True bipolar: Bipolar Disorder: Symptoms, Causes, Diagnosis, Treatment

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Bipolar Disorder: Symptoms, Causes, Diagnosis, Treatment

What Is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.

People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two “poles” of mood, which is why it’s called “bipolar” disorder.

The word “manic” describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren’t true and that they can’t be talked out of) or hallucinations (seeing or hearing things that aren’t there).

“Hypomania” describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.

The word “depressive” describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or “clinical depression,” a condition in which someone never has manic or hypomanic episodes.

Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.

Bipolar Disorder Types

There are a few types of bipolar disorder, including:

Bipolar I disorder: With this type, you have extreme erratic behavior, with manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks. 

Bipolar II disorder: With this type, you also have erratic highs and lows, but it isn’t as extreme as bipolar I.

Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II.

With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues. 

Bipolar Disorder Symptoms

In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.

How severe it gets differs from person to person and can also change over time, becoming more or less severe.

Symptoms of mania (“the highs”):

  • Excessive happiness, hopefulness, and excitement

  • Sudden changes from being joyful to being irritable, angry, and hostile

  • Restlessness

  • Rapid speech and poor concentration

  • Increased energy and less need for sleep

  • Unusually high sex drive

  • Making grand and unrealistic plans

  • Showing poor judgment

  • Drug and alcohol abuse

  • Becoming more impulsive

  • Less need for sleep

  • Less of an appetite

  • Larger sense of self-confidence and well-being

  • Being easily distracted

During depressive periods (“the lows”), a person with bipolar disorder may have:

  • Sadness

  • Loss of energy

  • Feelings of hopelessness or worthlessness

  • Not enjoying things they once liked

  • Trouble concentrating

  • Forgetfulness

  • Talking slowly

  • Less of a sex drive

  • Inability to feel pleasure

  • Uncontrollable crying

  • Trouble making decisions

  • Irritability

  • Needing more sleep

  • Insomnia

  • Appetite changes that make you lose or gain weight

  • Thoughts of death or suicide

  • Attempting suicide

Bipolar Disorder Causes

There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.

For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists aren’t exactly sure how or why.

Bipolar Disorder Risk Factors

When someone develops bipolar disorder, it usually starts when they’re in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.

Men and women are equally likely to get it. Women are somewhat more likely than men to go through “rapid cycling,” which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.

Bipolar disorder usually develops later in life for women, and they’re more likely to have bipolar disorder II and be affected by seasonal mood changes. 

A combination of medical and mental issues is also more common in women. Those medical issues can include thyroid disease, migraine, and anxiety disorders. 

Some things that make you more likely to have bipolar disorder include:

  • Having a family member with bipolar disorder

  • Going through a time of high stress or trauma

  • Drug or alcohol abuse

  • Certain health conditions

Many people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder.

Bipolar Disorder Diagnosis

If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you’re concerned about, have had, and any mental illnesses that run in the family. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.

Diagnosing bipolar disorder is all about the person’s symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?

The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.

Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.

Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.

If you think your child might have bipolar disorder, ask your doctor for a referral to a child psychologist who’s familiar with bipolar disorder.

Bipolar Disorder Treatments

Bipolar disorder can be treated. It’s a long-term condition that needs ongoing care. People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat.

Medication

Medication is the main treatment, usually involving the following:

  •  Mood stabilizers, such as carbamazepine (Tegretol), lamotrigine (Lamictal), lithium, or valproate (Depakote)

  • Antipsychotic drugs, such as cariprazine (Vraylar), lurasidone (Latuda), olanzapine (Zyprexa), and quetiapine (Seroquel)

  • Antidepressants

  • Antidepressant-antipsychotic drugs, a combination of an antidepressant and a mood stabilizer

  • Anti-anxiety medications or sleep medicines, such as sedatives like benzodiazepines

It can take a while to find the right combination for you. You may need to try a few things before you and your doctor figure out what works best. Once you do, it’s important to stay on your medication and talk with your doctor before stopping or changing anything.

Women who are pregnant or breastfeeding should talk with their doctors about medications that are safe to take. 

Psychotherapy, or “talk therapy,” is often recommended, too. There are several different types. Options can include:

  • Interpersonal and social rhythm therapy (ISPRT). This is based on the idea that having a daily routine for everything, from sleeping to eating, can help keep your mood stable.

  • Cognitive behavioral therapy (CBT). This helps you replace bad habits and actions with more positive alternatives. It also can help you learn to manage stress and other negative triggers.

  • Psychoeducation. Learning more and teaching family members about bipolar disorder can help give you support when episodes happen.

  • Family-focused therapy. This sets up a support system to help with treatment and helps your loved ones recognize the beginning of an episode.

Other treatment options for bipolar disorder can include:

  • Electroconvulsive therapy (ECT). Small doses of electricity shock the brain and set off a small seizure to kind of reboot it and change the balance of certain chemicals. While it’s still a last-resort treatment when medications and therapy haven’t worked, it is much better controlled and safer, with fewer risks and side effects, than in the early days of this procedure.

  • Acupuncture. There’s some evidence that  this complementary therapy may help with the depression caused by bipolar disorder.

  • Supplements. While some people take certain vitamin supplements to help with the symptoms of bipolar disorder, there are many possible issues with using them. For example,  their ingredients aren’t regulated, they can have side effects, and some can affect how prescribed medications work. Be sure to tell your doctor about any supplements you take.

Lifestyle changes may also help:

  • Get regular exercise.

  • Stay on a schedule for eating and sleeping.

  • Learn to recognize your mood swings.

  • Get support from friends or groups.

  • Keep a symptom journal or chart.

  • Learn to manage stress.

  • Find healthy hobbies or sports.

  • Don’t drink alcohol or use recreational drugs.

Bipolar Disorder Outlook

For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment.

Ongoing treatment is more effective than dealing with problems as they come up. 

The more you know about your condition, the better you can manage your episodes. And support groups, where you can talk with people who are going through the same things you are, can also help.

Bipolar Disorder and Suicide

Some people who have bipolar disorder may become suicidal.

Learn the warning signs and seek immediate medical help for them:

  • Depression (changes in eating, sleeping, activities)

  • Isolating yourself

  • Talking about suicide, hopelessness, or helplessness

  • Acting recklessly

  • Taking more risks

  • Having more accidents

  • Abusing alcohol or other drugs

  • Focusing on morbid and negative themes

  • Talking about death and dying

  • Crying more, or becoming less emotionally expressive

  • Giving away possessions

Bipolar Disorder: Symptoms, Causes, Diagnosis, Treatment

What Is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior.

People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two “poles” of mood, which is why it’s called “bipolar” disorder.

The word “manic” describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren’t true and that they can’t be talked out of) or hallucinations (seeing or hearing things that aren’t there).

“Hypomania” describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life.

The word “depressive” describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or “clinical depression,” a condition in which someone never has manic or hypomanic episodes.

Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms.

Bipolar Disorder Types

There are a few types of bipolar disorder, including:

Bipolar I disorder: With this type, you have extreme erratic behavior, with manic “up” periods that last at least a week or are so severe that you need medical care. There are also usually extreme “down” periods that last at least 2 weeks. 

Bipolar II disorder: With this type, you also have erratic highs and lows, but it isn’t as extreme as bipolar I.

Cyclothymic disorder: This type involves periods of manic and depressive behavior that last at least 2 years in adults or 1 year in children and teens. The symptoms aren’t as intense as bipolar disorder I or bipolar disorder II.

With any type of bipolar disorder, misuse of drugs and alcohol use can lead to more episodes. Having bipolar disorder and alcohol use disorder, known as “dual diagnosis,” requires help from a specialist who can address both issues. 

Bipolar Disorder Symptoms

In bipolar disorder, the dramatic episodes of high and low moods do not follow a set pattern. Someone may feel the same mood state (depressed or manic) several times before switching to the opposite mood. These episodes can happen over a period of weeks, months, and sometimes even years.

How severe it gets differs from person to person and can also change over time, becoming more or less severe.

Symptoms of mania (“the highs”):

  • Excessive happiness, hopefulness, and excitement

  • Sudden changes from being joyful to being irritable, angry, and hostile

  • Restlessness

  • Rapid speech and poor concentration

  • Increased energy and less need for sleep

  • Unusually high sex drive

  • Making grand and unrealistic plans

  • Showing poor judgment

  • Drug and alcohol abuse

  • Becoming more impulsive

  • Less need for sleep

  • Less of an appetite

  • Larger sense of self-confidence and well-being

  • Being easily distracted

During depressive periods (“the lows”), a person with bipolar disorder may have:

  • Sadness

  • Loss of energy

  • Feelings of hopelessness or worthlessness

  • Not enjoying things they once liked

  • Trouble concentrating

  • Forgetfulness

  • Talking slowly

  • Less of a sex drive

  • Inability to feel pleasure

  • Uncontrollable crying

  • Trouble making decisions

  • Irritability

  • Needing more sleep

  • Insomnia

  • Appetite changes that make you lose or gain weight

  • Thoughts of death or suicide

  • Attempting suicide

Bipolar Disorder Causes

There is no single cause of bipolar disorder. Researchers are studying how a few factors may lead to it in some people.

For example, sometimes it can simply be a matter of genetics, meaning you have it because it runs in your family. The way your brain develops may also play a role, but scientists aren’t exactly sure how or why.

Bipolar Disorder Risk Factors

When someone develops bipolar disorder, it usually starts when they’re in late adolescence or young adulthood. Rarely, it can happen earlier in childhood. Bipolar disorder can run in families.

Men and women are equally likely to get it. Women are somewhat more likely than men to go through “rapid cycling,” which is having four or more distinct mood episodes within a year. Women also tend to spend more time depressed than men with bipolar disorder.

Bipolar disorder usually develops later in life for women, and they’re more likely to have bipolar disorder II and be affected by seasonal mood changes. 

A combination of medical and mental issues is also more common in women. Those medical issues can include thyroid disease, migraine, and anxiety disorders. 

Some things that make you more likely to have bipolar disorder include:

  • Having a family member with bipolar disorder

  • Going through a time of high stress or trauma

  • Drug or alcohol abuse

  • Certain health conditions

Many people with the condition abuse alcohol or other drugs when manic or depressed. People with bipolar disorder are more likely to have seasonal depression, co-existing anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder.

Bipolar Disorder Diagnosis

If you or someone you know has symptoms of bipolar disorder, talk to your family doctor or a psychiatrist. They will ask questions about mental illnesses that you, or the person you’re concerned about, have had, and any mental illnesses that run in the family. The person will also get a complete psychiatric evaluation to tell if they have likely bipolar disorder or another mental health condition.

Diagnosing bipolar disorder is all about the person’s symptoms and determining whether they may be the result of another cause (such as low thyroid or mood symptoms caused by drug or alcohol abuse). How severe are they? How long have they lasted? How often do they happen?

The most telling symptoms are those that involve highs or lows in mood, along with changes in sleep, energy, thinking, and behavior.

Talking to close friends and family of the person can often help the doctor distinguish bipolar disorder from major depressive disorder or other psychiatric disorders that can involve changes in mood, thinking, and behavior.

Diagnosing bipolar disorder can be trickier for children and teenagers. Their symptoms may be the same as adults but might be confused for attention deficit hyperactivity disorder (ADHD) or even just bad behavior.

If you think your child might have bipolar disorder, ask your doctor for a referral to a child psychologist who’s familiar with bipolar disorder.

Bipolar Disorder Treatments

Bipolar disorder can be treated. It’s a long-term condition that needs ongoing care. People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat.

Medication

Medication is the main treatment, usually involving the following:

  •  Mood stabilizers, such as carbamazepine (Tegretol), lamotrigine (Lamictal), lithium, or valproate (Depakote)

  • Antipsychotic drugs, such as cariprazine (Vraylar), lurasidone (Latuda), olanzapine (Zyprexa), and quetiapine (Seroquel)

  • Antidepressants

  • Antidepressant-antipsychotic drugs, a combination of an antidepressant and a mood stabilizer

  • Anti-anxiety medications or sleep medicines, such as sedatives like benzodiazepines

It can take a while to find the right combination for you. You may need to try a few things before you and your doctor figure out what works best. Once you do, it’s important to stay on your medication and talk with your doctor before stopping or changing anything.

Women who are pregnant or breastfeeding should talk with their doctors about medications that are safe to take. 

Psychotherapy, or “talk therapy,” is often recommended, too. There are several different types. Options can include:

  • Interpersonal and social rhythm therapy (ISPRT). This is based on the idea that having a daily routine for everything, from sleeping to eating, can help keep your mood stable.

  • Cognitive behavioral therapy (CBT). This helps you replace bad habits and actions with more positive alternatives. It also can help you learn to manage stress and other negative triggers.

  • Psychoeducation. Learning more and teaching family members about bipolar disorder can help give you support when episodes happen.

  • Family-focused therapy. This sets up a support system to help with treatment and helps your loved ones recognize the beginning of an episode.

Other treatment options for bipolar disorder can include:

  • Electroconvulsive therapy (ECT). Small doses of electricity shock the brain and set off a small seizure to kind of reboot it and change the balance of certain chemicals. While it’s still a last-resort treatment when medications and therapy haven’t worked, it is much better controlled and safer, with fewer risks and side effects, than in the early days of this procedure.

  • Acupuncture. There’s some evidence that  this complementary therapy may help with the depression caused by bipolar disorder.

  • Supplements. While some people take certain vitamin supplements to help with the symptoms of bipolar disorder, there are many possible issues with using them. For example,  their ingredients aren’t regulated, they can have side effects, and some can affect how prescribed medications work. Be sure to tell your doctor about any supplements you take.

Lifestyle changes may also help:

  • Get regular exercise.

  • Stay on a schedule for eating and sleeping.

  • Learn to recognize your mood swings.

  • Get support from friends or groups.

  • Keep a symptom journal or chart.

  • Learn to manage stress.

  • Find healthy hobbies or sports.

  • Don’t drink alcohol or use recreational drugs.

Bipolar Disorder Outlook

For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment.

Ongoing treatment is more effective than dealing with problems as they come up. 

The more you know about your condition, the better you can manage your episodes. And support groups, where you can talk with people who are going through the same things you are, can also help.

Bipolar Disorder and Suicide

Some people who have bipolar disorder may become suicidal.

Learn the warning signs and seek immediate medical help for them:

  • Depression (changes in eating, sleeping, activities)

  • Isolating yourself

  • Talking about suicide, hopelessness, or helplessness

  • Acting recklessly

  • Taking more risks

  • Having more accidents

  • Abusing alcohol or other drugs

  • Focusing on morbid and negative themes

  • Talking about death and dying

  • Crying more, or becoming less emotionally expressive

  • Giving away possessions

Bipolar Disorder: Myths and Facts

 

Author: Mood Disorders Association of BC

 

Myth: Bipolar disorder cannot be diagnosed as easily as physical illness.

Fact: Bipolar disorder can be diagnosed similarly to physical illnesses. While there are no physical tests that can reveal the disorder, the diagnosis of bipolar illness is based on standard criteria. An accurate diagnosis of a bipolar illness is made by using the tools (or psychiatric laboratory tests) of a medical and psychiatric history, self-reported symptoms, observable behavior, input from friends and family, family medical history and specific psychiatric rating scales.

Myth: Children do not get bipolar disorder.

Fact: Bipolar disorder can occur in children as young as age six. It is more likely to affect children of parents who have bipolar disorder. Children tend to have very fast mood swings between depression and mania many times during the day whereas adults tend to experience intense moods for weeks or months at a time. Note—Bipolar disorder can best be diagnosed after examination of historical behaviour patterns. Parents should attempt to get independent verification and consider carefully any such diagnosis of a very young child.

Myth: It is impossible to help someone with bipolar disorder.

Fact: Bipolar disorder can be effectively treated and managed. More than 30% of bipolar patients can expect full and complete recovery while another 40% can expect a very marked reduction in their symptoms. Individuals can go into remission during various periods of their life. Successful management depends on many factors including education about the illness, good communication with professionals involved in your care, a good support system (family and friends) and adhering to your treatment plan.

Myth: Bipolar disorder is a figment of one’s imagination.

Fact: Bipolar disorder is a treatable brain disorder that is real and can cause a lot of suffering, especially if it is not well managed. Individuals cannot just snap out of it! Recovery takes time and hard work.

Myth: People who have bipolar disorder cannot work.

Fact: Proper medical treatment and good support enables most people (more than 75%) with bipolar to work and be successful.

Myth: Bipolar disorder is caused by a personal weakness or character flaw.

Fact: Bipolar disorder is a medical condition just like diabetes or any other health condition. People with bipolar disorder cannot “just pull themselves together” and get better. Treatment is necessary.

Myth: If you have bipolar disorder, you are ill all the time.

Fact: Bipolar disorder is characterized by episodes of highs and lows. In most people, these episodes are separated by periods of stability. People may go for months, sometimes even years without an episode by managing the illness well.

Myth: Once bipolar disorder is under control, people can stop their medications.

Fact: Bipolar disorder is an illness that most often requires people to continue taking medications, even if they are symptom free. Medication can act in a preventative way, helping people to avoid relapses. You should always consult with your doctor before stopping any medications.

Myth: Alcoholism and drug abuse cause bipolar disorder.

Fact: People with bipolar disorder are more likely to experience problems with the use of alcohol or other drugs but the drugs do not cause the disorder. People with bipolar disorder may use alcohol or street drugs to make themselves feel better (self-medicate) or as an escape from their problems.

 

 

About the author

The Mood Disorders Association of BC is a member of the BC Partners for Mental Health and Substance Use Information. The organization is dedicated to providing support, education, and hope for recovery for those living with a mood disorder or other mental illness. For more, visit www.mdabc.net or call 1-604-873-0103.

 

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After Searching 12 Years for Bipolar Disorder’s Cause, a Team Concludes It Has Many

Nearly 6 million Americans have bipolar disorder, and most have probably wondered why. After more than a decade of studying over 1,100 of them in-depth, a University of Michigan team has an answer — or rather, seven answers.

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In fact, the team says, no one genetic change, chemical imbalance or life event lies at the heart of every case of the mental health condition once known as manic depression.

Rather, every patient’s experience with bipolar disorder varies from that of others with the condition. But all of their experiences include features that fall into seven classes of phenotypes, or characteristics that can be observed, the team reports in a new paper in the International Journal of Epidemiology.

The team, from U-M’s Heinz C. Prechter Bipolar Research Program, collected and analyzed tens of thousands of data points over years about the genetics, emotions, life experiences, medical histories, motivations, diets, temperaments and sleep and thought patterns of research volunteers. More than 730 had bipolar disorder, and 277 didn’t. Three-quarters were active research participants in the Longitudinal Study of Bipolar Disorder.

Using those findings, the team developed a framework that could be useful to researchers studying the condition, clinical teams treating it and patients experiencing it. The team hopes it will give them all a common structure to use during studies, treatment decisions and more.

“There are many routes to this disease and many routes through it,” says Melvin McInnis, M.D., lead author of the paper and head of the program based at the U-M Depression Center. “We have found that there are many biological mechanisms that drive the disease and many interactive external influences on it. All of these elements combine to affect the disease as patients experience it.”

The Prechter program is named for a Detroit automotive pioneer who fought bipolar disorder even as he built a successful business.

Long-term funding from this program has made it possible to build a massive library of data from the Prechter cohort of patients, which is two-thirds female and 79 percent white with an average age at enrollment in the study of 38 years. On average, participants had their first depressive or manic episode at age 17. Many had other mental health conditions.

Overview – Bipolar disorder – NHS

Bipolar disorder is a mental health condition that affects your moods, which can swing from 1 extreme to another. It used to be known as manic depression.

Symptoms of bipolar disorder

People with bipolar disorder have episodes of:

  • depression – feeling very low and lethargic
  • mania – feeling very high and overactive

Symptoms of bipolar disorder depend on which mood you’re experiencing.

Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks (or even longer).

Depression

You may initially be diagnosed with clinical depression before you have a manic episode (sometimes years later), after which you may be diagnosed with bipolar disorder.

During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide.

If you’re feeling suicidal, read about where to get urgent help for mental health.

If you’re feeling very depressed, contact a GP, your care co-ordinator or speak to a local mental health crisis team as soon as possible.

Find a local NHS urgent mental health helpline

You could also call NHS 111 if you’re not sure what to do or if you cannot speak to your local NHS urgent mental health helpline.

If you want to talk to someone confidentially, call the Samaritans free on 116 123. You can talk to them 24 hours a day, 7 days a week.

Or visit the Samaritans website or email [email protected]

Mania

During a manic phase of bipolar disorder, you may:

  • feel very happy
  • have lots of energy, ambitious plans and ideas
  • spend large amounts of money on things you cannot afford and would not normally want

It’s also common to:

  • not feel like eating or sleeping
  • talk quickly
  • become annoyed easily

You may feel very creative and view the manic phase of bipolar as a positive experience.

But you may also experience symptoms of psychosis, where you see or hear things that are not there or become convinced of things that are not true.

Living with bipolar disorder

The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.

But there are several options for treating bipolar disorder that can make a difference.

They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible.

The following treatment options are available:

  • medicine to prevent episodes of mania and depression – these are known as mood stabilisers, and you take them every day on a long-term basis
  • medicine to treat the main symptoms of depression and mania when they happen
  • learning to recognise the triggers and signs of an episode of depression or mania
  • psychological treatment – such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships
  • lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep

It’s thought using a combination of different treatment methods is the best way to control bipolar disorder.

Help and advice for people with a long-term condition or their carers is also available from charities, support groups and associations.

This includes self-help and learning to deal with the practical aspects of a long-term condition.

Find out more about living with bipolar disorder

Bipolar disorder and pregnancy

Bipolar disorder, like all other mental health problems, can get worse during pregnancy. But specialist help is available if you need it.

Find out more about bipolar disorder in pregnancy

What causes bipolar disorder?

The exact cause of bipolar disorder is unknown, although it’s believed a number of things can trigger an episode.

These include:

  • extreme stress
  • overwhelming problems
  • life-changing events
  • genetic and chemical factors

Who’s affected

Bipolar disorder is fairly common, and 1 in every 100 people will be diagnosed with it at some point in their life.

Bipolar disorder can occur at any age, although it often develops between the ages of 15 and 19 and rarely develops after 40.

Men and women from all backgrounds are equally likely to develop bipolar disorder.

The pattern of mood swings in bipolar disorder varies widely. For example, some people only have a couple of bipolar episodes in their lifetime and are stable in between, while others have many episodes.

Bipolar disorder and driving

If you have bipolar disorder, it may affect your driving. You must inform the Driver and Vehicle Licensing Agency (DVLA).

Information:

Social care and support guide

If you:

  • need help with day-to-day living because of bipolar disorder
  • care for someone regularly because they have bipolar disorder (including family members)

Our guide to care and support explains your options and where you can get support.

What it’s like to have bipolar, by people who have bipolar

Around 1% of us will develop bipolar disorder, formerly known as manic depression.

People with bipolar experience both episodes of severe depression, and episodes of mania – overwhelming joy, excitement or happiness, huge energy, a reduced need for sleep, and reduced inhibitions.

The experience of bipolar is uniquely personal. No two people have exactly the same experience. 

Bipolar disorder has been associated with genius and with creativity. It is certainly true that a number of contemporary high achievers and creatives have spoken of their experiences, and throughout history it is possible to recognise bipolar type traits in the artistic, political and academic spheres. But what is it actually like?

Find out more about bipolar in our A-Z guide

I was diagnosed with bipolar in my late teens, in my first year at university. The diagnosis (and not – I hasten to add – the symptoms) have shaped my adult identity and experiences.

This week I have been collecting answers to four simple questions from a range of people who have bipolar, to demonstrate the range of experiences out there, and some of the things that help.

What impact has bipolar had on your life?

For me this is important because my experience is very unusual. I took antidepressants in my last year of school which, when I arrived at University and took the control of living away from home, helped to induce hypomania.

I was already aware of my mood swings, and studying biomedical sciences. I went to the doctor and said I thought I had bipolar, and he agreed. I had met a superb psychiatrist via student health. Because in my extended Irish family there were a few people who were unusual, and at least two with probable bipolar a working diagnosis was quick. 

My school and university experiences were coloured by mood swings. I cycled rapidly between deep depression and hypomania. I ate too much and drank too much, in part because of the medication and in part because of anxiety, and became very obese.

I had some embarrassing moments of drunkenness, self-harm, obnoxiousness and accruing of debt. By the time I felt properly back on an even keel seven years later I had accrued nearly £50,000 of unsecured debt, which it’s taken a decade to pay back.

So I don’t have a house, or a postgraduate degree which I’d have liked and which would help now. But. I had my life.

I avoided hospital, thanks to my psychiatrist, brilliant GP, online peer support and carefully nurtured insight. And because I found a sense of purpose through volunteering.

My parents were unquestioningly supportive, financially, emotionally and practically. They resolved to push me through my degree at whatever cost. I am lucky they were able to.

I got involved in the student union movement and student mental health campaigning, which led me to my career. Bipolar shaped me. But never broke me.

Nowadays all I have left is a ghost of an identity formed in a diagnosis. Sometimes my self-stigma or real stigma inhibits my career. Sometimes casual disclosure leads to awkwardness. But. I am recovered.

I’m constantly probing for where recovery ends and post mental illness starts. I am so aware of how a-typically bipolar I am and how lucky that makes me. Every time my heart swells with empathy for a fellow traveller in trouble, or dead to young, I thank my stars. And commit to continuing the work I do. Other people I spoke to had a range of views.

Bipolar can be cruel, as Brian, a man in his 40s describes:

“My first major episode had a big impact in my life, I lost my job, my marriage broke down, I struggled with relationships and lost any sense of who I was. At times suicide seemed the only real option. Fortunately, recovery and relearning about myself has brought its rewards and I have a good life today.”

Joan, a mother in her 30s adds:

“The impact has been massive. It disrupted education, disadvantaged my career, and decimated my relationships.”

Hannah, a woman in her 30s describes the need for constant awareness of experience:

“I’m constantly aware of it. I am bipolar all of the time. Trying to stay well and steady takes a lot of effort.”

Cait, a mother in her 20s talks about the ongoing impact of experience that started at a young age:

“It’s shaped my life because I became unwell in my teens, which resulted in me dropping out of school. Becoming unwell at such a critical period in my life shaped my self-image and I struggle with social anxiety.

“Episodes can be pretty destructive, and it means I find it very difficult to take anything for granted – no matter how well my life is going, I know I can get ill and it can be wiped out, as it has been many times before. I put off having children for a long time because I was frightened of getting ill.

“The positive aspects are that when I started blogging about it, I tapped into an entire network of people who had felt the same, who were living with all, and it gave me hope.”

Blogger Tanya added:

“I feel that having Bipolar disorder has been both a curse and a blessing. The negatives focusing on some of the more harmful actions I have taken as a result of the disorder, such as falling in to self-medicating habits which lead to addiction.

“Bipolar has provided some heavy limitations, such as having time off work and needing rest when episodes come along unpredicted, and not being able to look after my young daughter when it is in full swing.

“However, in a good light it has also separated my true friends and family from the false ones who did not care for me in the first place. I am very lucky to have a close circle now, each person I know truly value me, and see the real person that I am through the disorder.”

Blogger Anna said:

“I’ve had numerous admissions to hospital and crisis houses, taken overdoses, cut myself, and put myself in very dangerous situations when manic.

“All of those things have been awful, but they don’t even begin to compare to how soul-destroying it has been to not have the life I once believed was a given taken by bipolar. As a teenager, I was a high achiever. I was destined for academic and occupational success, but I haven’t been able to work since I was 18 and I had to drop out of university because I was too unwell.

“Being unable to have that life has forced me to find other ways to feel productive, valuable, and successful. I volunteer, study part time with the Open University (I will finally get my degree next year. I started university in 2009!), and earn a small income from blogging.”

What have you learned as a result of your experiences?

Living with bipolar, often for years, teaches you a lot about yourself, about mental health services, about medication…and sadly often about stigma, shame, and discrimination.

I’d say for me it was a key driver for learning about me…but also a red herring as I feel I vested too much of my own identity in clinging to the life-raft of the diagnosis as an explanation of my life in my early 20s…again though, there are a range of perspectives:

Brian talks of the possibility of recovery:

“Despite what others may tell you, or what you might believe, recovery is possible. I never thought I could be a worthwhile human being and have something meaningful to offer.

“That’s just illness speak and the effects of learned stigma. It doesn’t need to be that way.”

Anna points to learning about what is important in life:

“I have learnt that I am more resilient than I could have ever imagined. I have discovered that there is more to life than getting a degree or a good job. I have learnt that I have amazing friends who never stopped believing in me, even when I couldn’t believe in myself.”

Hannah draws on a theme park analogy to talk about assembling your team of helpers:

“I feel like I’m riding a constant rollercoaster of moods. There are people who are too scared to come to the theme park, those that will hop on rides with you and those that watch sensibly in awe and sickness from a distance minding your bags.

“All of those people have a valid and useful part to play in your life.”

This is a point echoed by Cait:

“I have learnt how important it is to reach out to others when I am unwell, even when I don’t feel like being around others. Going through episodes alone has had some disastrous consequences in the past.”

Hannah points to long experience of episodes to reflect that mania is the most dangerous state for her.  

“Depression can feel utterly shit and the worst thing in the world. But mania is the dangerous one.”

This can be a challenge when many believe mania to be exciting. I have even had people ask me how to get there.

Joan was right to the point:

“Faith, hope and love, the greatest of these being love.”

What do you do to keep well?

Keeping well when you have bipolar is an interesting concept. For some it revolves exclusively around manging moods. For others it means fitting life around moods.

For me, and others like me who are deep into a recovery that seems to be holding, it’s about keeping an eye, and investing in the things that help us all boost our mental health.

For many, if not most people with bipolar, life and keeping well includes taking medication. 

Blogger Tanya said:

“The thing I most prioritise with keeping myself well is to be strict in taking my medication. Missing doses or tweaking them without professional help can be devastating.

Again, I’m going to buck the trend and say I don’t take medication routinely. I took lithium for a decade, and then wanted, once I knew myself and had done my research, to try tapering off. That was eight years ago, and I’ve managed it. I did it carefully, over two years, with support, whilst learning other techniques.

Cait agrees:

“For 13 years, I took medication, but in the past six months, I’ve been trying to cope without it. So I have to be super careful, and alas, super boring. I don’t drink a lot, I have relatively early nights when I can.”

Bipolar can also be triggered by trauma, or other life events and sometimes part of therapy is addressing underlying concerns to get someone to a point where they can start to see a life worth living. 

Anna said:

“I had seven years of psychoanalytic psychotherapy. I believed it not only saved my life, but helped me actually have a life.”

Self-Management, either formally in courses the Mental Health Foundation or Bipolar UK run, or less formally can be key.

Hannah has a rigid menu:

“Monitoring. Mood diaries. Medication. Management plans. Making and keeping a routine. Being me.

Doing one thing that is the same every day. Doing one thing that pushes me out of my comfort zone every day.”

You can monitor mood via downloadable or printed mood diary charts, or through several apps and web resources. Personally, I monitor my moods consciously if I am worried, unconsciously otherwise, and I take have taken antidepressants for a year or so at a time when I feel I’ve needed extra help. I try and practice mindfulness daily, and remain wedded to my work and its importance to my identity.

Besides this, people say, unsurprisingly that they keep well by doing things that help everybody keep resilient and mentally healthy:

“Routine is important in bipolar disorder: I try and find the right balance with sleep, work and my social life. I can track the majority of my relapses down to a shift in routine or a major life change,” says Tanya.

“Balance is important. I make time for family and friends, time for me to relax and have fun, and I aim for at least seven hours sleep a day,” says Brian.

“The single most important thing I do to keep well is manage my sleep. I was diagnosed at 17 and spent my early twenties doing everything a person with bipolar shouldn’t (staying up late, drinking too much, taking drugs, taking on too many responsibilities or projects etc). I learnt what to do to keep well by doing everything wrong!” says Anna.

What single piece of advice would you give a person just diagnosed?

Based on all the insights shared we’ve come up with the following list…but it’s not exhaustive. Speaking personally, I’d say “Hold on. It gets better. Different. But better…”

  • Find out about bipolar. Use trusted web resources or library books. Learn about treatments. Research medications. Know your options. Talk to people. 
  • I know it’s tempting to hinge every experience and feeling you’ve ever had on the diagnosis, and to an extent, it’s a very natural thing to do, but you’re still you, you still have your own feelings and thoughts, and your own language and perception of your own life. Try not to adopt an illness identity. You are you. Not bipolar. Get to know yourself.
  • Throw yourself into treatment and get well…learn some good strategies for taking care of yourself, but remember there’s a person under the diagnosis- there was before you were diagnosed, and there will be after. Bipolar might change you, and that’s OK. Recovery doesn’t mean cure, but it can mean lots of new opportunities.
  • You and your doctor are equals your care. In the consultation room you bring the real life experience, your own personal circumstance (family, work, interests) and knowing what works for you. Your doctor brings years of valuable knowledge, study and experience of treating others. Work together. Respect each other. Ask tough questions and expect tough questions.
  • Reach out to other people with the diagnosis, whether that be through a community support group or via social media. It’s easy to feel the shock of isolation when you are first diagnosed. I believe that hearing other people’s experiences and connecting to those who are in the same boat can not only help with accepting the illness, but with also providing sense of ‘normality’ within the community
  • Find out about bipolar, join a support group and learn from peers how to live well. You need to work out what works for you. Learning about this and exploring what helps you ideally with people on a similar path can be very empowering.
  • Work with bipolar rather than against it. Pretending it doesn’t exist won’t make it go away. In fact, it will make it so much more difficult to control.
  • Build a circle of support. Friends, family, professionals, community resources…all can help.
  • Put safeguards around managing your money when well to protect yourself when too low to motivate and organise yourself or too high to care. I’ve always found banks and creditors very helpful when I tell them that I have bipolar.

With grateful thanks to all who contributed to this piece…your names have been changed to preserve your identity.

I live with bipolar disorder, and my moods are complete opposites of one another. How can I tell what is the real me?

I live with bipolar disorder, and my moods are complete opposites of one another. How can I tell what is the real me?

My short answer: neither depression nor mania is the real you. Here’s my long answer: it’s certainly true that depression and mania can have a huge impact on how you see and experience the world. When depressed, you might overestimate the negative or bad outcomes of any action. When feeling manic, you might minimize or ignore possible bad outcomes to the point of doing risky or dangerous things. When depressed, you might be unreasonably self-critical and blame yourself for everything. And when feeling manic, you might be unrealistically overconfident to the point of getting yourself in trouble.

But you are still a unique person, despite that back-and-forth. The real you is defined by your abilities, your personal values, and your passions. Those are the things that will sustain you and help you stay grounded through ups and downs in your mood. Mood swings can distract you from the things that you care about most, so you may need to make a special effort to stay in touch with the real you.

DBSA’s Wellness Plan is designed to help you clarify and stay focused on the real you. As you think about your personal recovery goals, you’ll ask yourself questions like

  • What motivates me?
  • What interests me?
  • What would I do more if I could?
  • What do I want?
  • What do I care about, or what did I care about before my illness?
  • Where do I want my life to go?
  • What brings me joy?
  • What are my dreams and hopes?

Once you set some long-term goals, you can think about short-term steps to start with. Deciding on those steps will bring up questions like

  • What kinds of activities help me stay healthy and balanced?
  • What relationships help me feel secure and supported?
  • What things do I need to do every day to maintain my health?

Creating your own wellness plan is not just about avoiding symptoms. It really is about the important things that define the real you.

For more wellness resources, go to the Wellness Toolbox and FacingUs.org

90,000 Causes and symptoms of bipolar disorder

Any person has a state of change of mood. But when is this condition called bipolar disorder? Experts define the term as a mental disorder associated with an alternation of depressive and manic states. Affective changes are associated with emotions, mood swings. The phases of depression and mania are characterized by cyclicity and a period of remission. So, the phase lasts from seven days to 3 years, and the period can last 4-5 years.

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Outpatient treatment

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Scientific methods of treatment

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Symptoms of the disease

Women are more likely to experience bipolar disorder than men. This fact can be explained by the fact that this group of patients turns more to specialists for help. To determine mood swings, the presence of emotional phases should be determined.

To determine the symptoms of the disease, you need to understand that for the phase of mania and depression, they will be different. The main signs of mania are considered:

  • Feeling of elation, which can last more than 3 hours for no reason;
  • Lack of desire to sleep;
  • Fast, accelerated speech that is not always intelligible. A person can lose meaning, a thread of communication, therefore, most often he uses an electronic version of communication;
  • About a person they say that he first does, and then thinks about actions;
  • Inadequate perception of oneself as a person – raising oneself above others;
  • Switching from one to the other, especially in work matters, which leads to a decrease in productivity;
  • Risky behavior.

Signs of depression include:

  • Spontaneous, unjustified sadness, for no apparent reason, factors of influence;
  • Locking in oneself – a person has no desire to communicate with loved ones, relatives, a state of inner experience is characteristic;
  • Lack of interest in life, joy from what is happening around;
  • Lack of appetite;
  • Lack of energy, fatigue, depression;
  • Loss of the ability to independently solve problems, make decisions, distraction, inability to concentrate;
  • The emergence of thoughts of suicide.
SERVICE PRICE
Psychotherapist appointment 4 950 rub
Family psychotherapy 7 150 rub
Hypnotherapy 6 600 rub
Psychiatric consultation 3 850 rub
HOSPITAL TREATMENT
3-bed superior room RUB 7,000
2-bed superior room RUB 9,000
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* The administration of the KORSAKOV medical center takes all measures to timely update the price list posted on the website, however, in order to avoid possible misunderstandings, we advise you to clarify the cost of services in the contact center by phone +7 (499) 288-19-74

Bipolar disorder has specific causes. This could be genetic inheritance. The risk group includes people who have had ailments in their family. The impetus for the manifestation of the disease can be serious stress, which becomes a catalyst.

Also, the reasons include emotional stress, fatigue. Stressful situations can change a person’s attitude to the environment, lifestyle. For example, it can be the loss of a relative, dismissal from work.

Bipolar disorder can occur against a background of hormonal disruption, which is most often characteristic of women during pregnancy, menopause.

Hyperreactivity, the nature of the melancholic lead to the fact that a person is easily exposed to stress. Bipolar disorder develops due to brain injuries, viral infections, alcohol, drug addiction, drug use, excessive consumption of coffee, cigarettes, energy drinks.

In women, bipolar disorder manifests itself after childbirth, if during pregnancy there was no proper regimen, nutrition, and there were frequent stresses. The active stage begins during the menstrual cycle, menopause.Also, the disease is characterized by a predisposition or the disease proceeds at the stage of remission. For prevention and prevention, it is recommended to undergo diagnostics, therapy, which will avoid a period of exacerbation.

What to do if I have bipolar disorder?

Initially, you need to determine if a person has a disease. Emotional changes are characteristic for everyone, but if they are hyperbolic, social activity is lost, there is no interest in life, work, habits change, then these are clear signs of bipolar disorder.It is necessary to determine whether there are symptoms of the phases of the disease, how they manifest themselves. In this case, you need to contact the specialized drug treatment clinic “Enlightenment”. Prior consultation with a specialist will help to confirm or rule out the presence of bipolar disorder.

Not always the signs can be recognized at the first stage of development. Especially if the ailment is in the phase of mania, because the person in every possible way denies that he is sick. For relatives, you need to be patient, and start a conversation during a period of depression.In this state, the patient is able to hear and agree to help. The best advice would be to go to the clinic to diagnose the disease. A person should understand that there is nothing shameful in this, but only for his good.

Emergency and planned hospitalization in a psychiatric hospital in Moscow is carried out around the clock, including on holidays and weekends. The waiting time for a visiting psychiatrist is usually between 30 minutes and 1 hour.

Treatment of bipolar disorder in the KORSAKOV clinic

Electroconvulsive, psychosocial therapy is used as the main methods of treatment.Psychotherapy can be carried out individually, in groups, in a family circle, using a cognitive-behavioral method. In our psychiatric clinic “KORSAKOV” patients have the opportunity to undergo an effective course of treatment, which is prescribed and conducted by experienced specialists in the industry. The doctor’s help will allow you to return to a normal state, to achieve a period of remission of the disease. Psychotherapy identifies the problems that cause disorders, teaches to understand, solve them, control the emotional background.

To undergo treatment for bipolar disorder in Moscow, leave applications by calling the free multichannel phone 8-800-555-4023.Or make an appointment remotely.

INPUT TREATMENT CONDUCTED

  • Polina Sergeevna

    NOSOVA


    Head of the psychiatric department.
    Senior Researcher. Psychiatrist

  • Anton Evgenievich

    NIKOLISHIN


    Psychiatrist, doctor expert

  • Sergey Vladimirovich

    KURENKOV


    Clinical psychologist. Psychotherapist. Hypnotherapist

  • Yuri Borisovich

    MOZHGINSKY


    Doctor of Medical Sciences. Psychiatrist-psychotherapist

  • Asiyat Mustafaevna

    NIYAZOV


    Analytical psychotherapist, clinical psychologist

  • Alexandra Mikhailovna

    MAKAROV


    Psychiatrist-psychotherapist

  • Teona Otarievna

    KACHARAVA


    Adolescent psychiatrist, sexologist

The full price list can be found at the medical center or ask a question by calling the hotline: +7 (499) 288-19-74

* The administration of the KORSAKOV medical center takes all measures to timely update the price list posted on the website, however, in order to avoid possible misunderstandings, we advise you to clarify the cost of services in the contact center by phone +7 (499) 288-19-74

The posted price list is not an offer. Medical services are provided on the basis of a contract.
There are contraindications. Consultation of a specialist is required.

“This is not me – this is my mood”

“Bipolar” sounds creative and fashionable. And from the outside it may even seem like a kind of gift – energy is in full swing! But what is behind the sudden mood swings – “super strength” or a serious illness? We figure it out together with the psychologist Ekaterina Pyatkova.

Fashionable diagnosis

– Fashionable diagnosis is a phenomenon that has been known for a long time.At different times, certain diseases were also attributed to one class or another, – explains Ekaterina Pyatkova. – For example, gout and nobility. If you are a nobleman, then you must have gout! And remember the expression “consumptive young lady.” Tuberculosis is a terrible disease, but there was a time when it was also romanticized – it was considered a fashionable disease of aristocrats.

Bipolar disorder is nothing more than manic-depressive psychosis. And, of course, there is definitely nothing romantic about psychosis.And all these flirting with the diagnosis: “I have a bipolar” – rather, from ignorance of the essence of the disease. Or from my own infantilism: “This is not me – this is my mood.”

According to statistics, true bipolar disorder occurs in five percent of the population. The onset of the disease manifests itself between the ages of 15 and 25 years. And the state into which it plunges is really like two poles – from the stage of mania or a very heightened mood to the stage of the deepest depression.

The rope over the abyss

Periods alternating with each other – such inverted poles – can take from several hours to several months.The extreme signs of mania include a decrease in the need for rest, agitation, excessive impulsivity and excessive emotionality – as if the sound on the TV suddenly increased. Speech speeds up – there is a feeling that the person is speaking faster than he thinks.

Self-confidence, risky behavior in this state border on the lack of self-preservation instinct. I’m not afraid of anything! Walk the tightrope over the abyss? Easy!

Bipolar patients can indeed look very attractive.Their unrestrained energy is capable of bewitching – people are drawn to them. And they themselves feel like “superheroes”. And, of course, in such a state they do not seek medical and psychological help. It is extremely difficult to track a bipolar in a cheerful mood of its owner. Relatives, by the way, also close their eyes to many things: “He is joyful! Yes, he sleeps a little … But he works with rapture almost 24 hours a day! And it brings a lot of money … ”

Only after the stage of ascent, there is always a stage of decline.And a sharp one. Suddenly, severe fatigue rolls over – there is absolutely no strength, loss of energy – “they turned me off.” This pole is characterized by a feeling of unmotivated sadness, hopelessness, isolation – a person in this state stops taking pipes, does not call back, loses interest in everything that was previously dear and valuable to him.

There are problems with memory – defocusing appears or, conversely, circular clinging to some specific events. During depression, destructive thoughts may appear, including thoughts of suicide.

The fix idea and dwarf chickens

A typical example of life with bipolar disorder is the artist Vincent Van Gogh, who, on the rise, could create a masterpiece in a day or overnight. And what was in the depression stage? He cut off his ear and ended up in a psychiatric hospital.

The danger of mania lies in irrational actions. During this period, millions of loans are taken – after all, there is complete confidence that I have come up with a super-project! A person can suddenly catch fire with the idea of ​​”fix” and sell his own apartment – buy with all the money, for example, dwarf chickens.But the state of mania is over – what to do with the chickens next?

In the stage of severe depression, a bipolar person is not able to clean up what he has done earlier. Coping with symptoms – anxiety, guilt, lethargy, apathy – is difficult for him. In this state, there is a high risk of death, since there is no sense of perspective and that everything will be fine in the future. Without the involvement of specialists – psychotherapeutic and drug treatment – it is impossible to cope.

Bipolar disorder can be inherited.But genetic predisposition is not the only provoking factor for development. It can be various head injuries, hormonal imbalances – especially in adolescence, or some traumatic life circumstances.

“Outrageous! All will pass!”

I had a teenage boy in my practice – a good family, the child always did well, was active, cheerful, energetic. And suddenly, according to his parents, it was as if he was replaced – “the self-destruction mode turned on.”

At the consultation, he did not open immediately, but during a confidential conversation, it was possible to find out that not long before that, the teenager had experienced a situation of grave humiliation – he, so strong and successful, was pressed by gopniks in the entrance. And psychotrauma became the reason that he changed his internal idea of ​​himself: “I am nobody. They took me and pounded me. ”

Locked himself in, began to “score” on studies, school Olympiads, stopped drawing attention to himself, sloppiness appeared – he was not happy about anything at all.The therapy, including family therapy, lasted about six months. And it’s good that the parents sounded the alarm – they asked for help. After all, sometimes the mood swings of a teenager are attributed to a difficult age: “Outrageous! All will pass!” And so, indeed, it happens – with cyclothymia, mood changes occur for weeks, but bipolar disorder – here everything is much more complicated.

During the day, the mood can “jump” several times. In the morning I woke up, and everything seemed to be fine, but after a couple of hours – severe depression, and you are already on an emotional day.Mood swings destabilize completely.

In the case of my client, bipolar disorder, fortunately, did not develop. Now the guy has everything in order with his self-esteem, he successfully graduated from school, entered the university. But what would the life scenario be if the despondency then took hold?

Uncontrollable Parsley

Bipolar disorder is medically classified into several types. All of them can lead to unpredictable changes in behavior.

The first type – a manic episode accompanied by a major psychosis. It’s like a swing – a sharp rise and an equally sharp drop. The reason for the outbreak of euphoria may be absolutely insignificant. I saw a ladybug – it became a trigger for superemotion. The states of rise and fall sometimes replace each other as quickly as a ticking clock, and lead to complete emotional and psychological exhaustion.

The second type – a person does not experience such pronounced phases, but this does not mean that the form of the disorder is less severe.Let’s say there are two bursts of increased excitement, like two small waves roll in, and then once – depression. The state that replaces mania, as a rule, does not go unnoticed. If not the patient himself, then his relatives seek help. But, unfortunately, if the emphasis is only on the depressive state, and the previous periods of “take-off” are lost sight of, then the initial diagnosis can be made erroneously, like ordinary depression.

Bipolar disorder is sometimes confused with multiple personality disorder, but depersonalization does not occur in bipolar patients.If, with a split personality, one subpersonality does not know about the existence of the second, there is a whole kaleidoscope of subpersonalities, then here the person does not lose himself.

He only loses control over his emotions. Like a Parsley doll pulled by the strings. Nobody knows when what thread is pulled. And it is possible that one stage will replace another just at the moment when the fearless tightrope walker has already passed half the way … But the way back over the abyss – alone – without support and help will simply not be able to master.

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Gone with the Wind: Bipolar Disorder and Tuberculosis Ruined Vivien Leigh’s Marriage

Vivien Leigh

Strong character and tenacity helped Vivien Leigh to become a Hollywood star at a time when English actresses were not favored in America. She broke stereotypes, demonstrating a non-standard approach to work: she joked to defuse the situation, argued with the directors while other artists were embarrassedly silent.

Until now, Vivienne is considered one of the most beautiful actresses in Hollywood. Lee feared that she would not be taken seriously because of her attractive appearance. Although some playwrights did show doubts about the British woman’s talent, she deservedly managed to win two Oscars.

Any successful woman should have a vivid love story. Vivienne was no exception to this rule, but, unfortunately, she could not save her marriage to her adored Laurence Olivier.What was the main reason for the collapse of the star union: the complex character of the actress, her mental disorder, or the indifference of Olivier?

DREAM FURTHER

The role of Scarlett made Vivien Leigh a star

Vivian Mary Hartley was born on November 5, 1913 in Darjeeling in a military family. The girl’s mother played in a small theater and once involved her three-year-old daughter in a play. From that moment on, Vivian dreamed of the idea of ​​becoming an actress.

The first educational institution of the child was a school at the monastery of the Sacred Heart in England.Contrary to the hopes of her mother, the girl did not grow up to be a humble Catholic: during the summer holidays, her father often took her home, took her to the races, dressed up in expensive dresses and proudly showed her to friends. No one noticed how from a teenager Vivian turned into an attractive girl.

With the support of her father, she entered the Royal Academy of Dramatic Arts in London. While still a student, Hartley began acting in commercials. The first significant role for the actress was the work in the film “Things are going well” in 1934.Then the artist decided to change her name to a pseudonym. This is how the movie star Vivien Leigh was born.

Vivien Leigh won two Academy Awards

Critics praised the actress’s performance in The Mask of Virtue, although after a few months the play lost popularity. But the director Alexander Korda drew attention to the artist, who offered her the first contract. At the same time, Vivienne’s fateful acquaintance with Laurence Olivier took place. Together they starred in Flame Over England, but the rising star was already dreaming about the role of Scarlett in Gone With the Wind.

After Yankees in Oxford, American directors became interested in Lee. Despite the fact that fifteen hundred actresses applied for the main role in the film adaptation of the novel by Margaret Mitchell, David Selznick took a chance and gave a job to a little-known British woman. It was not easy to play in the project: during the filming, two directors were replaced, Selznick found fault with trifles, and Leslie Howard, who embodied Ashley Wilkes on the screen, completely annoyed Vivien Leigh. At first, Clark Gable was skeptical of the foreigner, scolding her for being late, but after the very first obscene joke from the woman’s lips he realized that he was facing a strong personality that had nothing to do with prim English.

Even in such a difficult environment, the actress was able to create an image that audiences around the world fell in love with. Of the eight “Oscars” awarded to “Gone with the Wind”, one deservedly went to Vivien Leigh. She was called the Englishwoman who became the symbol of Hollywood. The success of the artist grew by leaps and bounds, and the directors offered her more and more new roles: in the films “Waterloo Bridge”, “Lady Hamilton”, “Anna Karenina”. But some playwrights were wary of Lee, hearing about her explosive nature. At that time, no one suspected that the disease was to blame, and not the banal bitchiness of the star.

The role of Blanche DuBois negatively affected the fragile mental health of Vivien Leigh

Repeating the triumph of Gone With the Wind turned out to be more difficult than the artist thought. After several films and touring with performances, Vivienne played Blanche DuBois, first in the play, and then in the film version of A Streetcar Named Desire. The character was completely different from the beloved Scarlett, and the picture contained hints of rape and promiscuous sex, which became the reason for numerous discussions. An obscene sense of humor helped the actress to embody a controversial story on the screen.For the role of Blanche Lee she received a second Oscar, but later admitted that this work seriously shook her psyche.

Vivienne continued to play in the theater and starred in a couple of films: “The Roman Spring of Mrs. Stone” and “Ship of Fools.” However, for the fans, the most striking roles of the actress remained Scarlett O’Hara and Blanche Dubois.

FATAL LOVE

Laurence Olivier was the main love in the life of Vivien Leigh

While studying at the Royal Academy, Vivienne met lawyer Herbert Leigh Holman.He was almost 14 years older, but the student thought that she could start a family with an experienced and wise man. The lovers got married, and a year later they had a daughter, Suzanne.

Family life quickly disappointed Vivienne: she did not want to stay at home, do housework and change diapers. Then the friends recommended the artist to the director of the picture “Things are going well”. Deeper and deeper into the work of the actress, the young mother was moving away from her husband and daughter every day.

Vivienne dreamed of a divorce, especially when she met Laurence Olivier.The baron was married, which, however, did not prevent the actress from going to his performances. Mutual passion gripped the artists on the set of Flame Over England. They abandoned their previous families, left their children in the care of the spouses and began to live together, but they officially broke up the marriage only in 1940. Colleagues were amazed at the all-consuming love that reigned between the stars. Parting was like a tragedy for them.

“I’m in hell, my love, – this is a real valley of shadows,” wrote Laurence Vivien from the filming of Wuthering Heights.”I have never felt so heavy in my heart.”

Dreaming of playing with her lover, Vivien Leigh agreed to the role of Lady Hamilton

Was Baron Olivier discouraged by the unexpected success of his chosen one after the release of “Gone with the Wind”? Friends believed that very much, because from now on the actor was called nothing but the husband of Vivien Leigh. Her fame overshadowed the popularity of Lawrence, which could not but affect family relationships.

Vivienne truly loved Olivier and tried to do everything not to harm his self-esteem.The actress declared that she hates Hollywood, propped up the door with an Oscar statuette, and tore up laudatory notes about herself in the newspapers. For the sake of her husband’s dreams of her own performances, Lee gave him all her savings. In addition, she wanted to give the chosen one of the heir, but her health did not allow: the body weakened from hard work and lack of sleep, which led to a miscarriage.

But what really destroyed the couple’s relationship? Increasingly, Lawrence drew attention to the strange behavior of his wife. For several days, the actress was hyperactive, then followed by an emotional breakdown, when she rushed at her husband with fists and sobbed, and then she remembered nothing and regretted.Olivier offered Vivienne to seek help from the hospital, but she refused to the last, because she believed: only love can save her.

SADNESS FINAL

After the divorce, Laurence Olivier married Joanne Plowright

Her husband’s expression of feelings really helped to improve Lee’s mental state for the first time. When Lawrence showed concern and sent loving letters, Vivienne felt elated. But the tantrums returned, and it became more and more difficult for Olivier to endure them.

The ailment worsened, and the actress expressed aggression not only at home, but also on the set. She forgot a lot, and when she finally went to the clinic, she learned about the disappointing diagnosis – manic depression. At that time, there was no effective treatment for personality disorder, and the pills and electroshock therapy made Vivienne’s behavior even more unbalanced. Once the artist was found naked in the park, another time she tried to open the hatch on the plane and jump out.

Modern physicians would point out that Lee had bipolar disorder, which caused her to go from a state of extreme rage to complete detachment, staring at one point.This serious illness was the cause of all the troubles of the actress, but Laurence Olivier sounded the alarm only when a new, more understandable diagnosis – tuberculosis – was added to him.

“Please, my angel, tell me word for word what the doctor said. Let him send a report on your health, says one of Olivier’s letters from Paris. “You are the only person in the world who could love such a disgusting egoist like me.”

The last role of Vivien Leigh in the movie was the alcoholic Mary from “Ship of Fools”

But time passed, and there was no improvement.For 20 years of marriage, Lawrence felt trapped: he was chained to a sick wife and the glamorous image of a Hollywood couple, obliged to smile dazzlingly, despite the inner suffering. Vivienne had felt for a long time how they drifted apart. The actress’s suspicions were confirmed when in one of the telegrams Olivier said that he loved Joan Plowright and was filing for divorce. The news crushed Lee, aggravating her already precarious state of mind.

Attempts to return her husband were pointless, and in 1960 Vivienne agreed to divorce.She continued to love Olivier, plunged deeper into depression, suffered from insomnia. Work and romantic relationships with colleague John Merivale could not heal the star of mental wounds, let alone a very real tuberculosis.

On the night of July 7, 1967, Lee was left alone while Merivale performed at the theater. He found the lifeless body of the actress on the floor when he returned home. Laurence Olivier was most worried about the death of the artist. Sadly, he revisited the last film with the participation of his ex-wife, where her heroine Mary in paints described her main misfortune.

“If you cannot get what you dream of, be satisfied with what you have. I wanted to live profitably, and for someone to love me forever, ”Mary Tradwell repeated from the screen. – Ridiculous, isn’t it? I chose the wrong person. He made me a famous wife, and I made his life hell. It all ended in divorce. So forgive me. I don’t like hearing about happy marriages. I envy them. ”

Based on materials from The Hollywood Reporter.

Photo: Getty Images, frame from the movie “Lady Hamilton”, frame from the movie “A Streetcar Named Desire”, Legion-Media, frame from the movie “Ship of Fools”

“Mental Health: Execution Error” / Habr

Looking for information for a new I came across an essay by Kenneth Reitz, a well-known popularizer of Python and an active contributor to open source projects, who writes about his experience of insanity and anxiety associated with this state.I am sharing with you the translation.

In the last couple of years, the IT community has begun to speak openly about its problems related to psychological diseases, so I will probably take this opportunity and share my problem on this wave too.

In general, my life is quite stable and not particularly remarkable. I spend time with my family and friends, I am fond of electronic music, synthesizers and photography. And, of course, I spend most of my time working on a huge number of open source projects.

However, about a year and a half ago, everything changed. As soon as I got rid of the constant, debilitating headaches, I immersed myself with interest in the study of yoga, meditation and Eastern philosophies. In fact, I have always been interested in different approaches to understanding the world and myself, so given the fact that I grew up in an extremely religious family, I spent a lot of time reading authors such as Ken Wilbor, Ram Des, Terence McKenna and Alex Gray. Naturally, I assimilated their ideas in my own worldview, which, by the way, at that time seemed to me quite normal and not promising any dangers.

Fast forward 12 months: I’m undergoing voluntary counseling at the mental health unit at Winchester Medical Center. I naively believed that at any moment I could collect my things and leave this institution, however, this was not entirely true. Nobody was going to let me out until I got better.

And I was sick.

Sounds strange, right? Successful man Kenneth Rietz from Riquest Fame undergoes a mandatory psychological examination.I understand you think that this can happen to anyone, but not to you.

Yeah, I thought so too.

I have bipolar disorder

In September last year, something happened to me that could be called a “general psychological crisis.” I was hospitalized with bipolar disorder and psychosis. This diagnosis was a complete shock to me. After all, I am always in a good mood, it was some kind of nonsense.

As it turns out, bipolar disorder is not always associated with depressive mood swings, as I previously thought.This disease can manifest itself in different ways, and a huge number of people daily face the problem of performing routine tasks that would not cause difficulties for a healthy person.

My brain can be in several phases, each of which could be classified as a characteristic of an individual:

  • Normal: people with a normal lifestyle.
  • Hypomanic: extremely productive, overly confident, very agitated, very talkative, very alert (even if he slept a little).
  • Manic: extreme degree of hypomania, absolute absence of fatigue, a huge amount of energy (it is impossible to fall asleep), often accompanied by hallucinations and psychosis.

Hypomania has always been the norm for me, and what’s more, the success of most of my open source projects has depended on this condition. I always had trouble sleeping when I was working on technical projects, I just never got tired.

However, the manic stage was something new to me. Actually, the same psychological crisis was caused by the manic phase of the disease, as well as the lack of sleep and food for four days (I was fasting). Now, assessing the situation, I can say that this was my second case of a manic phase. About a year ago, while traveling in Sweden, I did not sleep for almost a week, practicing spiritual practices. After that, I began to hallucinate and I began to make rash decisions.

It was then that I felt the manic phase of my illness for the first time.

When you are in a manic phase, you are the embodiment of vigor and you can only dream about sleep. And it doesn’t matter how long you slept. You want to avoid the manic phase at all costs.

Image of psychosis

I want to show you what my completely normal brain of an ordinary engineer looked like from the inside at the time of psychosis. I want to warn you, I’m sure you know that I’m usually a perfectly normal and reasonable person.And what you are reading now can happen to absolutely any person experiencing the slightest psychological difficulties. This can be shocking.

Without further ado, I was simply going crazy.

By the time I was taken to the hospital, I experienced several bouts of hallucinations, the essence of which was that my world had acquired its own set of rules that I had to figure out. This state is very similar to the sensation of a dream in reality, only all this happens in reality, and not in a dream.I was completely confused.

I was fully confident that I was experiencing the so-called “Kundalini awakening” (the process of cleansing the chakras, gaining knowledge of your inner nature, calming the mind and solving all kinds of mental, emotional and physical problems – translator’s note) and do not need medical help. I realized that I was acting inadequately, however, I thought that everyone else did not understand what was happening, and I was the only one who knew exactly what was happening.

I was experiencing a severe crisis of self-determination.When asked about my weight, I chose between 158 pounds and the weight of the entire universe. When asked for my name, again, there were several options: “Kenneth Reets” and “I ॐ AM”.

Because of the state in which I was during the hallucinations, every word that I uttered seemed to me an immutable truth, and therefore I tried to speak as convincingly as possible. Every time I was asked quite simple questions, I experienced a mild panic attack.

It seemed to me that I was deprived of my own emotions, and that all the emotions that I experience belong to the people around me.My task was to pass these emotions through myself, bringing peace to this room and healing the people in it.

It seemed to me that I was in several realities at once: in one of them I was in the hospital, in the other I was in prison, in the third in heaven, in the fourth in hell. It seemed to me that I was simultaneously alive and dead, asleep and awake, and at the same time I was in a place resembling purgatory, which is the center of all dimensions.

I did not have access to the Internet (and, in general, access to any gadgets), but in my pocket I kept a transparent heart made of quartz, which served as a “channel for transmitting the energy of the Internet.”

Since recently I have been actively studying philosophy, theology and what is called superstition in the modern world, I have consistently been in several theological incarnations of myself. Each of them represented an absolute truth through which I expressed myself and which I was forced to accept as myself.

At first it seemed to me that I am God myself (a.k.a I ॐ AM breath of life). Then I became Lucifer / The Devil (Python!). Then Narcissus. Then Jesus. But it seemed to upset the people around me.And so I decided that I am Archangel Metatron, who will create other angels. Therefore, for some time I tried to make friends with the patients of the clinic and explain to them that they are also angels, like me. Then I became a Hermes / Mercury messenger.

When my previous disguises were exhausted, I became the Shaman of purgatory (clinic) and my task was to look after the place of other patients who went to the “ceremony” (group therapy). At that moment, I behaved quite aggressively, because I believed that this was my destiny, and the choice I had was the following: to stay in the clinic forever extolling this land to the stars, or to finish my mission and leave (which the doctors wanted).And this was the most important decision in the history of all things, and this decision must be made immediately. You see, yes, how great the stress was. Thinking carefully, I remembered the Book of Genesis and the fact that on the seventh day the Lord rested from his great works. So I decided that a good engineer would start the mechanism by hand, and then figure out a way to make the mechanism work without his help, while he himself would go home to rest.

After seven days, my brain caught the second arrival. It may seem absolutely not normal to you, but as for me, he was very funny and creative.This time Kenneth Robert Reitz a.k.a. Metatron appeared as an interplanetary being from the Sirius galaxy. My brain was a great architect and creator of all kinds of physical and spiritual life, and was also responsible for the emergence of technology. Overall, I felt responsible for improving the quality of life of everyone around me. For example, it was my brain that created the great Egyptian pyramids. Several times a day, during meditations, I moved from Earth to the Sirius model, basking in the sun. The earth in my mind was the “ideal” logical storage of information (life itself), while the universe was the storage of the LUN.With the principle of potential consistency in mind, I used Amazon Dynamo (DB), built to recreate life across the universe. It should be noted that at the same time I just watered the plants in the garden. Right now, Amazon is actually using Request to do all the internal API management for AWS, effectively leveraging my code to make some of the internet work. Are you catching it? The AWS US-EAST Amazon region is 70 miles from my location, and it was in my head where the American version of the Egyptian pyramids was located.The earth was my Garden of Eden, and I wanted to go home to my Eve. After all, I created this place just for her. I really wanted doctors and my family members to just look at Dynamo’s technical documentation, and then they would definitely understand everything and believe me.

For your reference, by that time I had not slept for about 10 days, and I was not sure at all whether I was alive or dead.

It may sound crazy to you, but it was this moment that marked the fact that my brain is returning to normal perception of reality.I finally started to navigate the time and schedule of procedures for the day. Gradually, I stopped associating myself with theological absolutes, and moved on to things closer to my reality: my name, technologies / code, and my relatives.

The turning point was when I handed the doctor a piece of paper with the address of this website written on it. This allowed him to understand who I really was, and served as an excellent help in determining my diagnosis.

As soon as this period ended, I began to come to my senses and feel like an ordinary person. I tried to concentrate on the fact that my name is Kenneth and began to have fun with my unfortunate friends who are also at the clinic. But everything was not so smooth, I was still going through numerous crises of self-determination. I realized that I wanted to leave this institution, and I was not ready to stay there forever (as I had planned earlier). It was as if I was in a kind of puzzle, and I decided that the status of a doctor would help me get out of there! I approached doctors and other medical professionals and acted as if we were colleagues and I was helping them in their work.At some point, I asked the nurse for a form for depositing funds into the account (I saw it from one of the patients), deciding that this was the key to my admission to the staff of doctors. I was keen to let them all know that I am up to date on all matters with health insurance (HIPAA) and also understand the reasons for their transition from the AS400 system to the higher level of technology (EPIC).

In the end, I solved the puzzle and realized that the shortest way to freedom is to take the drugs that I was prescribed at the very beginning, and in a healthy sleep.By that time, I had not slept for over 12 days, but I did not feel any tiredness or sleepiness.

After a couple of days I was finally discharged with a bunch of recommendations and a diagnosis. And even on a multi-drug regimen, it took me several weeks to recover from my “journey.” I want to express my deepest gratitude to my family and Heroku for their endless support.

Fortunately, all this remained in the last September, and now I am 100% healthy.

How did all this happen ?!

The year before, when I was completely immersed in Eastern religion and modern philosophy, I had the first symptoms of psychosis. This usually happened after prolonged meditation, and these symptoms were considered by me as a spiritual experience or “progress.” These visions were so real and coincided with all the descriptions that I found in books and online that I actually believed that, finally, I was close to comprehending the meaning of life.

Now I am sure that a huge number of people who call themselves followers and members of the so-called spiritualist community are simply not healthy.Adherents of Kundalini Yoga are no exception. People in such communities regard such symptoms as a positive effect of the practice, and also believe that these manifestations of the human brain are beyond the understanding of modern medicine (a doctor is not able to put the bindu chakra in order!).

Around the same time, leaving my first Kundalini Yoga lesson, I met (and fell in love) with an amazing woman filled with mystical knowledge. She wholeheartedly introduced me to the course of affairs and taught me to think from the point of view: numerology, synchronicity, Reiki (a method of psychotherapy and self-improvement – approx.translator), self-disclosure, the Mayan calendar, tarot, crystals, etc. In the meantime, I was getting worse. We felt a special and deep connection between us. I idolized her and felt that she could teach me a lot. We began to spend all the time together, went on dates, traveled all over the world, got the same tattoos, participated in exciting experiments and shamanic ceremonies. We had a great time together (and it was the best year of my life), but it was at that moment that the symptoms of my mental disorder began to appear.During that manic year that we spent together, my inadequate vision of the world (and hallucinations) began to noticeably prevail over my mind, which ultimately led to those absurd visions that I described above.

When she first left my apartment, I watched endless sacred patterns spill over my pale white front door. I usually experienced similar hallucinations after long periods of meditation or periods of arousal. And these hallucinations have been interpreted as something of deep spiritual significance.By the way, most of the hallucinations were not visible, but were sensations described by yoga as life energy. The rest can be described as an explosion of some high-resolution images.

How is your health?

Mine is great.

Six months have passed since my hospitalization, and I am happy to announce that I am now completely healthy. For many years I suffered from bipolar disorder (and did not know about it), and this disease will now remain with me for the rest of my days.But today, with some knowledge of psychological disorders, the right pills and adherence to sleep patterns, I know how to cope with it. And yet now, for the rest of my life, I will need to pay special attention to my psychological health. My illness requires respect J

Before all this happened, I had never been examined and did not even suspect that the problem existed. That is why I have been so prone to illusions all this time. It is unlikely that this can happen to me again, and besides, now I know how to recognize an abnormal way of thinking and avoid psychological crises if it does happen again.

Also, I have learned to rely on my family and friends, who strive to provide me with their constant support and constantly check how I am doing. Before that, I was overconfident.

Now that I know my diagnosis, I understand much more how my brain works and works, and also, I know how to prevent such situations in the future.

For the first time in a year and a half since this all began, I returned to work on my open source projects.

Now I am completely healthy and feel like the same person, before all this nonsense reigned in my head. Moreover, thanks to everything that happened to me, I feel happier and more fulfilled. Now I stand firmly with both feet on the solid surface of materialistic / physical / scientifically grounded reality, and wonder how it could have been otherwise. Sometimes, however, I have trouble sleeping, but I try to adapt to these situations.

Unlike the transcendental distance of spirituality, now I prefer to rely on the foundations of being – I eat, I breathe, I die.Spirituality version 2.0 for people!

Also, I got rid of my rich collection of books and objects of a metaphysical nature. True, I left a rather large collection of crystal spheres and skulls, they just look cool on my desk J

Now I feel a strange relief that all these crazy things happened to me due to a psychological disorder, which turned out to be quite easy to control (now that I know my diagnosis).

I am now taking Lithium and it helps me a lot to stay in my normal or hypomanic state.

Conclusion

For the most part, I wanted to share this story because it will surprise many. I have said almost nothing about my illness publicly, and hardly anyone with a similar problem has ever dared to do so.

I want to be living proof that this can happen to anyone, including yourself. Perhaps this is already happening. And if so, don’t worry, everything will be fine.

Key findings

  • Sleep is very important
  • This can happen to anyone, even you.
  • Don’t fall in love with super intelligent interplanetary beings.

Read Kenneth’s original essay on his website.

how I live with my illness – Knife

First

Excess weight . It would seem that this is not a mental problem, but it was because of the psyche that I gained all the extra pounds. The worse I feel, the more I eat. In the most depressive periods of my life, all I do is eat and sleep.Repeating this cycle around the clock. In this connection, I am rapidly gaining weight. In my worst six months, I put on about 25 extra pounds. At the moment I weigh more than 90, which, of course, affects both my health and appearance, that is, self-esteem and attractiveness.

Second

Constant anxiety and obsessive thoughts. Imagine that you are a mother or a father and your child does not come home for a long time. You are worried, nervous. Nothing can make you calm down and relax.From time to time you forget to sleep, but as soon as you wake up, anxiety returns in full. So this is what I feel all the time. Every day. For any reason or not. To a greater or lesser extent, that’s how lucky you are.

Third

Sadness without any justification. It would seem that this happens to most people. Well, in general, yes. Only my sadness happens much more often, manifests itself more strongly, leads to tears and terrible desires. Again, she can catch me at any moment, even in Paris in the most romantic place in the city.My sadness doesn’t care where I am and what I do. She is merciless and annoying.

Fourth

Ambivalence. This means that I can have completely opposite feelings for the same person. For example, today I just adore my grandmother. I remember how delicious her pies are, how she hugs me and calls me Nastya. But tomorrow I wake up with the thought that I can’t stand my old nasty grandmother, who has always burnt greasy pies, from which I get even more fat.I remember how disgusting it becomes to me when she hugs me and calls me Nastya, that is, she lisps with me. And these are the pretzels my psyche gets up to every day. How to maintain balance in relationships with others in this state? So I don’t know.

Fifth

I change every day. I am fickle and unpredictable. You might even say unreliable, you can’t rely on me. Today I sympathize with you with all my heart, I speak pleasant words, I respond well to comic statements.I am cheerful and cheerful, I am the soul of the company. I’m just on fire. So, of course, when you, my friends, want to get together again, you will invite me to come with you. And what do you get this time? A dissatisfied, spiteful, silent shrew, who turns her face away for a joke, “imperceptibly” makes the music quieter and drinks and eats like a horse. Unpleasant? Do you want to have a girlfriend like me? Will you treat this with understanding or quickly delete my number from the phone book?

Sixth

I have crazy ideas .For example, last summer I suddenly wanted to go to China to study. So what if I don’t like Chinese and can’t live without my mother. So what if it is expensive and doubtful. I want, and that’s it. I want and, therefore, I will achieve it. Thank God that our family simply did not have the money for this, and soon they let me go. I was content with a Moscow university and a rented apartment. But now I am even afraid to imagine what it would be like if I ended up with my diagnosis in China, where, moreover, there are so few Russian speakers and no acquaintances.Next summer I also wanted something, but that’s another story.

Seventh

Social phobia . In other words, sometimes I literally shake when I find myself in the immediate vicinity of a person, for example, a doctor or a waiter. I am terrified of panic, I can escape from the office or cafe, forgetting about my purse or unpaid bill. Sometimes, when I walk along a crowded street, my eyes begin to double.As soon as I enter a safe apartment, everything goes away as if it never happened. The next day, everything is repeated. By the way, in my case, social phobia is still quite weak, you will talk to hardened social phobes, if you catch up with them, of course.

Eighth (and perhaps the last)

I have to to pretend . Every day I pass myself off as normal, so as not to provoke anyone, not to frighten, not to enrage, not to make anyone nervous. I do not reflect true emotions on my face, so I try to make my face indifferent, and those who don’t know me well think that I am just that kind of person.I cannot complain to anyone about my health. Let’s say classmates or acquaintances. If my leg hurt, people wouldn’t force me to play football. It’s as natural as breathing. But if you have a panic attack or melancholy, you cannot say: “Oh, I am sad / scared, I am not going to class.” At best, they will look at you strangely, the worst is not even worth imagining.

Join the club 90,000 Modern approaches to the diagnosis and pharmacotherapy of bipolar affective disorder :: DIFFICULT PATIENT

S.N. Mosolov, E.G. Kostyukova
Moscow Research Institute of Psychiatry, Ministry of Health of Russia, Moscow

Issues of diagnosis and treatment of bipolar disorder (BAD) in recent years have been one of the most widely discussed medical problems, both in connection with the significant prevalence of this disease and in connection with the difficulties of its diagnosis and therapy. The prevalence of bipolar disorder, according to various epidemiological studies, ranges from 0.5 to 2% (on average, about 1%) [34, 35, 61], the risk of developing during life, according to some data, reaches 5% [37], and taking into account subsyndromal forms – 12% [12].At the same time, no significant differences in morbidity rates associated with geographical or ethnic reasons have been established [59].
According to Lish JD et al. [42], 73% of patients with bipolar disorder are initially misdiagnosed, and subsequently the correct diagnosis is not established until an average of eight years after being examined by three different doctors; 59% of patients experience their first episode in childhood or adolescence, with more than half of them not receiving treatment for the next five years or more.15% of patients with bipolar disorder commit suicide [32]. Women who fall ill at the age of 25, in the absence of adequate treatment, can, on average, lose five years of life, 12 years of normal health, and 14 years of normal social functioning [40]. Most often, at the first stage of the disease, bipolar disorder is misdiagnosed as schizophrenia and / or alcohol or drug dependence, but most often as recurrent depression. In 5–20% of patients, the initial diagnosis of recurrent depression is subsequently changed to a diagnosis of bipolar disorder [17].It is known that 17% of patients who are seen by a general practitioner and receive long-term maintenance antidepressant therapy as prescribed by him, actually suffer from bipolar disorder.
BAR undoubtedly requires much more attention than that which has been given to it so far and is still being given. The consequence of this is the controversy in the field of bipolar disorder therapy that has developed to date. On the one hand, it is generally accepted that the therapeutic capabilities of bipolar disorder can and should be improved, and modern therapy standards allow this to be done.On the other hand, the small number of studies conducted in accordance with the requirements of evidence-based medicine limit the ability to defend the reliability of the therapeutic efficacy of a particular method.
Over the past decade, there have been major changes in conceptual approaches to the diagnosis and treatment of bipolar disorder. Making a diagnosis based on operational criteria is undoubtedly an important, albeit controversial, advancement in psychiatry over the past century. The most structured criteria are offered by DSM-IV.Obviously, for practice, strict adherence to research diagnostic criteria may be too strict a standard. However, this is exactly the standard to strive for, as the validity of the diagnostic criteria, especially for mania, is very high. In daily clinical practice, the use of self-questionnaires and standardized interviews seems to be very useful to improve the quality of diagnosis [33].
Bipolar disorder is currently the most commonly used term to describe recurrent mood elevations, usually alternating with episodes of depression.Descriptions similar to bipolar disorder have existed since antiquity, but the term manic-depressive psychosis was first introduced by E. Kraepelin and included all variants of affective psychoses. Patients with unipolar, including psychotic, depression fell into this diagnostic category, regardless of whether they had episodes of manic states or not. The emphasis on diagnosing mania and thus on bipolarity has been relatively recent. BAR-I is currently defined by the presence of extensive manic and, as a rule, depressive episodes.The prevalence of BAR-I is estimated in the range from 2 to 21 cases per 100 thousand population per year. This variation in prevalence estimates is primarily due to diagnostic difficulties. Indicators based on the first visit to the hospital, which is an obvious indication of the severity of the condition, have a smaller scatter and are defined as approximately three to four people per 100 thousand of the population per year. The lifetime risk of developing BAR-I is approximately 0.5% [11, 43]. In psychiatric practice, BAR-I has a significant proportion among other diagnoses, both due to its significant prevalence and due to frequent exacerbations.It is characterized by a chronic course with the frequency of episodes, defined on average as 9 per 10 years following the diagnosis. The recurrence rate in bipolar I disorder is higher than in unipolar depression, which is similar in severity [9, 60].
BAR-II is characterized by episodes of hypomania and extensive depression (Fig. 1). Using modern definitions (DSM-IV), the prevalence of BAR-II is higher compared to BAR-I [10].
The concept of bipolar spectrum disorders is often used to describe the course of disease that differs from the criteria found in current diagnostic manuals.These include borderline BAD-II, affective temperament (hyperthymic, dysthymic, cyclothymic, irritable), BAR-III (cyclothymia), BAR-IV, BAR-V, and BAR-VI (including patients with a hereditary history of bipolar disorder, the so-called unipolar mania, mania caused by antidepressants, hyperthymic depression, etc.).
Many of the symptoms of bipolar spectrum disorders can occur with other medical conditions, including anxiety disorders, psychotic disorders, personality disorders, etc.A few features from the spectrum of “mild bipolar disorders” by themselves may not constitute a diagnosis, but collectively they indicate a greater likelihood of belonging to the bipolar spectrum than to unipolar depression or other disease.
Since the time of E. Kraepelin it has been known that the disease often has a phase-return character and tends to progress, that is, to an increase in the frequency of exacerbations. The modern pathomorphosis of mental illness has led to a significant increase in the number of such cases.In recent years, more and more patients with a fast-cycling course have begun to be observed, that is, who have undergone more than four episodes per year [29], and cases even with a 48-hour cycle are described in the literature [36]. The unjustifiably widespread use of antidepressants is believed to have played a role in this [55, 58]. A fast-cycle course occurs in approximately one in four patients with bipolar disorder [26, 39] and is characterized by a poor prognosis and resistance to therapy [16, 56].
The concept of the etiology of bipolar disorder is based primarily on genetic theory [49].First-line relatives show an accumulation of cases of unipolar depression and bipolar disorder. In comparison with schizophrenia, the influence on the development of bipolar disorder of environmental factors, such as pathology of pregnancy and childbirth or living in large cities, is significantly less reliable [14, 23, 43]. Factors such as early onset and delayed diagnosis increase the risk of comorbid mental disorders and aggravate the course of bipolar disorder [41].
Significant prevalence of the disease, chronic course and significant maladaptive influence determine the need to search for new effective and safe therapy, and modern ideas about its pathogenesis dictate the need for a radical revision of the traditionally used therapy tactics.
The pharmacogenic factor has a powerful influence on the course of the disease. It was found that mortality rates in patients receiving pharmacotherapy are statistically lower than in patients not receiving treatment. At the same time, mortality from suicides is reduced in the process of pharmacotherapy by more than four times. Also impressive is the reduction in suicidal attempts during lithium therapy and their sharp increase when therapy is discontinued (see table).
Taking into account the chronic nature of bipolar disorder with the formation of various psychopathological formations at different periods of the disease, it is obvious that only complex pharmacotherapy with a flexible dynamic approach to the choice of therapeutic tactics depending on the clinical picture existing at a particular stage of the disease can stabilize the state and maintain the social adaptation of this contingent of patients.
Currently, there is no “ideal” drug that, in monotherapy, could provide all the clinical effects necessary for bipolar disorder, namely, antidepressant in the treatment of the next depressive phase, antimanic in the treatment of mania, antipsychotic in the treatment of affective-delusional states, prophylactic in regarding the prevention of recurrence of both poles.
At the same time, properly selected therapy using drugs of different pharmacological groups (normotimics, antipsychotics, antidepressants) can significantly reduce the severity of symptoms inherent in this disease.
In bipolar disorder, regardless of the phase and stage of the disease, the drugs of first choice are normotimics, which must be prescribed already at the initial stages, followed by continuous use throughout life. This group includes the traditionally used lithium carbonate, sodium valproate and carbamazepine, as well as the new drug lamotrigine.
Each of these drugs has its own spectrum, which differs from the others, as a normotimal activity (i.e., more or less prophylactic effect in relation to the phases of the opposite pole), and a more or less pronounced stopping effect in relation to depressive and manic symptoms.They also prevent the development of phase inversion caused by the additional prescription of antidepressants, which is often inevitable during periods of depressive conditions.
The ancestor of the group of normotimics is lithium carbonate, the prophylactic efficacy of which in bipolar disorder, especially in relation to manic phases, is well known, as is its suppressing antimanic effect. At the same time, the effectiveness of lithium as a topical therapy for depression is not so obvious. It is shown in several placebo-controlled studies, but their number is small, and the group of subjects includes both patients with bipolar and recurrent depression [13, 25, 28, 31].The antidepressant effect of lithium develops much more slowly than the antimanic effect. When lithium is prescribed during the depressive phase, it takes, on average, six to eight weeks to achieve a clear clinical effect, therefore, lithium monotherapy in the acute period of the depressive phase in most cases is insufficient. Long-term studies confirm its ability to prevent manic phases, but demonstrate less efficiency in relation to the development of depression [2-4, 6, 7, 18, 27, 50-52].Despite the fact that lithium carbonate is still a traditional treatment for bipolar disorder, the risk of toxic reactions, side effects and complications, as well as the need for constant monitoring of the drug in the blood, significantly limit the possibility of its long-term use.
Sodium valproate was the first drug to be used as an alternative to lithium. Over the past 20 years, its effectiveness has been studied in numerous open and controlled studies involving several hundred patients.Their results prove the effectiveness of valproate in bipolar disorder. The spectrum of its normotimal action is similar to the spectrum of lithium: it prevents the development of manic phases to a greater extent than depressive ones [3, 4, 6-8, 19, 24]. Its actual stopping effect is also more pronounced in relation to manic phases as compared to depressive ones [20, 46]. There have been no controlled studies of the efficacy of valproate in bipolar depression, and clinically it appears to be less effective in treating depression compared to mania [44].
Another drug widely used to treat bipolar disorder is carbamazepine. Despite its more than twenty years of widespread practical use, there have been no studies of its efficacy involving placebo control, randomization, and double-blind design. However, summarizing the data of numerous studies, we can say that their results convincingly prove a clear normotimic effect of carbamazepine [1-3, 5, 6, 15, 45, 54, 57]. In terms of overall effectiveness, carbamazepine is not inferior to lithium carbonate and sodium valproate, however, it has a different spectrum of normotimic action, since its effect is more fully manifested in relation to the reduction of depression compared to manias.The effectiveness of carbamazepine in the relief of manic states is inferior to the effectiveness of lithium. However, according to most studies of the anti-manic effect of carbamazepine, the number of responders to therapy is 50-70%. The antidepressant effect of carbamazepine is less pronounced than the antimanic effect [38, 53], but more than that of lithium and valproate. At the same time, well-designed placebo-controlled studies are needed to confirm the antidepressant effect of carbamazepine in bipolar depression, as for sodium valproate.In addition, the side effects of these drugs, as well as the risk of drug interactions in some cases, prevent long-term therapy.
Lamotrigine, a modern anticonvulsant, has long been used in the treatment of epilepsy, and is now also registered as a prophylactic agent for recurrent affective episodes (mainly depressive) in bipolar disorder. It should be noted that today lamotrigine is the only normotimic agent, the effectiveness of which, incl.including and in patients with “rapid phase change” [24], has been proven in methodologically accurately planned blind placebo- and lithium-controlled studies [21, 22]. Lamotrigine is close to carbamazepine in terms of its normotimal action spectrum. At the same time, its stopping effect on the symptomatology of the depressive phase in bipolar disorder seems to be more proven in comparison with other normotimics. The good tolerance of lamotrigine, both with short-term and long-term use, is its significant advantage over other drugs in this group.A meta-analysis of the results of a study of its tolerance in comparison with lithium and placebo shows that adverse events developed in only 10% of patients receiving lamotrigine, and, unlike lithium, the frequency of their development did not differ significantly compared with placebo.
Normotimics provide, first of all, a preventive effect and allow to prolong the euthymic period. The success of preventive therapy determines the global effectiveness of treatment for bipolar disorder and can significantly reduce or prevent social maladjustment of patients associated with the frequent development of exacerbations.Given the continuous long-term, almost lifelong nature of such therapy, it is necessary to minimize the manifestations of side effects, since they are often the reason for the spontaneous withdrawal of the drug and the patient’s refusal of preventive treatment.
The use of antidepressants and antipsychotics as a means of relieving depressive, manic and psychotic symptoms is inevitable during periods of exacerbation of bipolar disorder. Moreover, their influence on the course of the disease has its own characteristics.It has been shown that the use of antidepressants in the relief of bipolar depression is associated with a high risk of phase inversion, i.e., with the development of a hypomanic or manic state. In recurrent depression, the risk of phase inversion is extremely low (Fig. 2).
Pharmacogenic phase inversion is considered an unfavorable factor that aggravates the overall course of bipolar disorder. According to modern concepts, the number of previous episodes may be associated with a greater risk of subsequent exacerbations [30, 47, 48], ie, “the phase provokes the phase.”According to various studies, tricyclic antidepressants provoke phase inversion in bipolar disorder in 11-74% of cases [32, 50]. In this case, the frequency of inversions is dose-dependent and the higher, the higher the level of applied dosages.
Timely diagnosis of mixed and manic-delusional states is undoubtedly very important for choosing the right therapeutic tactics and predicting the subsequent course of the disease. Probably, it is precisely such states, along with manias that have psychotic features in their structure, that are mistakenly regarded as psychomotor agitation in schizophrenia.Such an erroneous diagnosis leads to the prescription of powerful classical antipsychotics for a long time, often in a depot form, which in itself contributes to the development of protracted states with the leveling of the affective radical and the formation of a frozen manic-delusional structure that does not undergo transformation, or causes an inversion of affect with prolonged adynamic depressions. … In addition, it has been shown that patients with bipolar disorder are more sensitive to the development of extrapyramidal side effects of classical antipsychotics.
Extrapyramidal symptoms caused by long-term use of classical antipsychotics in patients with bipolar disorder are sometimes the main reason for their disability. At the same time, the use of antipsychotics in manic states is inevitable in most cases and is determined by the high frequency of development of psychotic symptoms in its structure. About 50% of manic episodes are accompanied by delusional symptoms, 15% – hallucinatory and 20% – formal thinking disorders [32].
As in cases of inadequate prescription of antidepressants in bipolar disorder, prolonged use of classical antipsychotics, which, in addition to a negative somatotropic effect, have their own depressogenic effect, which is not justified by the need to control psychotic symptoms, can lead to chronicity of affective-delusional disorders and rapid disability of patients.
The foregoing determines the ongoing search for a drug that could provide all the effects necessary for bipolar disorder. In this regard, the focus of special attention at the moment are drugs of new generations, among which atypical antipsychotics occupy a special place. Moreover, theoretical views on bipolar disorder and schizophrenia as diseases having a common biological basis stimulate a new round of research on the efficacy of atypical antipsychotics as drugs, on the one hand, with proven efficacy in schizophrenia and, therefore, probable efficacy in bipolar disorder, and, on the other hand, which differ from classical antipsychotics in good tolerance.Recent studies show that the spectrum of their clinical action in bipolar disorder is close to the spectrum of action of normotimics. At the same time suppressing the development of symptoms of both poles and, above all, manic, they, like normotimics, do not cause phase inversion, while each of them has a more or less pronounced stopping effect in mania or depression. At the same time, atypical antipsychotics, in contrast to normotimics, have proven antipsychotic efficacy. The spectrum of clinical action of atypical antipsychotics in comparison with drugs from other groups to the greatest extent meets the requirements for this kind of “ideal” drug.Despite the undoubted promise of the use of atypical antipsychotics in bipolar disorder, further research is needed to prove their prophylactic efficacy and clarify the characteristics of clinical action.
Expansion of the arsenal of normotimic drugs with different spectrum of psychotropic action, in modern conditions, allows for more differentiated preventive therapy for bipolar disorder. Since there are no clearly verified clinical or laboratory predictors of the effectiveness of a particular normotimal therapy, the doctor should rely on various other signs when choosing a therapy.The choice of the drug is carried out, first of all, taking into account the peculiarities of the course of the disease, namely the predominant polarity of the phases: lithium carbonate and sodium valproate are the drugs of first choice in cases where manic symptoms dominate during the course of the disease, and carbamazepine and lamotrigine – with prevailing depressive symptoms. In a fast-cycling course, priority remains with carbamazepine, valproate and lamotrigine.
In addition, one should take into account the effectiveness of a particular drug in previous exacerbations or in the patient’s relatives, the presence of comorbid disorders (for example, drug addiction), signs of “organically defective soil”, etc.
Another important aspect when choosing a drug for long-term, almost lifelong therapy is the somatoneurological status of the patient and taking into account the spectrum of side effects of the prescribed drug. When relieving depressive and manic symptoms during periods of exacerbation, the drugs of first choice are also normotimics. In the case of their insufficient effectiveness, antidepressants (for depression) or antipsychotics (for manias and affective-delusional states) are added, and further stopping therapy is carried out against the background of normotimics.The appointment of antidepressants and classical antipsychotics should be justified and limited to the period of cupping therapy. When stopping manic and mixed states, as well as, if necessary, to influence psychotic symptoms in the structure of depression or mania, preference should be given to atypical antipsychotics.
Effective prophylactic therapy requires the use of adequate dosages of the prescribed drug. The drug regimen of treatment should be selected taking into account the patient’s individual tolerance of drugs in such a way as, on the one hand, to ensure their maximum effectiveness, and on the other hand, to neutralize possible side effects, which often in themselves are the reason for the patient’s refusal from any preventive therapy.In addition, throughout the course of treatment, it is necessary to adhere to the principle of a flexible, dynamic approach to the choice of drug dosages with the possibility of correcting them in the event of relapse or pre-relapse disorders, and if such correction is impossible, it is necessary to timely switch to a change in therapy using another normotimic or their combination.
Psychosocial support can be of significant help in the treatment of the depressive phase and reduce the rate of relapse. Some psychosocial techniques developed specifically for bipolar disorder are capable of reducing interpersonal conflicts, leveling potential trigger mechanisms for phase development, and / or smoothing out circadian rhythm.
Thus, BAD represents a wide layer of urgent and insufficiently studied problems of modern psychiatry, requiring close attention of researchers of various specialties, practitioners and a wide circle of the medical community. Only such interaction can support the existing theories with an evidence base on the way to establishing the truth and ensure the development of methods of therapy and social support that will ensure the preservation of the quality of life of a wide range of one of the most intact contingents of the mentally ill.

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90,000 Bipolar disorder, 3h Psychosocial factors

© By Andrey Arkadievich Shmilovich, Doctor of Medical Sciences, Doctor of the Highest Category, Head of the Department of Psychiatry and Medical Psychology of the Russian National Research Medical University named after V.I. N.I. Pirogova, chief physician of the clinic “Alter”:

Today we will talk about those psychosocial factors that in one way or another affect the course of bipolar disorder.

To begin with, a patient with this disease is very unstable in behavior, beliefs, plans, promises, deeds and, in general, in his life route. This route is very ornate, the pace and movement along it are very varied.

Communicating for a long time with such patients, we understand that relying on some long-term projects with them can be very risky, both in business and in some social ties, in family relationships. Everything that we see in periods when he is excited, when he is manic, all his progressive ideas, very often quite productive, creative impulses, can stop in one second.Serious social stagnation could ensue, and those who were filled with hopes and expectations will suffer.

This kind of instability creates a negative attitude towards such patients, which often develops into conflicts, which, by the way, are also implicated in their inherent impulsiveness. This is a very important point, because impulsive behavior, suddenness, unexpectedness, brutality of the reaction, as we say, all this gives rise to conflicts, serious disappointment.

Behavioral Problems

Often such a patient remains alone, is deprived of that very social environment, without which he simply cannot live.This is another aspect, another characteristic of the personality of bipolar patients. They simply cannot be without a social environment, emotional support is very important for them, it is very important for them to regularly receive confirmation of the success of their actions. When there is no one next to them, they have a natural feeling of fear, anxiety, anxiety that they will remain alone forever, therefore these patients are always in such a conscious and sometimes subconscious search for a social environment.

Wherever they are, in whatever society they are, they do everything to attract attention to themselves. In this sense, their behavior sometimes resembles the behavior of hysterics, although if a hysteric does this in a superficial way, simply for reasons of satisfaction of his inner ego and vanity, then in a bipolar patient this is simply vital communication. Sometimes a bipolar patient says: “We may not even communicate with you, I just need you to be near, so that someone is near, otherwise I will feel bad.”

Turning to doctors, such patients often formulate their complaints, first of all, about the psychological and social problems of their life, and not about what is happening in their souls, not about the classic medical complaints that patients with depression and manic state complain about. …

They say: “I have somehow more or less adapted to this, I already know which medications, which antidepressants or antipsychotics are suitable for me to cope with this.Please help me to establish good communication with my loved ones, with wives and husbands, with children, with parents, with friends, with bosses, with subordinates and so on. ”

And this is where a rather serious problem arises. We invite these very people for consultation, we often see that these people are not indifferent to what happens to the patient. Nevertheless, they are not ready to continue any relationship with him, and we have to engage in a rather complex and very long, thorny family psychotherapy, group psychotherapy, engage in psychoeducational activities, explaining what kind of disease it is, what symptoms should be ignored, and to which must be taken very seriously.

Relationship with loved ones

Relatives of the bipolar patient begin to assume that many of the behavioral problems are actually simulative, there are no symptoms, and this is already manipulation. A patient with a good experience of depressive disorders, being in euthymic remission, can easily portray this or that disorder at the right moment for him, cause the necessary self-pity, provoke a conflict when he needs it. And then refer to the fact that it was a manifestation of the disease, or that he was prescribed the wrong pills, or the stars did not align.

There is some truth in this. We often see this kind of simulative (aggravational) reactions, when the patient slightly exaggerates the severity of his problems and experiences. The boundaries are very blurred, it is extremely difficult to figure out what is from illness, and what is from cunning, from character, from personality, from a situation, from psychological or social moments. Having made a lurch towards the disease, we can overdo it with drugs, with dosage, or prescribe them where they are not needed.And vice versa, where they are needed, do not prescribe them, considering that we are talking about psychological factors and focus on psychotherapy.

Instability and volatility

Everything is very individual. That is why you should always keep your eyes open with patients with bipolar disorder, be in constant offline and online contact, using SMS, instant messengers, Skype, and so on.

It should be recalled that patients with bipolar disorder, as I have already said in previous videos, are very fickle, unstable, they can change their plans and location many times.They love to move around the world, saturated with impressions from new places, new mentality, from people, taking in different cultures.

We also know that people with bipolar disorder can often change jobs and activities.

It is impossible not to mention the enormous creative potential of patients with bipolar disorder. You can equate this diagnosis with creativity. If a person suffers from bipolar disorder, then they definitely have creativity.Even if at the same time he does nothing creative, he absolutely does not show his creativity in any way, this means that it must be found, discovered and developed.

Creativity

Creativity helps such patients to more easily endure the severity of depressive disorders, mixed affective states. It is in creativity that they can realize themselves and their potential, this will allow them to provide that important social component, without which they cannot.

They are often excellent artists, writers, poets, writers, actors, directors, screenwriters. I do not have a single patient with bipolar affective disorder who has never shown himself in creativity.

There is another very important psychosocial aspect. In cases where creativity is the main profession of the bipolar patient, a dilemma arises: how much should we treat this or that affective state if creativity depends on the presence of this state?

Many patients with bipolar affective disorder, finding themselves in euthymic remission, say that their works have faded, they stopped creating, everything that comes out of their pen becomes gray, devoid of color, expression, feelings and ceases to bear any pictorial value.Many patients in such a situation intentionally refuse treatment in order to return to the very painful state in which their creative activity and the chances of creating high-level works were much greater.

But there are patients who say: “To hell with creativity! I never again, for anything, under any circumstances, want to return to that terrible state in which I worked, in which I wrote my best novel or my best picture. I don’t want it at such a price, do everything to not be there anymore. ”

Finding the golden mean

We have to balance, look for a middle ground, such a subdepressive or hypomanic level of remission, at which a person is in a relatively stable mental state, his suffering from these disorders is minimal or absent, but at the same time this state is sufficient for productive, creative activity.

We quite easily find a common language with patients with bipolar disorder, this is one of the most promising diseases in this sense, for the most part patients are quite critical of their disease, and not only compliant, but even hypercompliant.

They willingly talk about their illness, like to describe their symptoms in creative works. In such a situation, it is much easier to find a consensus, to establish partnerships with an advanced patient who knows perfectly well what taking this or that drug is, what its effects are, what to expect from it, and, in principle, he is ready to take on some part of the responsibility. for your treatment.

But in the case when the patient is completely without medical help and switches to absolute autonomy in the therapeutic process, his disease is decompensated, so do not stop working with doctors, stay in touch, even if you are in a good remission state for a long time.Contact with a doctor can always be needed in case the disease begins to manifest itself somehow.

Do not hesitate, call, contact, we are always ready to help you.

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