of psychotherapy are used to help reduce the risk of relapse.

Today there are cards for self-registration of mood swings, as well as a self-monitoring sheet. These forms help to quickly monitor changes in mood and promptly adjust therapy and consult a doctor.

Separately, it should be said about the development of bipolar disorder during pregnancy. This disorder is not an absolute contraindication for pregnancy and childbirth. The most dangerous period is the postpartum period, during which various symptoms can develop. The issue of using drug therapy during pregnancy is decided individually in each specific case. It is necessary to assess the risk/benefit of using medications and carefully weigh the pros and cons. Psychotherapeutic support for pregnant women can also help in the treatment of ARB. If possible, you should avoid taking medications during the first trimester of pregnancy.

Forecast. Prevention

The prognosis of bipolar affective disorder depends on the type of disease, the frequency of phase changes, the severity of psychotic symptoms, as well as the patient’s adherence to therapy and control of his condition. Thus, in the case of well-chosen therapy and the use of additional psychosocial methods, it is possible to achieve long-term intermissions, patients adapt well socially and professionally.

The human brain is a complex mechanism that is difficult to study. The root of psychological deviations and psychoses lies deep in a person’s subconscious, destroys life and interferes with functioning. Manic-depressive psychosis is by its nature dangerous not only for the patient, but also for the people around him, so you should immediately contact a specialist.

Manic-depressive syndrome, or, as it is also known, bipolar personality disorder, is a mental illness that manifests itself as a constant change in behavior from unreasonably excited to complete depression.

Causes of TIR

No one knows exactly the origins of this disease - it was known back in Ancient Rome, but doctors of that time clearly separated manic psychosis and depression, and only with the development of medicine was it proven that these were stages of the same disease.

Manic-depressive psychosis (MDP) is a severe mental illness

It may appear due to:

suffered stress;
pregnancy and menopause;
disruption of brain function due to tumors, trauma, chemical exposure;
the presence of this psychosis or other affective disorder in one of the parents (it has been scientifically proven that the disease can be inherited).

Due to mental instability, women are more often susceptible to psychosis. There are also two peaks in which manic disorder can occur: menopause and 20-30 years. Manic-depressive psychosis has a clearly defined seasonal nature, since exacerbations most often occur in the fall and spring.

Manic-depressive psychosis: symptoms and signs

MDP expresses itself in two main stages, which appear for a certain period of time and replace each other. They are:

Manic-depressive psychosis and its varieties

Bipolar personality disorder is sometimes understood as a synonym for MDP, but in reality it is just one type of general psychosis.

The usual course of the disease involves the following stages:

manic;
intermission (when a person returns to his normal behavior);
depressive.

The patient may be missing one of the stages, which is called unipolar disorder. In this case, the same stage can alternate several times, changing only occasionally. Double psychosis also occurs, when the manic phase immediately turns into a depressive phase without intermediate intermission. The changes should be monitored by a doctor who will recommend appropriate treatment appropriate for the individual's condition.

The disease can manifest itself in manic and depressive forms

The difference between manic-depressive syndrome and other diseases

Inexperienced doctors, as well as loved ones, may confuse MDP with ordinary depression. This usually occurs due to short observation of the patient and rapid conclusions. One stage can last up to a year, and most people rush into treatment for depression.

It is worth knowing that in addition to loss of strength and lack of desire to live, patients with MDP also experience physical changes:

The person has inhibited and slow thinking, and an almost complete lack of speech. It's not a matter of wanting to be alone - during this stage the weakness can be so strong that it is difficult for a person to move his tongue. Sometimes this condition turns into complete paralysis. At this moment the patient especially needs help.
During a manic episode, people often report dry mouth, insomnia or very little sleep, racing thoughts, shallow judgment, and a reluctance to think about problems.

The dangers of manic-depressive psychosis

Any psychosis, no matter how minor or insignificant, can radically change the life of the patient and his loved ones. In the depressive stage, a person is able to:

The mechanism of development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex

commit suicide;
die of hunger;
develop bedsores;
fall out of society.

While in the manic stage the patient may:

commit a rash act, up to and including murder, since his cause-and-effect relationships are broken;
endanger your own or others' lives;
start having promiscuous sex.

Diagnosis of TIR

It often happens that the patient is diagnosed incorrectly, which complicates treatment, so the patient must undergo a full set of studies and tests - radiography, MRI of the brain and electroencephalography.

At the time of diagnosis, a complete picture is needed to exclude other mental disorders, infections and injuries.

Treatment of manic-depressive psychosis

The doctor usually prescribes a hospital stay. This makes it much easier to track changes in stages, identify patterns, and help the patient in case of suicide or other unjustified actions.

If the state of lethargy is dominant, antidepressants with analeptic properties are selected

Often prescribed:

antipsychotics with a sedative effect during the manic period;
antidepressants during the depressive stage;
Lithium therapy in the manic stage;
electroconvulsive therapy for prolonged forms.

During moments of activity, a patient with manic syndrome is capable of harming himself due to self-confidence, as well as endangering other people, so conversations with a psychologist who can calm the patient are very important.

Also at the moment of depression, a person needs constant care, since he has no appetite, is taciturn and often motionless.

How to live with manic-depressive psychosis?

3-5% of people admitted to hospital are diagnosed with MDP. With quality treatment of both stages, constant prevention and conversations with a psychiatrist, it is possible to live a normal and ordinary life. Unfortunately, few people think about recovery and make plans for life, so there should always be close people next to such a person who, in the event of an exacerbation, can forcibly put the patient on treatment and support him in every possible way.

Why is it worth treating manic-depressive psychosis?

Many people diagnosed with MDP express themselves through creativity. For example, the famous impressionist artist Vincent Van Gogh was also a hostage to this disease, while remaining a talented person, although not capable of socialization. The life path of this artist can serve as a good example for people who do not want to go to the hospital or solve a problem. Despite his talent and boundless imagination, the great impressionist committed suicide during one of his depressive stages. Due to problems with socialization and people, Vincent never sold a single painting in his entire life, but gained fame quite by accident, thanks to people who knew him.

Irritability and anxiety may not just be the consequences of a hard work week or any setbacks in your personal life. It may not just be problems with nerves, as many people prefer to think. If a person feels mental discomfort for a long time without any significant reason and notices strange changes in behavior, then it is worth seeking help from a qualified psychologist. Possibly psychosis.

Two concepts - one essence

In different sources and various medical literature devoted to mental disorders, one can find two concepts that at first glance may seem completely opposite in meaning. These are manic-depressive psychosis (MDP) and bipolar affective disorder (BD). Despite the difference in definitions, they express the same thing and talk about the same mental illness.

The fact is that from 1896 to 1993, mental illness, expressed in a regular change of manic and depressive phases, was called manic-depressive disorder. In 1993, in connection with the revision of the International Classification of Diseases (ICD) by the world medical community, MDP was replaced by another abbreviation - BAR, which is currently used in psychiatry. This was done for two reasons. First, bipolar disorder is not always accompanied by psychosis. Secondly, the definition of MDP not only frightened the patients themselves, but also alienated other people from them.

Statistical data

Manic-depressive psychosis is a mental disorder that occurs in approximately 1.5% of the world's inhabitants. Moreover, the bipolar variety of the disease is more common in women, and the monopolar type is more common in men. About 15% of patients treated in psychiatric hospitals suffer from manic-depressive psychosis.

In half of the cases, the disease is diagnosed in patients aged 25 to 44 years, in a third of cases - in patients over 45 years of age, and in older people there is a shift towards the depressive phase. Quite rarely, the diagnosis of MDP is confirmed in people under 20 years of age, since in this period of life, rapid changes in mood with a predominance of pessimistic tendencies are the norm, since the adolescent’s psyche is in the process of formation.

Characteristics of TIR

Manic-depressive psychosis is a mental illness in which two phases - manic and depressive - alternate with each other. During the manic phase of the disorder, the patient experiences a huge surge of energy, he feels great, he strives to channel the excess energy into new interests and hobbies.

The manic phase, which lasts quite a short time (about 3 times shorter than the depressive phase), is followed by a “light” period (intermission) - a period of mental stability. During the period of intermission, the patient is no different from a mentally healthy person. However, the subsequent formation of the depressive phase of manic-depressive psychosis, which is characterized by depressed mood, decreased interest in everything that seemed attractive, detachment from the outside world, and the emergence of suicidal thoughts, is inevitable.

Causes of the disease

As with many other mental illnesses, the causes and development of MDP are not fully understood. There are a number of studies showing that this disease is transmitted from mother to child. Therefore, the presence of certain genes and hereditary predisposition are important factors for the onset of the disease. Also, a significant role in the development of MDP is played by disruptions in the endocrine system, namely an imbalance in the amount of hormones.

Often, such an imbalance occurs in women during menstruation, after childbirth, and during menopause. That is why manic-depressive psychosis is observed more often in women than in men. Medical statistics also show that women who have been diagnosed with depression after childbirth are more susceptible to the occurrence and development of MDP.

Among the possible reasons for the development of a mental disorder is the patient’s personality itself and its key features. People belonging to the melancholic or statothymic personality type are more susceptible to the occurrence of MDP than others. Their distinctive feature is a mobile psyche, which is expressed in hypersensitivity, anxiety, suspiciousness, fatigue, an unhealthy desire for orderliness, as well as solitude.

Diagnosis of the disorder

In most cases, bipolar manic depression is extremely easy to confuse with other mental disorders, such as anxiety disorder or certain types of depression. Therefore, it takes a psychiatrist some time to confidently diagnose MDP. Observations and examinations continue at least until the patient’s manic and depressive phases and mixed states are clearly identified.

Anamnesis is collected using tests for emotionality, anxiety and questionnaires. The conversation is carried out not only with the patient, but also with his relatives. The purpose of the conversation is to consider the clinical picture and course of the disease. Differential diagnosis makes it possible to exclude mental illnesses in the patient that have symptoms and signs similar to manic-depressive psychosis (schizophrenia, neuroses and psychoses, other affective disorders).

Diagnostics also includes examinations such as ultrasound, MRI, tomography, and various blood tests. They are necessary to exclude physical pathologies and other biological changes in the body that could provoke the occurrence of mental disorders. These are, for example, improper functioning of the endocrine system, cancerous tumors, and various infections.

Depressive phase of MDP

The depressive phase usually lasts longer than the manic phase and is characterized primarily by a triad of symptoms: depressed and pessimistic mood, slow thinking and inhibition of movements and speech. During the depressive phase, mood swings are often observed, from depressed in the morning to positive in the evening.

One of the main signs of manic-depressive psychosis during this phase is a sharp weight loss (up to 15 kg) due to lack of appetite - food seems bland and tasteless to the patient. Sleep is also disturbed - it becomes intermittent and superficial. A person may experience insomnia.

As depressive moods increase, the symptoms and negative manifestations of the disease intensify. In women, a sign of manic-depressive psychosis during this phase may even be a temporary cessation of menstruation. However, the increase in symptoms is more likely to be a slowdown in the patient's speech and thought process. Words are difficult to find and connect with each other. A person withdraws into himself, renounces the outside world and any contacts.

At the same time, the state of loneliness leads to the emergence of such a dangerous set of symptoms of manic-depressive psychosis as apathy, melancholy, and extremely depressed mood. It can cause the patient to develop suicidal thoughts in his head. During the depressive phase, a person diagnosed with MDP needs professional medical help and support from loved ones.

Manic phase of MDP

Unlike the depressive phase, the triad of symptoms of the manic phase is directly opposite in nature. This is an elevated mood, vigorous mental activity and speed of movement and speech.

The manic phase begins with the patient feeling a surge of strength and energy, a desire to do something as soon as possible, to realize himself in something. At the same time, a person develops new interests, hobbies, and his circle of acquaintances expands. One of the symptoms of manic-depressive psychosis in this phase is a feeling of excess energy. The patient is endlessly cheerful and cheerful, does not need sleep (sleep can last 3-4 hours), and makes optimistic plans for the future. During the manic phase, the patient temporarily forgets past grievances and failures, but remembers the names of films and books, addresses and names, and telephone numbers that were lost in memory. During the manic phase, the effectiveness of short-term memory increases - a person remembers almost everything that happens to him at a given moment in time.

Despite the seemingly productive manifestations of the manic phase at first glance, they do not play into the patient’s hands at all. So, for example, a violent desire to realize oneself in something new and an unbridled desire for active activity usually does not end in something good. Patients during the manic phase rarely complete anything. Moreover, hypertrophied confidence in one’s own strengths and external luck during this period can push a person to take rash and dangerous actions. These include large bets in gambling, uncontrolled spending of financial resources, promiscuity, and even committing a crime for the sake of obtaining new sensations and emotions.

The negative manifestations of the manic phase are usually immediately visible to the naked eye. Symptoms and signs of manic-depressive psychosis in this phase also include extremely fast speech with swallowing of words, energetic facial expressions and sweeping movements. Even preferences in clothing may change - they become more catchy, bright colors. During the culminating stage of the manic phase, the patient becomes unstable, the excess energy turns into extreme aggressiveness and irritability. He is unable to communicate with other people, his speech may resemble the so-called verbal hash, as in schizophrenia, when sentences are broken into several logically unrelated parts.

Treatment of manic-depressive psychosis

The main goal of a psychiatrist in the treatment of a patient diagnosed with MDP is to achieve a period of stable remission. It is characterized by a partial or almost complete weakening of the symptoms of the existing disorder. To achieve this goal, it is necessary both to use special drugs (pharmacotherapy) and to turn to special systems of psychological influence on the patient (psychotherapy). Depending on the severity of the disease, the treatment itself can take place either on an outpatient basis or in a hospital setting.

Pharmacotherapy.

Since manic-depressive psychosis is a fairly serious mental disorder, its treatment is not possible without medication. The main and most frequently used group of drugs during the treatment of patients with bipolar disorder is the group of mood stabilizers, the main task of which is to stabilize the patient’s mood. Normalizers are divided into several subgroups, among which those used mostly in the form of salts stand out.

In addition to lithium drugs, a psychiatrist, depending on the symptoms observed in the patient, may prescribe antiepileptic drugs that have a sedative effect. These are valproic acid, Carbamazepine, Lamotrigine. In the case of bipolar disorder, taking mood stabilizers is always accompanied by neuroleptics, which have an antipsychotic effect. They inhibit the transmission of nerve impulses in those brain systems where dopamine serves as a neurotransmitter. Antipsychotics are used primarily during the manic phase.

It is quite problematic to treat patients in MDP without taking antidepressants in combination with mood stabilizers. They are used to alleviate the patient's condition during the depressive phase of manic-depressive psychosis in men and women. These psychotropic drugs, influencing the amount of serotonin and dopamine in the body, relieve emotional stress, preventing the development of melancholy and apathy.

Psychotherapy.

This type of psychological assistance, such as psychotherapy, consists of regular meetings with the attending physician, during which the patient learns to live with his illness like an ordinary person. Various trainings and group meetings with other patients suffering from a similar disorder help an individual not only better understand his illness, but also learn about special skills for controlling and relieving the negative symptoms of the disorder.

A special role in the process of psychotherapy is played by the principle of “family intervention”, which consists in the leading role of the family in achieving psychological comfort for the patient. During treatment, it is extremely important to establish an atmosphere of comfort and calm at home, to avoid any quarrels and conflicts, as they harm the patient’s psyche. His family and he himself must get used to the idea of the inevitability of manifestations of the disorder in the future and the inevitability of taking medications.

Prognosis and life with TIR

Unfortunately, the prognosis of the disease in most cases is not favorable. In 90% of patients, after the outbreak of the first manifestations of MDP, affective episodes recur again. Moreover, almost half of people suffering from this diagnosis for a long time go on disability. In almost a third of patients, the disorder is characterized by a transition from a manic phase to a depressive phase, with no “bright intervals.”

Despite the seeming hopelessness of the future with a diagnosis of MDP, it is quite possible for a person to live an ordinary normal life with it. Systematic use of mood stabilizers and other psychotropic drugs allows you to delay the onset of the negative phase, increasing the duration of the “bright period”. The patient is able to work, learn new things, get involved in something, lead an active lifestyle, undergoing outpatient treatment from time to time.

The diagnosis of MDP has been made to many famous personalities, actors, musicians and just people who are in one way or another connected with creativity. These are famous singers and actors of our time: Demi Lovato, Britney Spears, Jim Carrey, Jean-Claude Van Damme. Moreover, these are outstanding and world-famous artists, musicians, historical figures: Vincent van Gogh, Ludwig van Beethoven and, perhaps, even Napoleon Bonaparte himself. Thus, the diagnosis of MDP is not a death sentence; it is quite possible not only to exist, but also to live with it.

General conclusion

Manic-depressive psychosis is a mental disorder in which depressive and manic phases replace each other, interspersed with the so-called light period - a period of remission. The manic phase is characterized by an excess of strength and energy in the patient, an unreasonably elevated mood and an uncontrollable desire for action. The depressive phase, on the contrary, is characterized by depressed mood, apathy, melancholy, retardation of speech and movements.

Women suffer from MDP more often than men. This is due to disruptions in the endocrine system and changes in the amount of hormones in the body during menstruation, menopause, and after childbirth. For example, one of the symptoms of manic-depressive psychosis in women is the temporary cessation of menstruation. The disease is treated in two ways: by taking psychotropic drugs and by conducting psychotherapy. The prognosis of the disorder, unfortunately, is unfavorable: almost all patients may experience new affective attacks after treatment. However, with proper attention to the problem, you can live a full and active life.